bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasal Polyp Cell Populations and Fungal-Specific Peripheral Blood Lymphocyte Proliferation in Allergic Fungal Sinusitis
Authors: Pant Harshita , Beroukas Dimitra , Kette Frank E. , Smith William B. , Wormald Peter J. , Macardle Peter J.
Published: February 2010

Background

Allergic fungal sinusitis (AFS) is considered a different disease from other polypoid chronic rhinosinusitis diseases (CRS) with eosinophilic mucus (EM) termed eosinophilic mucus chronic rhinosinusitis (EMCRS). To substantiate this, studies on cellular responses to fungi and sinus mucosal inflammatory cell populations in AFS and other EMCRS diseases are required. This study was designed to examine polyp inflammatory cell populations and peripheral blood fungal–specific T-cell responses in AFS, other EMCRS subgroups (defined later), and polypoid CRS without EM.

Methods

A prospective study was performed. Clinical characteristics, including CRS symptoms, sinus computed tomography (CT) scans, allergy status, intraoperative endoscopy, presence of EM, and fungal culture results were used to define patient groups. Polyps and peripheral blood were examined for populations of eosinophils, lymphocytes (CD4+, CD8+ T cells, natural killer cells, and B cells), and neutrophils using immunohistochemistry, cytospin preparations and flow cytometry. Fungal-specific peripheral blood lymphocyte proliferation was examined in AFS patients, other EMCRS patients, CRS patients, and controls.

Results

There was no significant difference in the percentage of cell populations and fungal-specific lymphocyte proliferation between AFS and other EMCRS diseases. However, AFS and other EMCRS polyps had a higher percentage of eosinophils and CD8+ T cells whereas CRS polyps had higher CD4+ T cells. Fungal-specific lymphocyte proliferation was significantly greater in AFS and other EMCRS patients regardless of fungal allergy, whereas in CRS and controls, higher proliferation was observed in fungal-allergic individuals.

Conclusion

These findings question the basis for differentiating AFS from other EMCRS diseases based on fungal allergy and fungi in EM. Fungal-specific cellular response was present in AFS and other EMCRS diseases, different from that associated with fungal allergy, suggesting a nonallergic fungal immune response. Increased CD8+ T cells in EMCRS polyps signify a different type of inflammation to CRS that may be driven by CD8+ T cells.
Eosinophil Degranulation Patterns in Nasal Polyposis: An Ultrastructural Study
Authors: Armengot Miguel , Garín Luis , Carda Carmen
Published: February 2010

Background

Eosinophils are possibly the most important inflammatory cells in the pathogenesis of rhinosinusitis with nasal polyposis. Eosinophil degranulation is the mechanism by which these cells exert their inflammatory action. Knowledge of eosinophil state and degranulation mode therefore may help us to better understand this disease. A study is made of eosinophil state and degranulation mode using transmission electron microscopy (TEM), attempting to establish correlations with certain clinical variables considered to be of importance in patients with nasal polyposis.

Methods

A prospective TEM study was made to examine 582 eosinophils under 5000× magnification, classifying them according to their state and degranulation mode. The cells originated from 36 cases of nasal polyposis and were catalogued according to the clinical–radiological presentation of the disorder, the presence of asthmatic disease, or acetilsalicilic acid (ASA) triad syndrome (nasal polyposis, asthma, and nonsteroidal anti-inflammatory drug intolerance), and the degree of nasal tissue eosinophilia of the case of origin.

Results

A total of 30.75% of the eosinophils were inactive, 41.75% exhibited piecemeal degranulation (PMD), 27.5% exhibited cytolysis, and 0.34% were in apoptosis. The degranulation mode was significantly correlated to the clinical and histological parameters studied. Thus, cytolysis tended to be less pronounced and PMD greater, in the cells from cases with intense eosinophilia or severe polyposis (high clinical stage and ASA triad).

Conclusion

Cytolysis and PMD are the principal degranulation modes of eosinophils in nasal polyposis—apoptosis being very infrequent. Nasal polyposis shows a correlation between eosinophil degranulation mode and the clinical and radiological stage and the degree of tissue eosinophilia of the case of origin.
Can Nasal Surgery Improve Obstructive Sleep Apnea: Subjective or Objective?
Authors: Li Hsueh-Yu , Lee Li-Ang , Wang Pa-Chun , Fang Tuan-Jen , Chen Ning-Hung
Published: February 2010

Background

This study assessed changes in sleep-related symptoms and polysomnographic parameters after nasal surgery for nasal obstruction in obstructive sleep apnea (OSA) adults in Taiwan.

Methods

A total of 66 patients with OSA and chronic nasal obstruction were recruited (surgical, n = 44; control, n = 22). Nasal surgery alone was the treatment in surgical patients. Outcomes were measured in a Snore Outcome Survey (SOS), Epworth Sleepiness Scale (ESS), rhinomanometry, and polysomnographic parameters at baseline and again after 3 months.

Results

Significantly improved nasal resistance as measured by the SOS and ESS were found only in the surgical group (all, p < 0.001). Both groups revealed insignificant changes in polysomnographic parameters. The patients with lower body weight index, less daytime sleepiness, and lower tongue position had a better success rate than the others (50% versus 3%; p < 0.001).

Conclusion

Although nasal surgery relieved snoring and daytime sleepiness, it had variable effects on polysomnographic parameters.
Computed Tomography Findings in Sinonasal Wegener's Granulomatosis
Authors: Grindler David , Cannady Steven , Batra Pete S.
Published: February 2010

Background

Wegener's granulomatosis (WG), an autoimmune disease, is intimately associated with the sinonasal tract, with involvement reported in 85% of patients during the course of the disease process. The objective of this study was (1) to describe Lund-Mackay (L-M) scores, (2) to delineate patterns of neo-osteogenesis and bony erosion, and (3) to analyze the impact of surgery on the computed tomography (CT) findings of WG patients.

Methods

A retrospective review was performed on 74 patients with WG presenting to a tertiary care referral center. CT analysis was performed and graded by two independent reviewers.

Results

The mean age was 53 years with a male/female ratio of 0.6:1. The average L-M score was 10.0. Neo-osteogenesis was evident in 78% of the patients with overall average neo-osteogenesis score of 4.2 (range, 0–16). Bony erosion was noted on imaging in 62% of patients with overall average score for bony erosion of 2.0 (range, 0–8). Patients having undergone previous sinus surgery compared with no previous surgery had statistically significant elevation of overall L-M, bony erosion, and neo-osteogenesis scores (p = 0.024, 0.0009, and 0.0015, respectively).

Conclusion

CT imaging in WG patients shows elevated L-M scores and evidence of bony erosion and neo-osteogenesis. Furthermore, surgical manipulation in WG patients is associated with increased bony abnormalities and greater elevations of L-M scores, possibly because of worsening vasculitis and/or inflammation. The presence of concurrent neo-osteogenesis and bony destruction of the paranasal sinuses should raise clinical suspicion of WG in patients presenting with symptoms of chronic rhinosinusitis.
The Effect of Functional Endoscopic Sinus Surgery on Nasal Spray Distribution to the Middle Meatus in Patients with Rhinosinusitis
Authors: Tsikoudas Alexandros , Barnes Martyn L. , White Paul S.
Published: February 2010

Background

Because the principle behind functional endoscopic sinus surgery (FESS) recognizes the middle meatus as essential for the control of the disease, the effect of the operation in the distribution of drugs in the same area should be of similar importance. This study was designed to clarify whether nasal drug delivery is improved in patients after FESS. The study involved a prospective assessment within subject comparison. The subjects were 20 adult (>18 years old) patients on the waiting list for FESS. It was conducted within two teaching hospitals in the East of Scotland.

Methods

A novel method was used, positioning a neurosurgical patty in the middle meatus and assessing blue dye nasal spray absorption on a 4-point scale.

Results

A significant improvement was observed in the distribution of the indicator in the middle meatus postoperatively. Seventy percent of the patients showed improvement in the drug distribution after FESS. The median result for absorption score was 2 preoperatively (<50%) and 3 postoperatively (>50%). The difference was statistically significant (p < 0.001).

Conclusion

The distribution of nasal drugs is improved in the middle meatus after FESS. This can have important clinical applications that can benefit patients in otolaryngology as well as other disciplines.
Diagnosis and Endoscopic Surgery of Chronic Invasive Fungal Rhinosinusitis
Authors: Li Yongqi , Li Yuan , Li Peng , Zhang Gehua
Published: February 2010

Background

Chronic invasive fungal rhinosinusitis (CIFRS) was thought to be a rare fungal disease of the sinus but is becoming increasingly common. Methods for the early diagnosis of CIFRS and treatment efficacy have not been thoroughly explored. This study was designed to summarize the diagnosis and endoscopic surgical treatment of a group of patients with CIFRS.

Methods

Twenty-eight cases of CIFRS treated by nasal endoscopic sinus surgery between January 2000 and December 2006 were retrospectively analyzed.

Results

Each case underwent nasal endoscopic debridement surgery; six cases with progressive symptomatology were given systemic broad-spectrum antifungal drugs for at least 12 weeks after the operation. Long-term outcome was positive in most cases. Twenty-three cases were cured while five recurred, of which two recurred within 6 months. Four cases underwent further endoscopic surgery, two were subsequently cured, one died of severe intracranial Mucor infection, and one was lost to follow-up. The overall cure rate was 89.3%.

Conclusion

Endoscopic surgery is an effective and microinvasive therapy for patients with CIFRS. The procedure includes elimination of the diseased sinus mucosa with or without simultaneous administration of broad-spectrum antifungal medicines. Early diagnosis of CIFRS and surgical nasal sinus debridement can improve prognosis.
The Effect of Adenotonsillectomy on Changes of Position during Sleep in Pediatric Obstructive Sleep Apnea Syndrome
Authors: Choi Ji Ho , Kim Eun Joong , Choi Jun , Kim Tae Hoon , Kwon Soon Young , Lee Sang Hag , Shin Chol , Lee Seung Hoon
Published: February 2010

Background

It is unknown whether adenotonsillectomy influences changes of position during sleep in children with obstructive sleep apnea syndrome (OSAS). The aim of this study was to evaluate the effect of adenotonsillectomy on changes of position during sleep as determined by polysomnography in children with OSAS.

Methods

Forty-four polysomnograms from 22 children with OSAS were analyzed. We compared the frequency of positional changes during sleep and the distribution of sleep positions before and after adenotonsillectomy.

Results

Adenotonsillectomy significantly improved all respiratory parameters studied. The arousal index and sleep efficiency were improved among the sleep parameters. There was a significant decrease in the total number of positional changes during sleep ( p < 0.001) and positional change index ( p < 0.001). The proportion of sleep time spent in the supine position was significantly increased (p = 0.001), and the proportions spent in lateral ( p = 0.003) and up (p = 0.018) positions were significantly decreased.

Conclusion

Significant changes were found in the frequency of positional changes during sleep and the distribution of sleep positions in children with OSAS after adenotonsillectomy.
Technical Feasibility of Transnasal Endoscopic Anterior Ethmoid Artery Ligation: Assessment with Intraoperative Ct Imaging
Authors: Solares C. Arturo , Luong Amber , Batra Pete S.
Published: February 2010

Background

The objective of this study was to evaluate the technical feasibility of endoscopic anterior ethmoid artery (AEA) ligation for acute control of epistaxis.

Methods

A prospective study was conducted using eight cadaver heads. Pre- and intraoperative CT scans were performed using the xCAT (Xoran Technologies, Inc., Ann Arbor, MI). Skull base anatomy relative to the AEA was reviewed preoperatively. Endoscopic AEA ligation was attempted in all sides with a mesentery. Ligation was not deemed feasible in AEAs without a mesentery. It was attempted on two sides without a mesentery to assess risk of skull base and orbital disruption. Intraoperative CT scans were performed to assess the position of the clips and the integrity of the skull base and lamina papyracea.

Results

The mean lateral lamella height was 4.75 and 4.83 mm on the right and left, respectively. Of the 16 arteries, 6 (37.5%) of the AEAs were within a bony mesentery. No AEA canals were dehiscent. Four of the six AEAs (66%) within a mesentery were successfully clipped and two (33%) were partially clipped by endoscopic evaluation. Both arteries without mesentery where clipping was attempted were partially clipped by endoscopic examination. Review of intraoperative CT scans showed that the AEA with a mesentery was clipped successfully on three sides, partially on one side, and unsuccessfully on two sides. AEA clipping was unsuccessful on both sides without a mesentery. One AEA without a mesentery showed skull base disruption after ligation by endoscopy and CT. None of the specimens showed orbital injury.

Conclusion

Intraoperative CT scanning revealed that AEA ligation was less successful than was apparent endoscopically. Effective AEA clipping was performed in 50% of cases with a mesentery. Endoscopic clipping was not technically feasible in cases with AEA without a mesentery. Overall, AEA clipping was only technically feasible in 3 of 16 sides (18.8%).
Loratadine and Montelukast Administered in Combination Produce Decongestion in an Experimental Feline Model of Nasal Congestion
Authors: McLeod Robbie L. , Mingo Garfield G. , Xu Xiaoying , Palamanda Jairam , Hunter John C. , Jia Yanlin
Published: February 2010

Background

Histamine and leukotrienes act to exert numerous local and systemic effects that contribute to the pathophysiology of allergic rhinitis. The aim of these experiments was to evaluate the nasal decongestant effects of loratadine and montelukast alone and in combination in a feline model of nasal congestion. We also studied the decongestant actions of the alpha-agonist adrenergic agonist D-pseudoephedrine with and without desloratadine.

Methods

Acoustic rhinometry was used to determine nasal cavity dimensions after intranasal compound 48/80. Cats were given D-pseudoephedrine (0.3 mg/kg) alone or in combination with desloratadine (5 mg/kg) 1 hour before nasal provocation with compound 48/80 (1%, 75 microliters) to either the left or right nasal passageway. Using a similar design, the nasal decongestant effects of montelukast (1 mg/kg) and loratadine (10 mg/kg) were studied alone and in combination.

Results

The addition of desloratadine to D-pseudoephedrine did not improve decongestant efficacy compared with each drug given individually. In contrast, when montelukast (1 mg/kg) was given in combination with loratadine (10 mg/kg), the decongestant activity was greater than when these drugs were administered separately. Sixty minutes after compound 48/80 provocation the nasal cavity volume ratio (volume ratio of the compound 48/80 treated/untreated nasal passageway) for the control, montelukast alone, loratadine alone, and the montelukast plus loratadine–treated groups were 0.20 ± 0.03, 0.24 ± 0.01, 0.28 ± 0.03, and 0.50 ± 0.03.

Conclusion

Concomitant montelukast plus loratadine produces a greater degree of nasal decongestion compared with montelukast or loratadine alone in an experimental model of nasal congestion.
Impaired Mucosal Healing and Infection Associated with Staphylococcus Aureus After Endoscopic Sinus Surgery
Authors: Jervis-Bardy Joshua , Foreman Andrew , Field John , Wormald Peter John
Published: February 2010

Background

Differentiating normal nasal discharge and postoperative crust from infection after endoscopic sinus surgery (ESS) can be difficult. We investigated whether bacteria cultured at operation was predictive for postoperative mucosal infection—defined as frank pus, thick mucus, and/or abnormal crusting seen on endoscopic examination associated with positive microbiology.

Methods

The records of 48 patients with chronic rhinosinusitis (CRS) with infection at the time of ESS were retrospectively reviewed. Results of intraoperative cultures were compared with those taken at the time of postoperative mucosal infection.

Results

Fourteen of 16 patients (87.5%) with intraoperative infection with Staphylococcus aureus progressed to postoperative mucosal infection with S. aureus, whereas patients who cultured “other” bacteria intraoperatively progressed to postoperative mucosal infection in 6/19 cases (31.6%), with S. aureus cultured in only 3/19 cases (15.8%; p = 0.0001).

Conclusion

S. aureus infection at ESS predicts for abnormal, S. aureus–associated mucosal healing and infection post-ESS. Although a prospective trial is warranted, these findings suggest a future role for aggressive anti–S. aureus therapy peri- and/or postoperatively in patients who culture positive for this organism to improve postsurgical outcomes.
Acoustic Rhinometry and Rhinomanometry in the Preoperative Screening of Septal Surgery Patients
Authors: Pirilä Tapio , Tikanto Jukka
Published: February 2010

Background

The preoperative assessment of septal surgery patients with acoustic rhinometry (AR) or rhinomanometry (RMM) is still a controversial subject. This study was designed to apply AR and RMM in preoperative screening of septal surgery patients.

Methods

The gold standard is postoperative satisfaction expressed by patients as “very high,” “high,” “moderate,” or “low” subjective total benefit from the operation to the nasal obstruction 1 year after surgery. One hundred fifty-seven consecutive patients presenting for septal surgery because of an obstructing septum deviation in anterior rhinoscopy, sufficient pre- and postoperative data were available in 110 patients. Anterior rhinoscopy, AR, and RMM were performed before and 1 year after surgery.

Results

The preoperative AR and RMM had a statistically significant impact (p < 0.01) in predicting the postoperative satisfaction. The best single preoperative parameter for predicting postoperative satisfaction was the postdecongestion overall minimum cross-sectional area on the deviation side in AR; the estimated optimal cutoff value was 0.40 cm2. The most predictive preoperative RMM parameter was the postdecongestion intercavital flow ratio (the flow on the deviation side divided by the flow on the wide side); the estimated optimal cutoff value was 1:2. For both parameters the sensitivity/specificity for the cutoff values was around 65/60% in finding patients with high or very high postoperative satisfaction. For anterior rhinoscopy the optimal cutoff was a deviation between severe and moderate with sensitivity/specificity around 55/55%.

Conclusion

In patients with a very severe deviation, anterior rhinoscopy was sufficient for preoperative screening but in milder deviations AR and RMM significantly predicted postoperative success.
Nasoseptal Flap Reconstruction of High Flow Intraoperative Cerebral Spinal Fluid Leaks during Endoscopic Skull Base Surgery
Authors: Zanation Adam M. , Carrau Ricardo L. , Snyderman Carl H. , Germanwala Anand V. , Gardner Paul A. , Prevedello Daniel M. , Kassam Amin B.
Published: February 2010

Background

Over the past 10 years, significant anatomic, technical, and instrumentation advances have facilitated the exposure and resection of intradural lesions via a fully endoscopic expanded endonasal approach (EEA). The vascularized nasoseptal flap (based on the posterior nasoseptal artery) has become our primary endoscopic reconstructive technique. The goals of this study are to prospectively evaluate the nasoseptal flap and high-risk cerebral spinal fluid (CSF) leak variables.

Methods

Prospective evaluation was performed of EEA patients with intraoperative high-flow leaks (either a cistern or ventricle open to nasal cavity during tumor dissection) who underwent nasoseptal flap reconstruction.

Results

Seventy consecutive nasoseptal flaps for high-flow intraoperative leaks were evaluated prospectively by the primary author. Twelve risk factors were then graded at the time of the operations and correlated to CSF leak outcomes. The overall postoperative CSF leak rate was 5.7% (4/70). All four postoperative leaks were successfully managed with endoscopic repair and CSF diversion. A multivariate analysis of all 12 risk factors is detailed. Pediatric patients, large dural defects, and radiation therapy were noted to be factors in reconstructive failure. One flap death occurred in a patient with prior surgery and proton therapy, this leak was managed with a temporoparietal flap and endonasal repair.

Conclusion

The nasoseptal flap is an excellent anterior skull base reconstructive technique. Patients with high-flow intraoperative CSF leaks had a 94% successful reconstruction rate. Patients with skull base proton radiation therapy are at higher risk for flap failure and preparation for nonradiated tissue reconstruction should be discussed with the patient.
Acupuncture for Nasal Congestion: A Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Pilot Study
Authors: Sertel Serkan , Bergmann Zazie , Ratzlaff Kerstin , Baumann Ingo , Greten Henry Johannes , Plinkert Peter Karl
Published: February 2010

Background

Nasal congestion is one of the most common complaints dealt with in otorhinolaryngology. Side effects of decongestants are frequently seen in patients with chronic nasal congestion. This leads to an increasing demand of alternative treatments such as acupuncture. Future studies on acupuncture should aim at objectifying effects by both physical measuring and double blinding. Therefore, we were interested in whether these effects can potentially be measured as increase in nasal airflow (NAF) in ventus (“wind”) disease of traditional Chinese medicine (TCM).

Methods

Twenty-four patients with a history of nasal congestion due to hypertrophic inferior turbinates or chronic sinusitis without polyposis were additionally diagnosed according to the Heidelberg model of TCM. They were asked to score the severity of their nasal congestion on a visual analog scale (VAS). The acupuncturist was blinded according to the Heidelberg blinding assay. NAF was measured by using active anterior rhinomanometry (ARM). Specific verum acupoints according to the Chinese medical diagnosis were tested against nonspecific control acupoints. VAS and NAF were scored and measured before and 15 and 30 minutes after acupuncture.

Results

Control acupuncture showed a significant improvement in VAS and a deterioration of NAF. Verum acupuncture showed highly significant improvements in VAS and NAF. In addition, verum acupuncture improved NAF and VAS significantly over time.

Conclusion

Our control and verum acupoints fulfill the condition of a control and verum treatment, respectively. Measuring NAF by RRM and scoring VAS are possible and reflect acupuncture effects in vivo.
Proton Secretion in Freshly Excised Sinonasal Mucosa from Asthma and Sinusitis Patients
Authors: Cho Do-Yeon , Hajighasemi Mohammad , Hwang Peter H. , Illek Beate , Fischer Horst
Published: February 2010

Background

Proton (H+) secretion and the HVCN1 H+ channel are part of the innate host defense mechanism of the airways. The objective of this study was to determine H+ secretion in asthmatic and nonasthmatic patients with chronic rhinosinusitis (CRS) in freshly excised human sinonasal tissue.

Methods

Nasal or sinus mucosa from subjects with three different conditions (normal, CRS, and CRS with asthma) was harvested during sinus surgery. The equilibrium pH and the rate of H+ secretion were measured in an Ussing chamber using the pH-stat titration technique.

Results

Nasal epithelia isolated from subjects with CRS and asthma had a mucosal equilibrium pH = 6.95 (n = 5), which was significantly lower than in normal subjects (7.35 ± 0.21; n = 5) or from subjects with CRS without asthma (7.33 ± 0.15 In = 5). Nasal epithelia from CRS with asthma (n = 5) secreted H+ at a rate of 135 ± 46 nmol·min–1·cm–2. This rate was significantly higher compared with normal (73 ± 39 nmol·min–1·cm–2; n = 8) or CRS without asthma (51 ± 28 nmol·min–1·cm–2; n = 7). Mucosal addition of the HVCN1 blocker ZnCl2 blocked H+ secretion by 70% in normal, 53% in CRS without asthma, and by 51% in CRS with asthma. In contrast, measures in sinus tissues were unaffected by the disease condition.

Conclusion

Freshly excised human nasal and sinus epithelia secrete acid. Nasal (but not sinus) tissues from asthmatic CRS patients showed lower mucosal pH values and higher rates of H+ secretion than CRS and normal subjects. The increased acid secretion might contribute to epithelial injury in CRS patients with asthma.
The Role of Columellar Struts to Gain and Maintain Tip Projection and Rotation: A Randomized Blinded Trial
Authors: Sadeghi Mohammad , Saedi Babak , Sazegar Amir Arvin , Amiri Mandana
Published: February 2010

Background

Rhinoplasty is one of the most challenging esthetic surgeries. The ability to achieve precise and predictable changes in the shape and position of the nasal tip is still among one of the demanding areas of rhinoplasty. Columellar strut is one of many techniques to ensure an adequate nasal tip projection and rotation; however, there is little evidence to support long-term efficacy of this technique.

Methods

In a clinical trial, 93 patients who were rhinoplasty candidates were studied prospectively. They were randomly divided into two groups according to the use of columellar strut. The outcome measures were gaining and maintaining tip projection and rotation in the long term. Standardized photographs before and 3, 6, and 12 months after surgery were the measurements to compare the results between two groups.

Results

The mean age was 23.3 ± 4.8 years. In 47 cases, surgery was performed using columellar strut and in 45 cases this method was not used. Preoperatively, nasolabial angle and tip projection were not significantly different between the two groups. In addition, postoperatively, the mean of nasolabial angel and tip projection were not significantly different in the two groups 3, 6, and 12 months after surgery. The decreasing of these parameters was not significantly different during follow-up in the two groups.

Conclusion

It seems that columellar strut is not an essential technique to enhance and maintain tip projection and/or rotation in rhinoplasty. Using good techniques in qualified hands give the best results in the long term even without columellar strut.
In Vivo Effects of Citric Acid/Zwitterionic Surfactant Cleansing Solution on Rabbit Sinus Mucosa
Authors: Tamashiro Edwin , Banks Caroline A. , Chen Bei , Gudis David A. , Dogrhamji Laurel , Myntti Matthew , Medina Jennifer , Chiu Alexander G. , Cohen Noam A.
Published: February 2010

Background

Chronic rhinosinusitis that is refractory to medical or surgical intervention may involve a particularly resistant form of infection known as a bacterial biofilm that is recalcitrant to antibiotics secondary to physical barrier characteristics. Recently, a novel sinus cleansing solution, citric acid/zwitterionic surfactant (CAZS) was shown to be extremely effective in disrupting biofilms in vitro. The purpose of this study was to determine the effects of CAZS on sinonasal epithelium in vivo compared with normal saline.

Methods

Indwelling catheters were placed into the right maxillary sinus of New Zealand white rabbits. CAZS solution or normal saline (10 mL) was instilled at a rate of 20 mL/minute into the sinus followed by aspiration. Rabbits were killed 1, 3, and 6 days after treatment. Mucosa from both maxillary sinuses was harvested and evaluated for physiological activity (ciliary beating) as well as morphological integrity of the epithelium by scanning electron microscopy.

Results

One day after treatment, beating cilia was evident with morphological analysis shown intact epithelium with 80–85% denudation of cilia compared with saline. Three days after treatment, ciliary activity was again noted with morphological evidence of persistent denuded cilia. By day 6 after treatment, the epithelium had regenerated cilia over the apical surface. Throughout the recovery period beating cilia was evident in CAZS-treated sinuses.

Conclusion

This study shows that although CAZS acutely denudes respiratory cilia, the remaining cilia are active. Additionally, the epithelial barrier appears intact with active ciliogenesis, and reciliation of the mucosal surface occurring 6 days after treatment.
Laser-Induced Microbial Reduction in Acute Bacterial Rhinosinusitis
Authors: Krespi Yosef P. , Kizhner Victor , Kara Cuneyt O.
Published: February 2010

Background

This study was designed to assess laser-induced manipulation on bacterial load and host in an animal model of acute bacterial rhinosinusitis (ABRS). An animal study using 12 rabbits followed an elaborated efficient in vitro model. ABRS was created by packing the nose with a sponge soaked in solution containing pathogenic microorganisms. Eight infected animals were randomly allocated to two separate groups, each being exposed to different laser therapies. Two healthy animals served as treatment controls, and one animal without ABRS and treatment was observed.

Methods

ABRS was confirmed histologically, radiologically, and bacteriologically. Two days after bacterial inoculation, packing was removed and nasal passages were treated by laser irradiation. Two laser modalities were tested. A near infrared (NIR) 940-nm diode laser with diffuser fiber tip was used in four rabbits. A photosensitizer (methylene blue 0.01 or 0.05%) and 635-nm laser combination was used in the second cohort. Nasal cultures were obtained before and after the laser treatments. Animals were killed 5–10 days after laser treatment and bacteriological/histological results were analyzed.

Results

An average 2 log reduction in bacterial colony counts was achieved with both laser methods compared with control. Histological studies showed tissue integrity preservation without significant damage to nasal mucosa.

Conclusion

Significant bacterial reduction was achieved with both NIR laser and photograph activated therapies in an animal study of ABRS. This pilot study shows an innovative method of bacterial killing without host tissue damaging and may have potential future clinical application.
Chinook Wind Barosinusitis: An Anatomic Evaluation
Authors: Rudmik Luke , Muzychuk Adam , Paolucci Elizabeth Oddone , Mechor Brad
Published: February 2010

Background

Chinook, or föhn, is a weather phenomenon characterized by a rapid influx of warm, high-pressured winds into a specific location. Pressure changes associated with chinook winds induce facial pain similar to acute sinusitis. The purpose of this study was to determine the relationship between sinonasal anatomy and chinook headaches.

Methods

Retrospective computed tomography (CT) sinonasal anatomy analysis of 38 patients with chinook headaches and 27 controls (no chinook headaches). The chinook headache status was blinded from the CT reviewer. Forty-one sinonasal anatomy variants, Lund-Mackay status, and sinus size (cm3) were recorded.

Results

There were three statistically significant sinonasal anatomy differences between patients with and without chinook headaches. The presence of a concha bullosa and sphenoethmoidal cell (Onodi cell) appeared to predispose to chinook headaches (p = 0.004). Chinook headache patients had larger maxillary sinus size (right, p = 0.015, and left, p = 0.002). The Lund-Mackay score was higher in the control patients (p = 0.003) indicating that chronic sinusitis does not play a role in chinook headaches.

Conclusion

Chinook winds are a common source of facial pain and pressure. This is the first study to show that sinonasal anatomic variations may be a predisposing factor. Anatomic variants may induce facial pain by blocking the natural sinus ostia, thus preventing adequate pressure equilibrium.
An Evidence-Based Review of Endoscopic Frontal Sinus Surgery
Authors: Silverman Joshua B. , Prasittivatechakool Kajohnkiat , Busaba Nicolas Y.
Published: February 2010

Background

Endoscopic approaches to treat frontal sinus disease gained in popularity over the past 20 years with a plethora of published studies that emphasize the high success rate of such surgeries. This study was designed to determine the levels of clinical evidence in the otolaryngology literature that address the efficacy of endoscopic approaches in the management of frontal sinus disease including frontal sinusitis.

Methods

Twenty-three publications that reported the surgical outcomes of endoscopic approaches to treat frontal sinus disease were reviewed. Data were collected regarding the study design, operative technique, number of patients, duration of follow-up, diagnostic method, surgical success rate, and method(s) used to assess surgical outcome.

Results

The study designs were a retrospective case series without control (16 articles), prospective case series without control (3 articles), and retrospective case series with internal control (4 articles). Eighty-three percent of the published articles provide an evidence level of IV, while the remaining 17% provide an evidence level of III. The surgical technique was described as frontal sinusotomy (n = 4), frontal sinusotomy or frontal sinus drillout (n = 1), frontal sinus drillout alone (n = 1), endoscopic modified Lothrop procedure (n = 9), Draf types I, II, or III (n = 6); trans-septal frontal sinusotomy (n = 1); and frontal sinus rescue procedure (n = 1). The mean number of subjects was 44, and the average follow-up period was 23.6 months. Surgical success rate ranged from 50 to 100%.

Conclusion

Despite the number of reports in the literature that address the surgical outcome of endoscopic approaches for treatment of frontal sinus disease, the majority of these studies have a small population size, short follow-up period, and provide a low clinical evidence level.
Cigarette Smoke Extract Enhances Rhinovirus-Induced Toll-Like Receptor 3 Expression and Interleukin-8 Secretion in A549 Cells
Authors: Wang Jong Hwan , Kim Hyuk , Jang Yong Ju
Published: February 2010

Background

Using A549 alveolar epithelial type II–like cells, we investigated the effects of cigarette smoke on the expression of rhinovirus (RV)-induced Toll-like receptor (TLR) 3, interleukin (IL)-6, and IL-8 secretion and viral replication.

Methods

Cigarette smoke extract (CSE) was prepared by smoking two commercial cigarettes with filters (0.9-mg of nicotine and 8.5-mg of tar per cigarette). Cells were infected with RV serotype 16 (RV-16) and cultured for 2 days (RV group), pretreated with 1, 2.5, or 5% CSE for 1 day before RV infection, and culture with CSE for 2 days after infection (RV plus CSE group), or were cultured in medium for 3 days (control group), treated with 1, 2.5, or 5% CSE for 3 days (CSE group). Changes in TLR3, IL-6, and IL-8 mRNA expression were assayed by real-time polymerase chain reaction and TLR3 protein expression were assessed by flow cytometry; IL-6 and IL-8 secretions were measured by ELISA; and RV replication was assessed by viral culture.

Results

CSE increased RV-induced TLR3 expression and RV-induced IL-8 secretion at lower concentrations in A549 cells. On the contrary, CSE dose dependently inhibited RV-induced IL-6 secretions and had no effect on RV replications.

Conclusion

Our results suggest that cigarette smoke may potentiate viral common cold symptoms by enhancing IL-8 secretion at lower concentrations, but not by increasing viral replication.
Predictability of Quantification of Beta-Trace Protein for Diagnosis of Cerebrospinal Fluid Leak: Cutoff Determination in Nasal Fluids with Two Control Groups
Authors: Sampaio Marcelo Hamilton , de Barros-Mazon Silvia , Sakano Eulália , Chone Carlos Takahiro
Published: February 2010

Background

Cerebrospinal fluid (CSF) leak of the anterior skull base is an abnormal communication between the subarachnoid space and the nasal cavity or the paranasal sinus. Its presence increases the incidence of complications, as meningitis, with risk of sequelae. The early and correct diagnosis of the CSF leaks is important to perform surgical treatment as soon as possible. The CSF detection in nasal fluids could be made through the beta2-transferrin (beta2Tr) immunoelectrophoretic test, an expensive and cumbersome immunologic test, not available to the majority of the Brazilian hospitals. Recently, the detection of beta-trace protein (betaTP) for identification of CSF leaks has been described. The literature suggests there may be similar sensitivity and specificity to tests of beta2Tr, because betaTP is also a specific brain protein and it is present in CSF in high concentrations. The majority of Brazilian hospitals have the nephelometric equipment for betaTP detection. This study was designed to determine threshold values for betaTP concentrations in nasal cavity secretions as a predictor of CFS leak.

Methods

Nasal secretions were collected from patients with suspicion of CSF leak and from healthy volunteers. Pure CSF samples were used. A nephelometric assay was used to determine the betaTP concentration in samples.

Results

Values between 0.244 and 0.496 mg/L were determined for the cutoff.

Conclusion

Beta-trace concentrations above 0.496 mg/L are highly suggestive of the presence of CSF in examined nasal secretion. Positive predictive value and negative predictive value were 100%. BetaTP nephelometric test can predict the side of the CSF leak.
Surgical Instrument Force Exerted during Endoscopic Sinus Surgery: Differences within the Ethmoid Sinus Complex
Authors: Ross Peter D. , Joice Paul , Nassif Ramez G. , White Paul S.
Published: February 2010

Background

Endoscopic sinus surgery (ESS) has been the most important technical advance in surgical rhinology in the last 25 years. The technique is now used beyond its initial sinus confines but knowledge of the forces required to perform ESS is limited. Greater understanding of these forces will lead to improved surgical training and safety. The aim of this study was to quantify the magnitude of the forces exerted during punch osteotomy of the bony lamella of the paranasal sinuses and surrounding bony structures during ESS.

Methods

Fifteen formalin-fixed cadaveric heads underwent simulated ESS. Peak axial forces were measured using a pair of modified Blakesley forceps. Measurements were recorded during osteotomy of the paranasal sinus complex, skull base, and crests of the optic nerve and internal carotid artery. Statistical comparison between the mean forces was performed.

Results

A mean force of 6.06 N was required to breach the lamellae of the ethmoid sinus complex. This was significantly less than the mean force required to breach the skull base, excluding the olfactory cleft (17.80 N; p < 0.0001), crests of the optic nerve (15.43 N; p < 0.001), and internal carotid artery (13.15 N; p < 0.001). There was no significant difference between the ethmoid lamella and the lamina papyracea (6.13; p = 0.67).

Conclusions

Significantly greater force was required to breach the skull base and other safety critical areas encountered in ESS, than the bony lamellae of the ethmoid sinus complex. Although this result is reassuring, in vivo studies are now required to validate this relationship in the operative patient.
A Pilot Study of a Traditional Chinese Version of the University of Pennsylvania Smell Identification Test for Application in Taiwan
Authors: Jiang Rong-San , Su Mao-Chang , Liang Kai-Li , Shiao Jiun-Yih , Wu Shang-Heng , Hsin Chung-Han
Published: February 2010

Background

The 40-item University of Pennsylvania Smell Identification Test (UPSIT) is the most widely used smell test in the world. Presently, culturally modified versions of this test are available in 12 languages. This study describes the first assessment of a prototype traditional Chinese version of the UPSIT (UPSIT-TC) for administration in Taiwan. The goals were to determine the efficacy of specific items for testing Taiwanese subjects and to establish normative adjustments to allow for the use of North American norms.

Methods

The American version of the UPSIT and the UPSIT-TC were administered to 40 healthy Taiwanese subjects on two test occasions separated from one another by 2 weeks. One subject was excluded because of invalid data.

Results

The mean UPSIT score was 28.3 (median, 28; SD, 3.8) for the first test administration and 28.5 (median, 28.0; SD, 4.4) for the second test administration. The mean UPSIT-TC score was 33.1 (median, 33.0; SD, 2.9) for the first administration and 32.8 (median, 33.0; SD, 3.6) for the second test administration. The UPSIT-TC scores were significantly higher than those of the UPSIT on both test occasions (p < 0.0001). Pearson correlations computed across the two test occasions were positive and statistically significant for both the UPSIT and the UPSIT-TC (respectively, r = 0.803 and 0.664; p < 0.0001).

Conclusions

In accord with the modifications, the scores on the prototype UPSIT-TC were significantly higher than those on the American UPSIT when administered to a Taiwanese sample. Both versions of the UPSIT were stable across repeated test sessions.
Endoscopic Transnasal Craniectomy in the Management of Selected Sinonasal Malignancies
Authors: Villaret Andrea Bolzoni , Yakirevitch Arkadi , Bizzoni Andrea , Bosio Roberta , Bignami Maurizio , Pistochini Andrea , Battaglia Paolo , Castelnuovo Paolo , Nicolai Piero
Published: February 2010

Background

Because of a better understanding of the anatomy from an endoscopic perspective, the acquisition of surgical experience, and concomitant technological advances, endoscopic resection of the anterior skull base (ASB) and overlying dura has now become a reality, opening new possibilities in the management of sinonasal malignancies. Here, the authors review a series of 62 patients, the largest reported to date, who underwent endoscopic transnasal craniectomy (ETC) and endoscopic dural repair for the management of selected sinonasal malignancies. Special emphasis is placed on the surgical technique, technical tricks, choice of materials for endoscopic dural repair, postoperative management, and complications.

Methods

From 2004, 62 patients underwent ETC at two referral hospitals, which extended anteroposteriorly from the frontal sinus to planum sphenoidale and laterolaterally from the nasal septum to the lamina papyracea (unilateral resection, n = 28; 45%) or from papyracea to papyracea (bilateral resection, n = 34; 55%). Duraplasty with a three-layer technique was performed using the iliotibial tract and fat tissue.

Results

The most frequent histotypes were adenocarcinoma (58%) and olfactory neuroblastoma (22%). Forty-five (73%) patients were previously untreated. The incidence of early (T1–2, Kadish A-B) and advanced (T3–4, Kadish C) tumors was similar. The complication rate was 15%, mostly cerebrospinal fluid leaks (13%). Its prevalence did not correlate with patient age, medical comorbidities, previous treatment, presence of ASB involvement, or whether ETC was mono- or bilateral, but tended to correlate with advanced tumor stage, dural involvement, and the period of treatment. After a mean follow-up of 17.5 months (range, 1–54 months), 58 (94%) patients had no evidence of disease.

Conclusions

In correctly selected patients with sinonasal tumors involving the ASB, ETC offers a less invasive alternative than resection by an open approach with an acceptable morbidity.
Alterations in Gene Expression of Complement Components in Chronic Rhinosinusitis
Authors: Schlosser Rodney J. , Mulligan Ryan M. , Casey Sarah E. , Varela Juan C. , Harvey Richard J. , Atkinson Carl
Published: February 2010

Background

The complement cascade forms part of the initial innate response to pathogens in the airway. Complement activation is important in the maintenance of host homeostasis, but excessive and uncontrolled activation may lead to inflammation and disease. The role of the complement pathway in the innate response in chronic rhinosinusitis (CRS) is poorly characterized

Methods

Sinus mucosa biopsy specimens from the anterior ethmoid or uncinate process of patients with allergic fungal rhinosinusitis (AFRS), CRS without NPs (CRS–NPs), and controls were harvested and gene and protein expression of C3, factor B (fB), C5, and C7 complement proteins were analyzed using quantitative polymerase chain reaction and immunohistochemical techniques.

Results

fB, C3, and C5 gene expression were increased in both AFRS and CRS—NPs compared with controls (p < 0.05). Transcriptional activity for the terminal pathway protein C7 was not significantly increased when compared with controls, with C7 levels actually reduced in AFRS patients when compared with controls. Immunohistochemistry studies showed the presence of C3 and fB on the mucosal surface and in submucosa of both AFRS and CRS—NPs, but not normal controls. Terminal pathway protein C9 was not found in our specimens.

Conclusions

Both AFRS and CRS—NPs display up-regulation of the complement pathway, in particular, the alternative pathway (fB) and common pathways (C3 and C5). Enhanced innate responses as shown by alterations in complement components may play a pivotal role in the inflammatory response noted in CRS and provide potential therapeutic targets in the future.
A Case-Control Study of the Risk Factors Associated with Sinonasal Inverted Papilloma
Authors: Lun Sham Cheuk , Lee Dennis L.Y. , van Hasselt C. Andrew , Tong Michael C.F.
Published: February 2010

Background

The etiology of sinonasal inverted papilloma (IP) is unknown. This study was designed to evaluate the possible risk factors associated with IP

Methods

This is a case-control epidemiology study in a tertiary referral center. Fifty patients with IP and 150 matched controls were interviewed using a questionnaire on suspected risk factors. Univariate analysis of the risk factors and calculation of the matched odds ratios, the corresponding 95% CIs, and p values was performed. Significant risk factors were further studied using conditional logistic regression analysis.

Results

Outdoor and industrial occupations were associated with IP. Tobacco smoking, drinking alcohol, history of allergic rhinitis, sinusitis, nasal polyp, non-sinonasal papilloma and non-sinonasal malignancy were not significant factors.

Conclusions

Outdoor and industrial occupations were associated with IP and may be potential risk factors. Future studies are warranted to further evaluate the individual type of occupation and chemical involved.