bluuebunny/crossref_metadata_2025 huggingface dataset:
Differentiation-Related p53 Protein Expression in Nondysplastic Sinonasal Inverted Papillomas
Authors: Schwerer Michael J. , Sailer Adrian , Kraft Klaus , Baczako Karl , Maier Heinz
Published: August 2018

To clarify p53 protein expression in nondysplastic sinonasal inverted papillomas, archived surgical specimens from 19 patients were studied using immunohistochemistry. Staining results were compared between inverted papillomas and adjacent, nonpapillomatous nasal mucosa. Further, immunoreactivity was compared between columnar (respiratory), transitional (cuboidal), and squamous epithelium in inverted papillomas. Positive staining was found in 17 of 19 inverted papillomas (89%). Immunoreactivity involved predominantly basal and parabasal cells and was either comparable or higher in inverted papillomas compared with adjacent mucosa. In 65% of immunoreactive inverted papillomas comparable staining results were seen between columnar (respiratory), transitional (cuboidal), and squamous epithelium. In 35% of p53 protein-positive inverted papillomas, enhanced immunoreactivity was observed in transitional (cuboidal) and squamous epithelium compared with columnar (respiratory) epithelium. Within these cases, immunoreactivity was either comparable or higher in squamous compared with transitional (cuboidal) epithelium. Conclusively, the expression of p53 protein is present in 89% of nondysplastic sinonasal inverted papillomas and also involves the adjacent, nonpapillomatous nasal mucosa. A tendency toward increasing p53 protein expression from nonpapillomatous nasal mucosa to inverted papilloma as well as along the metaplastic process from columnar (respiratory) to transitional (cuboidal) and finally squamous epithelium within inverted papillomas can be postulated.
Atrophic Rhinitis: A Review of 242 Cases
Authors: Moore Eric J. , Kern Eugene B.
Published: August 2018

Atrophic rhinitis is a debilitating nasal mucosal disease of unknown etiology. It is characterized by progressive nasal mucosal atrophy, nasal crusting, fetor, and enlargement of the nasal space with paradoxical nasal congestion. Primary atrophic rhinitis has decreased markedly in incidence in the last century. This probably relates to the increased use of antibiotics for chronic nasal infection. Secondary atrophic rhinitis resulting from trauma, surgery, granulomatous diseases, infection, and radiation exposure accounts for the majority of cases encountered by the rhinologist today. Excessive turbinate surgery has been both acquitted and accused in the literature as an etiology for secondary atrophic rhinitis. We saw 242 patients with the diagnosis of atrophic rhinitis between 1982 and 1999. The diagnosis was confirmed by physical examination, biopsy, and imaging studies. Patients were diagnosed with primary atrophic rhinitis if their condition developed in a previously healthy nose and secondary atrophic rhinitis if their condition developed after sinonasal surgery, trauma, or chronic granulomatous disease. Prevention and treatment of the disease is discussed.
Anatomic Variations of the Lateral Nasal Wall in the Computed Tomography Scans of Patients with Chronic Rhinosinusitis
Authors: Krzeski Antoni , Tomaszewska Ewa , Jakubczyk Iwona , Galewicz–Zielińska Anna
Published: August 2018

The development of computed tomography (CT) technique results in the advance in visualization of the anatomic structures of the lateral nasal wall. It allows the anatomic variations of this region to be identified precisely, which is important in surgical treatment of chronic rhinosinusitis. The aim of this study was to determine the incidence of anatomic variations of the lateral nasal wall in a group of patients with chronic rhinosinusitis. The preoperative, frontal plane CT scans of the study group were evaluated using the method of the four-zone interpretation. The incidence of the anatomic variations of the lateral nasal wall was consistent with the results reported by other authors.
Endoscopic Transethmosphenoidal Approach for Pituitary Tumors with Image Guidance
Authors: Otori Nobuyoshi , Haruna Shinichi , Kamio Masami , Ohashi Genichiro , Moriyama Hiroshi
Published: August 2018

The advantages of endoscopic transethmosphenoidal surgery for pituitary tumors using a navigation system were reported. The surgical technique was as follows. First, sphenoidal sinuses were opened via the bilateral ethmoidal sinuses and the olfactory clefts. Then the septum of the sphenoidal sinuses was resected. Next, an endoscope was inserted via the left nasal cavity and fixed in place. The tumor was then removed via the right nasal cavity. Our approach for pituitary tumors provided sufficient working space and permitted the surgeon to carry out the procedure using both hands. In addition, use of the InstaTrak System made it possible to recognize the orientation of the surgical field in the sella turcica. Thus, the tumor could be resected more easily and safely. It is concluded that this approach will be particularly useful for patients with narrow nasal cavities or poor development of the paranasal sinuses.
Allergic Rhinitis as a Risk Factor for Orbital Complication of Acute Rhinosinusitis in Children
Authors: Holzmann David , Willi Ulrich , Nadal David
Published: August 2018

The purpose of this article is to determine allergic rhinitis and age as potential risk factors for the development of orbital complications of acute rhinosinusitis in children. One hundred two children presenting with orbital swelling were investigated by computed tomography (CT) of the paranasal sinuses and the orbit as well as for underlying allergic rhinitis. Sixty (58.8%) patients had orbital complications of clinical and radiological acute rhinosinusitis. They were grouped accordingly: preseptal cellulitis (n = 24), periostitis (n = 10), and subperiosteal abscess (n = 26). No abscess within the orbit or cavernous sinus thrombosis was found. Thirty-four (56.7%) of the 60 patients underwent allergy investigation. Allergic rhinitis was found in 9 (64.3%) of 14 children with preseptal cellulitis, in 1 (25%) out of 4 children with periostitis, and in 13 (76.5%) out of 17 children with subperiosteal abscess. The prevalence of allergic rhinitis was significantly higher in patients presenting in pollen season from February to August (17:4) than in patients presenting in the period between September and January (6:7). Thus, allergic rhinitis may be a cofactor in the pathogenesis of orbital complications of acute rhinosinusitis. According to our study population, age only influences the type of orbital complication of acute rhinosinusitis in the sense that older children are more likely to develop subperiosteal abscess, whereas younger children develop preseptal cellulitis.
Relationship between Subjective Nasal Stuffiness and Nasal Patency Measured by Acoustic Rhinometry
Authors: Larsson Christel , Millqvist Eva , Bende Mats
Published: August 2018

Nasal geometry measured by acoustic rhinometry was compared with the subjective sensation of nasal stuffiness in healthy subjects before and after provocation with histamine. The correlation was poor at rest, but it was significant after histamine provocation in children and adults. It is easier to find a relationship between subjective and objective nasal obstruction after inducing congestion.
Intranasal Application of the α2-Adrenoceptor Agonist BHT-920 Produces Decongestion in the Cat
Authors: Mcleod Robbie L. , Erickson Christine H. , Mingo Garfield G. , Hey John A.
Published: August 2018

The effect of α2-selective adrenoreceptor activation on nasal cavity dimension in an experimental model of congestion has not been defined. Presently, we used acoustic rhinometry to evaluate the decongestant activity of BHT-920, a selective α2-adrenergic agonist against nasal congestion produced by intranasal compound 48/80. Administration of the mast cell liberator compound 48/80 (1%) into a nasal passageway decreased ipsilateral volume and minimum cross-sectional area by 73 ± 4% and 42 ± 6%, respectively. The congestant effect of compound 48/80 was blocked by topical BHT-920 (0.3 and 1%) in a dose related manner. In addition, the decrease in minimum cross-sectional area produced by compound 48/80 was attenuated after topical BHT-920 treatment. As a comparison we also evaluated the topical decongestant activity effects of the α1-adrenergic agonist phenylephrine, and the nonselective α-agonist oxymetazoline. Both phenylephrine (0.1–1.0%) and oxymetazoline (0.01–0.3%) produced decongestion. The blood pressure effects of these three drugs also were evaluated. At doses of 0.3 and 1.0%, BHT-920 did not produce hypertension. In contrast, oxymetazoline (0.01–0.1%) produced a transient hypertension that peaked at 15 minutes and fully recovered 45 minutes after administration. The hypertensive effect of phenylephrine at 0.3 and 1.0% lasted over 60 minutes. The present findings indicate that selective α2-agonists may produce decongestant activity with an improved cardiovascular profile compared with current sympathomimetic drugs such as phenylephrine.
Study of Eosinophil Activation in Nasal Mucosa in Patients with Perennial Nasal Allergy: Effects of CO2 Laser Surgery
Authors: Furukido Kyosuke , Takeno Sachio , Osada Rika , Ishino Takashi , Yajin Koji
Published: August 2018

Carbon dioxide (CO2) laser surgery has been shown to be clinically effective in the treatment of nasal allergy. To investigate the mechanisms of eosinophil infiltration and activation underlying the therapeutic effects of CO2 laser surgery, we examined changes in the cytological profile of nasal mucosa after surgery. Twenty-two patients with perennial nasal allergy against house-dust mites underwent two or three rounds of laser surgery at 1-month intervals on an outpatient basis. The following parameters were evaluated at each visit: (i) improvement of clinical symptoms (nasal obstruction, rhinorrhea, and sneezing), (ii) percentage of infiltrating eosinophils in nasal mucosa, and (iii) the degree of EG2+ cells and intracellular adhesion molecule 1 (ICAM-1) expression by immunocyto-chemistry. All clinical symptoms significantly decreased after surgery. Significant reductions in eosinophil infiltration (p < 0.01) and the percentage of EG2+ cells (p < .005) were observed also. However, the degree of ICAM-1 expression in epithelial cells was not changed. These results suggest that CO2 laser surgery partially reduced the allergic reactions, leading to improvement of clinical symptoms.
Chromametric Assessment of Nasal Mucosal Color and Its Application in Patients with Nasal Allergy
Authors: Joko Hideo , Hyodo Masamitsu , Gyo Kiyofumi , Yumoto Eiji
Published: August 2018

The color of the nasal mucosa was evaluated quantitatively in patients with nasal allergy and was compared with that in normal subjects. The chromaticity of the inferior turbinate was measured with the aid of a chromometer coupled with a light projection unit. Chromaticity was indicated by two parameters: the x and y values, which indicate the proportions of the red and green components of a color, respectively. Subjects included patients with Japanese cedar pollinosis (CP; n = 70) and perennial allergic rhinitis (PAR; n = 49), and normal subjects (n = 60). Mucosal blood flow in the inferior turbinate also was measured with a laser Doppler flowmeter in normal subjects. In normal subjects, the x value ranged between 0.4013 and 0.4539, and the y value ranged between 0.3065 and 0.3379. The averages of the x and y values were 0.4264 ± 0.0119 and 0.3204 ± 0.0067, respectively. Age and sex were not related to the chromaticity value. Application of 0.1% epinephrine (0.12 mL) by aerosol spray decreased the x value significantly, in association with a significant decrease in blood flow in normal subjects. The x value of chromaticity in PAR patients was significantly lower than that in normal subjects; this showed the reduced red component of the color. There was no significant difference in the y value between PAR patients and the normal group. In the CP group, the x and y values were not significantly different from values in normal subjects. However, the x value in the first week after the onset of symptoms was significantly greater than that in the normal group. It subsequently decreased to the normal level in the second week and fell to a significantly lower level thereafter. This study found that the chromaticity of the nasal mucosa reflects local blood flow and that the circulatory dynamics in CP patients changes with time during the pollinosis season.
Endoscopic Management of Cerebrospinal Fluid Leaks
Authors: Lund Valerie J.
Published: August 2018

To examine the diagnosis and treatment of patients with cerebrospinal fluid (CSF) rhinorrhea, a cohort of 36 patients treated between 1993 and 2000 were examined to consider the role of imaging and other diagnostic tests such as the presence of β-transferrin in nasal secretion. The etiology of the condition was considered and was found to be congenital in 7 patients and acquired in 29 patients of which in 15 patients it was traumatic, in 12 patients it occurred spontaneously, and in 2 patients it was associated with Wegener's granulomatosis. Where it was possible to obtain nasal secretion, β-transferrin proved a highly sensitive and specific test and imaging included computed tomography (CT), CT cisternography, and magnetic resonance imaging (MRI) of which fine detail coronal CT and MRI proved the most helpful. In six patients neither imaging nor β-transferrin could be used to confirm the diagnosis in which case intrathecal fluorescein was used. Repair was performed endoscopically in all cases with one exception where the defect was felt to be too large for this technique. Middle turbinate mucosa, cartilage, and fascia were the preferred repair materials in the anterior skull base whereas dermal fat was preferentially used in the sphenoid. The overall success rate for an endoscopic approach was 94% although in three cases a second endoscopic procedure was required to produce closure and external approaches were used in two additional patients. The use of a diagnostic algorithm is helpful in both confirming the presence of CSF rhinorrhea and the optimum approach. In the vast majority of cases an endoscopic repair will be successful and it avoids many of the complications associated with craniotomy, particularly in a young population. Therefore, it is our preferred option, although surgeons must be prepared for alternative procedures should these prove necessary.
A Randomized Control Trial of Surgical Task Performance in Frontal Recess Surgery: Zero Degree versus Angled Telescopes
Authors: Kang Swee K. , White Paul S. , Lee Michael S.W. , Ram Bhaskar , Ogston Simon
Published: August 2018

The use of angled telescopes in frontal recess surgery has the theoretical advantage of improved visualization in areas characterized by reduced access such as the frontal recess. However, their use also is accompanied by the disadvantage of increased visuospatial distortion. To examine the surgical error and task performance of angled telescopes when compared with the use of the 0° telescope in frontal recess surgery, we carried out a surgical controlled trial on a cadaveric specimen. Ten surgeons performed randomly predetermined surgical tasks on both sides of the frontal recess. The surgical tasks were divided into three components (passing, grasping, and withdrawing) for analysis. Our study revealed significant difficulty passing instruments with the highly angled 70° telescope as implied by the increased passing time ratio (p = 0.000). This was associated with significant risk of passing instruments blindly (p = 0.011), resulting in significant surgical error of hits to the middle turbinate (p = 0.005). This study also showed that use of less-angled telescopes (30 and 45°) in frontal recess surgery does not appear to be associated with these risks.
Posttransplant Lymphoproliferative Disorder of the Nasopharynx
Authors: Vargas Hannah , Nazeer Tipu , Conti David , Parnes Steven M.
Published: August 2018

Posttransplant lymphoproliferative disorder (PTLD) is a serious complication of organ transplantation. Although the precise etiology is unknown, the Epstein-Barr virus and immunosuppressive agents appear to be risk factors. The presentation PTLD is diverse, including many patients with symptoms of the head and neck, which may make diagnosis difficult. We present a patient who had undergone renal transplantation referred for recurrent sinusitis. She was found to have PTLD of the nasopharynx. Three cases of head and neck PTLD treated at our institution are described. Although PTLD is uncommon in the general community, the incidence has continued to increase as more patients undergo transplants and clinical presentations of PTLD should be familiar to the otolaryngologist.
Histologic and Immunologic Observations of Viral-Induced Rhinosinusitis in the Mouse
Authors: Ramadan Hassan H. , Meek Robert B. , Dawson G. Stephen , Spirou George A. , Cuff Christopher F. , Berrebi Albert S.
Published: August 2018

Viral upper respiratory infection is one of the most common diagnoses made in primary care offices. Although symptoms resolve within 1 week for many patients, a percentage develops rhinosinusitis, and many of these patients are treated with antibiotics. We have developed a model of viral rhinosinusitis using intranasal inoculation of reovirus into mice that were then killed on postinoculation days 2, 4, 7, 10, 14, or 21 and heads were embedded in paraffin for histological and immunohistochemical analyses. Reovirus-like immunoreactivity was noted in the septa and paranasal sinus mucosa in mice as early as day 2, with peak intensity seen on day 4, and scant staining seen on day 7. Complete absence of viral staining was seen by day 10, which corresponded with increased intracellular adhesion molecule 1 immunostaining in the nose. By day 10, a large mucosal influx of B cells was observed, with a moderate influx of macrophages and smaller influx of T cells. By day 14, there was a peak in the number of B cells with a corresponding, but less pronounced peak in T cells, while macrophages began to decline at this point. By day 21, the panel of immune markers returned to near normal levels. The results of this study suggest that the immune system continues to produce a response as long as 2 weeks after clearance of viral antigens. One proposed mechanism for this phenomenon is that local factors such as cytokines are released continually after infection, even in the absence of persistent viruses or bacteria.
Wound Healing of the Nasal and Paranasal Mucosa: A Review
Authors: Watelet Jean-Baptiste , Bachert Claus , Gevaert Philippe , Van Cauwenberge Paul
Published: August 2018

Background

Wound healing is a highly coordinated process involving clot formation, inflammatory reaction, immune response, and, finally, tissue remodeling and maturation. Only few data regarding the specific healing of the nasal or sinusal mucosa are available.

Methods

After a short summary of the general principles of wound healing, the most important data regarding in vitro or in vivo models of wound healing of the nasal and paranasal mucosa are discussed. Attention is paid to clinical application.

Main Findings

First observations regarding the specific regulation of epithelial regeneration by growth factors have underlined the complex relationship between extracellular matrix and epithelium during the repair process. However, only poor and aspecific correlations can be described between endoscopically and histomorphologically defined postoperative phases.
The Effect of a Dissolvable Hyaluronic Acid–Based Pack on the Healing of the Nasal Mucosa of Sheep
Authors: McIntosh David , Cowin Allison , Adams Damian , Rayner Tim , Wormald Peter-John
Published: August 2018

Introduction

There is a paucity of knowledge about the healing of the nasal respiratory mucosa after endoscopic sinus surgery (ESS). Nasal packs often are placed after ESS in an attempt to reduce adhesions but the effect of these packs on the healing of the nasal mucosa is not known.

Methods

A standardized normal animal model (the sheep) was used to examine the healing of the nasal epithelium after ESS. A full-thickness wound was created in the nasal mucosa and either packed with a dissolvable hyaluronic acid–based pack or left unpacked to serve as control. The wounded areas were biopsied at 28, 56, 84, and 112 days postinjury and epithelialization, and cilial regeneration was assessed by light microscopy and scanning electron microscopy.

Results

The wounds with the dissolvable hyaluronic acid–based packs showed no differences in reepithelialization up to 84 days postwounding. However, a significant increase in reepithelialization was observed on day 84 in packed wounds compared with unpacked controls, indicating an increased rate of healing at that time point. In addition, there was a significant increase in the epithelial height in the packed wounds on day 28, indicating that packing was affecting the epithelial maturity of the mucosa. No significant difference was observed in cilial regeneration between the packed and control wounds.

Conclusions

Application of the hyaluronic acid–based nasal packs to wounds after ESS may improve reepithelialization of the nasal mucosa but appears to have minimal effect on reciliation at the time points studied in normal-healing wounds.
Sinus Inflammation Associated with Contralateral Inverted Papilloma
Authors: Orlandi Richard R. , Rubin Adam , Terrell Jeffrey E. , Anzai Yoshimi , Bugdaj Melissa , Lanza Donald C.
Published: August 2018

Objective

To assess with computerized tomography (CT) the association of unilateral inverted papilloma (IP) and contralateral sinus inflammation.

Design

Retrospective analysis of CT findings in a sample of patients with unilateral IP, a sample with other unilateral sinonasal tumors, and normal controls.

Patients and Methods

Sixteen patients with unilateral IP comprised the study population. Nine patients with other unilateral sinonasal tumors (five with squamous papilloma, two with squamous cell carcinoma, and one each with adenocarcinoma and large cell carcinoma) were used as a comparison population. Patients undergoing maxillofacial CT for nontraumatic orbital conditions comprised the control sample (n = 12 sides). Each patient's preoperative CT scan was evaluated with a modified Lund-Mackay scoring system. The scores for the sides opposite the IPs were compared with the sides contralateral to other sinonasal tumors as well as to normal controls.

Results

Analysis of all three samples’ contralateral sides simultaneously using analysis of variance revealed a difference (p = 0.010). The contralateral sinus scores in IPs tended to be higher than the sides opposite the other sinonasal tumors (mean, 2.66 ± 1.07 versus 1.18 ± 0.76; p = 0.06). These in turn were higher than the normal controls (mean, 0.75 ± 0.48; p < 0.02).

Conclusions

Unilateral IPs are associated with contralateral inflammation as detected by CT. This degree of contralateral inflammation is greater than that seen in other sinonasal tumors. The etiology of this association is unclear. A recent histological review suggested IP is an inflammatory polyp and not a true papilloma. Our data further suggest inflammation may be involved in the pathogenesis of IP. Further work is needed to better understand the pathophysiology and behavior of IP and to define its relationship to sinus inflammation.
Pitfalls in the Endoscopic Drainage of Subperiosteal Orbital Abscesses Secondary to Sinusitis
Authors: Noordzij J. Pieter , Harrison Scott E. , Mason John C. , Hashisaki George T. , Reibel James F. , Gross Charles W.
Published: August 2018

Objective

To review the safety and efficacy of endoscopic drainage of subperiosteal orbital abscesses (SPOAs) secondary to sinusitis and to evaluate risk factors that may be associated with failure.

Study Design

Retrospective chart review. Methods: All patients admitted to the University of the Virginia Health System with a diagnosis of SPOA between 1992 and 1999 were reviewed.

Results

Seven of the 10 SPOAs identified, each located medially, resolved without complication after endoscopic drainage. The remaining three patients required a second drainage. One patient had an inferiorly located SPOA, which recurred laterally after endoscopic drainage. A second pediatric patient, who did not undergo a routine second-look procedure, developed middle turbinate lateralization and synechiae, which led to recurrent SPOAs. A third patient with a significant history of sinusitis was found to have an ethmoid sinus mucocele extending into the medial and posterior orbit. All patients eventually resolved their symptoms.

Conclusions

Endoscopic drainage of medial SPOAs appears to be safe and effective. However, several risk factors must be recognized when present. Management of these risk factors is discussed.
Endoscopic Transmaxillary Biopsy of Pterygopalatine Space Masses: A Preliminary Report
Authors: Lane Andrew P. , Bolger William E.
Published: August 2018

Introduction

Although masses in the pterygomaxillary space are uncommon, they frequently present diagnostic challenges when they occur. If a tissue biopsy is required for pathological analysis, the relative inaccessibility of this region can make the surgical approach more extensive and technically difficult than seems justified. In this study, we describe a series of four cases in which a transnasal endoscopic technique was used to biopsy masses of the pterygomaxillary space.

Methods

The four patients described in this report had lesions of the pterygomaxillary space that were detected radiographically. The surgical approach involved an endoscopic uncinectomy and a wide maxillary antrostomy to provide maximum exposure of the posterior maxillary sinus wall. Careful opening of the bone and underlying periosteum provided ready access to the pterygomaxillary space in an atraumatic fashion. Biopsy specimens were taken under direct endoscopic visualization using traditional biopsy forceps.

Results

In each case, satisfactory exposure of the mass was achieved and diagnostic biopsy specimens were obtained. There were no adverse sequelae related to the procedure. One patient was returned to the operating room 2 weeks later for a repeat biopsy so that additional diagnostic studies could be performed. This was obtained easily through the previous antrostomy and posterior maxillary wall opening.

Conclusions

The transnasal endoscopic approach to the pterygomaxillary space is a safe, relatively noninvasive technique that can be performed by otolaryngologists trained in endoscopic sinus surgery. This procedure allows adequate exposure of the pterygomaxillary space for biopsy while avoiding the morbidity of an open surgical approach. (American Journal of Rhinology 16, 109–112, 2002)
Eosinophilia in the Ethmoid Mucosa and Its Relationship to the Severity of Inflammation in Chronic Rhinosinusitis
Authors: Szucs Eva , Ravandi Saied , Goossens Anita , Beel Mieke , Clement Peter A.R.
Published: August 2018

Background

The aim of this study was to analyze histopathologically mucosal inflammation in patients with chronic rhinosinusitis. In addition, we assessed tissue eosinophilia in relation to the severity of inflammation and to the computer tomographic (CT) findings.

Methods

Forty-eight pathological sinus mucosa specimens obtained during functional endoscopic sinus surgery were stained by hematoxylin and eosin. Total inflammatory cells and eosinophils were quantified. The preoperative CT scans were scored by the staging system of Lund-MacKay.

Results

The grade of the eosinophilic infiltration in the diseased sinus mucosa correlated significantly with the severity of the mucosal inflammation. Allergy or asthma had no effect on the proportion of the eosinophilic infiltrate. The CT scan scores assessed by the Lund-MacKay system correlated significantly with the severity of the inflammatory cellular infiltrate. The correlation between the CT scan scores and the eosinophilic infiltrate of the mucosa was close to significant.

Conclusion

Eosinophilic mucosal inflammation represents the most severe inflammatory changes of the mucosa. Twenty to forty percent of the patients with chronic rhinosinusitis had no eosinophilic inflammation of the mucosa. The CT-staging system of Lund-Mackay correlated with the extent of mucosal inflammation.
Electrophoretic Evaluation of Nasal Discharge in Patients with Allergic Rhinitis and Vasomotor Rhinitis
Authors: Tosun Fuat , Sezen Ilhan , Gerek Mustafa , Özkaptan Yalçın , Yapar Mehmet , Çalışkaner Zafer , Akman Serif
Published: August 2018

Background

Allergic rhinitis and vasomotor rhinitis are two common diseases that have similar symptoms and physical findings. This study was designed to assess the efficacy of electrophoretic analysis of nasal discharge for the differential diagnosis of allergic rhinitis and vasomotor rhinitis.

Methods

Two different groups of patients with allergic rhinitis (n = 18) and with vasomotor rhinitis (n = 18) diagnosed by current methods and 10 healthy subjects as a control group were included in this study. Component analyses of proteins in nasal wash were made by sodium dodecyl sulfate–polyacrylamide gel electrophoresis.

Results

The mean levels of total protein, 66-kDa proteins and 26-kDa proteins (277.2 ± 9 μ/mL, 114.5 ± 9 μg/mL, and 67.0 μ 4 μg/mL, respectively), in nasal washing samples of patients with allergic rhinitis were found to be higher than in the samples, (222.0 ± 6 μg/mL, 65.6 ± 6 μg/mL, and 42.9 ± 4 μg/mL, respectively) obtained from patients with vasomotor rhinitis. The control group showed the lowest rate of these proteins (167.8 ± 7 μg/mL, 34.3 ± 3 μg/mL, and 25.0 ± 3 μg/mL, respectively). The differences between mean levels of these proteins in all groups were statistically significant (p < 0.05).

Conclusions

These findings indicate that electrophoretic analysis of nasal discharge can be used for the diagnosis of allergic rhinitis and vasomotor rhinitis. However, further studies are needed to standardize the technique of nasal wash and to determine the range of proteins in nasal secretions that will confirm the diagnosis.
The Effects of Fluticasone Propionate on Nasal Epithelial Potential Difference
Authors: Graham Scott M. , Scott Shaun N. , Launspach Janice , Zabner Joseph
Published: August 2018

Background

Human airway epithelium maintains homeostasis of the fluid and salt composition at the airway surface by a regulated transport of sodium and chloride ions. The volume and composition of airway surface liquid have been shown to be important in the pathogenesis of cystic fibrosis, nasal inflammatory disease, and nasal polyposis. The presence of functional epithelial sodium and chloride channels in the airway epithelium can be evaluated electrically by measuring the voltage across the nasal epithelium (Vt). Because fluticasone propionate is commonly used to treat nasal inflammatory diseases, we tested its effect on the nasal ion transport.

Methods

A single-blind prospective trial was performed on 12 healthy volunteers. Subjects were randomized to receive either fluticasone propionate or normal saline nasal spray twice daily for 2 weeks. We measured the nasal voltage at baseline, days 3 and 14, and 2 weeks after cessation of treatment. The basal voltage, the change in voltage after perfusion with amiloride (sodium channel blocker), and the change in voltage after perfusion with isoproterenol in a low-chloride buffer (chloride channel activator) were recorded. Saccharin clearance times were measured also.

Results

Two-week treatment with fluticasone propionate resulted in a significant increase in the change in Vt after perfusion with amiloride. There was no significant change in the group treated with normal saline. These findings also were observed on day 3 and were reversed completely after the 2-week washout period. The increase in amiloride-sensitive Vt did not result in a decrease in mucociliary clearance.

Conclusions

This study suggests that one effect of fluticasone propionate use on nasal mucosa in normal volunteers is increased epithelial sodium absorption.
Clinical Outcome of Pediatric Endoscopic Sinus Surgery
Authors: Walner David L. , Markey Robin , Jain Vipin , Myer Charles M.
Published: August 2018

Background

The purpose of this study was to determine the efficacy of pediatric endoscopic sinus surgery based on a clinical symptom score outcome. We conducted a prospective analysis of established measures of clinical outcome based on a survey that was completed preoperatively and again 2 years after pediatric endoscopic sinus surgery.

Methods

Twenty-seven children underwent endoscopic sinus surgery. Twenty-three of the 27 children's surveys were completed both preoperatively and postoperatively by parents of the children. The main outcome measure was scores on parental survey and parental perception of surgical success.

Results

Results revealed that all children had an improved symptom score in all categories postoperatively as compared with preoperatively. Statistical analysis using the nonparametric sign test showed that a significant decrease (p < 0.05) in score occurred in 9 of the 15 categories (score lowered from preoperatively to postoperatively) for the children on an individual basis. These categories included a decrease in frequency of a cough (p = 0.013), nasal congestion (p = 0.031), visit to the doctor's office or hospital because of associated problems (p = 0.008), amount of days missing school or child care (p = 0.001), problems with routine activities such as eating and sleeping (p = 0.001), problems with attendance or conduct at school (p = 0.004), and a decrease in the child's sinus problems affecting the parent's performance at their job or at home (p = 0.035).

Conclusions

We concluded that parental perception of their child's clinical outcome after pediatric endoscopic sinus surgery appears favorable. (American Journal of Rhinology 16, 151–154, 2002)
PCR Analysis of Nasal Polyps, Chronic Sinusitis, and Hypertrophied Turbinates for DNA Encoding Bacterial 16S rRNA
Authors: Bucholtz Gerald A , Salzman Sherry A. , Bersalona Fernando B. , Boyle Timothy R. , Ejercito Victor S. , Penno Linda , Peterson Douglas W. , Stone Gwen E. , Urquhart Andrew , Shukla Sanjay K. , Burmester James K.
Published: August 2018

Background

Nasal polyps are considered to result from chronic inflammation, but the initial or persisting stimulus for the inflammation is not known. A variety of bacteria and fungi have been cultured from nasal polyps, but ∼35% have sterile cultures. Previously, Mycoplasma pneumoniae–specific DNA was detected in human nasal polyps using polymerase chain reaction (PCR) techniques, suggesting M. pneumoniae as a causative agent in the etiology of nasal polyps.

Methods

In this study, we tested for the presence of bacterial DNA in nasal polyps resected from 40 patients, in nasal mucosa membrane from 9 patients undergoing turbinectomy for hypertrophy, and in sinus mucosa membrane from 6 patients undergoing endoscopic surgery for chronic sinusitis. Tissue DNA was extracted and analyzed by PCR using M. pneumoniae specific primers for DNA that encode the 16S rRNA gene in 41 specimens (31 polyps, 6 turbinates, and 4 sinus), and by consensus sequence-based PCR using broad range primers for most eubacterial DNA encoding the 16S rRNA gene in 38 specimens (26 polyps, 7 turbinates, and 5 sinuses).

Results

Only two samples were positive for bacterial DNA encoding 16S rRNA: Streptococcus sp. DNA was isolated from one polyp specimen and Pseudomonas aeruginosa DNA was isolated in one maxillary sinusitis specimen. No evidence of M. pneumoniae–specific DNA encoding 16S rRNA was found in any of the tissues.

Conclusions

This study suggests that chronic bacterial infection is not a major component of nasal polyp etiology.
Heated Humidification during Nasal Continuous Positive Airway Pressure for Obstructive Sleep Apnea Syndrome: Objective Evaluation of Efficacy with Nasal Peak Inspiratory Flow Measurements
Authors: Winck João C. , Delgado J. Lúis , Almeida João M. , Marques José A.
Published: August 2018

Background

Nasal obstruction is one of the most frequent and sometimes troublesome side effects of nasal continuous positive airway pressure (nCPAP) therapy for obstructive sleep apnea syndrome (OSAS).

Methods

We describe a 60-year-old man with allergic seasonal rhinitis and OSAS, with worsening nasal symptoms 1 week after beginning home nCPAP, making nCPAP use difficult (nasal peak inspiratory flow [nPIF], 80 L/minute [57% of his best]).

Results

No significant improvement was obtained with topical steroids or cold humidification. Heated humidification was then considered, achieving an improvement in mean nPIF and symptom scores. An acceptable compliance with CPAP could be obtained during the heated humidification period (3.9 hours of mean daily use).

Conclusion

In this patient with moderately severe OSAS and allergic rhinitis, monitoring nasal symptoms and nasal PIF objectively showed the benefit of heated humidification to overcome nasal intolerance and increase compliance to nCPAP treatment.
Correlation between Rhinometric Measurement Methods in Healthy Young Adults
Authors: Numminen Jura , Ahtinen Mikko , Huhtala Heini , Laranne Jussi , Rautiainen Markus
Published: August 2018

The most common rhinometric measurement methods used in modern rhinology are acoustic rhinometry, rhinomanometry, and nasal peak expiratory flow (PEF) rate. In this prospective study, we wanted to clarify whether the parameters given by these three methods in the same subject support each other and can be used simultaneously in clinical practice. We also wanted to define the dimensions of normal nasal geometry and function based on these three methods. The rhinometric measurements were done in 249 healthy white subjects consisting of 171 women and 78 men. The geometry was analyzed with regard to body mass index (BMI) and smoking habits. The result could be used as some kind of reference value for the same kind of patient cohort as when rhinological pathology is investigated. The measurements obtained by acoustic rhinometry showed only statistically significant correlations between the measured volume and minimal cross-sectional area in the nasal cavities (r = 0.959). Rhinomanometry showed only a statistically significant correlation between the measured resistance in expiration and inspiration (r = 0.977). Acoustic rhinometry, rhinomanometry, and nasal PEF did not show any correlations and the BMI did not have any effect on the results. Although the smoking group was relatively small in this cohort, the rhinometric methods showed smaller nasal cavity volume, higher resistance, and lower nasal PEF values. Based on these results, we recommend the use of these three rhinometric methods as independent instruments in rhinological examinations. However, in the pathological nose, e.g., smokers, the methods show equal changes in measurements. It is important to measure at least acoustic rhinometry and rhinomanometry at the same time in clinical practice to achieve good quality of examinations.
Mucociliary Transport Function and Damage of Ciliated Epithelium
Authors: Yang Tian-qun , Majima Yuichi , Guo Yongqing , Harada Teruhiko , Shimizu Takeshi , Takeuchi Kazuhiko
Published: August 2018

The influence of epithelial damage on mucociliary transport was studied in relation to the amount of mucus. The mucosal epithelium of mucus-depleted frog palate was dissected and mounted on a plastic plate. Mechanical damages were created on the frog mucosa by pressing a different thickness of boards (2, 3, 5, and 8 mm). Two different amounts of frog mucus (7.9 L [small amount of mucus {S-mucus}]) and 51.0 L [large amount of mucus {L-mucus}])were applied on the frog mucosa with and without mucosal damage. There was no difference in mucociliary transport rate (MTR) on undamaged frog mucosa between S-mucus and L-mucus. However, on the damaged mucosa, MTR of S-mucus was significantly decreased compared with that of L-mucus. Moreover, capability of mucus transportation across the mucosal damage was significantly lower in S-mucus than in L-mucus. Results indicate that the larger the mucus amount becomes, the more the mucus travels the damaged epithelium. Moreover, MTR of L-mucus was decreased with increasing the degree of epithelial damage. This study indicates that the degree of loss of cilia is an important factor of mucociliary deceleration. (American Journal of Rhinology 16, 215–219, 2002)
A Comparison of Endoscopic Culture Techniques for Chronic Rhinosinusitis
Authors: Tantilipikorn Pongsakorn , Fritz Michael , Tanabodee Jirayu , Lanza Donald C. , Kennedy David W.
Published: August 2018

Background

Recent evidence suggests that endoscopically obtained cultures from the middle meatus give comparable results to antral puncture for acute sinusitis. The best method for obtaining middle meatal cultures remains somewhat controversial because it has been theorized that specimens obtained with a swab are contaminated easily. This study compares endoscopic culture results from two different methods: swab and aspiration. Specifically, this study sought to determine whether or not the culture contamination rate is higher using the swab versus an aspiration technique.

Methods

One hundred consecutive culture specimens from 81 chronic rhinosinusitis patients were compared. Fifty cultures were obtained using a swab technique (group I) and another 50 cultures were obtained by aspirating pathological material into a sterile suction trap (group II). The patient populations in each group were similar; there were no differences in terms of age, gender, comorbid medical conditions, or prior medical therapy. Cultures were considered contaminated if they yielded normal nasal flora or if rare or few Staphylococcus coagulase-negative colonies grew after no bacteria was identified in gram stain. Staphylococcus aureus, Staphylococcus coagulase-negative, and Pseudomonas aeruginosa were the three most common organisms in both groups.

Results

Gram-negative bacteria were noted in 21/60 (35%) positive cultures. Although the contamination rate of the suction aspiration group (14%) was less than the endoscopic swab group (10%), this did not approach statistical significance (p = 0.75).

Conclusions

Data from this study suggest that endoscopically guided aspiration of pathological material is no better than properly obtained swabs in directing antimicrobial therapy for chronic rhinosinusitis.
The Influence of the Size of the Maxillary Sinus Ostium on the Nasal and Sinus Nitric Oxide Levels
Authors: Kirihene Ravi K.D.R.A. , Rees Guy , Wormald Peter-John
Published: August 2018

Background

Nitric oxide (NO) is produced in significant quantities in the nasal sinuses and is thought to have a beneficial effect on the mucociliary transport of the sinuses and nose and to have significant antibacterial properties that contribute to the health of the sinuses. Recently, the concept of “mini-functional endoscopic sinus surgery” has been introduced where the uncinate is removed without enlargement of the maxillary ostium. Although no scientific evidence has been published, enlargement of the ostium is thought to possibly disrupt the mucociliary pathway and decrease the concentration of NO in the nose and sinuses. The aim of this study was to establish the effect of enlargement of the maxillary ostium on sinus and nasal NO.

Methods

Twenty-nine patients who were post-endoscopic sinus surgery were included with 52 who were maxillary sinus ostia cannulated. There were 22 large maxillary sinus ostia and 30 small ostia. Smoking, allergy status, and topical steroid use were recorded. NO levels were measured in the nose and maxillary sinus after decongestion with patients mouth breathing and breath holding.

Results

This study shows that enlargement of the maxillary sinus ostium above its normal size (20 mm2) produces a significant decrease in both the maxillary sinus and the nasal cavity NO levels. In addition, the size of the ostium showed a significant correlation to the sinus NO level. Use of topical nasal steroid sprays and topical decongestants were shown to effect NO levels in the sinuses and nasal cavity. The lowered levels of NO were found irrespective of the technique of measurement of the NO.

Conclusions

The effect of this lowered NO level on the susceptibility of the maxillary sinuses to recurrent infection is yet to be determined.
Computed Tomogram Findings of Mucous Recirculation between the Natural and Accessory Ostia of the Maxillary Sinus
Authors: Chung Seung-Kyu , Cho Do Yeon , Dhong Hun Jong
Published: August 2018

Background

The phenomenon of recirculation involves the circulation of mucous secretion between the natural ostium and other openings and is observed mainly after surgery when the surgical opening is not connected.

Methods

Seven patients with a mucous stream transporting into an accessory ostium, as found during endoscopic examination, were entered into study. The coronal computed tomogram findings of the mucous recirculation were analyzed at three levels: anterior, middle, and posterior portion of it.

Results

The anterior portion was visualized at the level of the natural ostium in five patients. The middle portion inside the maxillary sinus was visible in six cases. The posterior portion was visualized at the level of the accessory ostium in five patients. Among the axial scans, mucous rings were visible in two patients.

Conclusions

The primary mucous recirculation between the natural and accessory openings is shown as a ring structure in coronal computed tomogram scans.
Outcomes of the Modified Endoscopic Lothrop Procedure
Authors: Schulze Stacey L. , Loehrl Todd A. , Smith Timothy L.
Published: August 2018

Background

The aim of this study was to examine the long-term outcomes of the modified endoscopic Lothrop procedure for the management of the most severe forms of recalcitrant chronic frontal sinusitis.

Methods

This case series evaluated 13 consecutive cases of the modified endoscopic Lothrop procedure for chronic frontal sinusitis from April 1996 to December 1999. Patent communication to the frontal sinus was evaluated by postoperative endoscopic exam. Postoperative patient symptomatology and medication requirements were assessed during clinic evaluation and by standardized telephone questionnaire.

Results

At a mean follow-up period of 34.5 months, a 77% patency rate was obtained, with 2 of the 13 patients requiring an osteoplastic flap with obliteration. Telephone questionnaire results indicate improved symptoms and decreased medication requirements in the majority of patients who maintained patency.

Conclusions

These results show that the modified endoscopic Lothrop procedure provides a good alternative to the osteoplastic flap with obliteration for patients with the most severe forms of chronic frontal sinusitis. Initially, high patency rates decline with longer-term follow-up, and severe forms of chronic rhinosinusitis continue to significantly impact patient-perceived quality of life in some patients. The modified endoscopic Lothrop procedure should be reserved for patients who have failed more conservative endoscopic approaches to the frontal recess.