bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Noninvasive Fungal Sinusitis in South Australia
Authors: Collins Melanie M. , Nair Salil B. , Wormald Peter-John
Published: August 2018

Background

The aim of this study was to document the prevalence of noninvasive fungal sinusitis in patients with chronic sinusitis and thick viscous secretions in South Australia.

Methods

We studied of 349 patients with chronic rhinosinusitis undergoing endoscopic sinus surgery in a specialized rhinology practice. Patients with nasal polyposis and thick fungal-like sinus mucin had operative samples sent for microscopy and fungal culture. Evidence of atopy was taken as positive radioallergosorbent or skin-prick tests to fungi.

Results

One hundred and thirty-four (38%) patients were noted to have thick, viscid sinus mucin, raising suspicion of fungal disease. Ninety-three patients had positive fungal cultures or microscopy (26.6%). It was possible to classify 95.5% of the patients into subgroups of noninvasive fungal sinusitis or nonfungal sinusitis: 8.6% of patients with allergic fungal sinusitis, 1.7% of patients with allergic fungal sinusitis–like sinusitis, 15.2% of patients with chronic fungal sinusitis, one patient with a fungal ball, and the remaining 69% of patients with nonfungal chronic sinusitis.

Conclusion

This is the first prospective study to evaluate the prevalence of these increasingly widely recognized conditions. It highlights the need for otolaryngologists to be alert to these not uncommon diagnoses in order for early, appropriate medical and surgical management to be instituted.
Endoscopic Resection of Inverted Papilloma: University of Miami Experience
Authors: Kaza Sarita , Capasso Robson , Casiano Roy R.
Published: August 2018

Background

The aim of this study was to evaluate the efficacy and safety of endoscopically resecting paranasal sinus inverted papillomas at a tertiary medical center.

Methods

Over a 9-year period, 51 patients with a diagnosis of inverted papilloma underwent endoscopic resection at the University of Miami/Jackson Memorial Medical Center. The study group consisted of 14 women and 37 men with a mean age of 59 years (range, 20–88 years) enrolled in a clinical data base. All of the patients were followed endoscopically at regular intervals on an outpatient basis.

Results

Endoscopic evidence of extensive papillomas involving the anterior and posterior ethmoid sinuses and at least one (usually the maxillary) dependent sinus was found in 60% of the cases. Extensive radiological disease (varying degrees of mucoperiosteal thickening or opacification of all five cavities) was evident in 50% of the cases. All but two had unilateral disease. An association with chronic inflammatory polyps (clinically and pathologically) was observed in 25 of 51 patients (49%). Follow-up ranged from 6 to 99 months (mean, 30 months). There have been seven recurrences (14%). Four of these have been managed in the office under topical anesthesia. Three recurrences were managed surgically in the operating room. All of the patients have been free of disease. Complications included an intraoperative CSF leak (three patients); temporary infraorbital hypesthesia (three patients); periorbital ecchymosis, hematoma, or cheek edema (four patients); and orbital symptoms (two patients). Carcinoma was found in four patients (8%) who received postoperative radiotherapy and remain free of disease.

Conclusion

The endoscopic approach continues to provide at least equivalent short-term results as compared with external techniques for the removal of paranasal sinus inverted papilloma. The final cavity should allow for adequate postoperative surveillance and potential resection of recurrences in the office setting, without the need for a return to the operating room in most patients. The association of inverted papilloma with chronic inflammatory polyps and tobacco use warrants additional study.
Effects of Topically Applied Biomaterials on Paranasal Sinus Mucosal Healing
Authors: Maccabee Mendy S. , Trune Dennis R. , Hwang Peter H.
Published: August 2018

Background

Recently, nasal packing made of absorbable biomaterial has become increasingly popular. Although absorbable packs are effective for hemostasis, their impact on healing mucosa is unknown. Some have felt that a biocompatible sinus dressing actually may enhance healing, particularly in areas where the mucosa has been stripped. The aim of this study was to determine the effect of topical MeroGel and FloSeal on paranasal sinus mucosal healing in a rabbit model.

Methods

Bilateral maxillary sinuses of 12 New Zealand white rabbits were surgically opened and stripped of mucosa. The left maxillary sinus of six rabbits had sterile saline-soaked MeroGel placed in the antrum, and the other six rabbits received FloSeal. The right maxillary sinuses of all 12 animals were stripped and otherwise untreated to serve as stripped controls. The animals were killed at 2 weeks and specimens were examined by light microscopy.

Results

MeroGel-treated mucosa showed extensive fibrosis of the basal lamina and lamina propria, complete loss of surface epithelium, and loss of the mucociliary blanket. There was minimal resorption of the MeroGel, and MeroGel fibers were frankly incorporated into the regenerated epithelium, associated with an exuberant lymphocytic infiltrate. FloSealtreated mucosa showed similar fibrosis of the basal lamina and lamina propria with loss of the mucociliary blanket, although to a lesser degree than the MeroGel- treated group. FloSeal showed similar incorporation into the healed mucosa with lymphocytosis. Controls showed expected submucosal gland reduction, lamina propria fibrosis, and loss of cilia, but the lamina propria fibrosis seen in the MeroGel and FloSeal groups was markedly more prominent.

Conclusion

In a rabbit model, MeroGel and FloSeal appear to increase reactionary fibrosis of healing mucosa. These agents also appear to be incompletely resorbed and grossly incorporated into healing tissue. Mucosal healing may be impaired by the application of these agents.
Nasopharyngeal Reservoir of Bacterial Otitis Media and Sinusitis Pathogens in Adults during Wellness and Viral Respiratory Illness
Authors: Chi David H. , Hendley J. Owen , French Pamela , Arango Pablo , Hayden Frederick G. , Winther Birgit
Published: August 2018

Background

The carriage rate of pathogenic bacteria in the nasopharynx (NP) was determined using three separate techniques for obtaining samples.

Methods

The NP of 99 healthy adults was sampled with (1) nasal swab, (2) oral swab, and (3) nasal aspiration; 49 adults with common cold were sampled with an oral swab and nasal aspiration. Three selective agars were used to detect Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis.

Results

Seventy-three percent of healthy adults and 74% of cold sufferers had at least one pathogen detected in the NP. Detection rates were 65% (oral NP swab), 38% (catheter aspiration), and 28% (nasal swab; p < 0.001). Carriage rates for S. pneumoniae, M. catarrhalis, and H. influenzae were 45, 33, and 30%, respectively. Both a nasal and an oral sample were required for optimal detection.

Conclusion

Bacterial pathogens were present in the NP of three-quarters of adults during wellness and during colds.
Nitric Oxide and Collagen Expression in Allergic Upper-Airway Disease
Authors: Tewfik Marc A. , Bernardes Julio F. , Shan Jichuan , Robinson Michelle , Frenkiel Saul , Eidelman David H.
Published: August 2018

Background

The presence of nitric oxide (NO) in high concentrations has been described in the nasal mucosa of patients with untreated allergic rhinitis. We sought to examine the role of exogenous, as well as endogenous, NO in the production of collagen type I and type III by human nasal fibroblasts.

Methods

Primary cultured fibroblasts derived from eosinophilic nasal polyps were exposed to NO donors (500 μM of S-nitroso-N-acetyl-d,l-penicillamine (SNAP) 1000 μM of 3,3-bis(aminoethyl)-1-hydroxy-2-oxo-1-triazene (DETA-NONOate)) and various other compounds over a 24-hour incubation period. Collagen production was evaluated qualitatively by immunocytochemistry and quantitatively by Western blot analysis.

Results

Maximally stimulated fibroblasts established a 2.2-fold increase in the production of type III collagen relative type I, as compared with baseline. Oxyhemoglobin, an NO scavenger, abolished this effect. SNAP (500 μM) caused a 15.68 ± 0.68% increase in collagen type I synthesis as compared with unstimulated controls (p < 0.05). In contrast, incubation with SNAP caused an increase in collagen type III production by a factor of 34.68 ± 0.32% (p < 0.05).

Conclusion

NO stimulates collagen expression in human nasal polyp-derived fibroblasts. This stimulation appeared to favor the up-regulation of collagen type III, leading to a shift in the ratio of collagen type I to type III production.
Low-Grade Fibrosarcoma of the Anterior Skull Base: Endoscopic Resection and Repair
Authors: Kuhn Frederick A. , Javer Amin R.
Published: August 2018

Background

Fibrosarcomas of the paranasal sinuses and skull base are uncommon tumors. Traditionally, “open approach” surgery remains the mainstay for treatment of choice for these tumors.

Methods

A 49-year-old man underwent resection of a right anterior skull base fibrosarcoma using the endoscopic approach.

Results

Close follow-up using both endoscopic and imaging methods over a period of four years has revealed a well-healed skull base with no evidence of recurrence.

Conclusion

Significant resistance exists at present for such a technique to deal with malignant diseases of the head and neck, but results from advanced centers continue to prove that this may be a technique worth mastering and improving on.
Fungal DNA is Present in Tissue Specimens of Patients with Chronic Rhinosinusitis
Authors: Gosepath Jan , Brieger Juergen , Vlachtsis Konstantin , Mann Wolf J.
Published: August 2018

Background

It has been postulated that fungal organisms might represent the immunologic target initiating and maintaining the disease process in patients with chronic rhinosinusitis (CRS). The presence of fungi in nasal mucus has been established by different groups, but so far it has not been shown how the immune system could even recognize such extramucosal—extracorporal—fungal targets. The aim of this study was to determine whether fungal DNA is present in tissue specimens taken from patients with polypoid CRS.

Methods

Twenty-seven surgical specimens were collected from patients suffering from CRS. Fifteen surgical specimens from healthy ethmoidal mucosa served as controls. A second set of controls consisted of five surgical specimens of acoustic neuroma, which were included to rule out contamination within the protocol. All paranasal tissue samples were treated and rinsed carefully with a solution of Dithiothreitol to digest any nasal mucus and ensure that only tissue was examined. A highly sensitive two-step polymerase chain reaction (PCR) was applied to detect fungal DNA, using one universal primer for unspecific detection of fungal DNA and a second primer pair specific for Alternaria.

Results

Fungal DNA was detected in all 27 CRS specimens equally with both PCR primers. Controls from healthy paranasal mucosa were positive using the panfungal primers in 10 of 15 cases but were all negative for Alternaria DNA. PCR was negative for fungal DNA in all five neuroma specimens.

Conclusions

Fungal DNA can be detected within sinonasal tissue specimens of patients suffering from CRS. These findings need to be discussed with respect to the proposed hypothesis of the immune system recognizing extramucosal organisms and initiating an immune response in sensitized patients.
Immediate Correction of Nasal Septum Dislocation in Newborns: Long-Term Results
Authors: Tasca Ignazio , Ceroni Compadretti Giacomo
Published: August 2018

Background

The authors present the results of a long-term follow-up after an immediate reduction of nasal septum luxation in newborn infants.

Methods

Forty-nine children, who underwent a treatment for septal dislocation within 48 hours after birth, were reexamined in 2002 at a mean age of 13.2 years (range, 10–17 years). The examination was performed through inspection of the nasal pyramid, anterior rhinoscopy, nasal endoscopy, rhinomanometry, and acoustic rhinometry.

Results

Anatomic and functional findings showed satisfactory results for all children affected by septal dislocation. Three patients presenting irreplaceable septal-pyramidal deformity had no spontaneous reduction at 7-, 10-, and 11-year follow-ups and thus required surgical intervention.

Conclusions

Considering the simplicity and the safety of the reduction maneuver, the importance of early detection and treatment of neonatal septal dislocations is stressed. This is the longest follow-up study reported in international literature to date.
The Nasal Valve: A Review of the Anatomy, Imaging, and Physiology
Authors: Wexler David B. , Davidson Terence M.
Published: August 2018

Background

The nasal valve region has remained difficult to define in clinical practice in part because of lack of integration between physiological data and anatomic-surgical findings.

Methods

In this review, we summarize the anatomic, physiological, and imaging data regarding this complex area of airflow regulation.

Results

There is no singular resistive focus or singular valve structure to explain all of the reported findings.

Conclusion

We conclude that there is a nasal valve region that begins approximately at the limen nasi and continues for several millimeters within the nasal cavum beyond the piriform aperture. Intranasal pressure measurements reflect distributed resistance across this nasal valve region. The geometry and anatomic constitution of the nasal valve region change greatly from its entrance to its distal aspect. To refer consistently to the component portions of the nasal valve region, we suggest the terms cartilaginous valve segment and bony valve segment for use in reporting future studies.
Histopathological Features of Nasal Polyps with Asthma Association: An Immunohistochemical Study
Authors: Haruna Shinichi , Nakanishi Marcio , Otori Nobuyoshi , Moriyama Hiroshi
Published: August 2018

Background

Myofibroblasts are related to airway remodeling and may play an important role in the pathogenesis of the histological features of nasal polyps associated with asthma. The aim of this study was to analyze and compare the eosinophilic cationic protein, transforming growth factor (TGF) β, and myofibroblasts in the nasal polyps of patients with chronic sinusitis associated with and without asthma.

Methods

Nasal polyp samples were obtained during endoscopic sinus surgery and were classified into asthma and nonasthma groups. Immunohistochemistry was performed using antibodies against activated eosinophils, TGF-β, and myofibroblasts.

Results

The asthma group showed an increased number of activated eosinophils, TGF-β, and myofibroblasts compared with the nonasthma and control groups. We found no correlation of asthma and aspirin intolerance with the immunohistochemical findings.

Conclusion

The increased number of myofibroblasts in the nasal polyps of the asthma group may be responsible for the extracellular matrix accumulation, polyp formation, and polyp recurrence.
The Effect of the Modified Endoscopic Lothrop Procedure on the Mucociliary Clearance of the Frontal Sinus in an Animal Model
Authors: Rajapaksa S.P. , Ananda A. , Cain T. , Oates L. , Wormald P.-J.
Published: August 2018

Background

The surgical management of recalcitrant frontal sinus disease has been a dilemma for otolaryngologists for many years. Although the osteoplastic flap with obliteration has been the gold standard of treatment for years, the modified endoscopic Lothrop (MEL) procedure recently has been advocated as an alternative. However, little is known about the effect of this procedure on the mucociliary drainage of the frontal sinuses postoperatively and this animal study addresses this issue.

Methods

Fourteen sheep underwent the MEL procedure. The sheep were randomized regarding the use of postoperative irrigation via minitrephines. Each sheep had a nuclear medicine γ-scintigraphy frontal sinus clearance study via minitrephines performed on each frontal sinus preoperatively and then 3 months postoperatively. Then, the results of these studies were compared.

Results

The scans revealed a trend toward faster clearance times postoperatively. However, this decrease was not statistically significant. Importantly, there was no trend or significant increase in clearance times postoperatively. Also, the use of postoperative irrigation was associated with a nonsignificant trend toward faster clearance times postoperatively.

Conclusion

The MEL procedure has no adverse effects on the mucociliary clearance of the frontal sinus at 3 months postoperatively. Irrigation of the frontal sinus in the immediate postoperative period showed a trend toward improved postoperative mucociliary function at 3 months.
Midline Necrotizing Nasal Lesions: Analysis of 18 Cases Emphasizing Radiological and Serological Findings with Algorithms for Diagnosis and Management
Authors: Westreich Richard W. , Lawson William
Published: August 2018

Background

The aim of this study was to assess the principal signs and symptoms for severe necrotizing midline nasal lesions and give diagnostic and management algorithms.

Methods

Literature review and retrospective chart review were performed. Three patients with Wegener's granulomatosis (WG), six patients with sarcoid, eight patients with cocaine abuse, and one lymphoma patient were analyzed with respect to symptom complexes, laboratory results, and radiographic findings. Based on computed tomography findings, a nasal destruction score was tabulated for each patient.

Results

All diseases essentially had similar signs and symptoms within the head and neck but several extranasal sites were suggestive of specific etiologies. Serological laboratory testing was diagnostic in only two of the six sarcoid patients and two of the three WG patients. There were no specific tests associated with lymphoma or cocaine abuse, although erythrocyte sedimentation rate was consistently and significantly elevated in the latter group. Biopsy confirmed disease was found in one of the three sarcoid patients, in one of the three WG patients, and in one out of one of the lymphoma patients. Nasal destruction scores were highest in WG and lymphoma patients, intermediate in cocaine abuse patients, and lowest in patients with sarcoidosis. Two of the three WG patients had extensive neo-osteogenesis. One out of one lymphoma and five of the eight cocaine abuse patients had oronasal or oroantral fistulas.

Conclusion

Laboratory tests and biopsies were consistently unreliable in all diseases. Repeat studies should be performed in all cases of negative results if clinical suspicion is high. Neo-osteogenesis and mastoid disease were associated with WG when compared with patients with similar levels of nasal destruction due to other etiologies. Laryngeal and dermatologic changes without significant nasal bony abnormalities raised suspicion for sarcoidosis. Hard and soft palate defects were associated with cocaine abuse and extranodal nasal lymphoma.
Endoscopic Resection of Sinonasal Malignancies: A Preliminary Report
Authors: Roh Hwan-Jung , Batra Pete S. , Citardi Martin J. , Lee Joung , Bolger William E. , Lanza Donald C.
Published: August 2018

Background

A minimally invasive endoscopic approach for the management of sinonasal malignancy offers several advantages including excellent illumination, maximal preservation of uninvolved vital structures, and sparing of facial incisions. The purpose of this study was to evaluate the outcome and morbidity of endoscopic resection with or without combined radiotherapy and/or chemotherapy.

Methods

Forty-seven patients with sinonasal malignancy were diagnosed and/or treated with an endoscopic approach at The Cleveland Clinic Foundation and The University of Pennsylvania Medical Center from 1996 to 2003. Nineteen patients fulfilled the study criteria and had a minimally invasive endoscopic resection. Fifteen patients were treated with curative intent and four patients underwent palliative resection.

Results

The mean age was 56.9 (9–78 years) years and the mean follow-up period was 26.4 months. Combined radiation with or without chemotherapy pre- or postoperatively was given to 15 of 19 (78.9%) patients. Thirteen patients were resected strictly with an endoscopic approach and six patients were resected in combination with neurosurgery. There were no peri- and postoperative deaths. The local recurrence (LR) rate was 26.3% (5/19) and the distant metastasis rate was 15.8% (3/19). Overall survival rate (OS) was 78.9% (15/19) at a mean follow-up duration of 32.1 (4–74 months) months. The disease-free survival (DFS) rate was 68.4% (13/19) by clinical, endoscopic, and radiographic surveillance at a mean follow-up duration of 33.1 months. Patients treated with curative intent had LR, OS, and DFS rates of 21.4, 85.7, and 85.7%, respectively, and the patients treated for palliation had LR, OS, and DFS rates of 40, 60, and 15%, respectively.

Conclusion

Minimally invasive endoscopic resection of sinonasal malignancy in combination with adjunctive therapies reduces treatment morbidity and yields LR, OS, and DFS rates that are comparable with traditional anterior craniofacial approaches.
Outcomes of Frontal Mucocele Marsupialization: Endonasal and External Approaches
Authors: Nakanishi Marcio , Haruna Shinichi , Wada Kota , Otori Nobuyoshi , Moriyama Hiroshi
Published: August 2018

Background

Frontal sinus mucoceles are known to undergo repeated recurrences, and the management of this disease constitutes a challenge regarding the ideal treatment. The aim of this study was to evaluate the postoperative results of the endoscopic ventilation approach in the treatment of frontal mucoceles.

Methods

We retrospectively reviewed the charts of 24 subjects with mucocele who underwent endoscopic marsupialization. The preoperative characteristics of the frontal sinus on computed tomography scans were compared with the postoperative results.

Results

Postoperative endoscopic examination revealed in 15 nasal sides wide patency of the frontal outflow tract. The ostium was patent but had become slightly narrowed in nine nasal sides. Restenosis of the ostium was found in six cases.

Conclusion

A membranous type of obstruction in the region of the frontal outflow tract was related to a better outcome.
Endoscopic Management of Failed Frontal Sinus Obliteration
Authors: Chandra Rakesh K. , Kennedy David W. , Palmer James N.
Published: August 2018

Background

Frontal sinus obliteration (FSO) traditionally has represented the final stage in the algorithm for difficult to manage frontal sinus disease. In addition, FSO has been used in selected cases of frontal sinus trauma. However, this procedure has been associated with failure in 5–10% of cases. Advances in surgical instrumentation and image-guided surgical navigation have permitted endoscopic management of these failures.

Methods

Eleven patients presenting with failure of a previously performed FSO were managed endoscopically with the assistance of image-guided surgical navigation.

Results

Initial frontal sinus pathology included chronic inflammatory disease in six patients and frontal sinus trauma in two patients. Two patients underwent obliteration after neurosurgical frontal craniotomy and one patient underwent obliteration after curettage of a frontal sinus ossifying fibroma. Frontal sinuses were obliterated with fat in eight cases, bone chips in two cases, and bone cement in one case. The mean time interval to FSO failure was 11.1 years (range, 4 months–35 years). The etiology of failure included mucocele in eight patients, chronic frontal sinusitis in two patients, and Pott's puffy tumor in one patient. All 11 patients were managed endoscopically, of which 3 patients underwent a trans-septal frontal sinusotomy. Two patients required revision endoscopic surgery, but all were patent at last follow-up (mean, 14.8 months).

Conclusion

Endoscopic management of failed FSO may be performed safely. These approaches are viable alternatives to open revision procedures in the management of failed FSO. (American Journal of Rhinology 18, 279–284, 2004)
Computed Tomography-Generated Templates: A New Approach to Frontal Sinus Osteoplastic Flap Surgery
Authors: Fewins John L. , Otto Pamela M. , Otto Randal A. , Citardi Martin
Published: August 2018

Background

The aim of this study was to present a new technique for frontal sinus template creation used in osteoplastic flap surgery, obviating the need for the traditional 6-ft Caldwell radiograph.

Methods

Seventeen human cadaver skulls were studied prospectively. Using digital addition algorithms of sequential coronal computed tomography (CT) images of the frontal sinus to create a composite image, an image is printed to 1 cm = 1 cm scale. A frontal sinus template was created using this processed image and compared with a control 6-ft Caldwell radiograph.

Results

The mean variance between corresponding vertical points on the templates was 0.71 mm (95% confidence interval, 0.56–0.87 mm). The mean variance between horizontal points was 1.11 mm (95% confidence interval, 0.97–1.28 mm). The mean difference in width was 2.46 mm. The plain film templates were always wider than the CT-generated templates.

Conclusions

The CT-generated frontal sinus templates are virtually identical to the Caldwell radiograph-derived templates. They may obviate the need for additional imaging and minimize the potential errors commonly associated with 6-ft Caldwell templates. (American Journal of Rhinology 18, 285–290, 2004)
Economic Analysis of the Use of Limited Coronal Computed Tomography Scans in the Management of Sinusitis
Authors: Franzese Christine B. , Stringer Scott P.
Published: August 2018

Background

As medical costs increase, less expensive alternatives to standard diagnostic tests are sought to reduce the economic burden placed on society. One alternative is using limited, non-consecutive cut computed tomography (CT) scans for the evaluation of sinonasal disease. This study evaluates the cost-effectiveness of using limited CT scans instead of full sequence CT scans in the diagnosis and management of rhinosinusitis.

Methods

A Medline search was performed to obtain data for the sensitivity and specificity of limited CT scans, the prevalence of abnormal CT scans, and recommendations on using limited CT scans for operative management. A standard cost-effectiveness analysis, including a sensitivity analysis, was performed using a hypothetical population of patients with sinus complaints who failed prior appropriate medical therapy.

Results

At baseline, the limited CT scan was found to be less cost-effective than the full CT scan, costing $217.13 more per correct diagnosis. The sensitivity analysis demonstrated that changes in the prevalence of abnormal CT scans and the percentage of surgeons who would operate using a limited scan had the greatest impact on cost, whereas changes in the price of the full CT or limited CT scan had the least effect.

Conclusions

This study finds the use of limited CT scans to be economically unsound as a method to reduce costs in the defined population. Published literature recommends obtaining a full CT scan before operative management. Basing intervention on limited CT scans increases the possibility of erroneous diagnoses leading to either excessive or inadequate treatment of patients. (American Journal of Rhinology 18, 329–334, 2004)
Numerical Simulation of Airflow Patterns and Air Temperature Distribution during Inspiration in a Nose Model with Septal Perforation
Authors: Pless Daniela , Keck Tilman , Wiesmiller Kerstin M. , Lamche Ralf , Aschoff Andrik J. , Lindemann Joerg
Published: August 2018

Background

The most typical symptoms of patients with nasal septal perforation (SP) are crusting and recurrent nosebleed. The objective of the study was to determine the influence of SP on intranasal temperature profile and airflow patterns during inspiration by means of numerical simulation.

Methods

Two realistic bilateral models of the human nose with and without SP were reconstructed based on computed tomography (CT). A numerical simulation was performed. The intranasal air temperature distribution and airflow patterns during inspiration were displayed, analyzed, and compared.

Results

SP causes a highly disturbed airflow in the area of perforation. A spacious vortex within the perforation including various localized vortices was detected. A disturbed intranasal temperature distribution between the right and left nasal cavities developed.

Conclusions

The numerical simulation demonstrates the interaction between airflow patterns and heating of respiratory air. The disturbed airflow causes reduced air conditioning. This fact may contribute to crusting and recurrent nosebleed.
High Prevalence of Antibiotic Resistance in Isolates from the Middle Meatus of Children and Adults with Acute Rhinosinusitis
Authors: Huang Wei-Hsiung , Fang Sheen-Yie
Published: August 2018

Background

The pathogens in acute rhinosinusitis are similar worldwide. An increase in antibiotic resistance has been shown in a large number of studies in recent years. The prevalence of resistance varies greatly in different countries. This study was performed to determine the endemic prevalence of antibiotic resistance in pathogens of acute rhinosinusitis in Taiwan.

Methods

Middle meatus discharge was taken for aerobic culture in 133 outpatients with the diagnosis of acute rhinosinusitis.

Results

One hundred two isolates of pathogens were found, including three major bacteria: Haemophilus influenzae (37.3%), Streptococcus pneumoniae (28.4%), and Moraxella catarrhalis (11.8%). Polymicrobial infections and positive cultures occurred more frequently in pediatric patients, as did recovery of M. catarrhalis infection. An extremely high percentage of resistance to first-line antibiotics was noted, viz., penicillin-nonsusceptible S. pneumoniae (PNSSP) (72.4%), ampicillin-resistant H. influenzae (60.5%), and M. catarrhalis (58.3%).

Conclusion

The high prevalence of drug resistance is a great threat to public health. Antibiotic use should be more prudent, especially in pediatric patients, who were found to be more susceptible to bacterial rhinosinusitis and multiple pathogenic infection.
Decreased Connexin 43 Expression Correlated with Eosinophil Infiltration in Nasal Polyps
Authors: Yeh Te-Huei , Hsu Wei-Chung , Chen Yuh-Shyan , Hsu Chuan-Jen , Lee Shiann-Yann
Published: August 2018

Background

A nasal polyp usually is characterized by eosinophil infiltration. Eosinophil-fibroblast interaction is an important event of persistent inflammation in airways. We have found abundant connexin 43 (Cx43) expression in subepithelial fibroblasts of nasal mucosa. Thus, we aim to analyze the relationship of Cx43 expression and eosinophil in nasal polyps.

Methods

In 25 nasal polyps and 19 inferior turbinates, indirect immunofluorescent and hematoxylin and eosin staining were performed in adjacent sections. We calculated the density of Cx43 staining and eosinophil individually by fluorescent and light microscope.

Results

Positive Cx43 staining under confocal microscope was shown as punctated spots on cell margin. The density of Cx43 and eosinophil staining was significantly different between groups of inferior turbinate and nasal polyp (p = 0.01 and 0.03, respectively). Decreased Cx43 expression in the subepithelial fibroblast was correlated with eosinophil infiltration in nasal polyps. Spearman rank order coefficient was equal to —0.43 (p < 0.05).

Conclusion

This is the first demonstration of decreased Cx43 expression related to eosinophil infiltration. To the best of our knowledge, interleukin-8 may be a link between Cx43 and eosinophil and orchestrating both in developing nasal polyps.
New Immunohistologic Findings on the Differential Role of Cyclooxygenase 1 and Cyclooxygenase 2 in Nasal Polyposis
Authors: Gosepath Jan , Brieger Juergen , Mann Wolf J.
Published: August 2018

Background

Cyclooxygenase 1 (Cox-1) plays a key role in arachidonic acid metabolism and in the pathophysiology and immunology of nasal polyposis in patients suffering from aspirin intolerance. We hypothesize that Cox-2 also might be relevant in the etiology of nasal polyps of aspirin-tolerant patients by their effects on inflammatory mediators as well as on microvascular permeability.

Methods

Fifty-two surgical specimens were immunohistochemically labeled for Cox-1 and Cox-2. Specimens were taken from chronically inflamed mucosa (n = 19) and from nasal polyps (n = 19) during endonasal sinus surgery. Controls were obtained from healthy nasal respiratory mucosa (n = 14), harvested during turbinate surgery in patients with nasal obstruction without inflammatory disease. Staining intensities were semiquantitatively assessed and statistically analyzed.

Results

In chronically inflamed tissue the expression of Cox-1 and Cox-2 was strongly labeled. However, in nasal polyps the staining pattern of Cox-1 was similar, but Cox-2 expression in epithelial cells was significantly less than in inflamed, nonpolypous specimens.

Conclusion

These data suggest that while Cox-1 is strongly up-regulated, Cox-2 expression is significantly lower in epithelial cells of nasal polyps than in those of chronic sinusitis without polyps. The relevance of this finding has to be discussed with respect to the regulatory function of Cox on the inflammatory reaction in nasal respiratory mucosa and its hypothetical role in alterations of capillary permeability via vascular permeability factor/vascular endothelial growth factor.
Fungi: A Normal Content of Human Nasal Mucus
Authors: Lackner Andreas , Stammberger Heinz , Buzina Walter , Freudenschuss Kurt , Panzitt Thomas , Schosteritsch Stefan , Braun Hannes
Published: August 2018

Background

In recent studies, we showed that 91.3% of both CRS patients and healthy controls grew positive fungal cultures out of their nasal mucus, which therefore appears to be a common finding within the adult population. However, it still was unknown as of when fungi could be cultured from nasal mucus in human beings. We attempted to ascertain this point of time in the nasal mucus of neonates.

Methods

We examined nasal mucus from 30 neonates immediately after birth, on the 1st and 4th day postpartum and after 2 and 4 months of life. The samples obtained with sterile cotton swabs were cultured on agar plates. Fungal cultures were identified either conventionally by microscopy or with molecular techniques. To prove possible contamination during birth, mucus of the maternal birth canal was examined as well.

Results

In 6 of 30 (20%) of our neonates we found positive fungal cultures immediately after birth in (3 of them Candida albicans) most likely because of contamination passing the maternal birth canal. In 2 of 29 (7%) of our neonates, positive fungal cultures were obtained on the 1st day postpartum, and in 4 of 26 (15%) positive fungal cultures were obtained on the 4th day, all limited to 1 day only and without clinical symptoms of colonization. After the 2nd month of life, examination of nasal mucus yielded positive fungal cultures in 8 of 11 (72%), and after 4 months examination of nasal mucus yielded positive fungal cultures in 17 of 18 (94%) of our babies, with a wide array of different species.

Conclusions

Fungi can be cultured from nasal mucus as soon as contact with the environmental air exists but they are not persistent in the 1st day of life. However, after 4 months, the situation is similar to the one in adults: fungal cultures can be obtained from almost everyone's nose. Therefore, fungi must be considered a normal content of nasal mucus.
A Comparison of Symptom Scores and Radiographic Staging Systems in Chronic Rhinosinusitis
Authors: Bhattacharyya Neil
Published: August 2018

Background

The aim of this study was to determine if one of the popular computed tomography (CT) scan staging systems exhibits better correlation with sinonasal symptom severity in chronic rhinosinusitis (CRS).

Methods

Adult patients meeting diagnostic criteria for CRS were prospectively studied with the Rhinosinusitis Symptom Inventory and their paranasal sinus CT scan was staged according to the Kennedy, Harvard, and Lund staging systems. From the Rhinosinusitis Symptom Inventory, Likert symptom severity scores were obtained and the nasal, facial, oropharyngeal, systemic, and total symptom scores were computed. Correlation analysis was conducted between symptom scores and CT scan stage for each of the three staging systems.

Results

Two hundred patients met inclusion criteria (mean age, 41.1 years; 42% men). The mean Lund score for the entire cohort was 10.0 (SD, 5.3). The Kennedy stage distributions were 40, 42, 84, and 34 patients for stages 1–4, respectively. The Harvard stage distributions were 17, 53, 85, and 45 patients for stages 1–4, respectively. All three staging systems exhibited statistically significant Pearson correlation (all p < 0.001) for the nasal symptom domain (nasal obstruction, rhinorrhea, and hyposmia), although the magnitude of the correlation coefficient generally was small (range of Pearson's r, 0.242–0.345). The Kennedy and Harvard systems exhibited significant but negative correlation with the oropharyngeal symptom domain. All three staging systems failed to significantly correlate CT stage with facial symptoms, systemic symptoms, and total symptom scores.

Conclusion

The Lund staging system exhibited the best correlation between nasal symptom scores and CT stage in CRS, but the degree of correlation remained small. All three systems were lacking in staging value for nonnasal sinonasal symptoms.
Development of Transgenic Mouse Models for the Study of Human Olfactory Dysfunction
Authors: Lane Andrew P. , Zhao Haiqing , Reed Randall R.
Published: August 2018

Background

Olfactory loss is a significant health problem that remains incompletely understood. The development of suitable animal models is essential to the progress of human olfactory loss research. Recent advancements in transgenic technology allow the creation of model systems to address causes of olfactory neuron dysfunction.

Methods

This review describes two transgenic mouse models with potential usefulness in the study of olfactory loss and highlights the molecular techniques that underlie the development of such systems.

Results

Genetic constructs generated using standard molecular biological techniques are introduced into mouse germ lines either by homologous recombination or by random integration. One construct (UbI7) places the olfactory receptor I7 under control of the olfactory marker protein promoter. The other two constructs (TI) act together to direct expression of cytokines in the olfactory epithelium, creating a novel approach to the study of inflammatory olfactory loss.

Conclusions

Powerful scientific tools now exist to develop animal models useful to the study of human olfactory disease. Transgenic olfactory neurons from the UbI7 mouse strain will respond to known odorants, facilitating experiments that examine in vitro modulation of olfactory neuron function. The ability to express specific genes in the olfactory mucosa of the TI mouse has great potential in elucidating the role of cytokines in the development of olfactory dysfunction in vivo.
Early Effect of Exogenous Na Hyaluronate on Mucociliary Clearance
Authors: Yildirim Altan , Turgut Bulent , Bebek Ali Ihsan , Gumus Cesur , Kocaturk Sinan , Kunt Tanfer
Published: August 2018

Background

An animal study is performed to determine the early effect of 1% Na hyaluronate on mucociliary clearance function.

Methods

One percent of Na hyaluronate was introduced into the maxillary sinuses of rabbits by anterior antrostomy. A physiological solution of 1% NaCl was introduced into the maxillary sinuses of a control group to equalize the influence of Na for both groups. The treatment material was sprayed with an atomizer for coating the maxillary sinus lining. Technetium-99m diethylenetriamine pentaacetate dynamic scintigraphic imaging was performed to evaluate mucociliary clearance function on all rabbits 72 hours after the surgical procedure.

Results

Although the mean rate of mucociliary clearance of the Na hyaluronate group was slightly worse than the control group; there was no statistically significant difference between them.

Conclusion

There is no early effect of exogenous 1% Na hyaluronate on mucociliary clearance function.
Frequency Spectra of Normal Expiratory Nasal Sound
Authors: Seren Erdal
Published: August 2018

Background

The computerized analysis of the nasal sound reflects the nasal airflow. We have developed a new software program that analyzes the nasal sound to use in the research area and clinical applications. We aimed to analyze automatically the spectral parameters of nasal sound in healthy people by our new versatile PC-based nasal sound analyzer software.

Methods

In this study, we analyzed and recorded the expiratory nasal sound in 30 healthy people. This analysis includes the time-expanded waveform, the spectral analysis with time-averaged fast Fourier transform, the automatic detection, and the waveform analysis of nasal sound.

Results

We calculated the mean frequency of low-intensity sound (LIS) and high-intensity sound (HIS). The mean frequency of LIS was found as 1254 ± 10.23 Hz at the right nose and 1375 ± 18.45 Hz at the left nose. The mean frequency of HIS was found as 2453 ± 22.23 Hz at the right nose and as 2234 ± 21.12 Hz at the left nose. These results showed that the values between LIS and HIS are statistically significant (p < 0.005) and different from each other. We found that the nasal sound of the similar nasal airflow was the same type and amplitude in the analysis of the nasal sound recordings.

Conclusion

The frequency of the nasal sound is an indicator of the intensity of the nasal airflow. The method that provides the analysis of the nasal sound may lead to a new diagnostic method. The method, which is noninvasive, rapid, of low cost, and even applicable for small children, requires little cooperation of the subjects. In addition, it will be possible to record and save the analysis of the nasal airflow as digital data.
Correlation of Complications during Endoscopic Sinus Surgery with Surgeon Skill Level and Extent of Surgery
Authors: Soyka Michael B. , Holzmann David
Published: August 2018

Background

Endoscopic sinus surgery (ESS) produces a great range of potential complications. Rough segregation into “minor” and “major” complications seems insufficient. This study uses a recently published new classification system that is based more on the patient's point of view, with a greater variety of options.

Methods

A retrospective review was undertaken of 421 ESS procedures. Both, the surgeon's experience and the extent of surgery were correlated with the complication rate.

Results

The overall complication rate was 39.7% (grades A–D) and did not correlate significantly with either the experience of the surgeon or with the extent of surgery.

Conclusion

The new classification is simple, precise, and takes complications into account that used to be neglected. ESS is even safe in the hands of less skilled surgeons as long as the degree of difficulty stays highly adapted to his/her ability. Some complications (grade A) seem to be inherent to the procedure.
Effects of the Nasal Muscles on the Nasal Airway
Authors: Kienstra Matthew A. , Gassner Holger G. , Sherris David A. , Kern Eugene B.
Published: August 2018

Background

The nasal muscles and their function are not clearly defined. The nasal muscles generally are thought to act synergistically to produce mimetic motion and affect the nasal airway. We proposed direct examination of the effects of the nasal muscles on the nasal airway.

Methods

Rhinomanometry was performed on volunteers. After paralysis of the nasal muscles with lidocaine, rhinomanometry was performed again to measure nasal airway function with the patient at rest and attempting to flare his/her nostrils. Each patient's rhinomanometric results (at rest and attempting to flare the nostrils) taken before injection of lidocaine served as the control for comparison of his/her results postinjection. The structural tension of the ala at rest and with active flaring of the nostril was measured also, and the results pre- and postparalysis with lidocaine were compared.

Results

The data from both the stiffness (structural tension) and the airflow portions, taken together, support the following conclusions. First, the paralysis was significant, although not complete. Clinical and stiffness data supported complete paralysis. Airflow data, which we think most sensitive, support a statistically significant affect of the injection, although incomplete paralysis.

Conclusion

All of the evidence supports an important role for the nasal muscles when actively used to increase nasal airflow. Second, the majority of the evidence supports an important resting nasal muscle tension that opens the nasal airway.
The Effect of Lateral Osteotomy of Septorhinoplasty on Nasolacrimal Duct Functions: A Radionuclide Imaging Study
Authors: Uzun Lokman , Ugur Mehmet Birol , Peksoy Irfan , Cabuk Mehmet , Cinar Fikret
Published: August 2018

Background

The aim of this study was to evaluate the effects of lateral osteotomy of septorhinoplasty on nasolacrimal duct functions by dacryoscintigraphy.

Methods

The study group comprised 60 nasolacrimal systems of 30 consecutive patients who underwent septorhinoplasty. Dacryoscintigraphy images were taken in the preoperative period and postoperative 1st week and 3rd month. After Tc-99m pertechnetate instillation, dynamic images were obtained every 15 seconds. For cases of normal drainage, the study was terminated after 10 minutes but when obstruction was suspected, external ocular massage and rapid nasal inspiration were applied and the test was extended for an additional 10 minutes. Systems were classified either as passage without massage (normal nasolacrimal test), passage with massage (physiological obstruction), or presac or postsac obstruction (partial or complete obstruction) according to test results. Transit time was determined for cases with normal test or physiological obstruction.

Results

In the preoperative period eight systems (two presac and six postsac) had obstruction. There were a total of 11 (18.3%) additional systems with obstruction (4 presac and 7 postsac) in the 1st postoperative week and patient symptoms were not in complete agreement with the test results in this period. By the 3rd month, nine systems (three presac and six post sac) had obstruction. Transit time was prolonged in both the postoperative 1st week and the postoperative 3rd month tests compared with the preoperative tests (p = 0.000 and p = 0.023, respectively).

Conclusion

We did not encounter any permanent obstructions after lateral osteotomy of rhinoplasty. Temporary obstructions in the 1st postoperative week improved to normal preoperative status by the postoperative 3rd month.