bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunomodulatory Effect of Cytosine-Phosphate-Guanosine (CPG)-Oligonucleotides in Nonasthmatic Chronic Rhinosinusitis: An Explant Model
Authors: Tan Lorwai , Rogers Trisha J. , Hatzirodos Nick , Baker Leonie M. , Ooi Enghooi , Wormald Peter-John
Published: February 2010

Background

The use of cytosine-phosphate-guanosine-oligodeoxynucleotides (CpG-ODNs) or immunostimulatory sequences (ISSs) in the treatment of airway diseases is gaining interest. Binding of the CpG-ODN ligand to Toll-like receptor 9 (TLR9) triggers a shift from a Th2- to a Th1-type response in the target tissue. In this study, we explored the potential use of CpG-ODN to dampen the predominantly Th2-driven chronic inflammatory state in our cohort of patients.

Methods

An in vitro explant model comprising of sinonasal tissue from patients with asthma (n = 12) and without asthma (n = 11) were stimulated with CpG-ODN or Staphylococcus aureus enterotoxin B (SEB) or CpG-ODN in combination with SEBfor 48 hours. Ten of the 12 asthma patients had nasal polyps. RNA was extracted for multiplex real-time reverse transcription polymerase chain reaction analysis and the 2−delta deltaCT method used to determine interleukin (IL)-5, p35 IL-12, interferon (IFN) gamma, and TLR9 expression levels.

Results

CpG-ODN significantly reduced IL-5 mRNA expression in patients without asthma (p = 0.0379) but not in the asthma-associated group. SEB alone caused an increase in IL-5 levels that could be dampened when CpG-ODN was added in combination with SEB. Significant differences in mean IL-5 expression levels between the asthmatic and nonasthmatic categories were detected (Welch t-test; **p = 0.0041). Asthmatic and nonasthmatic patients present as two distinct categories as reflected by significant differences in their IL-5 response to CpG-ODN (F = 11.93; ***p = 0.0008), SEB (F = 41.34; *p = 0.0476) and CpG-ODN with SEB (F = 13.2; *p = 0.0114). In contrast, no significant differences were observed in the expression levels of IL-12, IFN-gamma, and TLR9.

Conclusion

Localized application of CpG-ODN on its own or in combination with SEB may potentially reduce the expression of the proinflammatory cytokine IL-5 in nonasthmatic patients and may be further developed as an immunotherapeutic agent.
Comparison of Vectorial Ion Transport in Primary Murine Airway and human Sinonasal Air-Liquid Interface Cultures, Models for Studies of Cystic Fibrosis, and other Airway Diseases
Authors: Zhang Shaoyan , Fortenberry James A. , Cohen Noam A. , Sorscher Eric J. , Woodworth Bradford A.
Published: February 2010

Background

The purpose of this study was to compare vectorial ion transport within murine trachea, murine nasal septa, and human sinonasal cultured epithelium. Our hypothesis is that murine septal epithelium, rather than trachea, will more closely mimic the electrophysiology properties of human sinonasal epithelium.

Methods

Epithelium from murine trachea, murine septa, and human sinonasal tissue were cultured at an air-liquid interface to confluence and full differentiation. A limited number of homozygous dF508 epithelia were also cultured. Monolayers were mounted in modified Ussing chambers to investigate pharmacologic manipulation of ion transport.

Results

The change in forskolin-stimulated current (delta-ISC, expressed as micro-A/cm2) in murine septal (n = 19; 16.84 ± 2.09) and human sinonasal (n = 18; 12.15 ± 1.93) cultures was significantly increased over murine tracheal cultures (n = 15; 6.75 ± 1.35; p = 0.035 and 0.0005, respectively). Forskolin-stimulated ISC was inhibited by the specific cystic fibrosis transmembrane regulator (CFTR) inhibitor INH-172 (5 μM). No forskolin-stimulated ISC was shown in cultures of dF508 homozygous murine septal epithelium (n = 3). Murine septal ISC was largely inhibited by amiloride (12.03 ± 0.66), whereas human sinonasal cultures had a very limited response (0.70 ± 0.47; p < 0.0001). The contribution of CFTR to stimulated chloride current as measured by INH-172 was highly significantly different between all groups (murine septa, 19.51 ± 1.28; human sinonasal, 11.12 ± 1.58; murine trachea, 4.85 ± 0.49; p < 0.0001).

Conclusion

Human sinonasal and murine septal epithelial cultures represent a useful model for studying CFTR activity and may provide significant advantages over lower airway tissues for investigating upper and lower respiratory pathophysiology.
Sternberg's Canal: Fact or Fiction?
Authors: Barañano Christopher F. , Cure Joel , Palmer James N. , Woodworth Bradford A.
Published: February 2010

Background

Sternberg's (lateral craniopharyngeal) canal was originally described in anatomic studies as a membranous space in the lateral wall of the sphenoid sinus. The canal has been etiologically associated with lateral sphenoid sinus “spontaneous” cerebrospinal fluid (CSF) leaks. A patent Sternberg's canal has been reported in up to 4% of adults, and persistent vestiges have been reported in up to 30%. However, no modern studies analyzing high-resolution CT scans have been published.

Methods

A consecutive analysis of 1000 high-resolution CT scans of sphenoid bones was performed. Scans were analyzed for a lateral recess, bony defects, arachnoid pits, and holes possibly representing Sternberg's canal. Data were compared with a case series of lateral sphenoid CSF leaks.

Results

Average patient age was 38.7 years (10-92 years). A sphenoid lateral recess was present in 35.3% (17.4% bilateral) of cases. Arachnoid pits were present on the floor of the middle cranial fossa in 23.4% of cases. Seven skull base defects were identified. Only one traveling medial to V2 resembled the description of Sternberg's canal. In contrast, a case series of 25 patients with lateral sphenoid sinus CSF leaks all had a lateral recess, defects, and arachnoid pits lateral to V2 (p < 0.00001).

Conclusion

Sternberg's canal as historically defined is not nearly as prevalent as previously reported. Furthermore, the presence of arachnoid pits in all sphenoid CSF leaks and the predominant leak location lateral to the sites of fusion of ossification centers suggests that the leaks are acquired. Contributing factors may include arachnoid pits/weaknesses in the skull base and intracranial hypertension.
Peripheral Blood Mononuclear Cells from Allergic Fungal Rhinosinusitis Adults Express a Th2 Cytokine Response to Fungal Antigens
Authors: Luong Amber , Davis Laurie S. , Marple Bradley F.
Published: February 2010

Background

The etiology of allergic fungal rhinosinusitis (AFRS) remains controversial. Initially thought to represent an immunoglobulin E (IgE)–mediated hypersensitivity to fungal antigens, additional data have implicated other non-IgE and cellular-mediated pathways. The aim of this study was to characterize T-helper type 1 (Th1) and Th2 immune responses of blood lymphocytes from AFRS patients by fungal antigen stimulation to help differentiate these possible pathways.

Methods

Peripheral blood mononuclear cells (PBMCs) isolated from AFRS patients (n = 10) and healthy controls (HCs; n = 11) were exposed to four different fungal extracts (Alternaria, Aspergillus, Cladosporium, and Penicillium) in duplicate. After a 72-hour incubation, the supernatants were analyzed for cytokine levels of three Th1 (interferon [IFN] gamma, interleukin [IL]-2, and tumor necrosis factor alpha) and three Th2 (IL-10, IL-5, and IL-4) cytokines by cytometric bead array flow cytometry. Serum fungal-specific IgE levels were measured by ImmunoCAP (Pharmacia Diagnostics, Kalamazoo, MI).

Results

Fungal extracts of Alternaria and Cladosporium stimulated higher levels of IL-5 from PBMCs in AFRS when compared with HCs (p < 0.05). IL-4 was also elevated for Alternaria in AFRS versus HCs (p < 0.05). A skewed Th2 response to fungal antigen exposure was confirmed by an elevated IL-5/IFN-gamma ratio in AFRS subjects (p < 0.05). Initial studies suggest a correlation between percent T-cell activation and IL-5 expression to IgE levels. Fungal antigens stimulated a notable but not statistically significant increase in IL-10 response in HCs.

Conclusion

In AFRS patients, fungal antigens stimulated T-cell activation, inducing a predominately Th2 immune response. Healthy controls expressed an inhibitory cytokine IL-10 when exposed to these fungal antigens, possibly serving as a protective response.
Nasal Patency by Rhinomanometry in Patients with Sensation of Nasal Obstruction
Authors: Canakcioglu Salih , Tahamiler Rauf , Saritzali Gkioukxel , Isildak Huseyin , Alimoglu Yalcin
Published: February 2010

Background

The objective assessment of nasal patency is a common challenge in clinical practice. This study was designed to show and compare the values of active anterior rhinomanometry (RMM) in patients with sensation of nasal obstruction.

Methods

According to the physical examination, 7283 individuals with sensation of nasal obstruction were divided into the nasal septal deviation (NSD) group and normal nasal anatomy group. The NSD group and normal nasal anatomy group were further divided into subgroups according to skin-prick test positivity or negativity, respectively. Nasal airway resistances (NARs) of the subgroups were evaluated and compared.

Results

The mean value of total inspiratory NAR was 0.51 and 0.34 Pa/cm3 per second at 150-Pa pressure point in allergic rhinitis subjects with and without NSD, respectively; 0.48 and 0.32 Pa/cm3 per second were the mean values of total inspiratory NAR in nonallergic rhinitis subjects with and without NSD, respectively. The total inspiratory resistances in groups with NSD were significantly higher than the others.

Conclusion

We believe that the results of so large a number of participants in this test will make an obvious contribution to the medical literature.
Protein Microarray Analysis of Nasal Polyps from Aspirin-Sensitive and Aspirin-Tolerant Patients with Chronic Rhinosinusitis
Authors: Zander Kelly A. , Saavedra Milene T. , West James , Scapa Victor , Sanders Linda , Kingdom Todd T.
Published: February 2010

Background

The purpose of this study was to apply protein microarray technology to the study of sinonasal tissue and to identify differential protein expression in nasal polyps from aspirin-sensitive (AS) versus aspirin-tolerant (AT) patients with chronic rhinosinusitis (CRS) and CRS with nasal polyps (CRSwNPs).

Methods

Nasal polyp specimens were prospectively obtained from two groups of patients with CRSwNP. The test group (AS) consisted of five patients that were diagnosed with CRSwNP and intolerance to aspirin based on medical history and physical exam. The control group (AT) consisted of four AT patients with CRSwNP. Protein was extracted and labeled from harvested polyps and the Sigma Panorama Antibody Microarray–Cell Signaling Kit was used to identify differences in protein expression between the two polyp groups. Western blot analysis was used to validate the results of the protein microarray.

Results

The protein microarray showed a greater than twofold change in expression of both beta-adaptin and heat shock protein 70 (HSP70). Western blot analysis confirmed up-regulation of beta-adaptin and HSP70 in nasal polyp tissue from AS patients.

Conclusion

Pooled samples of AS and AT nasal polyps evaluated by protein microarray show distinct protein expression profiles in the stress response and receptor-mediated endocytosis pathways. This study establishes the successful application of protein microarray technology to study nasal polyposis, which in turn can be validated by Western blot analysis.
The Role of Itraconazole in Recalcitrant Fungal Sinusitis
Authors: Seiberling Kristin , Wormald Peter-John
Published: February 2010

Background

Oral itraconazole is an antifungal that has been shown to be of benefit to patients with allergic bronchopulmonary aspergillus (ABPA). It is hypothesized that itraconazole may similarly benefit patients with allergic fungal sinusitis (AFS), a disease similar to ABPA. This study was designed to evaluate the therapeutic response of itraconazole in patients with refractory chronic fungal sinusitis who have failed maximal medical and surgical therapy.

Methods

A retrospective chart review was performed of 23 patients with AFS and nonallergic eosinophilic fungal sinusitis treated with oral itraconazole. Charts were reviewed for patient demographics, comorbidities, allergies, fungal cultures, type of surgery performed, and amount of oral steroids used before and after itraconazole. All patients were given a 6-month dose of itraconazole (100 mg b.i.d.) when recurrence developed after surgery. Time to next recurrence, change in oral steroid use, and outcomes were noted. Liver function tests were taken at monthly intervals while on itraconazole.

Results

Twenty-three patients, 13 men and 10 women, were started on oral itraconazole for recurrent fungal sinusitis. Nineteen patients responded to the medication with a decrease in symptoms and fungal mucin/polyps on endoscopy. Three patients had to stop because of elevated liver enzymes. In the remaining 16 patients a decrease in oral steroid use was noted. In addition, 11 of the 16 patients are disease free to date at a mean follow-up of 15.7 months. No permanent complications occurred from the use of the medication.

Conclusion

Oral itraconazole may be of benefit to those patients with recalcitrant fungal sinusitis who have failed maximal medical and surgical therapy. Itraconazole may prolong the time to next recurrence and may enable the patient to significantly decrease or stop oral steroids.
Bacterial Flora in Normal Adult Maxillary Sinuses
Authors: Hamad Walid Abou , Matar Nayla , Elias Michelle , Nasr Marwan , Sarkis-Karam Dolla , Hokayem Nabil , Haddad Amine
Published: February 2010

Background

Conflicting data exist about the presence of bacteria in healthy maxillary sinus cavities. This study was designed to determine the bacterial flora and to quantify the level of bacterial presence in healthy maxillary sinus cavities.

Method

Subjects included 34 patients undergoing Lefort I osteotomy for orthognathic surgery. All patients were preoperatively evaluated by a questionnaire and a complete physical examination including sinus endoscopy. Our exclusion criteria were presence of sinonasal symptoms, asthma, antibiotic treatment in the past 3 months, treatment with local steroids, previous sinonasal surgery, traumatic surgery, and an abnormal CT scan or sinus endoscopy. Washes were obtained from maxillary sinuses before surgery through an antral puncture. The sinus was irrigated with sterile saline followed by aspiration with a syringe attached to the trocar. Basic sterility rules were rigorously applied. Specimens were transported to the laboratory in an air-free syringe. Time between collection of materials and inoculation of the specimen did not exceed 15 minutes. Specimens were inoculated for aerobic and anaerobic organisms.

Results

After applying the selection criteria, 14 patients (28 sinuses) remained. Eight (57.1%) were men with a mean age of 22.7 years; 82.14% of the specimens were sterile. Bacterial organisms were recovered in only four patients with two different coagulase-negative staphylococci in the same patient: one in each sinus with 200 UFC/mL in the left sinus and 10 UFC/mL in the right sinus, one Citrobacter fundii (70 UFC/mL) and two polymorphic floras.

Conclusion

This descriptive study shows the large predominance of sterile maxillary sinus cavities in asymptomatic adults with endoscopically normal mucosa.
Endoscopic Management of Frontal Sinus Osteomas Revisited
Authors: Seiberling Kristin , Floreani Steve , Robinson Simon , Wormald Peter-John
Published: February 2010

Background

Recent articles have published guidelines regarding the role of endoscopic surgery in the removal of frontal sinus osteomas. These guidelines recommend the endoscopic approach for small osteomas but recommend an osteoplastic flap for larger tumors. This study presents a series of endoscopically resected tumors both large and small.

Methods

Retrospective chart reviews were performed. Charts were reviewed of all patients who underwent surgical resection of a frontal sinus osteoma from 1998 to 2008. Sinus CT scans were reviewed and each tumor was staged according to Kennedy's grading system proposed in 2005.

Results

Twenty-three patients, 8 with a grade IV tumor, 6 with a grade III tumor, and the remaining with a grade I or II tumor, underwent endoscopic resection of a frontal sinus osteoma. In 15 patients a modified Lothrop procedure was performed for tumor removal. In addition, a blepharoplasty incision was used in one patient for removal of a large orbital extension of the tumor and another underwent an enlarged frontal sinus trephine performed via a browline incision. In the remaining patients a frontal sinusotomy with minitrephination provided enough access for tumor removal. Over an average follow-up of 36 months no recurrences were noted. Symptoms improved in all but one patient. There were no postoperative complications.

Conclusion

Endoscopic resection of both large and small frontal sinus osteomas is feasible. In this article we have shown successful removal of large osteomas that fill the entire frontal sinus with the modified Lothrop procedure.
Effect of the Radiofrequency Volumetric Tissue Reduction of Inferior Turbinate on Expiratory Nasal Sound Frequency
Authors: Seren Erdal
Published: February 2010

Background

We sought to evaluate the short-term efficacy of radiofrequency volumetric tissue reduction (RFVTR) in treatment of inferior turbinate hypertrophy (TH) as measured by expiratory nasal sound spectra. In our study, we aimed to investigate the Odiosoft-rhino (OR) as a new diagnostic method to evaluate the nasal airflow of patients before and after RFVTR.

Methods

In this study, we have analyzed and recorded the expiratory nasal sound in patients with inferior TH before and after RFVTR. This analysis includes the time expanded waveform, the spectral analysis with time averaged fast Fourier transform (FFT), and the waveform analysis of nasal sound.

Results

We found an increase in sound intensity at high frequency (Hf) in the sound analyses of the patients before RFVTR and a decrease in sound intensity at Hf was found in patients after RFVTR.

Conclusion

This study indicates that RFVTR is an effective procedure to improve nasal airflow in the patients with nasal obstruction with inferior TH. We found significant decreases in the sound intensity level at Hf in the sound spectra after RFVTR. The OR results from the 2000- to 4000-Hz frequency (Hf) interval may be more useful in assessing patients with nasal obstruction than other frequency intervals. OR may be used as a noninvasive diagnostic tool to evaluate the nasal airflow.
Radiological Sinonasal Findings in Adults with Cystic Fibrosis
Authors: Orlandi Richard R. , Wiggins Richard H.
Published: February 2010

Background

Care of cystic fibrosis (CF) patients has extended the expected survival far into adulthood. The morphological changes of adult CF patients’ paranasal sinuses have not been thoroughly addressed.

Methods

A retrospective review was performed of computed tomography imaging of adult CF patients at an academic medical center. Developmental changes, bone sclerosis, mucoceles, and degree of inflammation (using a modified Lund-Mackay scoring system) were assessed.

Results

Forty-five patients were included in the study. The majority of frontal and sphenoid sinuses were either aplastic or hypoplastic. Maxillary hypoplasia was less commonly seen. Seven patients had mucoceles. Sclerosis of the sinuses was a common finding, affecting 84.4% of patients. Inflammation of the sinuses was also common, with a median modified Lund-Mackay score of 15.0 (out of a median 20 possible).

Conclusion

Poor development of the sinuses seen in pediatric CF patients persists into adulthood. Inflammation of the sinuses is a common finding. Bone sclerosis, likely caused by chronic inflammation, affects a large majority of these patients.
Frontal Sinus Inverted Papilloma: Surgical Strategy Based on the Site of Attachment
Authors: Yoon Bit-Na , Batra Pete S. , Citardi Martin J. , Roh Hwan-Jung
Published: February 2010

Background

The surgical management of inverted papilloma (IP) involving the frontal sinus (FS) remains a challenge given the narrow confines of the frontal recess and the close proximity to critical structures. The objective of this study was to elucidate a surgical strategy for management of frontal sinus IP based on the site of attachment.

Methods

A retrospective chart review was performed on 18 patients with FS IP treated at the Pusan National University Hospital and the Cleveland Clinic Foundation between 1998 and 2008.

Results

The mean age was 53.8 years with a male/female ratio of 13:5. The sites of tumor attachment included the medial wall (MW; six cases), posterior wall (PW; five cases), diffuse (all walls involved; five cases), intersinus septal cell (three cases), lateral wall (two cases), and anterior wall (two cases). IP involvement was unifocal in 10 cases and multifocal in 8 cases. Unifocal IP attached to the MW or PW was managed strictly by endoscopic frontal sinusotomy (EFS) in five of six cases (83%). Multifocal IP required endoscopic modified Lothrop (EML) and/or open approaches (endoscopic frontal trephination [EFT], four, osteoplastic flap [OPF], one) in seven of eight cases (88%). One additional patient with bilateral anterior table involvement required OPF. Four (22%) patients developed recurrences. Two were managed by EML, one was managed by EFS, and one was managed by EFT and EFS. Two patients developed cerebrospinal fluid leaks that were managed endoscopically without untoward effects. All patients were free of disease at the time of last evaluation with a mean follow-up of 36.6 months.

Conclusion

Frontal sinus IP with MW or PW involvement can generally be managed by standard EFS. Tumors with multifocal involvement often require EML, along with adjunct EFT in selected cases. OPF can be avoided as the primary surgical approach in most patients with sinonasal papilloma of FS.
Effect of Coblation Polypectomy on Estimated Blood Loss in Endoscopic Sinus Surgery
Authors: Eloy Jean Anderson , Walker Thomas J. , Casiano Roy R. , Ruiz Jose W.
Published: February 2010

Background

We conducted a pilot study comparing estimated blood loss (EBL) using coblation-assisted endoscopic sinus surgery (CAESS) where coblation is used to debulk nasal polyps before microdebridement with a traditional microdebrider technique in chronic rhinosinusitis (CRS) patients with sinonasal polyps undergoing endoscopic sinus surgery (ESS).

Methods

A retrospective analysis was performed at a tertiary care center on patients with nasal polyposis undergoing ESS between January 2008 and July 2008. The University of Miami CT staging system was used preoperatively to evaluate the extent of sinonasal disease. The duration of surgery, blood loss per minute, total EBL, and demographic data were collected.

Results

Twenty-one patients underwent nasal polypectomy/ESS using CAESS and 16 patients underwent nasal polypectomy/ESS using microdebridement. The two groups had comparable University of Miami CT staging scores (p > 0.05). The average EBL was 307.1 ± 169.8 mL using coblation compared with 627.8 ± 424.2 mL using microdebridement (p < 0.05). The average duration of surgery using coblation was 116.2 ± 41.7 minutes, compared with 125.3 ± 48.4 minutes using microdebridement (p > 0.05). The average blood loss per minute was 2.8 ±1.7 mL in the coblation group compared with 4.8 ± 2.1 mL in the microdebridement group (p < 0.05). Subgroup analyses showed a significant decrease in average EBL and EBL/minute to be only significant for revision cases (p < 0.05) and not for primary cases (p > 0.05).

Conclusion

Coblation-assisted nasal polypectomy/ESS is associated with a statistically significant lower EBL and blood loss per minute when compared with traditional microdebridement technique. Coblation represents a new device that can reduce blood loss in patients with nasal polyposis undergoing traditional revision ESS. Further prospective randomized trials are needed to validate these findings.
[6]-Gingerol Suppresses Interleukin-1β-Induced MUC5AC Gene Expression in Human Airway Epithelial Cells
Authors: Kim Jeong Hong , Chang Jung Hyun , Yoon Joo-Heon , Kwon Soon Ho , Bae Jung Ho , Kim Kyung-Su
Published: February 2010

Background

[6]-Gingerol is a major active component of ginger and a natural polyphenol compound. The present study investigated whether [6]-gingerol suppresses interleukin (IL)-1beta-induced MUC5AC gene expression in human airway epithelial cells and, if so, examined whether the suppression of MUC5AC gene expression is mediated via the mitogen-activated protein kinase (MAPK) signal transduction pathway.

Methods

MUC5AC mRNA and protein were measured using reverse transcription-polymerase chain reaction (PCR), real-time PCR, and Western blot analysis in cultured NCI-H292 human airway epithelial cells. Extracellular signal-regulated kinase (ERK) and p38 MAPK protein levels were analyzed by Western blot.

Results

Expression of MUC5AC mRNA increased in NCI-H292 cells upon treatment with 10 ng/mL of IL-1beta for 24 hours. When the cells were pretreated with 10 microM of [6]-gingerol, expression of IL-1 beta -induced MUC5AC mRNA and protein was significantly suppressed. Suppression of IL-1 beta-induced MUC5AC mRNA was also observed in cells pretreated with ERK- or p38 MAPK-specific inhibitors, suggesting that [6]-gingerol-mediated suppression of IL-1 beta -induced MUC5AC mRNA operated via the ERK- and p38 MAPK-dependent pathways.

Conclusions

[6]-Gingerol suppresses IL-1beta -induced MUC5AC gene expression in human airway epithelial cells via the ERK- and p38 MAPK-dependent pathways; therefore, [6]-gingerol may be considered a possible anti-hypersecretory agent.
Clinical Correlation between Irrigation Bottle Contamination and Clinical Outcomes in Post-Functional Endoscopic Sinus Surgery Patients
Authors: Welch Kevin C. , Cohen Michael B. , Doghramji Laurie L. , Cohen Noam A. , Chandra Rakesh K. , Palmer James N. , Chiu Alexander G.
Published: February 2010

Background

Sinonasal irrigation after endoscopic sinus surgery (ESS) is a common practice, but the role irrigation bottles play in iatrogenic contamination of the operated sinuses is unknown. Therefore, we investigated whether irrigation bottles used postoperatively become contaminated and have any potential association with immediate postsurgical infection and outcomes.

Methods

Patients irrigated twice daily after ESS. Bottle cleaning was performed as recommended by the manufacturer. New bottles were distributed at the time of the operation and at each postoperative visit. During postoperative weeks 1, 2, and 4, bottles were cultured. Medical charts were reviewed for the presence of postsurgical infection and changes in management.

Results

Twenty post-ESS patients were enrolled and examined at weeks 1, 2, and 4. A total of 51 bottles were collected and cultured. Overall, 15 of 51 (29%) bottles demonstrated bacterial growth when cultured. During the first two collection periods, 10 of 40 (25%) bottles demonstrated bacterial growth when cultured; however, five of 11 (45%) bottles collected at the last postoperative visit demonstrated bacterial growth when cultured. During the study, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae were frequently recovered during the collection periods. Other organisms isolated included Escherichia coli and Enterobacter spp. Although positive bottle cultures were more common at weeks 2 and 4, no postoperative infections occurred.

Conclusions

Irrigation bottles used postoperatively have a measurable incidence of contamination. Contamination rate increases when bottles are used for longer than 1 week, but this does not appear to result in postsurgical infection.
Effect of Intraoperative Injection of 0.25% Bupivacaine with 1:200,000 Epinephrine on Intraoperative Blood Loss in FESS
Authors: Javer Amin R. , Gheriani Heitham , Mechor Brad , Flamer David , Genoway Krista , Yunker Warren K.
Published: February 2010

Background

This study was designed to compare differences in intraoperative blood loss, mean arterial blood pressure (MABP), and duration of surgery when 0.25% bupivacaine with 1:200000 epinephrine is injected, preoperatively, versus normal saline (NS), during functional endoscopic sinus surgery (FESS).

Methods

A prospective, double-blind randomized placebo-controlled study was performed. Part I involved 46 patients who were infiltrated with 0.25% bupivacaine with 1:200000 epinephrine on one side of the nose and sterile NS on the other (control). Part II involved 30 patients infiltrated with 0.25% bupivacaine with 1:200000 epinephrine bilaterally and 30 patients with NS bilaterally (control). Patient demographics, preoperative MABP, intraoperative MABP, duration of surgery, and total estimated blood loss (EBL) were recorded for each side (part I) and case (part II).

Results

For part I, there were 46 patients (mean age, 49 years), 24 women and 22 men. MABP was 72 mmHg for each side (p = 0.97). Preoperative MABP was 93 mmHg. Duration of surgery was 48 minutes for epinephrine side and 45 minutes for control (p = 0.17). Total EBL was 185 mL for the epinephrine side and 197 mL for control (p = 0.53). For part II, there were 60 patients (mean age, 56 years), 28 women and 32 men. The MABP was 77 mmHg for the epinephrine group and 72 mmHg for control (p = 0.048). Preoperative MABP was 100 mmHg for the epinephrine group and 97 mmHg for control (p = 0.37). Duration of surgery was 2.25 hours for the epinephrine group and 2.08 hours for control (p = 0.17). Total EBL was 589 mL for the epinephrine group and 538 mL for control (p = 0.64).

Conclusion

There was no significant reduction in intraoperative blood loss during FESS when local anesthetic containing epinephrine was used compared with infiltration with NS. More importantly, part II shows a significantly higher MABP associated with infiltration of epinephrine. Parts I and II did not show a significant difference in preoperative MABP or duration of surgery.
Rhinoplasty to Correct Nasal Deformities in Postseptoplasty Patients
Authors: Yeo Nam-Kyung , Jang Yong Ju
Published: February 2010

Background

Although not so common, septoplasty carries the risk of inducing nasal deformity such as saddle nose and deviated nose. Surgical correction for those deformities is a formidable task to deal with, because the septal cartilage framework was already weakened due to previous procedure. This study was designed to examine various causes and effective techniques of rhinoplasty for correction of nasal deformities after septoplasty.

Methods

Subjects comprised 19 patients who developed nasal deformities after septoplasty. Pre- and postoperative photographs were analyzed by two rhinoplastic surgeons. Anthropometric measurements of the external nose before and after surgery were made using frontal and lateral photographs to objectively evaluate outcomes.

Results

Intraoperative analysis showed that 5 patients had weak L-struts and 13 patients had displaced caudal septa. Septum was reconstructed using costal cartilage in 13 cases. Spreader grafting was performed in 13 patients and caudal septal extension grafts were performed in 10 patients. All but 1 patient had successful functional and esthetic outcomes. In the saddle nose group, all parameters except nasolabial angle were significantly improved. In the deviated nose group, curved deviated angles were completely corrected, whereas the linear deviated angle was not.

Conclusion

Loss of caudal septal support appears to be a major reason for nasal deformity after septoplasty. The best surgical approach for septal cartilage framework reconstruction appears to involve the use of bilateral spreader or septal extension grafts using costal cartilage.
Cartilage Outgrowth in Fibrin Scaffolds
Authors: Sage August , Chang Angela A. , Schumacher Barbara L. , Sah Robert L. , Watson Deborah
Published: February 2010

Background

Fibrin glue has been a favorable hydrogel in cartilage tissue engineering, but implantation of chondrocyte-fibrin suspensions have resulted in volume loss. In this study, human septal cartilage chips were seeded onto a fibrin scaffold, and cellular proliferation and production of cartilaginous extracellular matrix (ECM) were evaluated.

Methods

Human septal cartilage was diced into cartilage chips and encased with and without fibrin glue. Four conditions were initially tested for DNA content and glycosaminoglycan (GAG) production: (1) control medium in tissue culture, (2) control medium with fibrin glue, (3) collagenase-supplemented medium in tissue culture, and (4) collagenase-supplemented medium seeded in fibrin glue. Cartilage chips cultured in collagenase-treated medium were then seeded onto either cell culture plates, suspended in alginate, or mixed with fibrin. Cellular proliferation, GAG production, and histochemistry were evaluated.

Results

Fibrin preparations increased cellular proliferation and DNA content. GAG levels were highest in collagenase-treated samples encased in fibrin. Cartilage chips treated with collagenase showed increased cellular proliferation in the fibrin preparations compared with preparations without fibrin. GAG increased with the addition of fibrin when compared with explant. Histochemistry revealed increased GAG accumulation in the regions between the cartilage chips with the addition of fibrin.

Conclusion

Adding fibrin glue to collagenase-treated cartilage chips results in increased proliferation and maintains ECM production and, therefore, may facilitate generation of cartilaginous tissue for use in reconstructive surgery.
Comparison between Three-Dimensional and Triplanar Computed Tomography Imaging of the Frontal Recess
Authors: Isaacs Seth J. , Goyal Parul
Published: February 2010

Background

Despite advances in endoscopic surgical techniques, management of frontal sinus disease remains challenging. Much of this is related to the complex nature of frontal recess anatomy. A thorough understanding of frontal recess anatomy is paramount for the safety and success of frontal sinus surgery. Three-dimensional (3D) computed tomography (CT) may allow surgeons to obtain a more complete preoperative assessment of frontal recess anatomy. The purpose of this study was to determine if reconstructed 3D CT images as an adjunct to conventional triplanar imaging provide additional information regarding the frontal recess anatomy.

Methods

A prospective study was performed. Two otolaryngologists reviewed the CT scans of 25 patients referred for routine paranasal sinus disease. The findings from review of the triplanar CT images were compared with the findings from review of the 3D reconstructions. Each study was assessed for (1) frontoethmoidal cells, (2) agger nasi cell, (3) subrabullar and frontal bullar cells, (4) intersinus septal cell, (5) superior uncinate process attachment site, and (6) and frontal sinus outflow tract. The examiners rated the usefulness of each study to identify each of the aforementioned anatomic subsites using a modified 5-point Likert scale.

Results

Intersinus septal cells, supraorbital ethmoid cells, and the anterior–posterior dimension of the frontal sinus outflow tract were better defined on the reconstructed 3D CT images.

Conclusion

Three-dimensional CT is a useful adjunct to the conventional triplanar studies for the evaluation of frontal sinus and recess anatomy. This technique can define certain anatomic variants more effectively than 2D multiplanar reconstructed images.
Dynamic Nasal Infrared Thermography in Patients with Nasal Septal Perforations
Authors: Lindemann Joerg , Wiesmiller Kerstin , Keck Tilman , Kastl Konrad
Published: February 2010

Background

Nasal obstruction is a typical symptom in patients with nasal septal perforations. Rhinomanometry and acoustic rhinometry are not reliable in these cases because the perforations generate incorrect results. Infrared thermography camera (ITC) systems allow contact-free intranasal recordings of the nasal surface temperature and the semiquantification of nasal airflow. The aim of this study was to perform contact-free temperature measurements of the nasal vestibular surface by application of ITC systems in patients with septal perforations to investigate the disturbed intranasal heat exchange and nasal airflow.

Methods

The surface temperature profiles within the nasal vestibules of healthy volunteers (n = 10) and patients with septal perforations (n = 3) were recorded with an ITC during several breathing cycles. Thermal images were taken (60/s) displaying the surface temperature in degrees centigrade corresponding to a color scale.

Results

The temperature recordings showed a disturbed intranasal heat exchange during inspiration and expiration in patients with septal perforations in comparison with healthy subjects. A reduced and irregular inspiratory cooling of the entire surface within the nasal vestibules visualizes a reduced and disturbed airflow volume.

Conclusion

The study was able to prove the feasibility of intranasal temperature recordings of the surface with an ITC system in patients with septal perforations. Contrary to rhinomanometry and acoustic rhinometry, thermography cameras can be applied to examine airflow in patients with septal perforations. The detected reduced cooling of the surface during inspiration might be a possible explanation for the patients' feelings of nasal obstruction.
Contemporary Assessment of the Disease Burden of Sinusitis
Authors: Bhattacharyya Neil
Published: February 2010

Background

The objective of this study was to determine the disease burden of sinusitis relative to other medical conditions.

Methods

The adult sample of the National Health Interview Survey for calendar years 1997 to 2006 was analyzed, extracting 1-year prevalence data for the disease conditions sinusitis, hay fever, peptic ulcer, acute, asthma, and chronic bronchitis. Disease burden data for emergency room visits, general and specialist visits, health care spending, and workdays lost were also extracted. The influence of each disease condition on disease burden variables was statistically determined. Comparisons among outcomes variables were conducted across disease conditions to determine their relative economic and health care impacts.

Results

Adult patients were studied (313,982; mean age, 45.2 years). The 1-year disease prevalences were: sinusitis (15.2%), hay fever (8.9%), ulcer (2.4%), acute asthma (3.8%), and chronic bronchitis (4.8%). Patients with sinusitis were significantly more likely to: visit the emergency room (22.7% versus 17.4%, p < 0.001), spend greater than $500/year on health care (55.8% versus 45.0%, p < 0.001), and see a medical specialist (33.6% versus 22.3%, p < 0.001), than those without sinusitis. Patients with sinusitis missed an average of 5.67 workdays per 12 months versus 3.74 workdays for those without (p < 0.001). The number of workdays lost with sinusitis was similar to that of acute asthma (5.79 workdays, p > 0.05), and health care spending with sinusitis was significantly greater than that of ulcer disease, acute asthma, and hay fever (p < 0.004).

Conclusions

Sinusitis imparts a significant disease burden both within and outside of the health care system that is comparable with or exceeds that of other conditions commonly thought to be more serious.
Nasal Air Conditioning in Relation to Acoustic Rhinometry Values
Authors: Lindemann Joerg , Tsakiropoulou Evangelia , Keck Tilman , Leiacker Richard , Wiesmiller Kerstin M.
Published: February 2010

Background

Changes of nasal dimensions can influence the air-conditioning capacity of the nose because of alterations of airflow patterns. The goal of this study was to evaluate the correlation between intranasal temperature and humidity values and nasal dimensions, assessed by means of acoustic rhinometry.

Methods

Eighty healthy volunteers (40 men and 40 women; median age, 51 years; range, 20–84 years) were enrolled in the study. In total, 160 nasal cavities were examined. All volunteers underwent a standardized acoustic rhinometry. Additionally, intranasal air temperature and humidity measurements at defined intranasal detection sites within the anterior nasal segment were performed.

Results

There was no statistically significant difference between the right and left side of the nose regarding air temperature, absolute humidity, and acoustic rhinometric values. A negative correlation was established between the rhinometric nasal volumes/minimal cross-sectional areas and air temperature and absolute humidity values at the three intranasal detection sites.

Conclusion

According to our results, nasal volumes and cross- sectional areas relevantly influence nasal air conditioning. A healthy nasal cavity with smaller volumes and cross-sectional areas seems to present a more effective air-conditioning function than a too “wide” open nose because of changes in airflow patterns. This observation should be considered as a limitation for overly extensive nasal surgery especially of the turbinates.
Detection of Staphylococcus Aureus in Nasal Tissue with Peptide Nucleic Acid–Fluorescence in Situ Hybridization
Authors: Corriveau Marie-Noëlle , Zhang Nan , Holtappels Gabriele , Van Roy Nadine , Bachert Claus
Published: February 2010

Background

Staphylococcus aureus (SA) in the nose can be a simple colonizer but also may create an intramucosal reservoir causing recurrent infections or can be a specific immune modulator through superantigenic mechanisms. Because the colonization rate of SA is high, but immunologic reactions causing chronic disease are less frequent, the purpose of this study was to identify the presence of intramucosal SA in healthy subjects and in patients with chronic rhinosinusitis (CRS) and to eventually relate those to the specific immunologic changes due to SA enterotoxins.

Methods

Nasal tissue was collected in 40 subjects (9 controls, 21 CRS patients with [CRSwNP], and 10 CRS patients without nasal polyps [CRSsNP]). Tissues were homogenized, and mediators and specific IgE-antibodies against SA enterotoxins (SAE-IgE) were measured using the UniCAP system. The tissue was analyzed for the presence of SA by the peptide nucleic acid–fluorescence in situ hybridization (PNA-FISH) technique (AdvanDx), and a semiquantitative scoring system was applied. Mann-Whitney exact test was used for statistical analysis.

Results

SA in the mucosal tissue was detected in a higher quantity among CRSwNP subjects with aspirin exacerbated respiratory disease (AERD) versus controls and CRSsNP (p = 0.03). Among CRSwNP patients, Th2 markers (eosinophil cationic protein, p = 0.006, and total IgE, p = 0.004) were increased related to the SAE-IgE status but not related to the presence of SA in the tissue.

Conclusion

This study describes the detection of SA within nasal tissue using the PNA-FISH technique. The presence of SA in the submucosa did not correlate with the amplification of the Th2-related inflammation typically found in CRSwNP patients, but this reaction is dependent on the formation of SAE-IgE within mucosal tissue. We also show, for the first time, that submucosal SA is a prevalent finding in CRSwNP patients with AERD.
Toxin-Induced Chemosensory Dysfunction: A Case Series and Review
Authors: Smith Wendy M. , Davidson Terence M. , Murphy Claire
Published: February 2010

Background

Toxic chemical exposures are estimated to account for 1–5% of all olfactory disorders. Both olfactory neurons and taste buds are in direct contact with environmental agents because of their relatively unprotected anatomic locations, thereby making them susceptible to damage from acute and chronic toxic exposures. The aim of this study was to illustrate different aspects of the diagnostic and therapeutic approach to this disorder using a series of case reports and review of the literature.

Methods

Cases were selected for inclusion based on a retrospective chart review of patients who presented to a university-based nasal dysfunction clinic with toxin-induced olfactory or gustatory dysfunction between January 1985 and December 2008. Workup included complete history, otolaryngologic examination, psychophysical testing, and imaging.

Results

Patient ages ranged from 31 to 67 years (mean, 49.3 years). Etiology of chemosensory impairment included exposure to ammonia, isodecanes, hairdressing chemicals, chemotherapy, gasoline, and intranasal zinc. Five of the seven patients (71%) presented with olfactory dysfunction alone, one patient (14%) presented with dysgeusia alone, and one patient (14%) presented with both smell and taste loss. Only one patient (14%) reported parosmias. Tests of olfaction revealed normosmia in one patient (14%), mild-to-moderate hyposmia in one patient (14%), and severe hyposmia to anosmia in five patients (72%). Both patients who reported taste disorders had hypogeusia on testing.

Conclusion

This case series illustrates the wide spectrum of this disorder and provides a framework for the workup and treatment of these patients.
Olfactory Bulb Volume in Taiwanese Patients with Posttraumatic Anosmia
Authors: Jiang Rong-San , Chai Jyh-Wen , Chen Wen-Hsien , Fuh Wen-Bin , Chiang Chin-Ming , Chen Clayton Chi-Chang
Published: February 2010

Background

Olfactory bulb (OB) volume has been shown to be an indicator of olfactory function. However, few studies have been done in Asia to investigate the influence of different disorders on OB volume.

Methods

Data from patients with posttraumatic anosmia were collected in our department. Their olfactory thresholds were assessed by the phenyl ethyl alcohol threshold test. They were treated with a course of high-dose steroid, and followed up for at least 3 months without any olfactory improvement. Magnetic resonance imaging was subsequently used to measure patients’ OB volumes. Subjects who self-reported their olfactory function was normal were also included in the control group for comparison.

Results

Fifty-four patients with posttraumatic anosmia and 30 subjects who self-reported their olfactory function was normal were enrolled in this study. The mean right OB volume was 45.2 mm3, and the mean left OB volume was 46.3 mm3 in patients with posttraumatic anosmia. The mean right OB volume was 59.7 mm3, and the mean left OB volume was 66.0 mm3 in control subjects. The OB volumes were significantly lower in patients with posttraumatic anosmia.

Conclusion

OB volumes were significantly lower in Taiwanese patients with posttraumatic anosmia.
Canine Fossa Trephine for the Severely Diseased Maxillary Sinus
Authors: Seiberling Kristin , Ooi Eng , MiinYip Jia , Wormald Peter-John
Published: February 2010

Background

The appropriate surgical approach to the severely diseased maxillary sinus is still debatable. Some advocate creating a wide maxillary antrostomy to allow for increased ventilation and improved delivery of postoperative medication. Others, however, recommend more aggressive surgery with complete clearance of all diseased tissue. The aim of this study was to evaluate the outcome of canine fossa puncture and canine fossa trephine (CFT) for the severely diseased maxillary sinus.

Methods

A retrospective chart review was performed on 97 patients who underwent a CFT as a part of endoscopic sinus surgery or modified Lothrop procedure. Outcomes were measured in terms of the maxillary sinus endoscopy grade at last follow-up and need for revision surgery. Two groups were formed: those who experienced recurrence of disease and those who were disease free at last follow-up. A comparison was made between the two groups and differences were noted.

Results

A CFT was performed in 97 patients with nasal polyposis (NP) who had an average number of 2.38 previous sinus surgeries. At an average follow-up of 27.8 months, 80 of the patients were disease free. In 17 patients disease recurred, and 11 of those required revision surgery with a CFT. Those patients who had recurrence of disease tended to be more allergic, have higher Lund-Mackay score, and had an increased number of prior sinus surgeries. In addition, allergic fungal sinusitis was associated with a poorer prognosis after CFT.

Conclusion

CFT allows for complete clearance of all gross disease in the maxillary sinus. CFT decreases the chance of disease recurrence in patients with severe NP.