Nasal Pathology Research Articles

Ozone-Induced Nasal Type 2 Immunity in Mice Is Dependent on Innate Lymphoid Cells.

Epidemiological studies suggest that elevated ambient concentrations of ozone are associated with activation of eosinophils in the nasal airways of atopic and nonatopic children. Mice repeatedly exposed to ozone develop eosinophilic rhinitis and type 2 immune responses. In this study, we determined the role of innate lymphoid cells (ILCs) in the pathogenesis of ozone-induced eosinophilic rhinitis by using lymphoid-sufficient C57BL/6 mice, Rag2(-/-) mice that are devoid of T cells and B cells, and Rag2(-/-)Il2rg(-/-) mice that are depleted of all lymphoid cells including ILCs. The animals were exposed to 0 or 0.8 ppm ozone for 9 consecutive weekdays (4 h/d). Mice were killed 24 hours after exposure, and nasal tissues were selected for histopathology and gene expression analysis. ILC-sufficient C57BL/6 and Rag2(-/-) mice exposed to ozone developed marked eosinophilic rhinitis and epithelial remodeling (e.g., epithelial hyperplasia and mucous cell metaplasia). Chitinase-like proteins and alarmins (IL-33, IL-25, and thymic stromal lymphopoietin) were also increased morphometrically in the nasal epithelium of ozone-exposed C57BL/6 and Rag2(-/-) mice. Ozone exposure elicited increased expression of Il4, Il5, Il13, St2, eotaxin, MCP-2, Gob5, Arg1, Fizz1, and Ym2 mRNA in C57BL/6 and Rag2(-/-) mice. In contrast, ozone-exposed ILC-deficient Rag2(-/-)Il2rg(-/-) mice had no nasal lesions or overexpression of Th2- or ILC2-related transcripts. These results indicate that ozone-induced eosinophilic rhinitis, nasal epithelial remodeling, and type 2 immune activation are dependent on ILCs. To the best of our knowledge, this is the first study to demonstrate that ILCs play an important role in the nasal pathology induced by repeated ozone exposure.

A Study of Conventional Dacryocystorhinostomy Operation without Silicon Tube Intubation in a Secondary Hospital

Dacryocystorhinostomy (DCR) is a bypass surgery in which an anastomosis is made between the medial wall of the lacrimal sac & the lateral wall of the nasal mucosa by cutting the intervening bone at the level of middle meatus to restore the flow of tears when the obstruction is beyond the common canaliculus. The only successful treatment of chronic dacryocystitis is DCR. The aim of this study was to evaluate the surgical intervention of conventional external DCR without silicon tube intubation. This prospective study was conducted at General Hospital, Faridpur from July 2012 to June 2014. Eighty cases with chronic dacryocystitis were selected for the study. We excluded the patients with lacrimal fistula, failed DCR and gross nasal pathology like deviated nasal septum, grossly hypertrophied inferior turbinate, atrophic rhinitis, nasal tumour, and polyp from our study. The patients' mean age at the time of surgery was 41.9±8.1 years ranged from 30 to 60 years. The operation was done under local anaesthesia by applying same technique. Then the patients were followed up for 12 months. In this study, we observed recurrence in five patients (6.25%) and complications from DCR are infrequent and not sight threatening. There were seven patients with reactionary haemorrhage, one wound infection, three wound gap, two epicanthal fold, one granuloma formation and five failed DCR. The success rate is 93.75% who underwent external DCR for the management of epiphora due to nasolacrimal duct obstruction.Faridpur Med. Coll. J. Jan 2015;10(1): 20-22

Computed tomography of paranasal sinuses for early and proper diagnosis of nasal and sinus pathology

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong>Pathological lesions of the paranasal sinuses include a wide spectrum of conditions ranging from inflammation to neoplasms both benign and malignant. Most patient of common cold present with symptoms of nasal discharge, nasal obstruction, headache and nasal allergy etc. The patient of paranasal mass usually present with facial deformity, swelling or repeated episodes of epistaxis. The aim of the study was to establish the role of CT in evaluation of pathologies and their proper early diagnosis.</p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong> It is a prospective study. A total of 100 patients who were referred to our department with clinical suspicion of PNS disease underwent CT evaluation of PNS using 64 multi slice CT scanner from December 2012 to October 2015. </p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>Out of 100 cases 51 (51%) cases were males and rest 49 (49%) patients were females. The majority of the cases were of age group 16-30 which were 37case (37%) The most common symptoms were nasal obstruction (50%), followed by nasal discharge (49%), headache in 20% cases. Most common anatomical variations seen was deviated nasal septum (49%) more commonly on right side next common was agger nasi in 48% of cases. Maxillary sinuses are most commonly involved in the study (82 cases), followed by the ethmoid sinuses (ant. group 77 cases, post group 40 case) and frontal sinus 55 cases. The most common pathology seen was masses in 30% cases followed by DNS in 21% cases. The most common form of mucosal thickening noted is circumferential type seen in 7% cases. The most common pathology involving the sinuses was sinusitis (30%) followed by polyp (25%).</p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>Most of the patients with PNS pathology were from 2<sup>nd</sup> and 3<sup>rd</sup> decade. Slight male preponderance was noted. Majority of the patients presented with nasal obstruction. Most common anatomical variant seen was DNS. Most common sinus involved was maxillary. Sinonasal pathologies were the most common followed by pure nasal or pure sinosal. The most common pathology was inflammatory (74%). The most common benign pathologies were polyps with 92% accuracy. 15% of cases had malignancy with diagnostic accuracy of 90%.</p>

Comparison of Voice Quality Between Patients Who Underwent Inferior Turbinoplasty or Radiofrequency Cauterization

The aim of this study was to analyze and compare the vocal quality in patients who underwent either submucosal turbinectomy or radiofrequency cauterization. In this study, we enrolled 60 patients diagnosed with inferior concha hypertrophy. These patients were divided into two groups by using computer program "Research Randomizer." Of the 60 patients, 30 underwent submucosal inferior turbinoplasty and 30 underwent radiofrequency cauterization. The control group was composed of 30 healthy adults with no nasal or upper aerodigestive system pathology. The patients were checked at weeks 1, 2, and 4. Voice records were taken before the procedure and at week 4 postprocedure. The mean age of patients in the inferior turbinoplasty group was 29.4 years (range: 19-42 years); in the radiofrequency group, it was 30.30 years (range: 18-50 years). There was no statistical difference in age between groups. In the inferior turbinoplasty group, there were 16 male and 14 female patients, and in the radiofrequency group, there were 13 male and 17 female patients. There was no significant difference in the number of males and females between groups. Voice professionals, especially singers, actors, and actresses, should be informed about possible voice changes before undergoing endonasal surgery because these individuals are more sensitive to changes in resonance organs. We believe that voice quality should be regarded as a highly important parameter when measuring the success of endonasal surgery.

Development of Strabismus in Children Initially Diagnosed with Pseudostrabismus

ABSTRACTPurpose: To evaluate the incidence of strabismus in children initially diagnosed with pseudostrabismus and to identify risk factors for the development of strabismus.Methods: The medical records of patients who were diagnosed with pseudostrabismus at initial examinations in outpatient clinic were reviewed retrospectively. Follow-up examinations were made at the strabismus department. Age at first examination, gender, family and developmental history, ophthalmic and orthoptic findings including orbit, and eyelid pathologies were investigated.Results: Sixty-five patients with the diagnosis of pseudostrabismus were identified; 2 patients (3.1%) had pseudoexotropia, and 63 patients (96.9%) had pseudoesotropia. The mean age at the initial exam was 29.26±26.68 months (range; 4–120 months). Epicanthal skin folds (n=35), flat broad nasal bridge (n=17), blepharophimosis syndrome (n=1), hypertelorism (n=1), telecanthus (n=1), and multiple pathologies (n=10) were the reasons for pseudostrabismus. Six patients (9.2%) had clinically significant hypermetropia. Anisometropia and amblyopia were detected in 1 (1.5%) and 3 patients (4.6%), respectively, at the initial examination. The mean follow-up period was 25.2±23.28 months (range; 1–154 months). During the follow-up period, true strabismus was detected in 8 cases (12%); of these, 5 cases had non-refractive esotropia, 2 cases had refractive accommodative esotropia, and 1 case had exotropia. Binocular single vision was not developed following amblyopia therapy and refractive correction in esotropic cases. Binocular single vision and best corrected visual acuity were statistically significant risk factors for the development of strabismus (P=0.001).Conclusion: The pseudostrabismic children with subnormal binocular single vision or low visual acuity require follow-up for the risk of development of true strabismus.

Normal Anatomy, Histology, and Spontaneous Pathology of the Nasal Cavity of the Cynomolgus Monkey (Macaca fascicularis).

The evaluation of inhalation studies in monkeys is often hampered by the scarcity of published information on the relevant nasal anatomy and pathology. We examined nasal cavities of 114 control cynomolgus monkeys from 11 inhalation studies evaluated 2008 to 2013, in order to characterize and document the anatomic features and spontaneous pathology. Compared to other laboratory animals, the cynomolgus monkey has a relatively simple nose with 2 unbranched, dorsoventrally stacked turbinates, large maxillary sinuses, and a nasal septum that continues into the nasopharynx. The vomeronasal organ is absent, but nasopalatine ducts are present. Microscopically, the nasal epithelium is thicker than that in rodents, and the respiratory (RE) and transitional epithelium (TE) rest on a thick basal lamina. Generally, squamous epithelia and TE line the vestibule, RE, the main chamber and nasopharynx, olfactory epithelium, a small caudodorsal region, while TE is observed intermittently along the passages. Relatively high incidences of spontaneous pathology findings, some resembling induced lesions, were observed and included inflammation, luminal exudate, scabs, squamous and respiratory metaplasia or hyperplasia, mucous cell hyperplasia/metaplasia, and olfactory degeneration. Regions of epithelial transition were the most affected. This information is considered helpful in the histopathology evaluation and interpretation of inhalation studies in monkeys.

Ozone-Induced Type 2 Immunity in Nasal Airways. Development and Lymphoid Cell Dependence in Mice.

Inhalation exposures to ozone commonly encountered in photochemical smog cause airway injury and inflammation. Elevated ambient ozone concentrations have been epidemiologically associated with nasal airway activation of neutrophils and eosinophils. In the present study, we elucidated the temporal onset and lymphoid cell dependency of eosinophilic rhinitis and associated epithelial changes in mice repeatedly exposed to ozone. Lymphoid cell-sufficient C57BL/6 mice were exposed to 0 or 0.5 parts per million (ppm) ozone for 1, 2, 4, or 9 consecutive weekdays (4 h/d). Lymphoid cell-deficient, Rag2(-/-)Il2rg(-/-) mice were similarly exposed for 9 weekdays. Nasal tissues were taken at 2 or 24 hours after exposure for morphometric and gene expression analyses. C57BL/6 mice exposed to ozone for 1 day had acute neutrophilic rhinitis, with airway epithelial necrosis and overexpression of mucosal Ccl2 (MCP-1), Ccl11 (eotaxin), Cxcl1 (KC), Cxcl2 (MIP-2), Hmox1, Il1b, Il5, Il6, Il13, and Tnf mRNA. In contrast, 9-day ozone exposure elicited type 2 immune responses in C57BL/6 mice, with mucosal mRNA overexpression of Arg1, Ccl8 (MCP-2), Ccl11, Chil4 (Ym2), Clca1 (Gob5), Il5, Il10, and Il13; increased density of mucosal eosinophils; and nasal epithelial remodeling (e.g., hyperplasia/hypertrophy, mucous cell metaplasia, hyalinosis, and increased YM1/YM2 proteins). Rag2(-/-)Il2rg(-/-) mice exposed to ozone for 9 days, however, had no nasal pathology or overexpression of transcripts related to type 2 immunity. These results provide a plausible paradigm for the activation of eosinophilic inflammation and type 2 immunity found in the nasal airways of nonatopic individuals subjected to episodic exposures to high ambient ozone.

The value of posterior rhinomanometry in evaluating patients with snoring and obstructive sleep apnea syndrome

Abstract BACKGROUND. Nowadays, snoring and obstructive sleep apnea are the most common sleep-related breathing disorders (SRBD) found in the medical practice and they are estimated to affect approximately 4% of men and 2% of women in the middle-aged workforce. There are some ENT pathologies that are involved in snoring, and also in obstructive sleep apnea syndrome. The nose plays an important part in both breathing and SRBD. The aim of this study was to determine the role of posterior rhinomanometry in the diagnoses of snoring and obstructive sleep apnea syndrome. MATERIAL AND METHODS. We present a retrospective observational study that took place during a three-year period, between 2009 and 2012. In this study were included 110 subjects, who have undergone polysomnographic investigations, as well as an ENT clinical examination focused on endoscopy and posterior rhinomanometry evaluation. RESULTS. The mean age was 46.09 ± 10.91 years, the mean height was 177.58 ± 10.02 cm and the mean weight was 98.45 ± 17.74 kg. Analysing these results, we found a significant correlation between them and the severity of the sleep pathology. The posterior rhinomanometry results were correlated with nasal allergic rhinitis (p = 0.06) and not correlated with other nasal pathology, such as nasal septum deviation. The changes in the size and shape of the tongue base or epiglottis proved to have an important impact upon rhinomanometric values, with a statistically significant value (p = 0.03, respectively p = 0.08). CONCLUSION. All diagnostic methods must be interpreted in connection with each other.

Determining the incidence of paranasal sinus abnomalities during nasolacrimal duct obstruction

Objectives: To determine the association between nasolacrimal duct obstruction (NLDO) and paranasal sinus abnomalities and to demonstrate the role of this association in the etiology. Materials and Methods: 50 patients diagnosed with nasolacrimal duct obstruction and 38 subjects with no obstruction (control group) were included in this study at a tertiary health institution. Each patient underwent an endoscopic examination and a paranasal sinus computed tomography evaluation. Thereafter, nasal pathologies, such as concha bullosa, chronic sinusitis, septal deviation, and turbinate hypertrophy, were identified. Results: Concha bullosa was detected in 26 (52%) patients with NLDO and 12 (31.6%) members of the control group. The difference between the groups was not statistically significant (p=0.057). A statistically significant correlation was found between the presence of NLDO with septal deviation and chronic sinusitis, while no association was discovered between NLDO and turbinate hypertrophy. Conclusion: We believe that the possible nasal pathologies that can accompany NLDO should be kept in mind in the evaluation of patients scheduled for surgery, and that preoperative nasal cavity evaluation should be considered for this reason.

Adult adenoid hypertrophy, is it persistent childhood adenoid hypertrophy?

Objectives: Adult adenoid hypertrophy is not common. More number of cases of adult adenoid hypertrophy is detected in recent years due to the free availability of endoscopes. The aim of this study is to know the etiopathology of adenoid hypertrophy in adults. Materials and Methods: Twenty-five cases of adult adenoid hypertrophy who underwent adenoidectomy were studied in our institution over a period of 5 years from 2008 to 2013. All the patients underwent diagnostic nasal endoscopy, and associated sinus and nasal pathology were studied. Results: Of 25 cases, 12 were males and 13 were females. In our study adult adenoid hypertrophy was more common in second and third decade. Nasal obstruction was main symptom in 80% of our cases. Allergic symptoms were seen in 28%, headache in 24%, and repeated throat infection in 20%. Adenoidectomy with tonsillectomy was done in 5 cases, adenoidectomy with septoplasty in 5 cases, septoplasty with turbinectomy along with adenoidectomy in 7 cases, functional endoscopic sinus surgery with adenoidectomy in 3 cases, adenoidectomy with tympanoplasty in 2 cases, myringotomy with grommet insertion in 2 patients, and isolated adenoidectomy in 1 patient. Conclusion: Since highest number of cases in our study is in early adulthood, we believe that adenoid hypertrophy is persistence of childhood hypertrophy.

Induced hypotension in ambulatory functional endoscopic sinus surgery: A comparison between dexmedetomidine and clonidine as premedication. A prospective, double-blind, and randomized study.

Background:Functional endoscopic sinus surgery (FESS) is the mainstay of a therapeutic technique for nasal pathologies. This study is to compare the ability of preoperative dexmedetomidine versus clonidine for producing controlled hypotensive anesthesia during FESS in adults in an ambulatory care setting.Materials and Methods:Sixty patients (25-50 years) posted for ambulatory FESS procedures under general anesthesia were randomly divided into Group C and D (n = 33 each) receiving dexmedetomidine 1 μg/kg and clonidine 1.5 μg/kg, respectively; both diluted in 100 ml saline solution 15 min before anesthetic induction. Nasal bleeding and surgeon's satisfaction score; amount and number of patients receiving fentanyl and nitroglycerine for analgesia and deliberate hypotension, duration of hypotension, post anesthesia care unit (PACU) and hospital stay; hemodynamic parameters and side effects were recorded for each patient.Results:Number and dosage of nitroglycerine used was significantly (P = 0.034 and 0.0001 respectively) lower in Group D compared to that in Group C. Similarly, number of patients requiring fentanyl and dosage of same was significantly lower in Group D. But, the duration of controlled hypotension was almost similar in both the groups. Group D patients suffered from significantly less nasal bleeding and surgeon's satisfaction score was also high in this group. Discharge from PACU was significantly earlier in Group D, but hospital discharge timing was quite comparable among two groups. Intraoperative hemodynamics was significantly lower in Group D (P < 0.05) without any appreciable side effects.Conclusion:Dexmedetomidine found to be providing more effectively controlled hypotension and analgesia, and thus, allowing less nasal bleeding as well as more surgeons’ satisfaction score.

A study of etiological factors, management, and complications of atrophic rhinitis

Background: Atrophic rhinitis (AR) is a chronic nasal disease that is characterized by progressive atrophy of the nasal mucosa and underlying bone of the turbinates. The etiological factors blamed for its genesis are specific infections, autoimmunity, chronic sinus infection, hormonal imbalance, poor nutritional status, heredity, and iron deficiency anemia. Although its prevalence is in increasing trend, the study of clinical cases of the AR is found very much less. Objectives: To throw light on the etiology and the various modalities of the management and complications. Materials and Methods: A prospective study carried out for 2 years enrolled a total of 41 cases. The detailed study of each case of AR was carried out and data were recorded in the preformed case record form. Participants were grouped in one of the three treatment plan groups. They were followed for 6 months for the response of the treatment and the complications. Result: Maximum incidence of AR was seen in the age group of 41–50 years (24.4%). It was common in women (65.9%) than in men (34.15%). The etiological factors showed 77% idiopathic type, and others were secondary to other diseases such as chronic sinusitis (12.5%), tuberculosis (7.5%), and leprosy (4.9%). The most common symptoms were crusting (100%) and fetor (97.6%). Investigations showed that 73.2% participants had hemoglobin level below 10 g% and 90% had increased erythrocyte sedimentation rate. The majority of the participants managed with injection placentrex and surgery showed good response on follow-up. Conclusion: No specific etiological factor is known for AR but possibly more than one factor is responsible for etiology. More prevalent in the people of lower socioeconomic status. Conservative treatment is acceptable, harmless, cheap, and effective line of treatment and can be taken as most effective approach. Maintenance of hygiene, balanced diet, avoidance of snuff inhalation, and smoking, as well as early diagnosis and prompt treatment of any nasal pathology can prevent the AR.

Controlled hypotension in day care functional endoscopic sinus surgery: A comparison between esmolol and dexmedetomidine: A prospective, double-blind, and randomized study.

Background:Functional endoscopic sinus surgery (FESS) is the cornerstone of therapeutic management for nasal pathologies. This study is to compare the ability of preoperative and intraoperative esmolol versus dexmedetomidine for producing induced hypotension during FESS in adults in a day care setting.Materials and Methods:Sixty patients (20-45 years) posted for FESS under general anesthesia were randomly divided into Group E (n = 30) receiving esmolol, loading dose 1 mg/kg over 1 min followed by 0.5 mg/kg/h infusion during maintenance and Group D (n = 30) receiving dexmedetomidine 1 μg/kg over 15 min before induction of anesthesia followed by 0.5 μg/Kg/h infusion during maintenance, respectively. Nasal bleeding and Surgeon's satisfaction score; amount and number of patients receiving fentanyl and nitroglycerine for analgesia and deliberate hypotension, Postanesthesia Care Unit (PACU) and hospital stay; hemodynamic parameters and side effects were recorded for each patient.Results:Significantly less number and dosage of nitroglycerine was required (P = 0.0032 and 0.0001, respectively) in Group D compared to that in Group E. Again the number and dosage of patients requiring fentanyl were significantly lower in Group D. However, the duration of controlled hypotension was almost similar in both the groups. Group D patients suffered from significantly less nasal bleeding, and surgeon's satisfaction score was also high in this group. Discharge from PACU and hospital were significantly earlier in Group D. Intraoperative hemodynamics were quite comparable (P > 0.05) without any appreciable side effects.Conclusion:Dexmedetomidine found to be providing more effectively controlled hypotension and analgesia and thus allowing less nasal bleeding as well as more surgeons’ satisfaction score.

Características moleculares y susceptibilidad a antibióticos de cepas de Staphylococcus aureus colonizantes de pacientes con patologías nasales procedentes de Cartagena (Colombia), 2015: estudio observacional

IntroducciónStaphylococcus aureus es uno de los principales patógenos tanto a nivel hospitalario como comunitario. La diseminación del clon ST8-IVc-PVL+ de Staphylococcus aureus meticilino resistente (SARM) genéticamente relacionado con el clon USA300 ha sido descrita en Colombia y otros países suramericanos. Objetivo: Determinar algunas características moleculares y los perfiles de resistencia a antibióticos de aislamientos de Staphylococcus aureus colonizantes de pacientes con patología nasal atendidos en el servicio de Otorrinolaringología del Hospital Universitario del Caribe de la ciudad de Cartagena, Colombia. Métodos: Los aislamientos de Staphylococcus aureus obtenidos de pacientes colonizados fueron sometidos a extracción de ADN y ensayos de PCR para determinar la presencia de los genes mecA y lukF-PV. Se determinó la pertenencia de las cepas a los complejos clonales CC5 y CC8, y se determinaron las relaciones clonales de los aislamientos mediante análisis de PFGE. A las cepas SARM se les tipificó y sub-tipificó el casete cromosomal estafilocócico SCCmec mediante PCR múltiple. Resultados: La prevalencia de colonización encontrada para Staphylococcus aureus fue 22.8% y 5.26% para SARM. Del total de aislamientos SARM, 33.3% estuvieron relacionados con el clon CC8-SARM-IVc y 22.28% con CC8-SARM-IVa. Los genes para la leucocidina PVL se identificaron en 66.7% de aislamientos SARM y 40% de aislamientos sensibles a meticilina (SASM). En cuanto a la distribución de los aislamientos SARM en complejos clonales, 41% pertenecieron al CC8 y 18% al CC5. Conclusiones: Los clones CC8-SARM-IVc y CC8-SARM-IVa, ambos relacionados con el clon USA300, circulan en población con patología nasal de la ciudad de Cartagena de Indias. Palabras claves: USA300, portación nasal, SARM, SCCmec, PFGE.Fuente: DeCS Server, BIREME

Comparative Evaluation of Chronic Rhinosinusitis Patients by Conventional Radiography, Computed Tomography and Diagnostic Nasal Endoscopy (DNE).

Chronic rhinosinusitis is a common condition in medical practice. It is defined as inflammation of the mucosa of nose and paranasal sinuses, the fluids within these cavities, and/or the underlying bone that has been present with or without treatment for at least 12weeks duration. In 1997, a detailed definition of the syndrome was developed by the Rhinosinusitis Task Force of the American Academy of Otolaryngology-Head and Neck Surgery, consisting of the major and minor diagnostic criterias. To study the role of conventional radiography, nasal endoscopy and computed tomography in the early diagnosis of chronic rhinosinusitis. The study was carried out in the Department of Otorhinolaryngology, Saraswati Institute of Medical Sciences. A total of 100 patients with clinical evidence of sinonasal diseases were evaluated with conventional radiography, Nasal endoscopy and computed tomographic evaluation. Out of 100 patients; 58 were male and 42 were female. M:F ratio=1.38:1. Majority of the patients were being in the age group of 21-30years (30%). The most common finding on conventional radiography was opacification of maxillary sinus (42%) followed mucosal thickening (26%), haziness of the maxillary sinus (19%) followed by air-fluid level (13%). Five basic radiological patterns of sinonasal inflammatory disease are identified among 100 patients. These were (1) Infundibular 16%, (2) Ostiomeatal unit 32%, (3) Sphenoethmoidal 8%, (4) Sinonasal polyposis 28%, (5) Unclassified 16%. The sensitivity and specificity of plain film radiography for detecting sinus opacifications was unacceptably low for paranasal sinuses, hence conventional radiography should not be used as a single diagnostic tool in preoperative evaluation. Nasal endoscopy having sensitivity and specificity almost as good as CT scanning, and being an outpatient procedure may reduce unnecessary diagnostic CT scanning procedures. It allows an unparalleled vision with brilliant illumination of nose and paranasal sinuses. Endoscopic directed procedures have high accuracy due to vision controlled and incomparable guidance in treatment of nasal and nasopharyngeal pathologies. CT scan can be reserved as second level investigation for the subgroup of patients with negative endoscopy who remain symptomatic on follow up.

Soy biodiesel emissions have reduced inflammatory effects compared to diesel emissions in healthy and allergic mice

Toxicity of exhaust from combustion of petroleum diesel (B0), soy-based biodiesel (B100), or a 20% biodiesel/80% petrodiesel mix (B20) was compared in healthy and house dust mite (HDM)-allergic mice. Fuel emissions were diluted to target fine particulate matter (PM2.5) concentrations of 50, 150, or 500 μg/m3. Studies in healthy mice showed greater levels of neutrophils and MIP-2 in bronchoalveolar lavage (BAL) fluid 2 h after a single 4-h exposure to B0 compared with mice exposed to B20 or B100. No consistent differences in BAL cells and biochemistry, or hematological parameters, were observed after 5 d or 4 weeks of exposure to any of the emissions. Air-exposed HDM-allergic mice had significantly increased responsiveness to methacholine aerosol challenge compared with non-allergic mice. Exposure to any of the emissions for 4 weeks did not further increase responsiveness in either non-allergic or HDM-allergic mice, and few parameters of allergic inflammation in BAL fluid were altered. Lung and nasal pathology were not significantly different among B0-, B20-, or B100-exposed groups. In HDM-allergic mice, exposure to B0, but not B20 or B100, significantly increased resting peribronchiolar lymph node cell proliferation and production of TH2 cytokines (IL-4, IL-5, and IL-13) and IL-17 in comparison with air-exposed allergic mice. These results suggest that diesel exhaust at a relatively high concentration (500 μg/m3) can induce inflammation acutely in healthy mice and exacerbate some components of allergic responses, while comparable concentrations of B20 or B100 soy biodiesel fuels did not elicit responses different from those caused by air exposure alone.

Non-allergic rhinitis with eosinophilia syndrome is not associated with local production of specific IgE in nasal mucosa.

Non-allergic rhinitis with eosinophilia syndrome (NARES) is an eosinophilic inflammation of the nasal mucosa without evidence of an allergy or other nasal pathologies. Patients complain about perennial symptoms like nasal obstruction, rhinorrhea, itchiness and sneezing of the nose sometimes accompanied by hyposmia. The aim of the study was to better characterize NARES patients using immunoassay-biochip technology to examine serum and nasal secretion. Sera and nasal secretion of patients with NARES (perennial nasal symptoms, no evidence of acute or chronic rhinosinusitis with or without polyps, negative SX1-Screening test and/or negative skin prick test, eosinophilic cationic protein in nasal secretion >200ng/ml) were tested by immunoassay-biochip technology (ImmunoCAP(®) ISAC, Phadia). 112 different allergen components from 51 allergen sources were tested on the chip. Furthermore, serum and nasal secretion were tested for specific IgE to Staphylococcus aureus enterotoxin TSST-1 by fluorescence-enzyme-immunoassay (UniCAP(®), Phadia). Unrecognized systemic sensitization could be ruled out by negative ISAC results in sera of all patients. Testing of nasal secretion for allergen-specific IgE by ISAC chip technology was negative as well in all cases. In one patient, a systemic sensitization to Staphylococcus aureus superantigen TSST-1 was detectable but no allergen-specific IgE to TSST-1 was measurable in nasal secretion of any patient. The results demonstrate that NARES is not associated with local allergy (entopy) nor with a local inflammation driven by Staphylococcus aureus enterotoxin TSST-1. Further studies are necessary to better understand the underlying mechanisms of NARES.

The Evaluation of Relationship Between Body Mass Index and Nasal Geometry Using Objective and Subjective Methods.

It is known that obesity causes obstructive sleep apnea syndrome by increasing upper airway resistance. Also, obese patients are admitted to the ear, nose, and throat clinic very often because of nasal obstruction complaint. The aim of this study is to identify the change and relation among body mass index (BMI), nasal resistance, reduction in nasal ariflow, nasal anatomy, and patients' subjective complaints. A total of 67 patients admitted to our clinic between August 2013 and January 2014 were included in the study.The study group comprised 33 patients who had a chief complaint-nasal obstruction and the other group consisted of 34 patients who had no complaint and nasal pathology. Both the groups were checked with acoustic rhinometry (AR), active anterior rhinomanometer, nasal obstruction symptom evaluation (NOSE), and visual analog study (VAS) questionnaire. There is a significant statistical correlation between the body mass increase and VAS and NOSE score increase (P < 0.05). But the authors did not find any statistically significant relation between BMI and total inspiratory and expiratory MR and MF measured by anterior active rhinomanometer and left and right nasal cavity MCA, and volume measured by acoustic rhinometery (P > 0.05). Contrary to belief, obesity does not change the nasal resistance, airflow, and anatomy but it can cause subjective nasal complaints.

Correlations between morphology and ultrasound exam in cases with nasal and paranasal sinuses pathology

Abstract BACKGROUND. Ultrasonography has been used in rhinology for diagnosing trauma lesions (fractures, hemosinus), second opinion in tumoral pathology, screening for sinusitis, but on a small scale and with future prospects of cost efficiency. OBJECTIVE. We hope to grow awareness of the possible use of ultrasound in screening for nasal and paranasal sinuses pathology at the level of ENT emergency departments. MATERIAL AND METHODS. We describe the technique for ultrasound examination of this region, emphasizing the need for a profound anatomical knowledge characteristic for ENT specialists. Any specialist having access to an ultrasound machine is encouraged to experiment with this imaging procedure. Two cases benefited from the use of ultrasonography in order to receive a better management and a swift treatment. One case presented with a maxillary sinus tumor and another with a paranasal tumor neighbouring the orbit. CONCLUSION. Ultrasonography of nasal and paranasal sinuses permits serial examination without irradiating the patient; it could be implemented as an addition to FAST-like protocols at the level of emergency departments in order to screen for occult head and neck pathology prior to conventional radiology and CT imaging and thus reducing costs

Therapeutic approach in monosymptomatic nasal obstruction

Abstract The term monosymptomatic nasal obstruction does not refer to the isolated nasal obstruction, but to a nasal pathology in which nasal obstruction is the predominant symptom. Four nasal structures may be involved in the isolated monosymptomatic nasal obstruction: the inferior nasal turbinates, the nasal septum or the nasal valve. Since the phenomenon of nasal obstruction can be due to various diseases, correct assessment of the patient is very important. Correctly performed anamnesis and clinical and paraclinical evaluations can help determine the definite diagnosis and choose the therapeutic strategy indicated in each individual case. In this review the authors present the proper therapeutic approach for each type of monosymtpomatic nasal obstruction, emphasizing the need of a preoperatory detailed and correct investigation and diagnosis.