phenylephrine-hydrochloride and Chronic-Disease

Granulomatous and vasculitic diseases of the airway may be part of more widespread systemic disease but can occur in isolation. They may present to the ear, nose, and throat (ENT) surgeon initially with vague symptoms that mimic more common chronic inflammatory unified airway conditions, such as rhinitis, chronic rhinosinusitis, and asthma. Early diagnosis is associated with better long-term outcomes, so a high index of suspicion is required. Bloody nasal discharge and crusting are highly suspicious for granulomatous disease, which should also be considered in atypical or recalcitrant disease. A combination of clinical findings, serologic tests, imaging, and histology may be required to confirm the diagnosis..

Topics: Asthma; Chronic Disease; Humans; Nose; Pharynx; Rhinitis; Sinusitis

Topics: Chronic Disease; Humans; Nose; Otitis Media; Rhinitis; Sinusitis

Control is a global disease metric defined as the extent to which manifestations of a disease are within acceptable limits. Control serves as the goal of treatment for chronic diseases, such as chronic rhinosinusitis (CRS), that cannot be cured. The objective of this review is to summarize recommendations for assessment of CRS control with a specific focus on how these recommendations align with patients' and healthcare providers' perspectives of CRS control.. Several staging systems for CRS control have been developed with the first and most widely recognized by the 2012 European Position Paper on Rhinosinusitis and Nasal Polyps, which was developed through expert opinion. Patients' and providers'/guideline-based assessments of CRS control frequently do not align. Patients understand the concept of CRS control and their assessment is dominated by the perceived severity of nasal symptoms. In comparison, providers' and guideline-based assessments of control are more global, incorporating nasal and extra-nasal symptoms, need for systemic antibiotics and corticosteroids, and nasal endoscopy.. Although more research is needed, future development of CRS control criteria through consensus around explicitly determined perspectives of healthcare providers and patients may one day serve as the foundation for a standardized approach to treatment of CRS.

Topics: Chronic Disease; Humans; Nasal Polyps; Nose; Rhinitis; Sinusitis

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogenous group of inflammatory conditions impacting the nose and paranasal sinuses. Our understanding of the underlying pathobiology of CRSwNP has substantially improved due to ongoing translational research efforts. Advances in treatment options, including targeted respiratory biologic therapy for CRSwNP, allow for more personalized approaches for CRSwNP patient care. Patients with CRSwNP are typically classified to one or more endotype based on the presence of type 1, type 2, and type 3 inflammation. This review will discuss recent advances in our understanding of CRSwNP and how this may impact current and future treatment approaches for patients with CRSwNP.

Topics: Chronic Disease; Humans; Inflammation; Nasal Polyps; Nose; Phenotype; Sinusitis

Disease control is conceptually recognized to be an important outcome measure for chronic rhinosinusitis (CRS). However, inconsistent usage is a significant factor in disadoption of important concepts and it is presently unclear how consistently the construct of CRS 'control' is being defined/applied. The objective of this study was to determine the heterogeneity of CRS disease control definitions in the scientific literature.. Systematic review of PubMed and Web of Science databases from inception through December 31, 2022. Included studies used CRS disease control as an explicitly stated outcome measure. The definitions of CRS disease control were collected.. Thirty-one studies were identified with more than half published in 2021 or later. Definitions of CRS control were variable, although 48.4% of studies used the EPOS (2012 or 2020) criteria to define control, 14 other unique definitions of CRS disease control were also implemented. Most studies included the burden CRS symptoms (80.6%), need for antibiotics or systemic corticosteroids (77.4%) or nasal endoscopy findings (61.3%) as criteria in their definitions of CRS disease control. However, the specific combination of these criteria and prior time periods over which they were assessed were highly variable.. CRS disease control is not consistently defined in the scientific literature. Although many studies conceptually treated 'control' as the goal of CRS treatment, 15 different criteria were used to define CRS disease control, representing significant heterogeneity. Scientific derivation of criteria and collaborative consensus building are needed for the development of a widely-accepted and -applied definition of CRS disease control.

Topics: Adrenal Cortex Hormones; Chronic Disease; Humans; Nose; Rhinitis; Sinusitis

Mechanical nasal obstruction (MNO) is a prevalent condition with a high impact on patient's quality-of-life (QoL) and socio-economic burden. The aim of this study was to determine the usefulness of both subjective and objective criteria in the appropriate management of MNO, either alone or associated to upper airway inflammatory diseases such as allergic rhinitis (AR) or chronic rhinosinusitis with nasal polyps (CRSwNP).. A long debate persists about the usefulness of subjective and objective methods for making decisions on the management of patients with nasal obstruction. Establishing standards and ranges of symptom scales and questionnaires is essential to measure the success of an intervention and its impact on QoL. To our knowledge this is the first real-life study to describe the management of MNO using both subjective and objective criteria in MNO isolated or associated to upper airway inflammatory diseases (AR or CRSwNP). Medical treatment (intranasal corticosteroids) has a minor but significant improvement in MNO subjective outcomes (NO, NOSE, and CQ7) with no changes in loss of smell and objective outcomes. After surgery, all MNO patients reported a significant improvement in both subjective and objective outcomes, this improvement being higher in CRSwNP. We concluded that in daily clinical practice, the therapeutic recommendation for MNO should be based on both subjective and objective outcomes, nasal corrective surgery being the treatment of choice in MNO, either isolated or associated to upper airway inflammatory diseases, AR or CRSwNP.

Topics: Chronic Disease; Humans; Nasal Obstruction; Nasal Polyps; Nose; Quality of Life; Rhinitis; Rhinitis, Allergic

Diagnosis in rhinology is currently based on the concept of inflammation (chronic rhinosinusitis [CRS]) or the clinical concept of chronic nasal dysfunction (CND). The complementarity between these two approaches can be discussed by a critical review of the literature structured by the analysis of the fundamental and diagnostic bases and the therapeutic implications linked to each. The concept of CRS is based on the anatomical continuity of the nasal and sinus respiratory mucosa and molecular biology data, seeking to analyze the mechanisms of chronic inflammation and to identify proteins and biomarkers involved in the different supposed endotypes of chronic inflammation of this mucosa. The concept of CND seeks to analyze medical, instrumental or surgical diagnostic and therapeutic strategies, taking account of both inflammatory and non-inflammatory causes impacting the anatomy or physiology of each of the three noses (olfactory, respiratory and sinus) that make up the mid-face sinonasal organ of evolution-development (Evo-Devo) theory. Thus, the concept of CRS offers an endotypic approach, based on biological characterization of mucosal inflammation, while the concept of CND offers a compartmentalized phenotypic and pathophysiological approach to sinonasal diseases. The joint contribution of these two concepts in characterizing nasal functional pathology could in future improve the medical service provided to patients.

Topics: Chronic Disease; Humans; Inflammation; Nasal Polyps; Nose; Rhinitis; Sinusitis

Among millions of sufferers of chronic rhinosinusitis (CRS), the challenge is not only constantly coping with CRS-related symptoms, such as congested nose, sinus pain, and headaches, but also various complications, such as attention difficulties and possible depression. These complications suggest that neural activity in the central nervous system may be altered in those patients, leading to unexpected conditions, such as neurodegeneration in elderly patients. Recently, some studies linked the presence of CRS and cognitive impairments that could further develop into Alzheimer's disease (AD). AD is the leading cause of dementia in the elderly and is characterised by progressive memory loss, cognitive behavioural deficits, and significant personality changes. The microbiome, especially those in the gut, has been recognised as a human organ and plays an important role in the development of various conditions, including AD. However, less attention has been paid to the microbiome in the nasal cavity. Increased nasal inflammatory responses due to CRS may be an initial event that changes local microbiome homeostasis, which may further affect neuronal integrity in the central nervous system resulting in AD. Evidence suggests a potential of β-amyloid deposition starting in olfactory neurons, which is then expanded from the nasal cavity to the central nervous system. In this paper, we reviewed currently available evidence that suggests this potential mechanism to advise the need to investigate the link between these two conditions.

Topics: Alzheimer Disease; Amyloid beta-Peptides; Brain; Chronic Disease; Humans; Microbiota; Nose; Rhinitis; Sinusitis

Topics: Chronic Disease; Humans; Nose; Quality of Life; Rhinitis; Sinusitis

Topics: Bacterial Infections; Chronic Disease; Humans; Nose; Rhinitis; Sinusitis

Topics: Chronic Disease; Endoscopy; Humans; Nose; Rhinitis; Sinusitis

Despite garnering minimal attention from the medical community overall, olfaction is indisputably critical in the manner in which we as humans interact with our surrounding environment. As the initial anatomical structure in the olfactory pathway, the nasal airway plays a crucial role in the transmission and perception of olfactory stimuli. The goal of this chapter is to provide a comprehensive overview of olfactory disturbances as it pertains to the sinonasal airway. This comprises an in-depth discussion of clinically relevant nasal olfactory anatomy and physiology, classification systems of olfactory disturbance, as well as the various etiologies and pathophysiologic mechanisms giving rise to this important disease entity. A systematic clinical approach to the diagnosis and clinical workup of olfactory disturbances is also provided in addition to an extensive review of the medical and surgical therapeutic modalities currently available.

Topics: Chronic Disease; Humans; Nasal Cavity; Nose; Olfaction Disorders; Olfactory Bulb; Smell

Staphylococcus aureus (SA) is a frequent colonizer in humans, and it is known to be associated with chronic allergic diseases including asthma. Recent individual studies suggested that nasal SA colonization may be positively associated with asthma.. To examine relationships between nasal SA colonization and asthma prevalence and activity in adults.. Electronic databases were searched for studies published until June 2018. Studies that reported nasal SA colonization prevalence and asthma outcome (prevalence and disease activity) in general adult populations or patients with chronic rhinosinusitis (CRS) were included. Random effects meta-analyses were performed to calculate pooled odds ratio (OR) of the relationships. Subgroup analysis was conducted for the presence of nasal polyps within CRS populations.. A total of 21 cross-sectional studies were identified, and the data from 16 studies using culture methods for SA detection were meta-analyzed (5 general population-based studies and 11 studies of patients with CRS). In studies of general populations, nasal SA colonization had significant relationships with asthma prevalence (OR 1.19; 95% confidence interval [CI] 1.06-1.34; I. This study demonstrated modest but significant relationships between nasal SA colonization and asthma, supporting potential roles of SA in adult patients with asthma. Further longitudinal cohort and intervention studies are warranted to identify host determinants and to clarify causality of the relationships.

Topics: Adult; Asthma; Chronic Disease; Humans; Nose; Prevalence; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus

Nasal surgery improves symptoms in a majority of patients for whom medical treatment has failed. In rhinosinusitis patients, endoscopic sinus surgery aims to alleviate obstruction and re-establish mucociliary clearance. Surgery alters the structure-function relationship within the nasal passage, which is difficult to assess clinically. Computational modelling has been used to investigate this relationship by simulating air flow and environmental variables inside realistic three-dimensional models of the human nasal airway but many questions remain unanswered and need further investigation. The application of computational models to improve pre-surgical planning and post-surgical treatment may not be currently possible due to the absence of knowledge correlating the model-predicted parameters to physiological variables. Links between these parameters to patient outcomes are yet to be established. This article reviews the recent application of computational modelling to understand the nasal structure-function relationship following surgery in patients with sinusitis and nasal obstruction.

Topics: Chronic Disease; Computer Simulation; Endoscopy; Humans; Nose; Paranasal Sinuses; Postoperative Period; Sinusitis

Chronic cough is one of the most common and troublesome nonspecific respiratory symptom for which patients seek a general practitioner and specialist advice. It is conventionally defined as a cough lasting for more than 8 weeks. Exhaled nitric oxide has proven to be a specific biomarker capable to discriminate between differential diagnoses of chronic cough and simultaneously provide information about the response to specific treatment. In this review, we will discuss the potential use of exhaled and nasal nitric oxide in the diagnosis of chronic chough.

Topics: Asthma; Biomarkers; Breath Tests; Chronic Disease; Cough; Exhalation; Humans; Nitric Oxide; Nose

Topics: Chronic Disease; Diagnosis, Differential; Emergency Medical Services; Epistaxis; Follow-Up Studies; Humans; Hypertension; Nose; Recurrence

To evaluate the outcomes of surgical intervention for empty nose syndrome (ENS).. Cochrane Collaboration database, U.S National Institutes of Health database (ClinicalTrials), U.S National Library of Medicine (PubMed).. Structured search using medical subject-heading terms: nose, turbinate, surgery, atrophic rhinitis, and empty nose syndrome.. A total of 128 patients were collated from eight studies with an age range of 18 to 64 years. Most patients had been suffering with ENS for many years, up to 29.7 years. The most common surgical technique involved a transnasal approach with implant material secured within a submucosal pocket. Common implant material used in the studies included biosynthetic, and autologous cartilage. The weighted mean preoperative Sino-Nasal Outcome Test (SNOT)-20 and SNOT-25 scores were 48.3 and 65.9, respectively. At latest follow-up, these scores improved significantly to 24.4 and 33.3, respectively. Although all SNOT subdomains improved following surgery, the highest improvement was observed in ENS symptoms and psychological issues. SNOT scores improved by 3 months postsurgery and this trend continued over time, although available data was limited to only 12 months follow-up. Nevertheless, 10 patients had less than 10 points improvement, including three patients who had no change in SNOT scores. Extrusion of the implant occurred in six cases, and one developed chronic rhinosinusitis.. Surgical intervention for ENS appears to result in clinical improvement, although not all patients derived benefit. Long-term follow-up should be considered utilizing using both subjective (SNOT-25) and objective (rhinomanometry) measures of clinical outcome.

Topics: Chronic Disease; Humans; Nose; Prostheses and Implants; Quality of Life; Sinusitis; Treatment Outcome; Turbinates

To assess the diagnostic value of nasal endoscopic findings in adults suspected of chronic rhinosinusitis.. PubMed, EMBASE, and the Cochrane Library.. A comprehensive search was performed up to March 5, 2013. Articles that assessed the diagnostic value of nasal endoscopy in adults suspected of chronic rhinosinusitis were included. For selected articles, the study design was assessed for directness of evidence and risk of bias. Prevalence, positive, and negative predictive values were extracted from reported data.. Out of 3899 unique publications, we included 3 diagnostic studies with a high directness of evidence and a low or moderate risk of bias for data extraction. They showed a prevalence of chronic rhinosinusitis (diagnosed with computed tomography) of .40 to .56. Compared with posterior probabilities we found an added value for ruling in chronic rhinosinusitis by a positive nasal endoscopy of 25% to 28% and an added value for ruling out chronic rhinosinusitis by a negative nasal endoscopy of 5% to 30%.. Computed tomography is not considered necessary in case of a positive nasal endoscopy. While nasal endoscopy cannot rule out chronic rhinosinusitis, we advise computed tomography only for patients with a prolonged or complicated course of rhinosinusitis.

Topics: Adult; Chronic Disease; Endoscopy; Humans; Nose; Practice Guidelines as Topic; Rhinitis; Sinusitis

Allergic rhinitis, particularly seasonal allergic rhinitis, is considered a classic Th2-mediated disease, with important contributions to pathology by interleukins 4, 5 and 13. As such, allergic rhinitis is an excellent model for studying allergic inflammation, with findings potentially relevant to the mechanism of lower airways inflammation seen in allergic asthma. However, recent evidence has revealed roles for additional non-Th2 cytokines in asthma, including IL-17 family cytokines and epithelial-derived cytokines. Additionally, putative roles for epithelial-derived cytokines and innate lymphoid cells have been described in chronic rhinosinusitis with nasal polyps. Here, evidence for the involvement of different cytokines and cytokine groups in allergic rhinitis is considered.

Topics: Animals; Chronic Disease; Cytokines; Epithelial Cells; Humans; Nose; Rhinitis, Allergic; Rhinitis, Allergic, Perennial; T-Lymphocytes, Helper-Inducer

The united airway concept in which upper and lower respiratory conditions are present in one patient requires special consideration. There is some evidence linking chronic rhinosinusitis and asthma, but a good understanding of the pathophysiology and combined management is still lacking, a fact that leads to discussion. Bronchial asthma is more prevalent in patients who suffer chronic rhinosinusitis. On the other hand, patients with asthma have a greater prevalence of rhinosinusitis than patients without asthma. The effect of chronic rhinosinusitis in patients with or without nasal polyps on asthma treatment, whether medical or surgical, is controversial. Some studies show worsening, other trials improvement, and others no effect. Direct comparisons between surgical and medical treatments are few. Most of the current literature available about this intriguing combination does not provide a good level of evidence. Thus, randomized clinical trials should be performed to better understand the management when asthma and CRS occur together. This review aims to summarize the current state of this association regarding the effects of different types of treatment.

Topics: Asthma; Chronic Disease; Diagnosis, Differential; Humans; Nose; Rhinitis; Treatment Outcome

Topics: Chronic Disease; Endoscopy; Humans; Nose; Rhinitis; Sinusitis

The review discusses the physiological and pathophysiological mechanisms associated with the symptoms of acute and chronic rhinosinusitis. An understanding of symptom mechanisms is important for the clinical diagnosis of rhinosinusitis and is important in assessing the efficacy of surgical and medical treatments for rhinosinusitis. The review will discuss the four primary symptoms used to diagnose rhinosinusitis: nasal obstruction, nasal discharge, facial pain and loss of sense of smell; and the secondary symptoms, cough, sneezing, sore throat and voice changes, epiphora, fever, and psychological effects and fatigue. The review will highlight that our understanding of a key diagnostic symptoms facial pain is limited, and that the incidence of pain with rhinosinusitis is controversial. Sneezing is a common symptom of acute rhinosinusitis with allergy but is not normally described as symptom in chronic rhinosinusitis and this anomaly is in need of more research. The mechanism of unilateral nasal obstruction with rhinosinusitis is discussed.

Topics: Chronic Disease; Humans; Nasal Obstruction; Nose; Olfaction Disorders; Pharyngitis; Rhinitis; Sinusitis; Sneezing; Tomography, X-Ray Computed

Topics: Chronic Disease; Endoscopy; Humans; Nose; Physical Examination; Rhinitis; Sinusitis

Pave the way to a better management of the chronical rhino-sinusitis diseases: Description and classification of the chronical rhino-sinusitis pathology, its medical and surgical treatments in order to help the radiologist in its CT-scan report.. Review of the literature and anatomical considerations. Paranasal sinuses CT-scan analysis.. The execution and the interpretation of CT-scans, in accordance with the progress made in the past 20 years in the knowledge of the rhino-sinusitis physiology and pathology, are today absolutely necessary for the management of chronical rhino-sinusitis diseases.

Topics: Chronic Disease; Humans; Nose; Paranasal Sinuses; Patient Care Planning; Radiology; Rhinitis; Sinusitis; Tomography, X-Ray Computed

Most studies agree that post-nasal drip syndrome (PNDS), asthma, gastroesophageal reflux disease (GORD), and laryngopharyngeal reflux (LPR) are the commonest causes of chronic cough in the immunocompetent, non-smoking patient who is not taking an angiotensin-converting enzyme inhibitor. No diagnostic test has been found to define those who are said to have PNDS other than a response to a first-generation antihistamine. Examining the available evidence suggests that mechanical stimulation of the pharynx by mucus is not an adequate theory for the production of cough. Inflammatory mediators in the lower airways are raised in PNDS, cough variant asthma and GORD, and the theory that an inflammatory process is affecting 'one airway' is a plausible one. Nasal disease is more likely to result in cough from the co-existing involvement of the lower airways through an as yet undefined pathway, and eosinophil and mast cell mediation appear a likely mechanism.

Topics: Angiotensin-Converting Enzyme Inhibitors; Asthma; Bronchitis, Chronic; Chronic Disease; Cough; Eosinophilia; Esophagitis, Peptic; Gastroesophageal Reflux; Humans; Mucus; Nose; Syndrome

Topics: Acute Disease; Chronic Disease; Female; Humans; Intermittent Positive-Pressure Ventilation; Lung Diseases, Obstructive; Nose; Pregnancy; Pregnancy Complications; Pulmonary Edema; Respiratory Insufficiency; Ventilator Weaning

Standard cauterization therapy for chronic epistaxis is less than ideal because of the inadequacy of topical anesthesia and the difficulty of treating young, often uncooperative patients. The author has developed a new procedure for treating these patients, which entails ligation and cauterization while the patient is under light general anesthesia in an outpatient surgical facility. Of the approximately 75 procedures the author has performed, only one failed to achieve expected results. This article describes how this safe, simple, and ultimately cost-effective procedure is performed.

Topics: Chronic Disease; Epistaxis; Humans; Ligation; Nose; Secondary Prevention; Vascular Surgical Procedures

Functional endoscopic sinus surgery, now the standard of care for surgical treatment of chronic and recurrent sinusitis, has changed current concepts of sinus health and disease. Interpretation of the CT scan must reflect this focus on anatomy and function. This article seeks to provide a clear understanding of sinonasal drainage. The normal frontal recess, ostiomeatal unit, and sphenoethmoid recess are considered along with the anatomic variations that distort their appearance and predispose the patient to developing sinus disease. The spectrum of uncomplicated and complicated sinonasal inflammatory disease is discussed.

Topics: Chronic Disease; Endoscopy; Ethmoid Sinus; Frontal Sinus; Humans; Maxillary Sinus; Nasal Polyps; Nose; Paranasal Sinuses; Recurrence; Rhinitis; Sinusitis; Sphenoid Sinus; Tomography, X-Ray Computed

In recent years, routine endoscopic examination of the nose and advances in medical imaging have led to a better understanding of the pathophysiology of chronic sinusitis and the development of "FESS". The CT san of the sinuses have superseded the conventional standard radiography in the evaluation of the paranasal sinuses as it offers more precise anatomic information to the surgeon on the complex anatomy of the sinus cavities and their drainage pathways, in particularly the ostiomeatal complex. The coronal plane is the best incidence because it most closely correlates with the surgical approach. The utilization of a high resolution bony algorithm is recommended. A window of intermediate type, 2500 with a center of 250 HU, is sufficient for nearly all diagnosis. Complementary direct axial sections are needed by the surgeon to guide the approach to the sphenoid sinus and the posterior ethmoidal cells. MRI plays a limited role in the evaluation of a non complicated sinusitis. But MRI has supplanted the CT scanner in the appreciation of intracranial and orbital complications of sinusitis because it provides better visualisation and differentiation of soft tissues than the CT scan. The injection of contrast is recommended in all cases of complicated sinusitis.

Topics: Algorithms; Brain; Chronic Disease; Contrast Media; Diagnostic Imaging; Endoscopy; Ethmoid Sinus; Humans; Magnetic Resonance Imaging; Nose; Orbit; Paranasal Sinuses; Radiographic Image Enhancement; Sinusitis; Sphenoid Sinus; Tomography, X-Ray Computed

The first endoscope was conceived as early as 1806. Since then successive technical advances led endoscopy of the nose and paranasal sinuses to a routine procedure. From the rediscovery of the rigid telescopes by Hopkins in the fifties, progress has stemmed essentially from the quality of the more powerful cold lights and the improvement in the light output of the fiber optics. Exam procedures of the nose and sinuses are conducted under general as well as local anesthesia, and are commonly combined with concomitant diagnostic procedures: measure of the mucociliary clearance with indicators, biopsies, smear sampling for bacterial and fungal examinations, and sinusomanometry which can help to estimate the patency of the maxillary ostium and of the nasofrontal duct. Sinus endoscopy has been widely used to correlate efficiency of other diagnostic techniques such as plain X-rays, CT scanners, A and B mode ultrasonography. A similar work should be done for MRI. Endoscopic exploration is the key to the management of chronic pathology as it brings precise information on the quality of the naso-sinus mucosa, the presence of secretions and, combined with sinusomanometry, the functional state of the ostia or ducts.

Topics: Anesthesia, General; Anesthesia, Local; Bacteria; Biopsy; Chronic Disease; Endoscopes; Endoscopy; Equipment Design; Fiber Optic Technology; Frontal Sinus; Fungi; History, 19th Century; History, 20th Century; Humans; Indicators and Reagents; Lighting; Magnetic Resonance Imaging; Manometry; Maxillary Sinus; Mucociliary Clearance; Mucous Membrane; Nose; Optical Fibers; Paranasal Sinuses; Pressure; Sinusitis; Tomography, X-Ray Computed; Ultrasonography

The authors present the clinical of a male patient aged 45 years whose main complaints were loud snoring and excessive daytime sleepiness. Polysomnographic study revealed a sleep obstructive apnea syndrome with an apnea/hypopnea index of 86.5. After being treated with nasal continuous positive air pressure, (12 cm H2O), the apneas ended and sleep architecture was corrected. Physical examination also indicated the presence of an acromegaly, and therefore, the patient was subjected to endocrinological and cerebral imagiological studies; the diagnosis confirmed it as a predisposing factor to the sleep breathing disorder. A brief literature review about the incidence of sleep apnea syndrome in acromegaly is also made; the authors conclude that there is still the need for a systematic screening of sleep breathing disorders in acromegalic patients in order to optimise the treatment and prognosis of this disorders.

Topics: Acromegaly; Chronic Disease; Humans; Male; Middle Aged; Nose; Polysomnography; Positive-Pressure Respiration; Sleep Apnea Syndromes

No ancillary or laboratory study can replace the medical history and physical examination, in the diagnosis of allergic diseases. It is mandatory to know the wide diversity of clinical manifestations to make an accurate diagnosis and select its best treatment.

Topics: Chronic Disease; Humans; Medical History Taking; Nose; Physical Examination; Rhinitis; Rhinitis, Allergic, Perennial; Sinusitis

Topics: Chronic Disease; Endoscopy; Humans; Nose; Paranasal Sinuses; Sinusitis; Tomography, X-Ray Computed

Topics: Acute Disease; Ambulatory Care; Blood Pressure; Brain; Chronic Disease; Diphosphoglyceric Acids; Erythrocytes; Follow-Up Studies; Humans; Hypertension, Pulmonary; Hypoxia; Intubation; Lung Diseases, Obstructive; Nose; Oxygen; Oxygen Inhalation Therapy; Partial Pressure; Physical Exertion; Polycythemia; Prognosis; Psychology; Respiratory Insufficiency; Spirometry; Vascular Resistance

Topics: Air; Bronchial Diseases; Chronic Disease; Humans; Humidity; Manometry; Mouth Breathing; Nose; Nose Diseases; Paranasal Sinuses; Respiration; Respiratory Hypersensitivity; Respiratory System; Temperature

Topics: Body Temperature; Capillary Resistance; Cheek; Chronic Disease; Cyanosis; Diagnosis, Differential; Ear; Female; Hand; Humans; Leg; Male; Nose; Pedigree; Raynaud Disease; Sex Factors; Skin Manifestations; Temperature; Vascular Diseases

Topics: Adrenal Cortex Hormones; Adult; Chronic Disease; Female; Humans; Interleukin-17; Male; Nasal Polyps; Nose; Rhinitis; Sinusitis

The aim of this study was to evaluate whether chronic nasal carriage of Staphylococcus aureus (SA) is related to relapses in patients with newly diagnosed ANCA-associated vasculitis (AAV).. In two clinical trials (n = 200), for early systemic (n = 83) and generalized (n = 117) AAV, nasal swabs were obtained monthly and at the time of a relapse. Chronic nasal SA carriage (CNSAC) was defined as ⩾ 75% of cultures being SA positive, with non-carriers being SA negative in all cultures and remaining patients being intermittent carriers. Fifty-five of 200 (27.5%) patients received prophylactic trimethoprim/sulfamethoxazole (T/S) against Pneumocystis jirovecii .. Of the total AAV patients, 24/200 (12%) were chronic, 102/200 (51%) intermittent and 74/200 (37%) non-carriers. Of 65 relapsing patients, 10/24 (41.7%) were chronic, 32/102 (31.4%) intermittent and 23/74 (31.1%) non-carriers (P = 0.59). For all AAV patients, CNSAC was not associated with an increased relapse risk [odds ratio (OR) = 1.57, 95% CI: 0.66, 3.76; P = 0.31]. However, 23/24 chronic carriers had granulomatosis with polyangiitis (GPA). In the 73 patients with generalized GPA (hazard ratio = 4.10, 95% CI: 1.37, 12.25; P = 0.01) and the 78 patients with early systemic GPA during immunosuppression (hazard ratio = 2.73, 95% CI: 0.95, 7.87; P = 0.06), relapse rates were higher for chronic SA carriers. Prophylactic T/S was not associated with a reduced relapse risk (OR = 0.71, 95% CI: 0.36, 1.41; P = 0.33). Nevertheless, prophylactic T/S reduced CNSAC (OR = 0.19, 95% CI: 0.04, 0.91; P = 0.04).. The frequency of CNSAC in newly diagnosed GPA paralleled that in the general population. This subset of GPA patients (23/151, 15.2%) has a high relapse rate despite immunosuppression and prophylactic T/S treatment, requiring further investigations on pathogenesis and therapy.

Topics: Adolescent; Adult; Aged; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antibodies, Antineutrophil Cytoplasmic; Chronic Disease; Female; Granulomatosis with Polyangiitis; Humans; Male; Middle Aged; Nose; Prospective Studies; Recurrence; Specimen Handling; Staphylococcal Infections; Staphylococcus aureus; Young Adult

To investigate the long term clinical effect of budesonide treatment in middle meatus for chronic rhinosinusitis(CRS) following endoscopic sinus surgery (ESS).. A total number of 53 patients with CRS received ESS were divided into two groups according to budesonide treatment: budesonide-treated group with 21 cases (39.6%) and control group with 32 cases (60.4%). Gelatin sponges soaked with 1 ml budesonide suspension were put in middle meatus in budesonide-treated group, while only gelatin sponges were put in middle meatus in control group. Visual analogy score (VAS), sino-nasal outcome test-22 (SNOT-22) and Lund-Kennedy endoscopic scale were carried out before ESS and two years after ESS.. In budesonide-treated group, there were a statistical difference before and after ESS in the VAS, SNOT-20 and Lund-Kennedy score (P<. 05). In control group, difference was also significant in VAS, SNOT-20 and Lund-Kennedy score before and after ESS (P < 0.05). The VAS gap of post-operative and pre-operative in two groups are significantly different (P<. 05). However, there was no significant difference in the SNOT-20 and Lund-Kennedy endoscopic scale gap before or after the operation between two groups.. It is safe, convenient and practicable to perform budesonide treatment in middle meatus following ESS, which can significantly ease the post-operative discomfort of nose.

Topics: Budesonide; Chronic Disease; Endoscopy; Humans; Nose; Paranasal Sinuses; Postoperative Period; Rhinitis; Sinusitis

The growing awareness of increased X-ray exposure to the public has led to the propagation of several methods for reducing the radiation dose during CT examination. Low-dose CT protocols do not, however, have an established role in pre-operative evaluation. The aim of this article was to assess the usefulness of nasal endoscopy in the selection of patients under pre-operative care for low-dose CT examination.. A cadaver head was used to discover institutional minimum acceptable CT image quality and scanning settings. Then, 134 adult patients with chronic rhinosinusitis (CRS) were enrolled into the study and divided randomly into standard dose (120 kVp, 100 mAs) or low-dose CT groups (120 kVp, 45 mAs). Subjective assessment of the diagnostic image quality of the surgically relevant anatomical structures was compared using a five-point scale (from excellent to unacceptable) by a radiologist and sinus surgeon independently. Pathologic states of the nose were quantified according to the Lund-Kennedy endoscopic system (LKES) and Lildholdt's scale.. Image quality was similar in low-dose and standard dose groups in patients without polyps. The quality of 13% of scans from patients with polyps from the low-dose group and 4% from the standard dose group was in the range from moderate to poor. The quality of scans obtained with low milliamperes second (mAs) values worsened in patients with polyps in the middle meatus, but the difference was particularly pronounced compared with standard dose among subjects with Lildholdt's score above 2 (p < 0.001). Correlation with LKES revealed that changes other than polyps (i.e. discharge, oedema, scaring or crusting) in the nasal cavity alone do not affect the image quality. Interobserver agreement in both groups was very high.. Low-dose scanning should be promoted as the screening imaging method of choice in patients with suspected CRS. Furthermore, low mAs value examination can be performed pre-operatively without fear of significant image quality deterioration in uncomplicated CRS patients without polyps, or with minor changes in nasal endoscopy. Standard dose CT, which provides a better identification of bony landmarks, minimizes diagnostic errors and risk to patients, so it might be considered in those with polyps below the middle turbinate.

Topics: Chronic Disease; Endoscopy; Female; Humans; Male; Middle Aged; Nose; Patient Selection; Preoperative Care; Radiation Dosage; Rhinitis; Sinusitis; Tomography, X-Ray Computed

Chronic rhinosinusitis (CRS) has been defined as inflammation of the paranasal sinuses lasting at least 12 weeks with corresponding 2 or more "cardinal symptoms" that include: (1) nasal obstruction; (2) thick nasal discharge; (3) facial pain/pressure; and (4) reduction or loss of sense of smell. Although prior studies have investigated symptoms of CRS after sinus surgery, none have compared the outcomes of these specific symptoms to ongoing medical therapy.. Patients with CRS were prospectively enrolled into a multi-institutional, comparative effectiveness, cohort study. Subjects elected either continued medical management or endoscopic sinus surgery (ESS). Baseline characteristics and objective clinical findings were collected. Cardinal symptoms of CRS were operationalized by 4 questions on the 22-item Sino-Nasal Outcome Test (SNOT-22). Symptom improvement was evaluated in subjects with at least 6-month follow-up.. A total of 342 subjects were enrolled, with 69 (20.2%) electing continued medical management, whereas 273 (79.8%) elected ESS. Subjects electing surgical therapy were more likely to have a higher baseline aggregate SNOT-22 score (44.3 (18.9) vs 53.6 (18.8); p < 0.001). All subjects improved across all cardinal symptoms; however, subjects undergoing ESS were significantly more likely (p ≤ 0.013) to experience improvement in thick nasal discharge (odds ratio [OR] = 4.36), facial pain/pressure (OR = 3.56), and blockage/congestion of nose (OR = 2.76). Subjects with nasal polyposis were significantly more likely to report complete resolution of smell/taste following ESS compare to medical management (23.8% vs 4.0%; p = 0.026).. Across a large population, surgical management is more effective at resolving the cardinal symptoms of CRS than ongoing medical management with the exception of sense of smell/taste.

Topics: Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Canada; Chronic Disease; Cohort Studies; Endoscopy; Facial Pain; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mucus; Nasal Obstruction; Nose; Olfaction Disorders; Prospective Studies; Quality of Life; Rhinitis; Severity of Illness Index; Sinusitis; Surveys and Questionnaires; United States

To explore the effection of the pulmonary function of patients of chronic rhinosinusitis (CRS) with asthma which treated with endoscopic sinus surgery (ESS) based comprehensive treatment.. There were 50 cases of chronic rhinosinusitis with asthma whom met the study criteria. 35 cases enrolled in the tri al group, which treated with endoscopic sinus surgery, and routine perioperative tratment. Another 15 cases as control group which underwent conservative treatment. Both groups underwent the rule treatment of asthma. The main monitoring indexes, which included visual analogue scale (VAS) score, endoscopic Lund-Kennedy score, control of asthma symptoms, the pulmonary function which involved forced expiratory volume in first second (FEV1), forced vital capacity (FVC), the ratio of forced expiratory volume in first second and forced vital capacity (FEV1/FVC) and peak expiratory flow (PEF), were measured in the patients of each groups before surgery, follow-up for 1 year and 3-year.. Our study found that the VAS score of CRS with asthma was significantly negatively correlated with FEV1 and PEF (P < 0.05), endoscopic Lund-Kennedy score was significantly negatively correlated with PEF (P < 0.05); After the trial group underwent ESS based comprehensive treatment, the improvement of VAS score and endoscopic Lund-Kennedy score of postoperative compared with preoperative and the same period in the control group were significantly (P < 0.05). The difference of the postoperative asthma control rate of trial group after 1 year and after 3 years, respectively, compared with the same period control group were statistically significant (P < 0.05). The preoperative FEV1, FVC, FEV1/FVC and PEF of trial group compared with preoperative were significantly (P < 0.05). Even the difference of them compared with the same period control group were significantly (P < 0.05), except the FVC in the follow-up 3 years (P = 0.088).. The CRS may aggravate asthma symptoms and affect negatively the pulmonary function, and poor asthma control or aggravate may exacerbate the CRS in the course of CRS with asthma patient. With ESS based on combined therapy, it can improve the condition of CRS significantly and improve the control of asthma symptoms and pulmonary function else.

Topics: Adolescent; Adult; Asthma; Chronic Disease; Endoscopy; Female; Humans; Male; Middle Aged; Nose; Pulmonary Ventilation; Rhinitis; Sinusitis; Young Adult

Indigenous children in high-income countries have a heavy burden of bronchiectasis unrelated to cystic fibrosis. We aimed to establish whether long-term azithromycin reduced pulmonary exacerbations in Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease.. Between Nov 12, 2008, and Dec 23, 2010, we enrolled Indigenous Australian, Maori, and Pacific Island children aged 1-8 years with either bronchiectasis or chronic suppurative lung disease into a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial. Eligible children had had at least one pulmonary exacerbation in the previous 12 months. Children were randomised (1:1 ratio, by computer-generated sequence with permuted block design, stratified by study site and exacerbation frequency [1-2 vs ≥3 episodes in the preceding 12 months]) to receive either azithromycin (30 mg/kg) or placebo once a week for up to 24 months. Allocation concealment was achieved by double-sealed, opaque envelopes; participants, caregivers, and study personnel were masked to assignment until after data analysis. The primary outcome was exacerbation (respiratory episodes treated with antibiotics) rate. Analysis of the primary endpoint was by intention to treat. At enrolment and at their final clinic visits, children had deep nasal swabs collected, which we analysed for antibiotic-resistant bacteria. This study is registered with the Australian New Zealand Clinical Trials Registry; ACTRN12610000383066.. 45 children were assigned to azithromycin and 44 to placebo. The study was stopped early for feasibility reasons on Dec 31, 2011, thus children received the intervention for 12-24 months. The mean treatment duration was 20·7 months (SD 5·7), with a total of 902 child-months in the azithromycin group and 875 child-months in the placebo group. Compared with the placebo group, children receiving azithromycin had significantly lower exacerbation rates (incidence rate ratio 0·50; 95% CI 0·35-0·71; p<0·0001). However, children in the azithromycin group developed significantly higher carriage of azithromycin-resistant bacteria (19 of 41, 46%) than those receiving placebo (four of 37, 11%; p=0·002). The most common adverse events were non-pulmonary infections (71 of 112 events in the azithromycin group vs 132 of 209 events in the placebo group) and bronchiectasis-related events (episodes or investigations; 22 of 112 events in the azithromycin group vs 48 of 209 events in the placebo group); however, study drugs were well tolerated with no serious adverse events being attributed to the intervention.. Once-weekly azithromycin for up to 24 months decreased pulmonary exacerbations in Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease. However, this strategy was also accompanied by increased carriage of azithromycin-resistant bacteria, the clinical consequences of which are uncertain, and will need careful monitoring and further study.. National Health and Medical Research Council (Australia) and Health Research Council (New Zealand).

Topics: Anti-Bacterial Agents; Australia; Azithromycin; Bronchiectasis; Carrier State; Child; Child, Preschool; Chronic Disease; Disease Progression; Double-Blind Method; Drug Resistance, Bacterial; Early Termination of Clinical Trials; Episode of Care; Female; Haemophilus influenzae; Humans; Infant; Intention to Treat Analysis; Length of Stay; Lung Diseases; Male; Microbial Sensitivity Tests; Moraxella catarrhalis; Native Hawaiian or Other Pacific Islander; Nose; Severity of Illness Index; Staphylococcus aureus; Streptococcus pneumoniae; Suppuration; Time Factors

Chronic rhinosinusitis (CRS) recalcitrant to surgery is a frustrating clinical entity. Recently, mupirocin sinonasal rinses have been suggested as an efficacious treatment alternative in these patients where Staphylococcus aureus infection is demonstrated. To our knowledge, how best to treat this S aureus reservoir has not been previously evaluated in a double-blinded, randomized, placebo-controlled trial.. Prospective, double-blinded, placebo-controlled study.. Twenty-five S aureus-positive CRS patients with persistent sinonasal infection despite endoscopic sinus surgery received either a 1-month, twice-daily treatment course of mupirocin sinonasal rinses (MUP) or saline rinses (CON). The primary outcome was S aureus-culture negativity at the conclusion of treatment; secondary rhinological outcomes included subjective and objective measures of rhinosinusitis.. Twenty-two patients satisfactorily completed the treatment period. Of CON patients, 0/13 (0.0%) returned an S aureus-negative sinonasal culture at 1 month, compared to 8/9 (88.9%) of MUP patients (P < .01). Improvements in rhinological outcomes observed in MUP patients following treatment were not subsequently evident when these patients were followed up at a delayed assessment 2 to 6 months after completing treatment.. Mupirocin sinonasal rinses are an effective short-term anti-S aureus treatment in surgically recalcitrant CRS as assessed by microbiological and selected rhinological outcomes, although the latter improvements may not be durable with time.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Chronic Disease; Double-Blind Method; Female; Humans; Male; Middle Aged; Mupirocin; Nasal Lavage; Nose; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

This study aimed to compare differences between medicated and nonmedicated Merocel middle meatal spacers (MMSs) on sinonasal mucosal healing (histopathologic and endoscopic difference), patient discomfort, and pain on removal of the MMS following functional endoscopic sinus surgery.. Forty-eight patients with chronic rhinosinusitis undergoing bilateral functional endoscopic sinus surgery were enrolled in a prospective study. Patients were randomized and blinded to receive a medication-soaked Merocel MMS (either one of budesonide, gentamicin, or manuka honey) in one nostril and a nonmedicated Merocel MMS in the contralateral side. Patients were seen on postoperative day 7 and were asked to complete a visual analogue score to report the level of discomfort from nasal packing on each side. Under endoscopic visualization, biopsies of mucosa were taken from both middle meati and assessed by a blinded pathologist to determine the level of mucosal inflammation on a scale of 0 to 4.. The budesonide-soaked Merocel MMS showed a trend toward reduced mucosal inflammation when compared to the control Merocel MMS, but the results were not statistically significant. There was no statistically significant difference in the degree of discomfort and pain on the removal of the packings between the medication-soaked Merocel MMS and the nonmedicated Merocel MMS, although there was a trend toward less pain for the manuka honey-soaked Merocel MMS.. Although our study failed to show any significant benefit from the addition of medication to the Merocel MMS, further studies with different compounds are recommended to determine whether a medicated MMS could indeed be a superior alternative to the standard MMS.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Chronic Disease; Double-Blind Method; Endoscopy; Female; Follow-Up Studies; Formaldehyde; Hemostatics; Humans; Male; Middle Aged; Nose; Pain Measurement; Polyvinyl Alcohol; Prospective Studies; Rhinitis; Sinusitis; Surgical Sponges; Treatment Outcome; Wound Healing; Young Adult

An open randomized comparative study was conducted in order to observe the efficacy and safety about intranasal Budesonide in the treatment of chronic nonallergic rhinitis.. Forty-two patients with chronic nonallergic rhinitis were treated with Budesonide aqueous nasal spray (256 microg once daily intranasally) for 8 weeks. All the patients were asked for return at week 1 and week 8. Efficacy was evaluated by measurement of nasal symptom scores and sign scores at week 0, week 1 and week 8.. All the parameters measured were improved after treatment. Specifically, from week 0 to week 1, the scores of nasal secretions, itchy feeling of the nose and headache showed a significant decrease than that before treatment. From week 0 to week 8, the scores of nasal obstruction, nasal secretions, itchy feeling of the nose, closed rhinolalia and headache were significantly less than the record at week 0. However, there were not significant influences on the smell disturbances, dryness of the throat. No serious adverse events were reported in the study.. Intranasal Budesonide is effective and safe in alleviating the symptoms of chronic nonallergic rhinitis.

Topics: Administration, Intranasal; Adult; Aged; Budesonide; Chronic Disease; Female; Glucocorticoids; Humans; Male; Middle Aged; Nose; Rhinitis; Treatment Outcome

There is an increasing knowledge that the severity of perennial allergic rhinitis is associated with nasal carriage of Staphylococcus aureus (S. aureus). The aim of this study was to evaluate the rate of bacterial colonization with S. aureus in the nose of subjects with and without chronic rhinosinusitis (CRS) and to correlate these findings with the severity of symptoms and the extent of the disease.. Open, prospective controlled trial.. 190 subjects with CRS and 42 subjects with septal deviation without sinusitis (control subjects) were included in this study. Swabs were taken endoscopically from the middle meatus and bacteria were cultured and identified. Airway symptoms were assessed by subjects in standardized questionnaires and frequencies of respiratory tract infections were noted. The rhinosinusitis extent was graded by CT scan assessment. Analysis of variance, chi-square test, and Pearson's correlation test were applied for statistical analyses.. The S. aureus carriage rate was 25.5% in CRS and 31.4% in control subjects. Further facultative pathogens were cultured in 20.6% of subjects with CRS and in 8.5% of controls. 73.8% of S. aureus were ampicillin-resistant, multiresistant strains were cultured in 5.8%. Most airway symptoms and the frequencies of respiratory tract infections were significantly higher in the CRS group compared with control subjects. In post hoc comparison between the subgroups with and without S. aureus colonization, no significant differences were found between the extent of rhinosinusitis and the severity of airway symptoms.. Facultative pathogens were detected in more than 40% of CRS patients without acute respiratory tract infections. In contrast to the findings in atopic dermatitis and perennial allergic rhinitis, the colonization rate with S. aureus is not increased and S. aureus carriage is not a risk factor for the severity or the extent of rhinosinusitis.

Topics: Adult; Chronic Disease; Female; Humans; Hypersensitivity; Male; Middle Aged; Nose; Prospective Studies; Rhinitis, Allergic, Perennial; Severity of Illness Index; Sinusitis; Staphylococcus aureus

Chronic rhinitis patients often suffer from unrefreshing sleep and snoring, related to increased nasal resistance to airflow. Previous trials based on subjective assessment of snoring have demonstrated beneficial effects of Breathe Right (BR), a noninvasive external nasal dilator. Polysomnography (PSG) was applied to objectively assess the effects of BR on snoring. Twelve nonobese chronic rhinitis patients participated in the present study, which had a randomized, placebo-controlled design. The presence of snoring and the absence of sleep apnoea was demonstrated during a baseline overnight sleep study. Patients were then randomized for placebo or true nasal dilator treatment, which was also assessed by overnight PSG. The use of BR had no effect on sleep quality, arousal-index apnoea-hypopnoea-index or snoring loudness. Snoring frequency was significantly lowered by BR (173+/-29 snores x h(-l)), compared with placebo (258+/-34 snores x h(-1); p=0.016). The results support the hypothesis that Breathe Right is effective in reducing the amount of snoring in patients with chronic rhinitis. This objective finding is in line with some other reports on subjective improvement of snoring, based upon the judgement of bedpartners.

Topics: Adult; Chronic Disease; Cross-Over Studies; Dilatation; Double-Blind Method; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Placebos; Polysomnography; Prospective Studies; Rhinitis; Sleep; Snoring

To evaluate the short-term physiologic effects of two settings of nasal pressure-support ventilation (NPSV) in stable COPD patients with chronic hypercapnia.. Randomized controlled physiologic study.. Lung function units and outpatient clinic of two affiliated pulmonary rehabilitation centers.. Twenty-three patients receiving domiciliary nocturnal NPSV for a mean (+/- SD) duration of 31 +/- 20 months.. Evaluation of arterial blood gases, breathing pattern, respiratory muscles, and dynamic intrinsic positive end-expiratory pressure (PEEPi,dyn) during both unassisted and assisted ventilation. Two settings of NPSV were randomly applied for 30 min each: (1) usual setting (U), the setting of NPSV actually used by the individual patient at home; and (2) physiologic setting (PHY), the level of inspiratory pressure support (IPS) and external positive end-expiratory pressure (PEEPe) tailored to patient according to invasive evaluation of respiratory muscular function and mechanics.. All patients tolerated NPSV well throughout the procedure. Mean U was IPS, 16 +/- 3 cm H(2)O and PEEPe, 3.6 +/- 1.4 cm H(2)O; mean PHY was IPS, 15 +/- 3 cm H(2)O and PEEPe, 3.1 +/- 1.6 cm H(2)O. NPSV was able to significantly (p < 0.01) improve arterial blood gases independent of the setting applied. When compared with spontaneous breathing, both settings induced a significant increase in minute ventilation (p < 0.01). Both settings were able to reduce the diaphragmatic pressure-time product, but the reduction was significantly greater with PHY (by 64%; p < 0.01) than with U (56%; p < 0.05). Eleven of 23 patients (48%) with U and 7 of 23 patients (30%) with PHY showed ineffective efforts (IE); the prevalence of IE (20 +/- 39% vs 6 +/- 11% of their respiratory rate with U and PHY, respectively) was statistically different (p < 0.05).. In COPD patients with chronic hypercapnia, NPSV is effective in improving arterial blood gases and in unloading inspiratory muscles independent of whether it is set on the basis of patient comfort and improvement in arterial blood gases or tailored to a patient's respiratory muscle effort and mechanics. However, setting of inspiratory assistance and PEEPe by the invasive evaluation of lung mechanics and respiratory muscle function may result in reduction in ineffective inspiratory efforts. These short-term results must be confirmed in the long-term clinical setting.

Topics: Aged; Carbon Dioxide; Chronic Disease; Diaphragm; Female; Follow-Up Studies; Home Care Services; Humans; Hypercapnia; Inhalation; Lung; Lung Diseases, Obstructive; Male; Maximal Voluntary Ventilation; Nose; Oxygen; Positive-Pressure Respiration; Positive-Pressure Respiration, Intrinsic; Pressure; Respiration; Respiratory Mechanics; Respiratory Muscles

Topics: Adult; Aerosols; Atrophy; Beclomethasone; Chronic Disease; Clinical Trials as Topic; Common Cold; Hemorrhage; Humans; Infections; Nasal Polyps; Nose; Rhinitis; Rhinitis, Allergic, Seasonal

Topics: Airway Resistance; Bronchitis; Bronchodilator Agents; Chronic Disease; Clinical Trials as Topic; Humans; Isoproterenol; Nose; Phenylephrine; Plethysmography; Pulmonary Emphysema; Respiratory Therapy; Spirometry

Topics: Cadaver; Chronic Disease; Humans; Nose; Rhinitis; Sinusitis

Allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP) are of high importance in otorhinolaryngology. Some of their symptoms are related to changes in the nasal trigeminal sensitivity. The aim of this study was to compare nasal trigeminal sensitivity in patients with AR, CRSwNP, and healthy controls (HC).. A total of 75 individuals participated (age 19-78 years; 34 AR, 10 CRSwNP and 31 HC). Olfactory function was determined using the extended Sniffin' Sticks test battery. Trigeminal sensitivity was assessed with CO. In comparison to HC, AR patients had lower CO. AR patients seemed to be more sensitive to trigeminal stimuli than CRSwNP patients. Importantly, the differences could be shown on psychophysical and electrophysiological levels. The changes in trigeminal sensitivity appear to be present already at the level of the respiratory epithelium. The differences between the two groups may depend on the specific inflammatory changes accompanying each disorder, the degree of inflammatory activity, or duration of the inflammatory disorder. However, because the sample sizes are relatively small, these results need to be confirmed in the future studies with larger groups.. 4 Laryngoscope, 133:654-660, 2023.

Topics: Adult; Aged; Carbon Dioxide; Chronic Disease; Humans; Middle Aged; Nasal Polyps; Nose; Rhinitis; Rhinitis, Allergic; Sinusitis; Young Adult

Chronic or recurrent rhinosinusitis without polyps (CRSsNP) is characterized by a persistent inflammation of the sinonasal mucosa. The underlying cause is unclear but increasing interest has been directed toward changes in the sinonasal microbiome as a potential driver.. Twenty-two patients diagnosed with CRSsNP were treated with antibiotics for 13 days, followed by 5 consecutive days of nasal microbiome transplants from healthy donors. Outcome measures were 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire, total nasal symptom score (TNSS), endoscopic grading, 16S ribosomal RNA (rRNA) next generation sequencing (microbiome analysis), and nasal lavage fluid analysis of inflammatory cytokines. Patients were examined at the start of the study and after antibiotic treatment as well as 10 days and 3 months after the transplant series.. At the end of the study, patients reported significantly reduced SNOT-22 scores and microbiome analysis showed significantly increased abundance and diversity. No significant change was observed for TNSS or endoscopic scoring.. Nasal microbiome transplants obtained from healthy individuals and administered as nasal lavages to patients with CRSsNP are feasible. The patients reported significant and lasting reduction of symptoms and these findings were associated with a lasting increase in abundance and diversity of the local bacterial flora. The observations, which need to be confirmed by randomized controlled trials, may constitute a new treatment avenue for these difficult to treat patients where antibiotics only provide short lasting symptom control.

Topics: Anti-Bacterial Agents; Chronic Disease; Humans; Microbiota; Nasal Polyps; Nose; Rhinitis; Sinusitis

Exposure to microbes may be important in the development of chronic rhinosinusitis (CRS). Dysbiosis of the nasal microbiome is considered to be related to CRS with nasal polyps (CRSwNP). The link between the nasal microbiota and eosinophilic CRSwNP (eCRSwNP) has rarely been studied.. The aim of this study was to rigorously characterize nasal dysbiosis in a cohort of patients with eCRSwNP and compare the nasal microbiomes of these patients with those of healthy controls (HCs).. We performed a cross-sectional study of 34 patients with eCRSwNP, 10 patients without CRSwNP, and 44 HCs by using 16S rRNA gene sequencing. An independent cohort of 14 patients with eCRSwNP, 9 patients without CRSwNP, and 11 HCs was used to validate the results.. Compared with the nasal microbiome of healthy controls, the nasal microbiome of patients with eCRSwNP was characterized by higher α-diversity (Shannon and Chao1 index) and a distinct composition of microbes. Notably, the distinct differences in microbial composition between patients with eCRSwNP and HCs were significantly correlated with eCRSwNP disease status. Furthermore, in a diagnostic model generated by using these differences, a combination of 15 genera could be used to distinguish patients with eCRSwNP from HCs, with an area under the curve of approximately 0.8 in both the exploration and validation cohorts.. Our study establishes the compositional alterations in the nasal microbiome in eCRSwNP and suggests the potential for using the nasal microbiota as a noninvasive predictive classifier for the diagnosis of eCRSwNP.

Topics: Chronic Disease; Cross-Sectional Studies; Dysbiosis; Humans; Nasal Polyps; Nose; Rhinitis; RNA, Ribosomal, 16S; Sinusitis

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disease causing considerable disease burden. The anti-inflammatory monoterpene 1,8-Cineol is a natural plant-based therapeutic agent that is well established to treat chronic and acute airway diseases. Aim of this study was to investigate whether the herbal drug 1,8-Cineol reaches the nasal tissue via the gut and the blood stream upon its oral administration. A highly sensitive gas chromatography mass spectrometry-based method with stir bar sorptive extraction (SBSE) for sample preparation has been developed and validated for the extraction, detection and quantification of 1,8-Cineol in tissue samples of nasal polyps from 30 CRSwNP patients. Data revealed a highly sensitive detection of 1,8-Cineol in nasal tissue samples after 14 days of oral administration of 1,8-Cineol prior to surgical treatment. There was no significant correlation between the measured 1,8-Cineol concentrations and bodyweight or BMI values of the analyzed patients, respectively. Our data indicate a systemic distribution of 1,8-Cineol in the human body after its oral administration. Individual differences in terms of metabolic characteristics and have to be further investigated. The study increases our understanding of the systemic effects of 1,8-Cineol upon its therapeutic application and benefit in patients with CRSwNP.

Topics: Chronic Disease; Eucalyptol; Gas Chromatography-Mass Spectrometry; Humans; Magnoliopsida; Mass Spectrometry; Nasal Polyps; Nose; Sinusitis

The nasal airflow in chronic obstructive pulmonary disease (COPD) is poorly characterized. Peak nasal inspiratory flow (PNIF) is a valuable instrument for assessing nasal airflow and the effect of pulmonary pathology such as COPD on PNIF remains unknown. To test the hypothesis that nasal airflow is reduced in COPD, we assessed airflow using PNIF in COPD and a control group. We also explored whether there is an association between COPD, chronic rhinosinusitis without nasal polyps (CRSsNP), and other predefined covariates with PNIF.. Ninety patients with COPD and 67 controls underwent PNIF and spirometry. The associations between PNIF and COPD and pre-bronchodilator forced expiratory volume in the first second (FEV1) (% predicted) were assessed by multivariable linear regression in two separate models.. PNIF was significantly lower in the COPD group than in the control group. Multivariable linear regression showed that COPD and pre-bronchodilator FEV1 (% predicted) were significantly associated with lower PNIF after adjustment for age, sex, CRSsNP, weight and height. CRSsNP was not associated with PNIF in either of the adjusted regression analyses.. PNIF is lower in COPD than in a control group. The finding of a low PNIF in the absence of disease in the upper airways may be due to obstructive lower airways diseases and special care should be taken when interpreting PNIF values in patients with COPD or reduced FEV1.

Topics: Bronchodilator Agents; Chronic Disease; Humans; Nasal Polyps; Nose; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests; Sinusitis; Spirometry

Glucose concentrations are increased in nasal secretions in chronic rhinosinusitis (CRS). However, the glucose metabolism and its contribution to disease pathogenesis in CRS remain unexplored.. We sought to explore the glucose metabolism and its effect on the function of nasal epithelial cells in CRS with and without nasal polyps (CRSwNP and CRSsNP).. Glucose metabolites were detected with mass spectrometry. The mRNA levels of glucose transporters (GLUTs), metabolic enzymes, and inflammatory mediators were detected by quantitative RT-PCR. The protein expression of GLUTs was studied by immunofluorescence staining, Western blotting, and flow cytometry. Glucose uptake was measured by using fluorescent glucose analog. Human nasal epithelial cells (HNECs) were cultured. Bioenergetic analysis was performed with Seahorse XF analyzer. Gene expression in HNECs was profiled by RNA sequencing.. Increased glucose concentrations in nasal secretions was confirmed in both CRSsNP and CRSwNP. GLUT4, GLUT10, and GLUT11 were abundantly expressed in HNECs, whose expression was upregulated by inflammatory cytokines and D-glucose and was increased in CRS. Glucose uptake, glycolysis and tricarboxylic acid cycle metabolites, metabolic enzymes, and extracellular acidification rate and oxygen consumption rates were increased in HNECs in CRSsNP and CRSwNP, with a predominant shift to glycolysis. HNECs treated with high-level apical D-glucose showed enhanced glucose uptake, predominant glycolysis, and upregulated production of IL-1α, IL-1β, TNF-α, CCL20, and CXCL8, which was suppressed by 2-deoxy-D-glucose, an inhibitor of glycolysis.. Increased glucose in nasal secretions promotes glucose uptake and predominant glycolysis in epithelial cells, augmenting the proinflammatory function of epithelial cells in CRS.

Topics: Cells, Cultured; Chronic Disease; Cytokines; Epithelial Cells; Humans; Nasal Mucosa; Nasal Polyps; Nose; Rhinitis; Sinusitis

Conservative therapy for chronic polyposis rhinosinusitis are well covered, and modern endoscopic rhinosurgery can effectively cope with this pathology. Clinical cases of large destructive anthrochoanal polyps are not uncommon, the pathology is well studied. However, cases with giant sinonasal polyposis, which lead to bone-destructive changes in the bones of the nose and the walls of the paranasal sinuses are very rare. We found only one case similar to the clinical observation presented in this article.. В настоящее время вопросы консервативной терапии полипозного риносинусита хорошо освещены в литературе, а современная эндоскопическая ринохирургия позволяет эффективно справляться с данной патологией. Клинические случаи выявления больших антрохоанальных полипов нередки, патология хорошо изучена. Особый интерес представляют случаи полипозного риносинусита с полипами большого размера, которые приводят к костно-деструктивным изменениям костей носа и стенок околоносовых пазух; в литературе описаны единичные случаи, подобные представленному в данной статье клиническому наблюдению.

Topics: Chronic Disease; Humans; Nasal Cavity; Nasal Polyps; Nasopharyngeal Neoplasms; Nose; Paranasal Sinuses; Sinusitis

We conducted a national survey to understand how rhinology practice has changed with the advent of biologics and how this affected patients with uncontrolled, severe chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to analyse the results of the survey and infer practical recommendations for clinical practice.. A group of ear, nose, and throat specialists (ENTs) experienced in the management of CRSwNP developed a 74-question survey. ENTs from rhinology centres authorised to prescribe biologics in the context of the national health system were invited to answer it between 01/05/2022 and 31/07/2022. The responses underwent descriptive analyses, and the authors discussed the results and derived practical recommendations for clinical practice.. ENTs working in rhinology centres changed their practices coinciding with the advent of biologics. CRSwNP evaluations have become more complex because they involve diagnostic confirmation, determining the patients' immunologic profile, and other factors. We observed heterogenous behaviours in practice that may be conditioned by the novelty of the topic. The results of the survey were used to develop practical recommendations for ENTs and are summarised herein.. Clinical practice in rhinology outpatient clinics has changed profoundly in the era of biologics. Our practical recommendations for clinicians working in rhinology centres are expected to help standardise practice and improve care.. Raccomandazioni pratiche nella gestione ambulatoriale della rinosinusite cronica con poliposi nasale severa, nell’era dei biologici.. Abbiamo condotto un’indagine nazionale per capire come la pratica rinologica sia cambiata con l’avvento dei biologici e come questo abbia influenzato i pazienti con rinosinusite cronica grave non controllata con polipi nasali (CRSwNP). L’obiettivo è analizzare i risultati dell’indagine e dedurre raccomandazioni pratiche per la pratica clinica.. Un gruppo di otorinolaringoiatri esperti nella gestione della CRSwNP ha sviluppato un sondaggio di 74 domande. Gli otorinolaringoiatri dei centri di rinologia autorizzati a prescrivere biologici nel contesto del sistema sanitario nazionale sono stati invitati a rispondere tra il 01/05/2022 e il 31/07/2022. Le risposte sono state sottoposte ad analisi descrittiva e gli autori hanno discusso i risultati e definito alcune raccomandazioni applicabili alla pratica clinica.. Gli otorinolaringoiatri che lavorano nei centri di rinologia hanno modificato la loro routine diagnostica con l’avvento dei biologici. La valutazione della CRSwNP è diventata più complessa, perché implica la conferma diagnostica, la determinazione del profilo immunologico del paziente e non solo. Abbiamo osservato comportamenti eterogenei nella pratica che possono essere condizionati dalla novità dell’argomento. I risultati dell’indagine sono stati utilizzati per sviluppare raccomandazioni pratiche per gli otorinolaringoiatri e sono qui riassunti.. La pratica clinica negli ambulatori di rinologia è profondamente cambiata nell’era dei biologici. Le nostre raccomandazioni pratiche per i medici che lavorano nei centri di rinologia dovrebbero contribuire a standardizzare le pratiche e a migliorare l’assistenza.

Topics: Biological Products; Chronic Disease; Humans; Nasal Polyps; Nose; Rhinitis; Sinusitis

Dupilumab significantly improves symptom control in chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with large polyps at the initiation of treatment (total polyp score (TPS) ≥ 5) have been the focus in published studies. Patients with significant burden of disease but small polyps (TPS ≤ 4) have not yet been evaluated for clinical response. This study set out to evaluate the benefit of dupilumab treatment on cohorts of small (TPS ≤ 4) compared to large polyps (TPS ≥ 5). Furthermore, benefit of concomitant oral and/or nasal steroid therapy has been evaluated.. 97 patients with CRSwNP, who were begun on dupilumab between January 2020 and October 2021, were included. All patients were followed-up for 6 months. At each visit they underwent nasal endoscopy, smell identification tests and filled out validated patient questionnaires.. Significant drops in TPS were seen in both patient groups after 6 months of therapy, dropping from a median score of 3 to 0 and from 6 to 2 in patients with small and large polyps respectively. Furthermore, a linear mixed model calculated a drop of 22% and 24% in TPS per month in patients with small and large polyps respectively with no significant difference in rate of decline. Finally the model showed that neither oral nor nasal steroids influenced the rate of response to dupilumab therapy.. Polyp size at the initiation of dupilumab therapy and whether patients continue to take steroid therapy does not appear to influence effectiveness of dupilumab treatment.

Topics: Antibodies, Monoclonal, Humanized; Chronic Disease; Humans; Nasal Polyps; Nose; Sinusitis; Steroids

Topics: Chronic Disease; Humans; Inflammation; Nasal Polyps; Nitric Oxide; Nose; Rhinitis; Sinusitis

In this study we aimed to investigate the prevalence of abnormal nasality in patients with unilateral rhinosinusitis and their nasality outcomes following functional endoscopic sinus surgery (FESS).. A total of 42 patients with unilateral chronic rhinosinusitis who underwent unilateral FESS between April 2016 and November 2017 were enrolled. Questionnaires on sinonasal symptoms and nasality were recorded. The change in the nasalance score of vowels [a], [i] [u], nasal consonant [m], 2 nasal syllable repetitions, and 2 Chinese sentences were measured. The patients were evaluated preoperatively, 6 months, and 12 months after the operation. The patients were divided into two groups, wide opening surgery and limited surgery, according to the severity of the disease.. Among 42 patients, the subjective reports showed that one-third of unilateral chronic rhinosinusitis (CRS) patients had abnormal nasality preoperatively and significant improvement following FESS. The Lund-Mackay score was significantly negatively correlated with preoperative nasalance of [i] and positively correlated with change of nasalance of [i]. The increase in the value of [i] is statistically significant (p = 0.01) following FESS. In the further subgroup analysis, the change in nasalance was significant in the wide opening surgery group, but not in the limited surgery group.. Although only one side of the nasal airway was involved, one-third of the patients reported abnormal nasality. In patients with more disease severity who underwent wide opening surgery, the nasalance significantly increased 1 year after FESS. The increase in the objective nasalance score was corresponded to a significant improvement of subjective self-reported nasality assessment postoperatively.

Topics: Chronic Disease; Endoscopy; Humans; Language; Nose; Sinusitis

Nasal pathologies are characterized by a symptomatology that hardly allows to distinguish allergic rhinitis (AR), non-allergic rhinitis (NAR), and chronic rhinosinusitis (CRS). Nasal cytology (NC) has shown increasing importance in helping the clinician to differentiate the various phenotypes of rhinitis. NC allows us to evaluate nasal cellularity by distinguishing AR and various types of NAR. The objective of the study is to assess the diagnostic performance of the NC by evaluating its sensitivity, specificity, and predictive value.. We recruited 387 patients with persistent rhinitis symptoms, and nasal cytology was performed. The rhinocytogram was obtained by reading for fields and the cellular count was made using quantitative and semi-quantitative grading together.. Two hundred and fifteen patients (55.5%; 38 had acute rhinitis, 24 acute sinusitis, 153 chronic rhinosinusitis) out of 387 referred nasal symptoms. Cytological specimen showed a mean of 94 ± 4% ciliated cells, 29 ± 0.2% mucinous cells, 16 ± 0.1% neutrophils, 11 ± 0.08% eosinophils, 4 ± 0.03 lymphocytes, 4 ± 0.03% mast cells, and 4 ± 0.01% other cells. NC was positive in 271 cases (70%). After revision of medical history, 153 patients (39%) were considered positive for NAR. Test sensibility was 100% (95% CI 97-100), specificity was 49.6% (95% CI 43-56%). Positive predictive value (PPV) was 56% (95% CI 50-62%), and negative predictive value (NPV) was 100% (95% CI 96-100%). The positive likelihood ratio was 1.98 (95% CI 1.75-2.25). Accuracy of the test was 69.5% (95% CI 64.6-74.0%).. Our data showed ability to identify the true-positive patients with NAR but a low ability to identify the true-negative patients, with a global accuracy of 69.5%.

Topics: Chronic Disease; Eosinophils; Humans; Nose; Rhinitis; Rhinitis, Allergic; Sinusitis

Abnormal remodeling of the nasal mucosal epithelium and persistent chronic inflammation are important pathological features of chronic sinusitis with nasal polyps (CRSwNPs). In order to explore the molecular regulation mechanism of CRSwNPs, we performed iTRAQ protein profile analysis on 18 clinical samples collected (9 patients with nasal polyps and 9 healthy patients) and found that S100A11, a Ca2+-binding protein, was significantly higher in CRSwNPs. Subsequently, we demonstrated that S100A11 was mainly located in nasal mucosal epithelial cells and is up-regulated in human nasal epithelial stem/progenitor cells (hNESPCs) from CRSwNPs patients and CRSwNPs epithelial cell model established with S. aureus. To determine the functional role of S100A11 and the signal pathways in epithelial cells, we constructed S100A11 overexpression vector, small interfering RNA, recombinant protein-S100A11 (rh-S100A11) and RAGE inhibitor (sRAGE). Results showed that upregulation of S100A11 inhibited epithelial cell viability and promoted apoptosis and inflammation, in addition, S100A11 can regulate the signal homeostasis of AMPK-STAT3 via RAGE mediation in epithelial cells. Our findings suggest that S100A11 is involved in CRSwNPs epithelial tissue remodeling and inflammatory response regulation and may be a useful target for CRSwNPs therapy.

Topics: Adolescent; Adult; Aged; AMP-Activated Protein Kinases; Antigens, Neoplasm; Apoptosis; Cell Line; Cell Proliferation; Child; Chronic Disease; Epithelial Cells; Humans; Inflammation; Middle Aged; Mitogen-Activated Protein Kinases; Models, Biological; Nasal Polyps; Nose; S100 Proteins; Signal Transduction; Sinusitis; Staphylococcus aureus; STAT3 Transcription Factor; Up-Regulation; Young Adult

To assess whether nasal nitric oxide (nNO) levels differ between healthy and sick sinuses in chronic rhinosinusitis (CRS). A secondary aim was to assess whether nNO levels change after treatment of CRS and whether there is an association with radiological findings or symptoms.. Three groups of 12 participants each were examined: patients with CRS without polyposis (CRS group), patients with symptoms of CRS but radiologically normal sinuses (symptoms-only), and healthy controls. Measurements of nNO were carried out using aspiration method and humming maneuver. All participants completed the Sino-Nasal Outcome Test (SNOT-22). A second nNO measurement was done after treatment in the CRS group (n = 9) and the healthy control group (n = 12).. Nasal NO did not differ between any of the groups with any of the measurement techniques. There was a trend toward lower nNO values in the CRS group compared with the symptoms-only group and healthy controls, but it did not reach statistical significance. The SNOT-22 demonstrated inferior values for the CRS and symptoms-only groups compared with the healthy controls. At follow-up, no statistically significant change was found for the nNO measurements in either group.. Irrespective of occluded or open ostiomeatal complexes, no statistically significant differences in nNO were found in CRS compared with healthy controls using aspiration and humming methods. Treatment of CRS improved sinus patency without accompanying a significant change in nNO. This study can therefore not conclude that nNO can be used as a diagnostic tool for CRS without polyposis.

Topics: Adult; Aged; Case-Control Studies; Chronic Disease; Correlation of Data; Female; Humans; Longitudinal Studies; Male; Middle Aged; Nitric Oxide; Nose; Pilot Projects; Rhinitis; Sino-Nasal Outcome Test; Sinusitis; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

Topics: Adaptor Proteins, Signal Transducing; Chronic Disease; Humans; Interleukin-13; Nasal Mucosa; Nasal Polyps; Nose; Rhinitis; Sinusitis; Transcription Factors; YAP-Signaling Proteins

In recent decades, posterior nasal neurectomy (PNN) with submucosal inferior turbinectomy (ST) has been increasingly used for the treatment of intractable severe rhinitis; however, to the best of our knowledge, there have been few studies regarding its long-term therapeutic effects or its influence on patient quality of life (QOL). Therefore, this study examined the long-term therapeutic effects in patients who underwent PNN with ST, as well as their QOL and medication use after surgery.. This retrospective cohort study initially included 16 consecutive patients who underwent PNN with ST from January 2010 to December 2011. Ten of the 16 patients participated in a paper-based survey questionnaire between June 2018 and November 2018; the responses of these 10 patients were used for analysis in this study. To clarify the effects of surgical treatment on symptoms, QOL, and medication status, data recorded before and 3 months after surgery were compared with data recorded at 8 years after surgery using the Japan Rhinoconjunctivitis Quality of Life Questionnaire No. 1 and Classification of the Severity of Allergic Rhinitis Symptoms I and II.. Nasal symptoms including runny nose and nasal congestion, medication score, respective total symptoms medication scores (i.e., combined average total symptoms score and medication score), and the scores of troubles with daily life and total QOL were significantly improved at 3 months and 8 years after surgery, compared with before surgery; scores were not significantly worsened at 8 years after surgery, compared with 3 months after surgery. In addition, there were no adverse events requiring treatment after surgery.. Our findings suggest that PNN with ST is effective and safe for long-term treatment of severe chronic rhinitis symptoms, as well as reduction of medication use and improvement of QOL.

Topics: Adolescent; Adult; Chronic Disease; Denervation; Endoscopy; Female; Humans; Japan; Male; Middle Aged; Nose; Patient Reported Outcome Measures; Quality of Life; Retrospective Studies; Rhinitis, Allergic; Turbinates

Topics: Chronic Disease; Diplopia; Humans; Nose; Orbit; Otolaryngology; Pharynx; Sinusitis

Posterior nasal nerve (PNN) cryoablation is a novel surgical technique used to address chronic rhinitis. The purpose of this study is to review the medical device reports (MDRs) submitted to the Food and Drug Administration's (FDA) Manufacturer and User Device Facility Experience (MAUDE) database to identify adverse events related to the use of ClariFix, a device designed for office-based cryosurgical ablation of the PNN. A total of 12 adverse events associated with ClariFix from January 2017 to August 2020 were identified and analyzed. The most common adverse events associated with ClariFix PNN cryoablation include epistaxis and nasal swelling. Further studies are needed to clarify whether PNN cryoablation is associated with epistaxis in certain populations.

Topics: Chronic Disease; Cryosurgery; Edema; Epistaxis; Humans; Nose; Rhinitis; United States

Topics: Adult; Chronic Disease; Cystic Fibrosis; Disease Progression; Endoscopy; Female; Humans; Male; Nose; Olfaction Disorders; Prospective Studies; Quality of Life; Rhinitis; Sinusitis; Smell

Aspirin-exacerbated respiratory disease (AERD) is a severe form of chronic rhinosinusitis with nasal polyps (CRSwNP) accompanied by asthma and an aspirin intolerance. The underlying pathomechanism of AERD still remains unclear, recent data suggest a complex inflammatory imbalance. In the present study, we investigated the cytokine patterns in AERD, CRSwNP and healthy control patients. Furthermore, we describe the change in cytokine level in the course of aspirin desensitization (AD) with continuous intake of aspirin.. The study included a total of 104 participants, 48 healthy controls, 45 patients with nasal polyps and 11 patients with AERD undergoing AD. Nasal secretions were analyzed for IL-1β, IL-4, IL-5, IL-10, IL-12, IL-13, IL-17, THF-α, IFN-γ, eotaxin and ECP using Bio-Plex Human Cytokine Assay and Uni-CAP FEIA. Baseline measurements of cytokine levels were performed in all 104 patients; in patients with AERD, follow-up was performed 1-6 and 6-24 months after the initiation of AD.. Our preliminary results show a T. For the first time, the present work shows the cytokine pattern in nasal secretions of AERD patients before and during AD. Further investigation of the complex interaction of inflammatory cytokines during AD might reveal important insights into the disease entity of AERD and open up new horizons for a targeted therapy.

Topics: Adult; Aspirin; Asthma, Aspirin-Induced; Bodily Secretions; Chronic Disease; Cytokines; Desensitization, Immunologic; Female; Humans; Interleukin-13; Male; Middle Aged; Nasal Polyps; Nose; Preliminary Data; Rhinitis; Sinusitis; Young Adult

All nontechnical factors were analyzed to predict nasal bacterial culture results in patients with chronic rhinosinusitis (CRS). Four hundred and ninety-six CRS patients, who underwent functional endoscopic sinus surgery (FESS), were enrolled. Prior to FESS, the severity of each patient's CRS was evaluated using a questionnaire, endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and CT scan. Nasal bacterial cultures were collected from both middle meati using a cotton-tipped stick. Our results showed that the symptom severity complained of by patients and their loss of smell function did not influence the bacterial culture rate. We discovered that the bacterial culture rate was significantly higher in nostrils with nasal polyps than those without polyps, along with nostrils experiencing thick, purulent discharge as opposed to those without discharge. Additionally, this result also occurred in nostrils with a saccharin transit time of more than 30 min than it did in those with a saccharin transit time of less than or equal to 30 min. Both the total endoscopic score and anterior group CT score were significantly higher in nostrils with positive culture than those with negative culture, while the second minimal cross-sectional area (MCA

Topics: Adult; Aged; Bacteria; Chronic Disease; Colony Count, Microbial; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Polyps; Nose; Rhinitis; Sinusitis; Young Adult

Topics: Chronic Disease; Humans; Nasal Mucosa; Nasal Polyps; Nose; Prevalence; Rhinitis; Sinusitis

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disease with different clinical characteristics and different treatment responsiveness. The aims of this study were to compare the nasal fluid cytology and cytokines between eosinophilic CRSwNP (eCRSwNP) and non-eosinophilic CRSwNP (neCRSwNP) and establish a new multivariate model to predict eCRSwNP before surgery to improve personalized treatment for CRSwNP patients.. Eighty-six consecutive patients with CRSwNP and sixteen healthy controls were recruited in this study. Nasal fluid (NF) was collected from all subjects and nasal polyp tissue was collected during the surgery. The differential cell counts and concentrations of IL-6, IL-8, TNF-77; and IL-10 in NF were measured. Univariate and multivariate logistic regression were used to identify predictors for eCRSwNP.. There were more inflammatory cells in NF of CRSwNP than controls. The eosinophil percentage was significantly higher in eCRSwNP than neCRSwNP and controls. The level of IL-8 was significantly higher in neCRSwNP than in eCRSwNP and controls. Blood eosinophilia, nasal fluid eosinophilia, higher total ethmoid score / total maxillary score (E/M ratio) and higher visual analogue scale (VAS) score of CRS were associated with eCRSwNP, the area under receiver operating characteristic curve (AUC) was 0.800, 0.755, 0.703 and 0.648, respectively. Using the coefficients of multivariate regression, we set up a scoring system to predict eCRSwNP with three of the variates and the AUC was 0.883.. ECRSwNP, neCRSwNP and healthy controls demonstrated different cytology and cytokine profiles in NF. A new preoperational multivariate prediction model for eCRSwNP with NF eosinophilia, blood eosinophilia and higher E/M ratio was established.

Topics: Chronic Disease; Cytokines; Eosinophils; Humans; Nasal Polyps; Nose; Rhinitis; Sinusitis

Endonasal endoscopic surgery of the paranasal sinuses is the gold standard in surgical treatment of chronic inflammatory diseases of the paranasal sinuses. Improvement of subjective complaints and objective findings has been confirmed in numerous studies. Due to the discrepancy between objective and subjective results after paranasal sinus surgery, the assessment of patient reported outcomes has gained importance.Quality and efficiency in medicine became increasingly important during the last years. In many countries and transnationally, the association of experts, partly coordinated by different medical societies, led to initiatives focusing on improvement of the quality of surgical care.The present article represents an overview of quality-related factors in surgical treatment of chronic inflammatory diseases of the paranasal sinuses, summarizing the existing literature and focusing particularly on process and outcomes quality. Particular attention will be paid to the outcome quality individually assessed by the patients.. Die endonasale endoskopische Nasennebenhöhlenchirurgie hat sich als Standard der operativen Therapie bei chronisch entzündlichen Erkrankungen der Nasennebenhöhlen etabliert. Eine Verbesserung der subjektiven Beschwerden und objektiven Befunde konnte in zahlreichen Studien nachgewiesen werden. Aufgrund der häufig beobachteten Diskrepanz zwischen objektiven und subjektiven Ergebnissen nach Nasennebenhöhlenchirurgie kommt der Messung des sog. patient reported outcome eine zunehmende Bedeutung zu.Qualität und Effizienz in der Medizin haben in den letzten Jahren zunehmend an Bedeutung gewonnen. In vielen Ländern und auch länderübergreifend wurden bereits durch Zusammenschluss von Experten, z.T unter Federführung verschiedener Fachgesellschaften, Initiativen zur Verbesserung der Qualität in der chirurgischen Versorgung gegründet.Die vorliegende Arbeit stellt eine Übersicht qualitätsrelevanter Faktoren in der chirurgischen Therapie chronisch entzündlicher Erkrankungen der Nasennebenhöhlen anhand der vorhandenen Literatur, v.a. der Prozess- und Ergebnisqualität, dar. Ein besonderes Augenmerk liegt auf der subjektiven Bewertung der Ergebnisqualität durch den Patienten.

Topics: Chronic Disease; Endoscopy; Humans; Nose; Paranasal Sinus Diseases; Paranasal Sinuses

Topics: Case-Control Studies; Chronic Disease; DNA, Bacterial; DNA, Ribosomal; Humans; Microbiota; Nose; Sinusitis

Although cases of empty nose syndrome (ENS) are not very common, the suffering that ENS causes patient is immense and could be very difficult to imagine. Nasal nitric oxide (nNO) is an airway disease biomarker, and its levels increase after endoscopic sinus surgery. The trend of nNO levels in ENS before and after surgical treatment remains unknown. This study aimed to evaluate the role of nNO in ENS.. Patients with ENS who received surgical implantation and with chronic hypertrophic rhinitis (CHR) who underwent turbinoplasty and completed at least 1 year of follow-up were prospectively enrolled. nNO measurements and subjective assessments [SinoNasal Outcome Test (SNOT)-22, Beck Depression Inventory (BDI)-II, and Beck Anxiety Inventory (BAI)] were performed preoperatively and at 3, 6, and 12 months postoperatively.. We enrolled 19 ENS and 12 CHR patients. nNO levels were significantly lower in the ENS than in the CHR patients before surgical treatment (p < 0.001). nNO levels in the ENS patients significantly increased 3 months after implantation and remained plateaued (p = 0.015). BDI-II and BAI scores significantly improved after surgical treatment for the ENS patients but not for the CHR patients; changes in nNO levels correlated well with improvements in BDI-II and BAI scores (p = 0.025 and 0.035, respectively).. nNO significantly increased at third month after surgical treatment and remained plateaued in ENS patients. This increase correlated with improvements in BDI-II and BAI scores. Therefore, nNO may be important in assessing the psychiatric status of empty nose syndrome.

Topics: Adult; Aged; Chronic Disease; Female; Humans; Hypertrophy; Male; Middle Aged; Nitric Oxide; Nose; Nose Diseases; Rhinitis; Syndrome; Young Adult

It is generally believed that the microbiome plays a role in the pathophysiology of chronic rhinosinusitis (CRS), though its exact contribution to disease development and severity remains unclear. Here, samples were collected from the anterior nares, nasopharynx, and maxillary and ethmoid sinuses of 190 CRS patients and from the anterior nares and nasopharynx of 100 controls. Microbial communities were analyzed by Illumina sequencing of the V4 region of 16S rRNA. The phenotype and patient characteristics were documented, and several serum inflammatory markers were measured. Our data indicate a rather strong continuity for the microbiome in the different upper respiratory tract (URT) niches in CRS patients, with the microbiome in the anterior nares being most similar to the sinus microbiome. Bacterial diversity was reduced in CRS patients without nasal polyps compared to that in the controls but not in CRS patients with nasal polyps. Statistically significant differences in the presence/absence or relative abundance of several taxa were found between the CRS patients and the healthy controls. Of these,

Topics: Adult; Chronic Disease; Cluster Analysis; DNA, Bacterial; DNA, Ribosomal; Female; Humans; Male; Microbiota; Middle Aged; Nasopharynx; Nose; Paranasal Sinuses; Phylogeny; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Sinusitis; Young Adult

Chronic rhinosinusitis (CRS) is a proposed risk factor for meningitis and other intracranial complications following the endoscopic endonasal transsphenoidal approach (TSA). Some have recommended staging TSA following surgery for CRS; however, delaying TSA has important ramifications. The objective of this study is to determine whether asymptomatic sinonasal inflammation (RSNI) on preoperative computed tomography scans, without clinical CRS, is associated with postoperative complications following TSA.. All consecutive TSA cases performed at a single tertiary care institution from January 1, 2009, to December 31, 2017, were reviewed for patient demographics, prior surgery, presence of RSNI on preoperative computed tomography scan based on Lund-Mackay (LM) score, intraoperative cerebrospinal fluid (CSF) leak, and postoperative complications (postoperative CSF leak, bleeding, infection). The association between preoperative RSNI and postoperative complications was analyzed via multivariate logistic regression.. One hundred seventy-one cases of TSA were included with mean patient age of 52.6 years, 42.7% males, 18.1% revision cases, and mean LM score of 1.9 ± 2.7. Complications were identified in 9.9% of patients at the following rates: 5.3% postoperative CSF leak, 2.9% bleeding, and 1.8% infection (all sinusitis, no episodes of meningitis). Neither total LM score nor LM score > 5 (representative of clinically significant radiographic CRS) were predictors of any postoperative complication (both P > 0.05). Age, sex, revision status, intraoperative CSF leak, and total LM score were not independent predictors of any postoperative complication on multivariate analysis (all P > 0.05).. In asymptomatic patients, radiographic evidence of sinonasal inflammation is not associated with increased risk of complications following TSA.. 4 Laryngoscope, 129:1545-1548, 2019.

Topics: Adult; Aged; Asymptomatic Diseases; Chronic Disease; Endoscopy; Female; Humans; Inflammation; Logistic Models; Male; Middle Aged; Multivariate Analysis; Nose; Paranasal Sinuses; Pituitary Diseases; Pituitary Gland; Postoperative Complications; Preoperative Period; Retrospective Studies; Rhinitis; Sinusitis; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adult; Aged; Chronic Disease; Eosinophils; Female; Granulomatosis with Polyangiitis; Humans; Intercellular Adhesion Molecule-1; Leukocyte Count; Male; Middle Aged; Nasal Polyps; Nose; Prospective Studies; Sinusitis; Vascular Cell Adhesion Molecule-1

The airway is the major entry route of pathogens due to continuous gas exchange with the environment. In particular, the nasal epithelial layer is the common site of airborne mucotropic virus infections. The inflammatory response to such infections must be tightly controlled due to its non-specific nature. Unrestrained inflammation breaks down the physiological mucosal defense system and leads to secondary bacterial or fungal infections. Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease that compromises quality of life. In spite of its importance in the initiation of inflammation, the role of interferon signaling in nasal airway epithelial cells is largely unknown. We analyzed the expression of interferon signaling genes using clinical lavage specimens and nasal airway epithelial cells collected from CRS patients and controls. Basal expression of IFNAs, IKBKE, STAT1, and some CXC chemokines was elevated in samples from CRS patients. In subsequent in vitro studies, we found IKKε to be the key molecule and augmented CXCL10 secretion. Based on our findings and review of the literature, we hypothesized that high levels of IKKε might induce intractable inflammation via CXCL10. We tested the hypothesis in an animal model and found not only that IKKε induced severe eosinophilic inflammation with CXCL10 over-production, but also that inhibition of IKKε resolved the inflammation.

Topics: Animals; Chemokine CXCL10; Chronic Disease; Disease Models, Animal; Epithelial Cells; Gene Expression Regulation; Humans; I-kappa B Kinase; Inflammation; Interferon-alpha; Mice, Inbred BALB C; Mice, Nude; Nose; Rhinitis; Sinusitis

Munchausen syndrome by proxy (MSBP) is a condition diagnosed when a caregiver knowingly fabricates or inflicts illness on another for his/her own gain. Typical cases of MSBP detected by otolaryngologists involve facial trauma or otologic injury, while descriptions involving the nose are rare. Destructive nasal lesions have a broad differential diagnosis and may require visits to numerous specialists, placing strain on both the patient and the healthcare system. Early recognition of MSBP in patients with chronic nasal destruction may prevent such unnecessary strain. We present a case of MSBP involving two half-brothers with unexplainable nasal destruction and discuss the literature and current recommendations for managing the diagnosis.

Topics: Chronic Disease; Diagnosis, Differential; Epistaxis; Humans; Infant; Male; Munchausen Syndrome by Proxy; Nose; Nose Deformities, Acquired; Siblings

Cystatins are epithelial protease inhibitors that participate in sinonasal immunity and inflammation. Nasal mucus-derived exosomes (NMDEs) are small vesicles secreted by epithelial cells that carry protein cargo reflective of their host cell. NMDEs have been used as a noninvasive biomarker source to study chronic rhinosinusitis with nasal polyps (CRSwNP) proteomics with superior sensitivity to whole mucus. The purpose of this study was to noninvasively quantify exosomal cystatins in a heterogenous population to determine their utility in predicting phenotype and disease severity.. This was an Institutional Review Board-approved study in which NMDEs were purified from 105 patients undergoing sinonasal surgery by ultracentrifugation. Demographic and clinical variables were collected and phenotypes were assigned a priori. Linear discriminant analysis was executed based on normalized Cystatin values as phenotype predictor variables. Unsupervised cluster analysis was performed using Ward's linkage followed by Duda/Hart Je(2)/Je(1) index cluster stopping rules. Analysis of variance (ANOVA), Welch's test, and Fisher's exact tests were used for continuous and categorical variables.. NMDE Cystatin-2 expression segregated by phenotype (mean ± standard error [SEM]): control (23.4 ± 4.2 pg/µg, n = 32); CRS without NP (CRSsNP) (56.6 ± 8.3 pg/µg, n = 33); and CRSwNP (130.5 ± 16.7 pg/µg, n = 40) (p < 0.0001). Seven clusters were identified among patients where the highest NMDE Cystatin-2 levels clustered with asthma, tissue eosinophilia, and aspirin-exacerbated respiratory disease (AERD).. Cystatin levels in NMDEs predict CRS phenotype and disease severity. As a "liquid biopsy," noninvasive NMDE collection offers a promising opportunity to study disease pathophysiology, discriminate disease states, and potentially reveal novel therapeutic targets.

Topics: Adult; Aged; Chronic Disease; Cluster Analysis; Discriminant Analysis; Disease Progression; Exosomes; Female; Humans; Male; Middle Aged; Mucus; Nose; Phenotype; Predictive Value of Tests; Prognosis; Rhinitis; Salivary Cystatins; Severity of Illness Index; Sinusitis

Nasal endoscopy is a cornerstone in diagnosing sinonasal disease, but different raters might generate different results using the technique. Our study aims to evaluate the agreement between multiple raters to assess the validity of nasal endoscopy.. Three independent and blinded raters evaluated 28 patients (56 nasal cavities) diagnosed with chronic rhinosinusitis according to the European Position Paper on Rhinosinusitis and Nasal Polyps. The ratings were compared using unweighted Fleiss' kappa coefficients (K. The department of Otorhinolaryngology, Odense University Hospital, Denmark.. The ratings were quantified in a modified Lund-Kennedy endoscopy score and focused on the objective parameters specified in the diagnostic criteria: polyps, oedema and discharge.. Using nasal endoscopy, the evaluation of polyps by multiple raters showed sufficient reliability indicating an acceptable objective evaluation. The evaluation of discharge achieved a fair level of agreement while the assessment of oedema could not achieve a sufficient reliability questioning the inclusion of oedema in the criteria for diagnosing sinonasal disease.

Topics: Adult; Aged; Chronic Disease; Denmark; Diagnosis, Differential; Endoscopy; Female; Humans; Incidence; Male; Middle Aged; Nose; Reproducibility of Results; Rhinitis; ROC Curve; Sinusitis

Olfactory dysfunction is common among the general population, with chronic rhinosinusitis (CRS) as one of the leading causes. Patients affected by CRS often report changes in taste sensations; however, quantitative measurements have not been performed to date. Therefore, the present study aimed to investigate gustatory and olfactory function in CRS patients prior to and after multimodal treatment.. Prospective cohort study.. Twenty-one patients suffering from CRS with nasal polyps (14 male, seven female) with a mean age of 48 ± 15 years were included in the study. Chemosensory function was assessed prior to and approximately 190 days after multimodal treatment, which included endoscopic sinus surgery, oral antibiotics for 5 days, oral steroids for 12 days, and at least 6 weeks of topical nasal steroids. Olfactory function was tested with the Sniffin' Sticks test battery, whereas gustatory function was measured with taste strips. A clinically relevant change in olfactory function was defined as a change of ≥5 points in the threshold, discrimination, and identification scores.. Compared to normative data, patients baseline gustatory and olfactory function was impaired. After multimodal treatment, improvements were seen in olfactory function for eight patients (42%), remained stable in 10 patients (53%), and deteriorated in one patient (5%). Taste function remained unchanged following sinus surgery.. Patients suffering from CRS with polyps exhibit olfactory and taste dysfunctions. Multimodal treatment leads to an improvement in olfactory, but not gustatory functionality.. 4. Laryngoscope, 128:E86-E90, 2018.

Topics: Administration, Oral; Administration, Topical; Adult; Anti-Bacterial Agents; Chronic Disease; Combined Modality Therapy; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Surgical Procedures; Nose; Olfaction Disorders; Paranasal Sinuses; Prospective Studies; Rhinitis; Sinusitis; Smell; Steroids; Taste; Taste Disorders; Treatment Outcome

Eosinophilic granulomatosis with polyangiitis (EGPA) is a necrotizing vasculitis that predominantly affects small- to medium-sized vessels. It is characterized by a wide spectrum of extrapulmonary symptoms, including sinonasal and paranasal sinus abnormalities. These are the most common features of this disease, constituting diagnostic criteria for EGPA. However, the actual clinical features, cellular mechanisms and impact on patients' quality of life (QoL) are still a matter of study.. Thirty-nine EGPA patients underwent multidimensional rhinological evaluations, including rhinofibroscopy, nasal cytology, and QoL questionnaires. This was coupled with respiratory and rheumatological assessments.. Twenty-eight patients were diagnosed with chronic rhinosinusitis (CRS). Of these, 18 had nasal polyposis (NP). Chronic rhinitis was diagnosed in 10 patients. Of these, 3 had allergic rhinitis (AR) and seven had non-AR (NAR). Overall, only 1 patient (2.6%) was normal. Nasal cytology showed that hypereosinophilia was present in 17/28 patients with CRS, 4/7 patients with NAR and all patients with AR. SNOT-22 and SF-36 showed a severe impact of nasal symptoms on QoL. No differences in asthma control or rheumatological patterns for EGPA were observed among patients with or without NP.. Even when the rheumatological assessment scored EGPA "under control" according to the Birmingham Vasculitis Activity Score and Vasculitis Damage Index, sinonasal diseases and related nasal inflammatory processes were not controlled. Therefore, there is a need for clinical monitoring and targeted treatment to control the inflammatory processes and improve the QoL of EGPA patients.

Topics: Adult; Aged; Cell Movement; Chronic Disease; Churg-Strauss Syndrome; Eosinophils; Female; Humans; Italy; Male; Middle Aged; Nasal Polyps; Nose; Paranasal Sinuses; Quality of Life; Rhinitis, Allergic; Sinusitis; Surveys and Questionnaires

We report the case of a 27-year-old female who presented with a peculiar story of anosmia fluctuating in a circadian manner. Olfactory function appeared an hour after breakfast, was normal during daytime, and disappeared in the early evening. Imaging confirmed chronic rhinosinusitis (CRS). Initial systemic, followed by topical steroid treatment, rapidly and sustainably reversed this condition. The olfactory fluctuation paralleled the endogenous steroid production. This suggests that slight congestion changes in a chronically inflamed nasal mucosa may have been sufficient to induce this circadian anosmia. The importance of identifying fluctuation of olfactory function as a sign of CRS is emphasized and discussed. Laryngoscope, 128:1537-1539, 2018.

Topics: Adult; Chronic Disease; Circadian Rhythm; Female; Glucocorticoids; Humans; Nose; Olfaction Disorders; Rhinitis; Sinusitis; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Child; Chronic Disease; Female; Humans; Male; Microbiota; Middle Aged; Nose; Rhinitis, Allergic; Sinusitis; Young Adult

Synechiae formation in the middle meatus is the most common complication of functional endoscopic sinus surgery (FESS). Our objectives were to determine the incidence of synechiae occurring in a cohort of patients that have undergone FESS and identify characteristics associated with the development of synechiae postoperatively.. A retrospective chart review was conducted of CRS patients, with or without nasal polyposis, that had undergone bilateral FESS in the past. All patients had received non-absorbable spacers intraoperatively that were left in situ for 6 days. Demographic and preoperative variables were analyzed to identify synechiae risk factors. A multivariable logistic regression model was constructed to estimate the probability of developing synechiae, given demographic and preoperative variables.. Two hundred cases of bilateral FESS were retrospectively reviewed. Thirty-eight (19.0%, 95% CI 13.6-24.4%) patients developed synechiae. Individuals receiving primary FESS and nasal septal reconstruction (NSR) were strongly associated with the development of synechiae (OR 3.5, 95% CI 1.5-8.5; OR 3.0, 95% CI 1.3-6.9). A multivariable logistic regression model adjusting for NSR, recurrent FESS, concha bullosa, requirement of anterior and posterior ethmoidectomy, Lund-Mackay CT score and gender, identified the likelihood of developing synechiae with a sensitivity of 68%, specificity of 73%, positive predictive value of 38% and likelihood ratio of 2.5.. Patients undergoing primary FESS and NSR are at greatest odds of developing postoperative synechiae. Methods of assessing risk factors and preventing synechiae formation in this population should be evaluated in future prospective investigations.

Topics: Adult; Aged; Chronic Disease; Endoscopy; Female; Follow-Up Studies; Humans; Logistic Models; Male; Middle Aged; Nose; Postoperative Complications; Retrospective Studies; Rhinitis; Risk Factors; Sinusitis; Tissue Adhesions; Treatment Outcome

Introduction Nasal endoscopy (NE) is an essential element of office-based clinical rhinology, including the evaluation of chronic rhinosinusitis. Despite the presence of guidelines, variability exists regarding coding and billing for NE especially with regard to inclusion of evaluation and management (E&M) codes and use of the 25 modifier. The goal of this survey was to assess the billing patterns for NE among American Rhinologic Society (ARS) members. Methods An invitation to participate in a web-based survey was electronically sent to all ARS members. Survey participants were queried regarding demographics and billing patterns for NE in several different clinical scenarios using a 5-point Likert-type scale, with a score of 5 representing "always" and a score of 1 representing "never" for billing E&M. Results A total of 93 respondents successfully completed the survey with a range of the number of years since completing training, practice type (50.5% private, 44.1% academic) and completion of a rhinology fellowship (40.9%). Variable responses for billing patterns for distinct clinical scenarios were noted. Higher scores for billing both E&M and NE for the queried clinical scenarios were noted for new patients (mean 4.50) compared to established patients (mean 3.81) and postoperative patients (mean 3.04). Inclusion of a septoplasty as part of the surgery impacted billing an E&M code 28% of the time. Practice type and history of performing a fellowship did not significantly influence billing patterns for NE. Conclusions Significant variability exists among ARS respondents with regard to billing patterns for NE, despite the presence of coding guidelines. Additional teaching of standard coding practices for NE may limit variability among otolaryngologists.

Topics: Chronic Disease; Endoscopy; Fees and Charges; Humans; Nose; Otolaryngology; Practice Guidelines as Topic; Practice Patterns, Physicians'; Rate Setting and Review; Rhinitis; Rhinoplasty; Sinusitis; Societies, Medical; Surveys and Questionnaires; United States

Background Dysfunctional innervation might contribute to the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP), but the state of the axonal outgrowth signaling in CRSwNP is unknown. The purpose of this study was to explore the axonal outgrowth pathway-related protein expression in CRSwNP. Methods Institutional review board approved study in which tissue proteomes were compared between control and CRSwNP patients (n = 10/group) using an aptamer-based proteomic array and confirmed by whole transcriptomic analysis. Results Compared with controls, proteins associated with axonal guidance signaling pathway such as beta-nerve growth factor, semaphorin 3A, Ras-related C3 botulinum toxin substrate 1, Bcl-2, protein kinase C delta type, and Fyn were significantly decreased in patients with CRSwNP (fold change [FC] = -1.17, P = .002; FC = -1.09, P < .001; FC = -1.33, P < .001; FC = -1.31, P < .001; FC = -1.31, P = .004; and FC = -1.20, P = 0.012, respectively). In contrast, reticulon-4 receptor, an inhibitory factor, was significantly increased in patients with CRSwNP (FC = 1.25, P < .001). Furthermore, neuronal growth-associated proteins such as ciliary neurotrophic factor receptor subunit alpha, neuronal growth regulator 1, neuronal cell adhesion molecule, neural cell adhesion molecule L1, platelet-derived growth factor subunit A, and netrin-4 were all significantly decreased in patients with CRSwNP (FC = -1.25, P < .001; FC = -1.27, P = .002; FC = -1.65, P = .013; FC = -4.20, P < .001; FC = -1.28, P < .001; and FC = -2.31, P < .001, respectively). In contrast, tissue eosinophil count ( P < .001) and allergic inflammation factors such as IgE, periostin, and galectin-10 were all significantly increased in patients with CRSwNP (FC = 12.28, P < .001; FC = 3.95, P < .001; and FC = 2.44, P < .001, respectively). Furthermore, the log FC of the studied proteins expression significantly and positively correlated with log FC of their mRNA expression ( P < .001, r = .88). Conclusions Axonal guidance signaling and neural growth factors pathways proteins are significantly suppressed in eosinophilic CRSwNP.

Topics: Adult; Axon Guidance; Chronic Disease; Eosinophils; Female; Gene Expression Regulation; Humans; Immunoglobulin E; Inflammation; Male; Middle Aged; Nasal Polyps; Nerve Growth Factors; Nogo Receptor 1; Nose; Proteome; Rhinitis; Signal Transduction; Sinusitis; Young Adult

Chronic rhinosinusitis with nasal polyp (CRSwNP) patients are often characterized by asthma comorbidity and a type-2 inflammation of the sinonasal mucosa. The mucosal microbiota has been suggested to be implicated in the persistence of inflammation, but associations have not been well defined. To compare the bacterial communities of healthy subjects with CRSwNP patients, we collected nasal swabs from 17 healthy subjects, 21 CRSwNP patients without asthma (CRSwNP-A), and 20 CRSwNP patients with co-morbid asthma (CRSwNP+A). We analysed the microbiota using high-throughput sequencing of the bacterial 16S rRNA. Bacterial communities were different between the three groups. Haemophilus influenzae was significantly enriched in CRSwNP patients, Propionibacterium acnes in the healthy group; Staphylococcus aureus was abundant in the CRSwNP-A group, even though present in 57% of patients. Escherichia coli was found in high amounts in CRSwNP+A patients. Nasal tissues of CRSwNP+A patients expressed significantly higher concentrations of IgE, SE-IgE, and IL-5 compared to those of CRSwNP-A patients. Co-cultivation demonstrated that P. acnes growth was inhibited by H. influenzae, E. coli and S. aureus. The nasal microbiota of healthy subjects are different from those of CRSwNP-A and CRSwNP+A patients. However, the most abundant species in healthy status could not inhibit those in CRSwNP disease.

Topics: Adult; Asthma; Bacteria; Bacterial Infections; Case-Control Studies; Chronic Disease; Dysbiosis; Female; Humans; Inflammation; Male; Middle Aged; Nasal Polyps; Nose; Rhinitis; Sinusitis

Recent studies leveraging next-generation sequencing and functional approaches to understand the human microbiota have demonstrated the presence of diverse, niche-specific microbial communities at nearly every mucosal surface. These microbes contribute to the development and function of physiologic and immunological features that are key to host health status. Not surprisingly, several chronic inflammatory diseases have been attributed to dysbiosis of microbiota composition or function, including chronic rhinosinusitis (CRS). CRS is a heterogeneous disease characterized by inflammation of the sinonasal cavity and mucosal microbiota dysbiosis. Inflammatory phenotypes and bacterial community compositions vary considerably across individuals with CRS, complicating current studies that seek to address causality of a dysbiotic microbiome as a driver or initiator of persistent sinonasal inflammation. Murine models have provided some experimental evidence that alterations in local microbial communities and microbially-produced metabolites influence health status. In this perspective, we will discuss the clinical implications of distinct microbial compositions and community-level functions in CRS and how mucosal microbiota relate to the diverse inflammatory endotypes that are frequently observed. We will also describe specific microbial interactions that can deterministically shape the pattern of co-colonizers and the resulting metabolic products that drive or exacerbate host inflammation. These findings are discussed in the context of CRS-associated inflammation and in other chronic inflammatory diseases that share features observed in CRS. An improved understanding of CRS patient stratification offers the opportunity to personalize therapeutic regimens and to design novel treatments aimed at manipulation of the disease-associated microbiota to restore sinus health.

Topics: Animals; Chronic Disease; Disease Models, Animal; Dysbiosis; Host Microbial Interactions; Humans; Inflammation; Microbial Interactions; Microbiota; Nasal Mucosa; Nose; Rhinitis; RNA, Ribosomal, 16S; Sinusitis

The pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP) has not been fully elucidated. This study sought to explore the role and mechanism of transient receptor potential canonical channel 6 (TRPC6) in the pathogenesis of CRSwNP.. Immunohistochemistry (IHC) was employed to evaluate TRPC6 immunolabeling. Real-time polymerase chain reaction (PCR) was conducted to assay TRPC6, stromal interaction molecule 1 (STIM1), and calcium release-activated calcium channel protein 1 (Orai1) messenger RNA (mRNA) levels in 70 patients with CRSwNP, including eosinophilic CRSwNP (ECRSwNP) or non-eosinophilic CRSwNP (nECRSwNP), and 28 control subjects. The concentrations of inflammatory mediators, including interleukin (IL)-1β, IL-5, and IL-25, were assayed by enzyme-linked immunosorbent assay (ELISA). In experiments on human nasal epithelial cell (HNEC) culture and stimulation, the mean fluorescence intensity (MFI) of intracellular Ca. Upregulation of TRPC6, STIM1, and Orai1 levels was found in CRSwNP patients, particularly in those with ECRSwNP. TRPC6-positive cells correlated positively with the numbers of eosinophils and neutrophils, respectively. Moreover, TRPC6 mRNA was positively correlated with STIM1 and Orai1 mRNA levels. The concentrations of inflammatory mediators, including IL-1β, IL-5, and IL-25, were elevated in CRSwNP, especially in ECRSwNP. In cultured HNECs, TRPC6, STIM1, Orai1, Ca. TRPC6 plays a pro-inflammatory role in the pathogenesis of CRSwNP via regulating Ca

Topics: Adult; Calcium; Cells, Cultured; Chronic Disease; Cytokines; Eosinophilia; Epithelial Cells; Female; Humans; Male; Middle Aged; Nasal Polyps; Neoplasm Proteins; Nose; ORAI1 Protein; Rhinitis; Sinusitis; Stromal Interaction Molecule 1; TRPC6 Cation Channel; Up-Regulation

The role of bacterial communities in canine nasal disease has not been studied so far using next generation sequencing methods. Sequencing of bacterial 16S rRNA genes has revealed that the canine upper respiratory tract harbors a diverse microbial community; however, changes in the composition of nasal bacterial communities in dogs with nasal disease have not been described so far. Aim of the study was to characterize the nasal microbiome of healthy dogs and compare it to that of dogs with histologically confirmed nasal neoplasia and chronic rhinitis. Nasal swabs were collected from healthy dogs (n = 23), dogs with malignant nasal neoplasia (n = 16), and dogs with chronic rhinitis (n = 8). Bacterial DNA was extracted and sequencing of the bacterial 16S rRNA gene was performed. Data were analyzed using Quantitative Insights Into Microbial Ecology (QIIME). A total of 376 Operational Taxonomic Units out of 26 bacterial phyla were detected. In healthy dogs, Moraxella spp. was the most common species, followed by Phyllobacterium spp., Cardiobacteriaceae, and Staphylococcus spp. While Moraxella spp. were significantly decreased in diseased compared to healthy dogs (p = 0.005), Pasteurellaceae were significantly increased (p = 0.001). Analysis of similarities used on the unweighted UniFrac distance metric (p = 0.027) was significantly different when nasal microbial communities of healthy dogs were compared to those of dogs with nasal disease. The study showed that the canine nasal cavity is inhabited by a highly species-rich bacterial community, and suggests significant differences between the nasal microbiome of healthy dogs and dogs with nasal disease.

Topics: Animals; Chronic Disease; Dog Diseases; Dogs; Female; Male; Microbiota; Nose; Nose Neoplasms; Rhinitis; RNA, Ribosomal, 16S

Epistaxis constitutes a significant proportion of the Otolaryngologist's emergency workload. Optimal management differs in relation to the anatomic origin of the bleeding. The outcome of our study was to determine which artery(ies) could be considered as the cause of severe bleeding in the context of severe epistaxis.. Fifty-five procedures of embolization preceded by angiography were reviewed. Medical records of interventionally treated patients were analysed for demographics, medical history, risk factors and clinical data. Angiographic findings were also assessed for active contrast extravasation (blush), vascular abnormality and embolised artery.. Previous angiography showed an active contrast extravasation in only 20 procedures. The most common bleeding source was the sphenopalatine artery (SPA) followed by anterior ethmoïdal artery (AEA) and facial artery. Majority of multiple or bilateral extravasations occured in patients with systemic factors.. A better understanding of the potential bleeding source might help and limit the risk of treatment failures. Our study confirms that the SPA is the most common cause of severe bleeding. We also emphasise the role of the AEA not only in traumatic context. Others arteries are rarely involved except in patients with comorbidities or frequent recurrences.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Angiography; Arteries; Chronic Disease; Comorbidity; Embolization, Therapeutic; Epistaxis; Female; Humans; Male; Middle Aged; Nose; Risk Factors; Treatment Outcome

Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by epithelial inflammation and tissue eosinophilic infiltration. Interleukin-33 (IL-33) is a key inflammatory cytokine that mediates eosinophilic infiltration.. The aim of our study was to investigate the expression and role of IL-33 in eosinophilic CRS with nasal polyps (ECRSwNP) and in noneosinophilic CRS with nasal polyps (nECRSwNP), and to analyze their correlation with clinical severity.. The study enrolled 25 patients with ECRSwNP, 27 patients with nECRSwNP, and 12 control subjects, based on immunohistochemical staining. Protein and mRNA expressions of IL-33 in sinus mucosal samples were determined by immunohistochemistry and real-time polymerase chain reaction. Sino-Nasal Outcome Test-20 (SNOT-20) score, visual analog scale (VAS) score, endoscopy score, and computed tomography (CT) score were assessed preoperatively.. IL-33 expression levels in the CRSwNP group were significantly higher than those in the control group (p < 0.01), especially in the ECRSwNP group (p < 0.05). There were no significant differences between the ECRSwNP and nECRSwNP groups with respect to SNOT-20 score, VAS score, endoscopy score, or CT score. IL-33 mRNA expression showed a positive correlation with the number of eosinophils (p < 0.05) and endoscopy score (p < 0.05) but not with VAS score and CT score.. IL-33 expression plays an important role in patients with CRSwNP. No significant differences were observed between the ECRSwNP and nECRSwNP groups with respect to SNOT-20 score, VAS score, endoscopy score, or CT score. IL-33 expression was correlated with eosinophil counts and endoscopy score.

Topics: Adolescent; Adult; Aged; Chronic Disease; Endoscopy; Eosinophilia; Female; Humans; Immunohistochemistry; Interleukin-33; Male; Middle Aged; Nasal Mucosa; Nasal Polyps; Nose; Paranasal Sinuses; Real-Time Polymerase Chain Reaction; Rhinitis; Severity of Illness Index; Sinusitis; Visual Analog Scale; Young Adult

Little is known on endonasal trigeminal sensitivity in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The aim of our study was to investigate changes in trigeminal sensitivity in patients with CRSwNP and the effect of functional endoscopic sinus surgery (FESS) on trigeminal perception.. A prospective study was performed to investigate the trigeminal sensitivity at three different locations within the nose (anterior septum, anterior lateral wall, middle turbinate) using electrical stimuli. Therefore 45 CRSwNP patients were compared to 30 healthy subjects. Further, the effect of FESS was investigated in 31 patients before and 3 months after surgery.. CRSwNP patients had a significantly higher trigeminal threshold at all tested locations than healthy subjects. The lowest trigeminal detection threshold could be shown at the entrance of the nose in healthy subjects and in patients with CRSwNP. Three months after FESS a significant improvement of trigeminal detection threshold was observed at the anterior nasal septum.. Protective function of the trigeminal system is preserved in CRSwNP patients. FESS seems to show beneficial effects on restoring sentinel function at the entrance of the nose.

Topics: Adult; Chronic Disease; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Polyps; Nose; Olfactory Perception; Prospective Studies; Respiration; Rhinitis; Sensory Thresholds; Sinusitis; Trigeminal Nerve; Young Adult

Objective of this study was to test whether there is a difference between chronic rhinosinusitis patients with (CRSwNP) and without (CRSsNP) nasal polyps in the association of extent of disease on CT scans with symptom severity and health-related quality-of-life (HRQL) impairment. Data sets from 271 chronic rhinosinusitis (CRS) patients who completed the Sino-Nasal Outcome Test 22 (SNOT-22) and visual analog scale (VAS) scores were subjected to principal component analysis (PCA) to identify a symptom components related to CRS. After controlling for demographics, medical therapy, and comorbidities, the association between symptom components/items excluded from PCA and Lund-Mackay score (LMS) was evaluated. No association was found between the total SNOT-22 score and LMS in CRS patients. There was an independent association between a higher "nasal" symptom component derived from SNOT-22 PCA and LMS in patients with CRSwNP (p < 0.001), but not in CRSsNP patients, with a statistically significant difference between two patient subsets (p = 0.003). In patients with CRSsNP, higher (worse) SNOT-22 "facial pain" was associated with lower LMS (p = 0.022), although the estimated change in LMS was modest. Considering VAS PCA components, higher "nasal" symptoms were associated with higher LMS in CRSwNP patients (p < 0.001) but not in CRSsNP, with a statistically significant difference between CRS groups (p = 0.024). A higher "pain" PCA component was associated with lower LMS in CRSsNP patients (p = 0.019). This study found significant differences in the relationship between symptom burden and CT scores between CRS phenotypes and no association between HRQL impairment and CT scores.

Topics: Adult; Chronic Disease; Facial Pain; Female; Humans; Male; Middle Aged; Nasal Polyps; Nose; Rhinitis; Severity of Illness Index; Sinusitis; Tomography, X-Ray Computed

Topics: Chronic Disease; Humans; Nasal Polyps; Nose; Rhinitis; Sinusitis

Topics: Biofilms; Chronic Disease; Humans; Nose; Ofloxacin; Paranasal Sinuses; Rhinitis; Sinusitis

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder associated with asthma. This association is well described in patients with CRSwNP undergoing endoscopic sinus surgery (ESS); however, some patients are never referred for surgery, and the frequency of asthma in this group is largely unknown.. To determine the frequency of asthma in patients with CRSwNP treated in a primary care (PC) setting who have never been referred for surgery and to compare this with ESS patients.. Fifty-seven patients with CRSwNP who had never undergone ESS were prospectively recruited from nine PC ear, nose, and throat clinics in the Copenhagen area. CRSwNP was diagnosed according to the European Position Paper on Chronic Rhinosinusitis and Nasal Polyps; severity was assessed by using a visual analog scale. Allergy, lung function, and asthma tests (reversibility to β2-agonist, peak expiratory flow variability, and mannitol challenge) were performed. Findings were compared with our previously published data from patients with CRSwNP referred for surgery.. Asthma was diagnosed in 25 patients (44%) based on respiratory symptoms and a positive asthma test; of these, 12 (48%) had undiagnosed asthma prior to study onset. Furthermore, when using the same methods, we found a lower frequency of asthma in PC patients compared with ESS patients (44% versus 65%, p = 0.04).. A high prevalence of asthma in PC patients with CRSwNP was found. Frequently, asthma was undiagnosed. However, asthma was significantly less prevalent in PC patients compared with patients referred for ESS. The frequent concomitance of asthma, i.e., united airways disease, in PC patients calls for closer collaboration between ear, nose, and throat specialists, and asthma specialists.

Topics: Adult; Aged; Asthma; Chronic Disease; Denmark; Ear; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Polyps; Nose; Pharynx; Prevalence; Primary Health Care; Prospective Studies; Rhinitis; Sinusitis; Young Adult

Two hundred and fourteen patients who had a cough illness lasting at least 2 weeks were studied to investigate Bordetella pertussis as a cause of prolonged cough in adolescents and adults. Medical history and nasopharyngeal swab specimens for culture and polymerase chain reaction (PCR) were obtained at presentation. Three (1·4%) patients were B. pertussis culture-positive; 15 (7%) were B. pertussis PCR-positive (including the culture-positive patients) and 11 (5·1%) were Bordetella spp. PCR-positive. Symptom combinations were significantly high both in patients with pertussis and patients with indeterminate results (P < 0·05). We conclude that B. pertussis should be considered among differential diagnoses of prolonged cough in adolescents and adults and PCR and culture should be used to detect these cases and facilitate public health response.

Topics: Adolescent; Adult; Bordetella pertussis; Child; Chronic Disease; Cough; DNA, Bacterial; Female; Humans; Male; Medical History Taking; Nose; Pharynx; Turkey; Vomiting; Whooping Cough; Young Adult

To study the pulmonary function and nasal resistance characteristics of patients with chronic nose-sinusitis and nasal polyps (CRSwNP), to explore the evaluation role of nasal resistance in nasal ventilation function and the effect of endoscopic sinus surgery on pulmonary function in patients with CRSwNP.. Fifty CRSwNP patients that met the study criteria were selected . The patients were performed endoscopic surgeries according to Messerklinger surgical procedures under general anesthesia. Extent of surgery was based on preoperative CT showing the range of the lesion of disease and endoscopic findings. Perioperative treatments contained intranasal corticosteroids, cephalosporin or penicillin antibiotics, nasal irrigation and other treatments. Main outcome measures included visual analog scale (VAS), endoscopic Lind-Kennedy scores, nasal resistence, pulmonary function in patientsone week before and after surgery, three months and six months after surgery. Pulmonary function includes forced expiratory volume in one second (FEV1), forced vital capacity FEV1/FVC and peak expiratory flow (PEF).. The study found that there were significantly positive correlations among VAS score, Lund-Kennedy score and nasal resistance (P < 0.05) in CRSwNP patients, but there is a significantly negative correlation between VAS score, Lund-Kennedy score, nasal resistance and pulmonary function indexes of FEV1, FVC and PEF (P < 0.05). The VAS score, Lund-Kennedy score and nasal resistance values of CRSwNP patients were decreased significantly after comprehensive treatments with nasal endoscopic operation as the major one, the difference was statistically different (P < 0.05). And the pulmonary function indexs (FEV1, FVC, PEF) were significantly increased after surgery in CRSwNP patients.. The nasal resistance can objectively and reliably reflect the degree of nasal congestion and the recovery of nasal function in CRSwNP patients after endoscopic sinus surgery. The detection method of nasal resistance is simple. Functional endoscopic sinus surgery can effectively improve the pulmonary ventilation function in CRSwNP patients, providing some clinical references about the prevention and treatment of CRS related lower respiratory disease.

Topics: Administration, Intranasal; Adrenal Cortex Hormones; Anti-Bacterial Agents; Chronic Disease; Endoscopy; Humans; Nasal Lavage; Nasal Polyps; Nose; Pulmonary Ventilation; Respiratory Function Tests; Rhinitis; Sinusitis

Rhinoscleroma (RS) is a chronic specific disease of nose and upper respiratory passages caused by Klebsiella rhinoscleromatis bacilli. It is endemic in Egypt and in sporadic areas worldwide. Diagnosis of RS depends on identification of the pathognomonic Mickulicz cells (MCs) which is most prominent during granulomatous phase but spares or absent during catarrhal or sclerotic phases of the disease. This study aimed to identify the potential diagnostic features of nasal RS when MCs are absent. Nasal biopsies from 125 patients complaining of chronic nasal symptoms were retrieved for this study; including 72 chronic non specific inflammatory lesions and 53 RS diagnosed by PAS and Geimsa stains. The detailed histological differences among the two groups were measured statistically. RS was frequently a bilateral disease (P < 0.05) of young age (P < 0.001) with a female predominance (P < 0.05) and usually associated with nasal crustations (P < 0.001). Five strong histological indicators of RS were specified by univariate binary logistic regression analyses including squamous metaplasia (OR 27.2, P < 0.0001), dominance of plasma cells (OR 12.75, P < 0.0001), Russell bodies (OR 8.83, P < 0.0001), neutrophiles (OR 3.7, P < 0.001) and absence of oesinophiles (OR 12.0, P < 0.0001). According to Multivariate analysis, the diagnostic features of RS in absence of MCs can be classified into major criteria including dominance of plasma cells infiltration and absence of oesinophiles and minor criteria including young age, female gender, bilateral nasal involvement, nasal crustation, squamous metaplasia, Russell bodies, and neutrophiles. The diagnostic model using the two major criteria confirmed or excluded RS in 84.3% of the investigated cases.

Topics: Adolescent; Adult; Age Factors; Aged; Biopsy; Chi-Square Distribution; Child; Chronic Disease; Eosinophils; Epithelial Cells; Female; Humans; Logistic Models; Male; Metaplasia; Middle Aged; Multivariate Analysis; Neutrophils; Nose; Plasma Cells; Predictive Value of Tests; Retrospective Studies; Rhinoscleroma; Risk Factors; Sex Factors; Young Adult

Topics: Body Piercing; Chronic Disease; Erythema; Facial Dermatoses; Female; Humans; Nose; Telangiectasis; Young Adult

Topics: Chronic Disease; Cytokines; Eosinophils; Humans; Nasal Decongestants; Nose; Pulmonary Disease, Chronic Obstructive; Pulmonary Ventilation; Rhinitis; Sinusitis

To investigate the incidence of chronic rhinosinusitis and its influence on life quality for junior middle school students in Zhengzhou Municipal.. Two thousand and twenty junior middle school students in Zhengzhou Municipal were randomly selected as the object of investigation by designed survey and visual analogue scale (VAS) questionnaire of chronic rhinosinusitis the sino-nasal outcome test-20 (SNOT-20) and nasal examination. Effect on the quality of life was investigated based on the degree of troubles caused by symptoms.. The incidence of chronic rhinosinusitis in junior middle school students in Zhengzhou Municipal was 6.73% (136/2 020), in which, 22.79% (31/136) of these students' quality of life was affected (VAS>5).. Chronic rhinosinusitis is common in junior middle school students, and the life quality is affected. So we should pay attention to this diseases and take the positive and effective intervention measures.

Topics: China; Chronic Disease; Nose; Pain Measurement; Quality of Life; Sinusitis; Students; Surveys and Questionnaires

Topics: Adolescent; Adult; Aged; Chronic Disease; Female; Hospitals, University; Humans; Male; Maxillary Sinusitis; Middle Aged; Nose; Suppuration; Togo; Young Adult

Pseudomonas aeruginosa sinusitis may be the focus for intermittent lung colonization in patients with cystic fibrosis (CF). The sinusitis may induce elevated IgA levels in nasal secretion and saliva against P. aeruginosa.. 120 CF patients chronically infected, intermittently colonized or without P. aeruginosa in the lungs participated in this cross-sectional study. IgA and IgG against P. aeruginosa sonicate and alginate were measured in nasal secretions, saliva, and in serum by ELISA.. The intermittently colonized patients had significantly higher IgA levels in nasal secretions and saliva than those without P. aeruginosa in the lungs, indicating that P. aeruginosa sinusitis may precede intermittent colonization and chronic infection of the lungs.. Specific IgA against P. aeruginosa in nasal secretions and saliva can contribute to differentiation between patients chronically infected, intermittently colonized, and without P. aeruginosa in the lungs. The diagnostic value of the IgA ELISA awaits a prospective study.

Topics: Adolescent; Body Fluids; Chronic Disease; Cross-Sectional Studies; Female; Humans; Immunoglobulin A, Secretory; Immunohistochemistry; Male; Nose; Pseudomonas Infections; Respiratory System; Sensitivity and Specificity; Sputum

In this retrospective study of 41 cats with chronic nasal disease diagnoses included nasal neoplasia (n = 19), idiopathic chronic rhinosinusitis (ICRS) (n = 12), nasopharyngeal polyps (n = 3), foreign bodies (n = 2), nasopharyngeal stenosis (n = 1) and nasal aspergillosis (n = 1). In 3 cats diagnosis could not be established despite thorough work-up. Gender, indoor or outdoor housing, quality or quantity of nasal discharge, bacteriological findings of nasal flushes, radiology and CT findings did not differ significantly between cats with neoplasia and cats with ICRS. Cats with neoplasia were older (3 - 15, median 11 years) and showed clinical signs for a shorter period of time (1 - 8, median 2 months) than cats with ICRS (age 1 - 13, median 7.5 years; signs: 1 - 36, median 5 months). In all cats with neoplasia a mass was detected rhinoscopically, while this was only seen in 30 % of cats with ICRS. The exact diagnosis has to be established by examination of biopsy samples. A combination of physical examination, imaging studies and rhinoscopy with cytological and histopathological examination of samples enhances the likelihood for a correct diagnosis.

Topics: Age Factors; Animals; Aspergillosis; Biopsy; Cat Diseases; Cats; Chronic Disease; Diagnosis, Differential; Female; Foreign Bodies; Male; Nasal Polyps; Nose; Nose Diseases; Nose Neoplasms; Paranasal Sinus Diseases; Retrospective Studies; Rhinitis; Sinusitis

Topics: Adult; Chronic Disease; Facial Dermatoses; Female; Humans; Lateral Medullary Syndrome; Nose; Skin Ulcer; Trigeminal Nerve Diseases

To observe the clinical efficacy of spherical headed silicone implantation in the treatment of chronic dacryocystitis under nasal endoscopy.. Twenty six patients (31 eyes) with chronic dacryocystitis were subjected to spherical headed silicone implantation under topical anesthesia (lacrimal passage and nasal mucosal surface). Lacrimal passage irrigation was performed daily throughout the first postoperative week , and once each month thereafter.. All spherical headed silicone tube placements were successfully performed. The operative time ranged from 6 to 11 minutes. Symptoms of epiphora were immediately ameliorated post-operatively, and irrigation demonstrated patency of the lacrimal system in all patients. All patients were followed from 7 to 24 months, during which symptoms of tearing were improved. The lacrimal ducts of 27 eyes (87.7%) were normal. The lacrimal ducts of 4 others (12.3%) were still blocked. Lacrimal passage irrigation was open and secretion disappeared in 28 eyes (90.3%). Tearing was observed in 3 eyes (9.68%).. Spherical headed silicone tube implantation under nasal endoscopy is successful in relieving symptoms of tearing.

Topics: Anesthesia, Local; Chronic Disease; Dacryocystitis; Dacryocystorhinostomy; Endoscopy; Female; Humans; Intubation; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Lacrimal Duct Obstruction; Male; Nasal Mucosa; Nose; Operative Time; Postoperative Period; Prostheses and Implants; Silicones; Tears

Chronic rhinosinusitis is a multifactorial disease with pathophysiological mechanisms, which remain unclear, and with a high prevalence worldwide. They generate social problems due to the high number of days of leave and relatively elevated medical expenses. The histopathological and immunohistochemical study that we conducted revealed many lesional aspects of the epithelium of the sinus mucosa, which ranged from hypertrophy, hyperplasia and metaplasia, to erosion and discontinuities. In the chorion of the sinus mucosa there was an inflammatory infiltrate composed mainly of lymphocytes, plasma cells and macrophages, and also a highly developed vascular network. Among immune cells, T-cells appeared to be more numerous than B-lymphocytes and macrophages. We believe that microscopic changes are due mainly to microscopic organisms that make up the biofilm of the sinus cavity, whose virulence has been more or less influenced by exogenous or endogenous factors.

Topics: Adolescent; Adult; Aged; Child; Chronic Disease; Epithelial Cells; Humans; Immunohistochemistry; Inflammation; Maxillary Sinus; Middle Aged; Mucous Membrane; Nose; Sinusitis; Suppuration; T-Lymphocytes

Endoscopic endonasal surgery (EES) is standard practice in sinonasal disease and is becoming more accepted in the performance of anterior skull base resections. We report our experience with image-guided surgery (IGS) in difficult cases of paranasal sinus (PNS) and skull base pathologies and discuss advantages and disadvantages of this technique.. A retrospective chart review was performed for the period 2004-2009. Degree of PNS involvement, indication for IGS, incidence of major complications, need for revision surgery, and technical data regarding the system were gathered.. Sixty-two of 86 patients were followed for at least one year and therefore included in the analysis. Indications for IGS were mostly revision surgery for polyposis (42%), chronic rhinosinusitis (CRS) of frontal and/or sphenoid sinuses (14.5%), skull base tumours (30.6%), and foreign body removal (4.8%). Revision rates after IGS in polyposis, CRS, and benign skull base tumours were 7.7%, 11.11%, and 7.1%, respectively.. IGS is of particular benefit in the management of sinonasal polyposis, benign skull base tumours, palliative surgery, and foreign body removal. IGS may avoid trauma to the orbit and anterior skull base and reduces the rate of revision surgeries rendering more meticulous and complete operations possible. We also think it could be helpful for foreign body removal.

Topics: Adolescent; Adult; Aged; Chronic Disease; Endoscopy; Female; Foreign Bodies; Humans; Male; Middle Aged; Nasal Polyps; Nose; Otorhinolaryngologic Surgical Procedures; Reoperation; Retrospective Studies; Rhinitis; Sinusitis; Skull Base Neoplasms; Surgery, Computer-Assisted; Young Adult

This report describes a combined approach to the maxillary sinus, used to deal with mucosal pathology. The technique uses a powered microdebrider with angled endoscopes and is minimally invasive. It is cost-effective and offers the potential for decreased surgical time, reduced post-operative healing time and reduced post-operative morbidity.

Topics: Chronic Disease; Endoscopes; Endoscopy; Humans; Maxillary Sinus; Nasal Polyps; Nose; Otorhinolaryngologic Surgical Procedures; Papilloma; Sinusitis; Treatment Outcome

To investigate the correlationship between the assessment of subjective and objective in patients with chronic(CRS) rhinosinusitis before and after FESS.. Seventy patients with CRS were objectively assessment of VAS and subjectively assessment including the Lund-Kennedy endoscopic scale and Lund-Mackay scale. All patients were followed up 1 year and repeated both the objective and subjective assessment. The correlationship among the different assessments were investigated and the scales of before and after FESS were compared.. There were positive correlation between the scale of VAS and Lund-Mackay(r = 0.866, P < 0.01), positive correlation between the scale of Lund-Kennedy and Lund-Mackay(r = 0.803, P < 0.01), and positive correlation between the scale of VAS and Lund-Kennedy (r = 0.912, P < 0.01) before the FESS. There were positive correlation between scale of VAS and Lund-Kennedy after 6 and 12 months of FESS with the r-value of 0.798 and 0.882 respectively. The scales of VAS including nasal obstruction, nasal discharge and head pain have positive correlation with the total scale of Lund-Kennedy with r-value of 0.691, 0.760 and 0.751 respectively. And the scales of VAS including hyposmia and general malaise have positive correlation with the total scale of Lund-Kennedy with r-value of 0.327, and 0.438 respectively. The scale of Lund-Mackay before has positive correlation with both the scale of Lund-Kennedy and VAS.. In patients with CRS, there were correlations among the scales of CT assessment, nasal endoscopic evaluation and VAS before FESS, and there were also correlations between the scales of CT assessment and nasal endoscopic evaluation after 6 and 12 months of FESS. It indicated that to evaluate the patients with CRS properly, the comprehensive assessment including subjective and CT and endoscopic scale should been applied in clinic.

Topics: Adolescent; Adult; Chronic Disease; Endoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Sinusitis; Treatment Outcome; Young Adult

Topics: Animals; Chronic Disease; Dog Diseases; Dogs; Endoscopy; Female; Nose; Rhinitis; Streptococcal Infections; Streptococcus equi

To study the relationship between nasal anatomic abnormalities and the bacteria infection status of maxillary sinus.. The anatomic abnormalities of 115 cases of maxillary sinuses were detected with the CT images and confirmed with chronic infection, which were divided into two groups: high anatomic abnormality group and low anatomic abnormality group. The sinusal contents were sent to bacteria culture, compare the bacteria infection rate and the distribution of bacteria between the two groups.. The bacteria positive rate of the high anatomic abnormality group and low anatomic abnormality group was 90.32% and 56.60% (P < 0.01) respectively. The contribution of gram-positive bacteria and gram-negative bacteria are 47.76% and 52.24% in high anatomic abnormality group, 62.16% and 37.84% in low anatomic abnormality group.. Nasal anatomic abnormalities can improve the bacteria infectious rate of maxillary sinuses. High anatomic abnormality may more induces gram-negative bacteria infections,while low anatomic abnormality may more induces gram-positive bacteria infections.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Chronic Disease; Humans; Middle Aged; Nose; Sinusitis; Young Adult

Topics: Biopsy; Chronic Disease; Disease Progression; Eosinophilia; Fibrosis; Granuloma; Humans; Hypertrophy; Male; Middle Aged; Nose; Nose Diseases; Vasculitis

Topics: Chronic Disease; Female; Genitalia; History, 19th Century; History, 20th Century; Humans; Libido; Male; Nose; Nose Diseases; Reflex; Sexual Behavior

To correlate subjective and objective clinical features with nasal smear cytology findings in noninfectious chronic rhinitis.. An analysis of prospectively collected data of consecutive patients with non-infectious seasonal and perennial rhinosinusitis seen at a tertiary health institution.. Clinical assessments including Visual Analog Scale (VAS) scoring of presenting symptoms of 45 patients suffering from non-infectious chronic rhinosinusitis are measured. Subjects had a medical questionnaire regarding presence and duration of symptoms, family history of atopy or allergy, occupational exposure to allergens, provocative agents, and medication usages. Subjects had detail Ear, Nose, and Throat assessment, and nasal secretions were analyzed for eosinophils counts and statistically correlated with clinical parameter.. A total of 45 patients were recruited. Age range was 13 to 71 years (SD 11.516). 73% (n=33) were females while 27% (n=12) were males. The modal occupation was homemaking (24%, n=11). 38% (n=17) had family history of atopy, while 13% (n=6) had family history of allergy. Symptoms were perennial in 62% (n=28) and seasonal in 38% (n=17). 9% (n=4) of the subjects keep pets at home, while 40% (n=18) grow flowers or trees around the house. All subjects gave a history of identifiable provocative agents. There is positive correlation of itchy nose with total symptom score. There was negative history of occupational exposure to allergens in all subjects. The average subjective symptom score are Sneezing (6.3), Itchy nose (6.1), Nasal obstruction (6.2) and Runny nose (6.7). There is a high positive correlation of sneezing with runny nose (r = 0.51), but poor correlation with nasal obstruction (r = 0.15). There is negative correlation of total individual symptom score with keeping of pets (r = -0.24) or growing of flowers or trees around house (r = -0.039). There is also low correlation of total symptom score with family history of atopy (r = 0.06). There is positive correlation of total symptom score with number of provocative agents identified (r = 0.34). There is low positive correlation of nasal smear eosinophilia with total symptom score (r = 0.030) and itchy nose score (r = 0.038). Nasal smear eosinophilia show negative correlation with sneezing score (r= -0.076).. The best predictors of nasal smear eosinophilia in non-infectious chronic rhinosinusitis are itchy nose score and Individual Total Symptom (ITS) score.

Topics: Adolescent; Adult; Aged; Chronic Disease; Eosinophilia; Female; Health Status Indicators; Humans; Male; Middle Aged; Nose; Occupational Exposure; Pilot Projects; Rhinitis, Allergic, Perennial; Severity of Illness Index; Sinusitis

Rhinosinusitis is an inflammation or infection of the nose and air pockets (sinuses) above, below and between the eyes which connect with the back of the nose through tiny openings (ostia). Rhinosinusitis can be caused by bacteria, viruses, fungi (molds) and possibly by allergies. Chronic rhinosinusitis (CRS) is an immune disorder caused by fungi. The immune response produced by eosinophils causes the fungi to be attacked, which leads to damage of the sinus membranes, resulting in full-blown rhinosinusitis symptoms. Gaseous nitric oxide (NO) is naturally released in the human respiratory tract. The major part of NO found in exhaled air originates in the nasal airways, although significant production of NO also takes place in the paranasal sinuses. Proper ventilation is essential for maintenance of sinus integrity, and blockage of the ostium is a central event in pathogenesis of sinusitis. Concentrations of NO in the healthy sinuses are high. Nasal NO is known to be increased 15- to 20-fold by humming compared with quiet exhalation. NO is known to be broadly antifungal, antiviral and antibacterial. This case report shows that a subject hummed strongly at a low pitch ( approximately 130 Hz) for 1h (18 hums per minute) at bedtime the first night, and hummed 60-120 times 4 times a day for the following 4 days as treatment for severe CRS. The humming technique was described as being one that maximally increased intranasal vibrations, but less than that required to produce dizziness. The morning after the first 1-h humming session, the subject awoke with a clear nose and found himself breathing easily through his nose for the first time in over 1 month. During the following 4 days, CRS symptoms slightly reoccurred, but with much less intensity each day. By humming 60-120 times four times per day (with a session at bedtime), CRS symptoms were essentially eliminated in 4 days. Coincidentally, the subject's cardiac arrhythmias (PACs) were greatly lessened. It is hypothesized that strong, prolonged humming increased endogenous nasal NO production, thus eliminating CRS by antifungal means.

Topics: Chronic Disease; Complementary Therapies; Humans; Male; Middle Aged; Nasal Mucosa; Nitric Oxide; Nose; Respiration; Respiratory Sounds; Rhinitis; Sinusitis

The aim of this study was to evaluate the effects of Staphylococcus aureus exotoxin B (SE-B) on proinflammatory cytokine/chemokine releases in primary nasal epithelial cell cultures (NECC) of subjects with and without chronic rhinosinusitis (CRS).. NECC (CRS: n = 14;. n = 11) were stimulated with SE-B. Protein concentrations of interleukin-(IL)-1beta, IL-6, and IL-8 levels were measured in NECC supernatants by ELISA before (T0) and after 24 hr stimulation with SE-B (T1).. T0: supernatants of the NECC of CRS patients contained significant lower levels of IL-8 (2.1 ng/ml) compared to CONTROLS (IL-8: 6.2 ng/ml; P < 0.01). T1: SE-B induced a significant increase of IL-6 in NECC (P < 0.001). IL-1beta was not detectable.. This is the first study evaluating the effects of exotoxins on NECC. SE-B showed proinflammatory effects on NECC.. Our data suggest that resident NECC are involved in immunological responses to Staphylococcus aureus toxins, supplementing the so-called "superantigen hypothesis" in CRS.

Topics: Cells, Cultured; Chronic Disease; Culture Media, Serum-Free; Epithelial Cells; Exotoxins; Humans; Interleukin-1; Interleukin-6; Interleukin-8; Nose; Rhinitis; Sinusitis; Staphylococcus aureus; Superantigens

The objective of this study was to evaluate the incidence of bronchopulmonary dysplasia (BPD), nutritional intake, and growth in premature infants receiving synchronized nasal intermittent positive-pressure ventilation (SNIPPV) versus nasal continuous positive airways pressure (NCPAP) after extubation, at an institution with no prior experience with SNIPPV. This was a retrospective case-control study of infants (born May 2000 to December 2003) at < or = 32 weeks gestation. Extubation to SNIPPV was performed in accordance with a standardized protocol. Infants in the control group were extubated to NCPAP, as per standard nursery practice. There were no significant differences in the maternal characteristics, antenatal corticosteroid use, mode of delivery, gestational age, birthweight, male gender, Apgar scores at 1 and 5 minutes, number of surfactant doses, and duration of endotracheal tube PPV between infants in the control group (n = 30) and those extubated to SNIPPV (n = 30). The duration of NCPAP (median [range]: control versus SNIPPV, 601 [24 to 1270] versus 230.5 [36 to 1200] hours; P < 0.001) and supplemental oxygen (mean +/- standard error of the mean: 84.10 +/- 6.43 versus 63.68 +/- 5.34 days; p = 0.02) was significantly lower in the SNIPPV group. The number of infants with BPD was significantly less in the SNIPPV group (73% versus 40%; p < 0.01). There were no differences between the two groups in total days on parenteral nutrition, caloric intake (total, carbohydrate, protein, or fat), or weight gain. Our results show that introduction of SNIPPV in a neonatal intensive care unit resulted in infants having significantly less need for supplemental oxygen and decreased BPD, without affecting their weight gain or the incidence of other short-term morbidities.

Topics: Adult; Bronchopulmonary Dysplasia; Case-Control Studies; Chronic Disease; Energy Intake; Female; Humans; Incidence; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Intensive Care, Neonatal; Intermittent Positive-Pressure Breathing; Male; Maternal Age; Nose; Oxygen Inhalation Therapy; Retrospective Studies; Treatment Outcome

We describe a patient with localized chronic fibrosing vasculitis who presented with a rhinophymalike eruption of the nose. To our knowledge, the manifestation of this condition on the nose has not been previously reported. The differential diagnosis also is examined.

Topics: Chronic Disease; Fibrosis; Humans; Male; Middle Aged; Nose; Skin Diseases; Vasculitis

To evaluate the access to the frontal recess by identifying the agger nasi cell and uncinate process.. Forty-seven patients (85 sides) who underwent endoscopic frontal sinus surgery in our department constituted the study population. Computed tomographic (CT) scans of the sinuses were obtained in coronal and axial views. The frontal ostium was identified by using agger nasi cell approach or identifying the uncinate process.. The frontal sinus ostium was identified in 100% of patients (85 sides). After an average follow-up of 9 months, 41 sides of 49 sides (84%) had endoscopically healed sinuses by using agger nasi cell approach. And 21 sides of 36 sides (81%) had endoscopically healed sinuses by identifying the uncinate process.. The agger nasi cell approach to the frontal recess gives an access and allows identification of the frontal ostium. In addition, it provides direct visualization with a 0 degree endoscope into the frontal recess.

Topics: Adult; Chronic Disease; Endoscopy; Female; Frontal Sinus; Humans; Male; Middle Aged; Nasal Cavity; Nose; Paranasal Sinuses; Sinusitis

Topics: Chronic Disease; Face; Humans; Masks; Nose; Respiration, Artificial; Respiratory Insufficiency

Recent laser and radiofrequency techniques for the treatment of snoring have provided improvements, but intraoperative and postoperative risks, complications, and long-term results have not been explored in a statistically large enough sample of patients. The goal of this article is to provide practitioners with important data and guidelines to help them in decision-making and prepare them to anticipate problems and recommend a systematic approach to avoid or treat complications.. This investigation was a retrospective review of 5,600 cases, performed over a 10-year period by a single investigator, in a private practice setting. The data on complications were gathered from chart review as well as questionnaires filled out on each patient and by patient reports. The inclusion criteria for this review were: 1) patients with a history of chronic snoring or nasal congestion; 2) patients with an American Society of Anesthesiologists physical status classification (ASA) Classes I or II medical history; 3) patients provide a detailed preoperative snoring questionnaires; 4) patients provide informed consent; 5) patients were followed for a minimum of 2 years following surgery; 6) patients completed a comprehensive postoperative survey; 7) operative report stating the exact nature of any complications; 8) surgeons provided a clinical assessment; 9) sleep apnea reports if available; and 10) patient body mass index of less than 30 kg/m2.. Laser-assisted uvulopalatopharyngoplasty (LA-UPPP) was used for the treatment of snoring and mild obstructive sleep apnea in all cases; 40% of patients also had simultaneous nasal radioablation. No fatalities were recorded and fewer than 3% of patients had long-term complications. The most common intraoperative complication was bleeding, which occurred in 9.5% of patients.. Reducing the amount of tissue resected from the soft palate helped reduce or eliminate the common complications of traditional uvulopalatopharyngoplasty procedures. LA-UPPP and radioablation procedures are effective, safe, and can be carried out in an office setting equipped with anesthesia monitors and services. The complications associated with the procedure were rare and usually manageable.

Topics: Adult; Aged; Blood Loss, Surgical; Catheter Ablation; Chronic Disease; Female; Follow-Up Studies; Hiccup; Humans; Laser Therapy; Male; Middle Aged; Nose; Nose Diseases; Palate, Soft; Pharynx; Postoperative Complications; Retrospective Studies; Rhinitis; Safety; Sleep Apnea, Obstructive; Snoring; Treatment Outcome; Uvula

To determine radiographic, magnetic resonance imaging (MRI), computed tomography (CT), and rhinoscopic features of nasal aspergillosis in dogs.. Prospective study.. 15 client-owned dogs.. All dogs had clinical signs of chronic nasal disease; the diagnosis of nasal aspergillosis was made on the basis of positive results for at least 2 diagnostic tests (serology, cytology, histology, or fungal culture) and detection of typical intrasinusal and intranasal fungal colonies and turbinate destruction via rhinoscopy. Radiography, MRI, and CT were performed under general anesthesia. Rhinoscopy was repeated to evaluate lesions and initiate treatment. Findings of radiography, MRI, CT, and rhinoscopy were compared.. MRI and CT revealed lesions suggestive of nasal aspergillosis more frequently than did radiography. Computed tomography was the best technique for detection of cortical bone lesions; the nature of abnormal soft tissue, however, could not be identified. Magnetic resonance imaging allowed evaluation of lesions of the frontal bone and was especially useful for differentiating between a thickened mucosa and secretions or fungal colonies; however, fungal colonies could not be differentiated from secretions. Rhinoscopy allowed identification of the nature of intranasal and intrasinusal soft tissue but was not as useful as CT and MRI for defining the extent of lesions and provided no information regarding bone lesions.. The value of CT and MRI for diagnosis of nasal aspergillosis was similar and greater than that of radiography. Rhinoscopy is necessary because it is the only technique that allows direct visualization of fungal colonies.

Topics: Animals; Aspergillosis; Chronic Disease; Diagnosis, Differential; Dog Diseases; Dogs; Endoscopy; Female; Magnetic Resonance Imaging; Male; Nose; Nose Diseases; Prospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

The Caldwell-Luc operation for treatment of medically refractory chronic maxillary sinusitis has largely been replaced by functional endoscopic sinus surgery. Despite this change, the Caldwell-Luc procedure still has well documented indications including treatment of both failed endoscopic middle meatus antrostomy and irreversible mucosal changes. The purpose of the study was to review the authors' experience and results of Caldwell-Luc procedure after failed endoscopic middle meatus antrostomy in patients clinically deemed to have irreversible mucosal changes.. Retrospective review of preoperative and postoperative results of patients who underwent Caldwell-Luc procedure for refractory chronic maxillary sinusitis after failed endoscopic middle meatus antrostomy.. The preoperative and postoperative clinical course of patients treated with Caldwell-Luc procedure performed by a single surgeon between 1996 and 2001 were reviewed. Only patients with a history of chronic sinusitis after failed maximal medical therapy, no prior Caldwell-Luc procedure, prior endoscopic middle meatus antrostomy, and at least 6 months of follow-up were included. Outcome measurements including documented endoscopic examinations and the need for repeat surgery, and postoperative computed tomography scan results were evaluated to assess treatment success.. The study involved 11 men and 26 women who underwent 50 Caldwell-Luc procedures. Caldwell-Luc procedure was performed bilaterally in 13 patients. The average number of prior endoscopic middle meatus antrostomies before Caldwell-Luc procedure was 2. Of all patients, 92% responded to surgical treatment as demonstrated by an endoscopic examination or computed tomography scan revealing a disease-free maxillary sinus. Repeat Caldwell-Luc procedure was required in 8.0% (n = 3) because of continued sinusitis. Two of the three cases with repeat Caldwell-Luc procedures demonstrated clinical improvement during follow-up. Average follow-up was 23.5 months.. Caldwell-Luc procedure seems to be highly effective in the management of medically refractory chronic sinusitis after failed endoscopic middle meatus antrostomy. Caldwell-Luc procedure should remain in the otolaryngologist's surgical repertoire for these selected cases.

Topics: Chronic Disease; Endoscopy; Female; Humans; Male; Maxillary Sinus; Maxillary Sinusitis; Middle Aged; Nose; Reoperation; Retrospective Studies; Treatment Outcome

Rhinosinusitis represents one of the most common chronic diseases. The association of rhinosinusitis with asthma has been frequently reported. Eosinophils and Th2 cells play a pathogenic mechanism in asthma.. The aims of the study were to evaluate the cytokine pattern in chronic rhinosinusitis in asthmatic children and to compare the findings in allergic vs. non-allergic asthmatics.. Thirty-five asthmatic children were evaluated, 19 males and 16 females, with an average age of 8.7 years. All children were asthmatic and suffered from chronic rhinosinusitis. Twenty were allergic and 15 were non-allergic. Ten healthy children were studied as normal controls. Evaluated parameters were the levels of the following cytokines: IL-1beta, IL-4, IL-6, IL-8, IL-12, IFN-gamma and TNF-alpha. Cytokines were recovered from rhinosinusal lavage and measured by immunoassays. Nasal cytology was also performed in all subjects and inflammatory cells were counted by conventional staining.. Allergic subjects showed a significant increase of IL-4 (P < 0.01) and TNF-alpha (P < 0.05) and a significant decrease of IL-12 (P < 0.05) and of IFN-gamma (P < 0.0001), whereas IL-1beta, IL-6 and IL-8 were not significantly increased. Non-allergic children showed a significant increase of IL-4 (P < 0.05) and a significant decrease of IFN-gamma (P < 0.0001), IL-12 was not significantly decreased, and IL-1beta, IL-6 and IL-8 were not significantly increased. A significant inflammatory infiltrate was present in all asthmatic children. Significant correlations were demonstrated between IL-4 and IL-12 (P < 0.001), IL-12 and IFN-gamma (P < 0.001), IL-8 and neutrophils (P < 0.01), and TNF-alpha and monocytes/macrophages (P < 0.05), in allergic asthmatics. IL-4 and IL-12 were significantly correlated (P < 0.05) as well as IL-8 and neutrophils (P < 0.01) in non-allergic asthmatics.. This study shows that allergic asthmatic children with chronic rhinosinusitis have a typical Th2 cytokine pattern, but also non-allergic asthmatic children share a similar pattern. These findings would suggest the existence of a common pathophysiological mechanism shared by upper and lower airways and are consistent with the concept of united airways disease.

Topics: Asthma; Child; Child Welfare; Child, Preschool; Chronic Disease; Cytokines; Female; Forced Expiratory Volume; Humans; Male; Nose; Phagocytes; Rhinitis; Severity of Illness Index; Sinusitis; Statistics as Topic

Rigid fixation has been used over the past 20 years for the long-lasting correction of traumatic and congenital craniofacial defects. It has been noted that the use of plates and screws can result in the migration of the hardware through the skull to the inner cerebral cortex where it embeds in the dura. In addition, there is controversy concerning the safety of using titanium plates in the pediatric population. We report here on an 8-year-old boy who presented to our clinic with a chronic headache after rigid craniofacial fixation using titanium plates 7 years before.

Topics: Bone Plates; Bone Screws; Child; Chronic Disease; Craniosynostoses; Craniotomy; Dura Mater; Foreign Bodies; Foreign-Body Migration; Headache; Humans; Male; Nose

We report 3 new cases of a centrofacial destructive process associated with chronic nasal abuse of cocaine. This complex first described in 1988 is a rare entity involving sinonasal tract necrosis after cocaine abuse. Of special interest in this report is a male patient with columella and lip involvement instead of the more usual rhinopalatal destruction. This cocaine abuse complex should be included in the differential diagnosis of centrofacial midline destructive processes in young patients as the first diagnostic possibility. We suggest a management strategy for these patients.

Topics: Adult; Bone Transplantation; Chronic Disease; Cocaine-Related Disorders; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Nose Diseases; Oral Fistula; Oroantral Fistula; Palatal Obturators; Respiratory Tract Fistula; Rhinoplasty; Surgical Flaps; Turbinates

The present study was designed to investigate the significance and the relationship between nasal carriage of Staphylococcus aureus and staphylococcal skin infections. Thirty-one S. aureus strains, isolated from 12 patients with chronic and recurrent skin infections, one patient with septicemia and one patient with otitis externa were studied. The staphylococcal strains were isolated from the site of infection and from the anterior nares of each patient. The identity of both strains of each pair could be demonstrated by determination of phenotypic properties and by genotyping of the isolates. The phenotypic properties included hemolytic activities, antibiotic resistance data, and the production of enterotoxins. The identity was additionally confirmed by phage-typing, by determination of the size and the number of repeats of the X region of spa gene, by determination of gene polymorphisms of coa gene and by macrorestriction analysis of the chromosomal DNA of the isolates by pulsed-field gel electrophoresis. The present results showed an identity of the S. aureus obtained from anterior nares and from skin infection of each patient indicating the importance of nasal carriage of these bacteria for development of human skin infection.

Topics: Bacteriophage Typing; Carrier State; Chronic Disease; Disease Susceptibility; Electrophoresis, Gel, Pulsed-Field; Enterotoxins; Genes, Bacterial; Genotype; Humans; Microbial Sensitivity Tests; Nose; Otitis; Polymerase Chain Reaction; Polymorphism, Genetic; Restriction Mapping; Skin; Staphylococcal Skin Infections; Staphylococcus aureus

We performed nasal lavage (NAL) combined with induced sputum to determine exudative inflammation in the upper and lower airways in patients with chronic sinusitis and in controls. To monitor plasma exudation into the respiratory lumen and loss of size-selectivity of the mucosa, we determined the sample-to-serum ratio of albumin and alpha-2-macroglobulin, Qa1b and Qa2m, and the dilution independent Relative Coefficient of Excretion, RCE=Qa2m/Qa1b. To detect low protein levels in NAL and induced sputum we adapted an ELISA system for alpha-2-macroglobulin described by Out et al. [Clin. Chim. Acta, 165 (1987) 277-288], and modified this into a sensitive ELISA for albumin. Dithiothreitol, added to increase sputum solubility, did not interfere with the analysis, nor did N-ethylmaleimide, added to block dithiothreitol. In this study plasma exudation in induced sputum is significantly increased in patients with chronic sinusitis, compared to controls. Plasma exudation in NAL is also increased in patients, although not significant. The RCE in NAL and sputum is well-correlated in one of the three study visits. There is much variation in sample protein-levels partly due to differences in dilution and the heterogeneity of the studied population. Determination of plasma exudation together with RCE in NAL and induced sputum is a good, non-invasive way to quantify inflammation of airway mucosa.

Topics: Adult; Aged; alpha-Macroglobulins; Chronic Disease; Enzyme-Linked Immunosorbent Assay; Female; Humans; Male; Middle Aged; Nasal Lavage Fluid; Nose; Serum Albumin; Sinusitis; Sputum; Therapeutic Irrigation

Oral respiration associated with an obstructed nasal airway is common in orthodontic patients. For several years chronic oral respiration has been implicated as a prime causative factor in the development of "adenoid facies or the "long-face syndrome. The animal experiment reported here begins a series designed to study, as separate variables, the 2 components of chronic oral respiration: (1) chronic absence of active nasal respiration and 2) chronic mouth opening to find out what dentofacial changes can be attributed to chronic absence of active nasal respiration alone. In this pilot study, 5 growing dogs underwent tracheotomy so that significant active nasal respiration was not possible and oral respiration was not essential.

Topics: Animals; Cephalometry; Chronic Disease; Dental Arch; Disease Models, Animal; Dogs; Facial Bones; Facies; Female; Male; Malocclusion; Mandible; Maxilla; Mouth Breathing; Nasal Obstruction; Nose; Palate; Pilot Projects; Respiration; Skull; Syndrome; Tracheotomy; Zygoma

Low-dose, long-term macrolide treatment has recently been reported to be very effective in patients with chronic airway diseases. We examined the in vivo and in vitro effects of 14-membered macrolide antibiotics erythromycin (EM) and clarithromycin (CAM) on interleukin (IL)-8 secretion from human nasal epithelial cells. Fifteen patients with chronic sinusitis received macrolide treatment (CAM 400 mg/day) for 1 to 3 months. The number of infiltrated neutrophils and IL-8 concentrations in the nasal discharges of these patients decreased significantly at 1 to 2 months after the treatment. In vitro effects of EM and CAM on IL-8 secretion were examined in nasal epithelial cells cultured at the air-liquid interface. After 14-day culture in the air-liquid interface, macrolide antibiotics were added in medium for 24 h. EM and CAM at concentrations of 10(-4) M did not affect spontaneous secretions or IL-1 beta-induced secretions of IL-8 either apically or basolaterally. When cells were preincubated with 10(-4) M CAM for 7 days, the IL-1 beta-induced secretion of IL-8 decreased significantly. However, no difference was observed between the effects of 10(-4) M CAM and 10(-4) M josamycin, a 16-membered macrolide. These results suggest that macrolide treatment inhibits neutrophil infiltration and IL-8 secretion in nasal epithelium in vivo and that these clinical effects depend on a mechanism other than the direct action of macrolide on nasal epithelial cells.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cells, Cultured; Child; Chronic Disease; Clarithromycin; Drug Administration Schedule; Epithelium; Erythromycin; Humans; Interleukin-1; Interleukin-8; Middle Aged; Nasal Mucosa; Neutrophils; Nose; Sinusitis

Topics: Adult; Biopsy; Chronic Disease; Esophagoscopy; Gastritis; Gastroesophageal Reflux; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Male; Nose; Polyps; Vocal Cords

Topics: Chronic Disease; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Nose; Pharynx; Respiratory Tract Infections; Staphylococcus aureus

The reported association of allergy and sinusitis varies greatly between study, and the exact role of allergy in predisposing to sinusitis is not clear. We attempted to determine whether patients with perennial allergic rhinitis are at greater risk of developing sinusitis with respect to a control group, and to determine whether there is a correlation between rhinomanometry, endoscopy, and nasal swab, and computed tomography (CT) findings.. Forty adult patients with perennial allergic rhinitis underwent CT scans of the paranasal sinuses, and the results were then compared to CTs of the paranasal sinuses of 30 control subjects. All allergic patients underwent nasal endoscopy, nasal swab, and active anterior rhinomanometry, and the results were studied in relation to the CT findings.. We found sinusitis in 67.5% of the allergic patients and in 33.4% of the controls, with a statistically significant difference between the two groups (P = 0.017). Twenty-three patients had a positive nasal swab; 22 showed increased nasal resistance on rhinomanometry, and 36 had positive endoscopy, but the association of CT findings with endoscopy, rhinomanometry, or nasal swab was not statistically significant (P = 0.583, P = 1.00, P = 0.506, respectively).. Allergic rhinitis is often associated with sinusitis, but the underlying mechanism has yet to be determined. Evidently, factors other than classical pathogen growth and mechanical factors, such as the association of the various factors and immunologic mechanisms, may contribute to the pathogenesis of chronic sinusitis in allergic patients.

Topics: Adolescent; Adult; Airway Resistance; Antigens, Dermatophagoides; Case-Control Studies; Chronic Disease; Endoscopy; Female; Glycoproteins; Humans; Male; Middle Aged; Nasal Cavity; Nasal Mucosa; Nose; Paranasal Sinuses; Rhinitis, Allergic, Perennial; Risk Factors; Sinusitis; Skin Tests; Tomography, X-Ray Computed

Topics: Chronic Disease; Cranial Nerve Diseases; Female; Habits; Humans; Middle Aged; Nose; Reflex; Sensation Disorders; Skin Ulcer; Syndrome; Trigeminal Nerve

To measure route of breathing in chronic asthmatic patients during and after an acute severe exacerbation.. Thirteen asthmatic patients were studied during hospital admission for acute asthma and, in 9 patients, again when asymptomatic. Nine healthy subjects were also studied.. Spontaneous route of breathing was qualitatively assessed using oral and nasal thermistor probes, and was then quantified using a dual compartment face mask with attached pneumotachographs.. All asthmatic patients had severe bronchoconstriction initially (FEV(1), 46 +/- 3% of predicted) that had resolved at follow-up (FEV(1), 91 +/- 6% of predicted). No healthy subject had evidence of bronchoconstriction (FEV(1), 102 +/- 5% of predicted). During acute asthma, 11 asthmatics were spontaneously breathing oronasally, as assessed using thermistor probes, while all 13 breathed oronasally via face mask. When assessed using thermistor probes, seven of nine asymptomatic asthmatic patients studied were breathing exclusively via the nose; however, all breathed oronasally via face mask. In contrast, while eight of nine healthy subjects were also breathing exclusively via the nose when assessed using thermistor probes, all breathed nasally only via face mask.. Thus, when asymptomatic and at rest, asthmatic patients breathe exclusively via the nose. However, during acute exacerbations of asthma, these patients switch to oronasal breathing. Unlike healthy subjects, chronic asthmatic patients also switch to oronasal breathing when wearing a face mask, irrespective of the degree of bronchoconstriction. We speculate that asthmatics may have an increased tendency to switch to oral breathing, a factor that may contribute to the pathogenesis of their asthma.

Topics: Adult; Asthma; Bronchoconstriction; Chronic Disease; Female; Forced Expiratory Volume; Humans; Male; Middle Aged; Mouth; Nose; Respiration

Coronal computerized tomography (CT) scanning is imperative in the preoperative work-up for functional endoscopic sinus surgery (FESS). This study describes additional information provided by lateral CT reconstruction with special attention to the (naso-) frontal recess. Thin axial scans were taken from 10 patients suffering from chronic rhinosinusitis. This procedure avoided artefacts from dental fillings on the computerized reconstructions. The common landmarks of the lateral nasal wall as described in the surgical anatomy of FESS were easily identified on sagittal views. The average angulation of the sagittal plane from the midline required to obtain optimal images of the frontal recess was antero-posteriorly 8.7 degrees (SD, 2.4), cranio-caudally 7.7 degrees (SD, 2.6). Size and condition of the frontal recess could be demonstrated. Variations of the angle between frontal sinus and ethmoid infundibulum appeared to depend on the anterior projection of the frontal sinus and may give an indication as to the optimal endoscopic angle for visualization of the frontal ostium. Sagittal reconstructions provide information for better spatial orientation particularly in the plane of the surgical approach and may help to diagnose underlying functional changes of chronic frontal sinusitis.

Topics: Chronic Disease; Endoscopy; Humans; Image Processing, Computer-Assisted; Nose; Paranasal Sinuses; Sinusitis; Tomography, X-Ray Computed; Turbinates

The purpose of this study was to evaluate the applicability of virtual endoscopy (VE) in the region of the nose and paranasal sinuses on the basis of volume-rendered spiral CT data. Forty-five patients underwent a low-dose spiral CT of the sinuses. The data were transferred to a workstation running software for volume rendering (EasyVision, Philips Medical Systems, Eindhoven, The Netherlands). Six orthogonal views of the maxillary sinuses and the nasopharynx and a fly-through movie of the nose were calculated. Two radiologists evaluated the coronal reconstructions and virtual endoscopy with respect to detectability of pathology using a checklist comprising 10 points. In 30 patients who underwent subsequent endoscopic surgery, surgeons were asked to rank the degree of assistance of the preoperative virtual endoscopy. In general, virtual endoscopy was possible in all 45 patients. The mean time required for path definition and movie calculation for virtual endoscopy were 8 (+/- 2) min and 3 (+/- 1) min, respectively. Overall, more anatomical details were depicted on coronal reconstructions; however, a high degree of similarity between virtual endoscopy and the intraoperative impression was reported by the surgeons. We conclude that virtual endoscopy of the nose and paranasal sinuses may develop into a standard means to guide surgeons during endoscopic interventions.

Topics: Adolescent; Adult; Chronic Disease; Endoscopy; Humans; Image Processing, Computer-Assisted; Maxillary Sinus; Maxillary Sinusitis; Middle Aged; Nose; Radiography

Thirty-three subjects with chronic rhinitis used nicotine nasal spray in an open study as an aid in smoking cessation. Thirty-eight percent of them were completely abstinent at 12 weeks, whereas 35% were completely abstinent at 20 weeks. The nasal spray was associated with irritant nasal side effects, which occurred most often in the early stages of treatment. Clinical nasal examinations could not observe any significant impairment in nasal conditions following spray use. In conclusion, this study confirms the short-term safety of the nicotine nasal spray as an aid in smoking cessation.

Topics: Administration, Intranasal; Adult; Aerosols; Aged; Cell Nucleus; Chronic Disease; Cilia; Cytoplasm; Epithelial Cells; Evaluation Studies as Topic; Female; Follow-Up Studies; Goblet Cells; Humans; Irritants; Male; Middle Aged; Nasal Mucosa; Nicotine; Nicotinic Agonists; Nose; Peak Expiratory Flow Rate; Rhinitis; Safety; Smell; Smoking; Smoking Cessation; Smoking Prevention

Seventy-six patients with oroantral communications after tooth extraction and chronic maxillary sinusitis were treated as follows: bacterial cultures were taken in all of them and maxillary sinuses were irrigated with an antibiotic from the cephalosporin group. Then, in 36 patients, drainage using the Caldwell Luc procedure was performed, including a naso-antral window. In all patients operations were completed by closing oroantral communications with flaps of the mucosa of the alveolar process close to the fistula. Antibiotics according to antibiogram were administered to all patients at least 10 days after surgery. Retrospective comparison between the results obtained in the first group and those in the second group 1, 3 and 6 months after operation was based on objective findings (condition of the oroantral communication, maxillary sinusitis), side effects (pain, numbness of the operated area, headache) and control radiographs (clear maxillary sinus or with mucosal thickening). The study suggests that transnasal drainage is not required in maxillary sinus surgery and in the closure of oroantral communications. Equally good results are achieved by treating with antibiotics and without drainage of the maxillary sinus into the nose.

Topics: Cephalosporins; Chronic Disease; Drainage; Follow-Up Studies; Headache; Humans; Maxillary Sinus; Maxillary Sinusitis; Mouth Mucosa; Nose; Oroantral Fistula; Pain, Postoperative; Radiography; Recurrence; Retrospective Studies; Sensation Disorders; Staphylococcal Infections; Streptococcal Infections; Surgical Flaps; Therapeutic Irrigation; Tooth Extraction

Patients born with cleft lip and palate (CLP) present with a variety of nasal deformities. These are either congenital or iatrogenic. Our aim was to establish a correlation between aesthetic and functional nasal impairments in patients with CLP whose nasal reconstruction had been delayed. Fifty-four randomly selected patients with CLP deformities, all of whom had delayed nasal repairs were evaluated objectively, aesthetically in three planes, and functionally for symptoms of nasal obstruction, chronic maxillary sinusitis, and olfactory disturbances. Aesthetically the patients were analysed from 1:1 life-size full face, profile, and submental-vertex photographs, and full skull cephalograms. Nasal patency was assessed by rhinomanometry. The presence of chronic maxillary sinusitis and olfactory disturbances were deduced from the history. The degree of nasal dismorphism correlated with the severity of nasal functional impairments. Delayed nasal repairs in patients with CLP did not produce satisfactory aesthetic or functional results, probably because growth was retarded and midfacial development was disturbed at the time of delayed rhinoplasty and resulted in asymmetry. In CLP the nose should be repaired during the early primary cheilorhinoplasty, as this is essential for the restoration of a normally functioning and aesthetically pleasing nose.

Topics: Adolescent; Adult; Cephalometry; Chronic Disease; Cleft Lip; Cleft Palate; Esthetics; Evaluation Studies as Topic; Facial Asymmetry; Facial Bones; Female; Humans; Iatrogenic Disease; Male; Maxillary Sinusitis; Nasal Obstruction; Nose; Nose Deformities, Acquired; Nose Diseases; Olfaction Disorders; Photography; Postoperative Complications; Pulmonary Ventilation; Rhinoplasty; Time Factors; Treatment Outcome

Endonasal dacryorhinocystostomy is a surgical procedure performed to re-establish continuity of the lacrimal duct by partial diversion followed by dilatation. A simultaneous rhinologic and ophthalmologic approach is used. This simple and elegant procedure that results in no residual scarring is indicated for any blockage of the lacrimal duct due to congenital or acquired causes. Except for children under 6 years of age and in patients in poor general condition, contra-indications are uncommon. Operative and postoperative complications are rare. After a review of the relevant anatomy the authors of this report describe the equipment and basic techniques used to perform dacryorhinocystostomy. Endonasal dacryorhinocystostomy was performed in 15 patients presenting chronic (n = 14) or acute (n = 1) dacryocystitis in Madagascar. At six months follow-up the procedure was successful in 14 cases and unsuccessful in one case due a cutaneous fistula. Because it is simple and well-tolerated and results in no residual scarring, endonasal dacryorhinocystostomy is the method of choice for treatment of lacrimal duct obstruction in tropical areas in general and in Black Africa in particular.

Topics: Acute Disease; Adult; Age Factors; Chronic Disease; Contraindications; Dacryocystitis; Dacryocystorhinostomy; Female; Follow-Up Studies; Humans; Madagascar; Male; Nose

The aim of this study is to show our experience in the surveillance of home mechanical ventilation in pediatric patients.. Between July 1992 and September 1996, 14 patients (20 months to 18 years of age) received home ventilation on 16 occasions. There were 10 boys and 4 girls. Home ventilation lasted from 7 days to 28 months. All patients had chronic respiratory failure secondary to neuromuscular disease, cystic fibrosis or sleep apnea syndrome.. Tolerance was good in 11 patients and bad in 3, 2 of which suffered from cystic fibrosis and died in terminal respiratory failure. The patients who benefited most were those with neuromuscular disease, cyphoscoliosis and sleep apnea syndrome. The technique also has been used for ventilator weaning and as a bridge to lung transplantation.. Home nasal mechanical ventilation is a useful technique for the treatment of chronic respiratory failure in adults and children.

Topics: Adolescent; Adult; Child; Child, Preschool; Chronic Disease; Cystic Fibrosis; Equipment Design; Female; Home Care Services; Humans; Infant; Male; Nose; Respiration, Artificial; Respiratory Insufficiency; Retrospective Studies; Ventilators, Mechanical

To determine the prevalence and clonality of non-toxigenic Corynebacterium diphtheriae biovar gravis in a community with two cases of endocarditis caused by this organism.. A Koorie (Aboriginal) community in Gippsland, eastern Victoria, in 1994.. Nose and throat swabs were collected from 359 community contacts of the cases and cultured for C. diphtheriae. Strains isolated from the contacts were compared by pulsed-field gel electrophoresis (after digestion with Sma1, Not1 and Sfi1) with those from the invasive cases in the same community, another invasive case in Victoria, a cluster of invasive cases in New South Wales (NSW) (1990-1991), and other stored strains isolated from skin ulcers and sore throats.. Non-toxigenic strains of C. diphtheriae biovar gravis were isolated from throat swabs of five of the case contacts. Uniform DNA patterns were found for the two community cases, the other Victorian case, nine of ten isolates from NSW, and the five throat isolates from case contacts.. An invasive clone of C. diphtheriae biovar gravis appears to have been responsible for the three Victorian cases of endocarditis. It was also present among case contacts and responsible for previous invasive cases in NSW. Prophylactic treatment should be considered for clearly defined contacts in all instances where C. diphtheriae is isolated from a normally sterile site, regardless of the toxigenic nature of the strain.

Topics: Adult; Arthritis, Infectious; Australia; Carrier State; Child; Chronic Disease; Corynebacterium diphtheriae; Corynebacterium Infections; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Native Hawaiian or Other Pacific Islander; Nose; Pharynx; Prevalence; Skin Ulcer

Chronic sinusitis is one of the most common diseases treated in outpatient centres. In this prospective study, 49 patients with the diagnosis of chronic maxillary sinusitis were evaluated microbiologically by using sinus swab, irrigation fluid and sinus mucosal tissue specimens obtained during endoscopic sinus surgery. There was no bacterial growth in seven cases. In the remaining 42 cases a total of 89 bacteria were isolated, 28 of them being classical pathogens and 61 being non-classical pathogens. Among the classical pathogens Staphylococcus aureus was the most common one. The correlation between the isolates obtained from maxillary sinus and isolates obtained from throat, nose and nasopharynx did not have a predictive value. Since the overall rate of classical pathogen isolation from patients with chronic sinusitis was not significantly high, the possible role of factors other than bacterial growth should be identified in the pathogenesis of chronic sinusitis.

Topics: Adolescent; Adult; Bacteria, Anaerobic; Chronic Disease; Female; Haemophilus influenzae; Humans; Male; Maxillary Sinus; Maxillary Sinusitis; Middle Aged; Nasopharynx; Nose; Pharynx; Prospective Studies; Staphylococcus aureus; Streptococcus pneumoniae; Streptococcus pyogenes

A case of chronic facial pain and headache is presented. This was found to be due to two pieces of windscreen-glass lodged in the superior meatus of the patient's nose since a road-traffic-accident 14 years earlier. Despite being reported as normal, review of previous X-rays of her sinuses showed that the glass was visible. The importance of carefully assessing the intranasal area on sinus-views is illustrated.

Topics: Accidents, Traffic; Adult; Chronic Disease; Facial Pain; Female; Foreign Bodies; Glass; Humans; Nose; Radiography; Time Factors

Headache associated with acute sinusitis is a well-recognized entity; the diagnosis is easily made due to the associated nasal and sinus symptoms. However, the phenomenon of referred headache from chronic sinusitis or intranasal abnormalities or both without upper respiratory symptoms is not well understood. Only recently have the nasal and sinus cavities been adequately visualized by both the human eye and radiographic techniques; a fact that may account for the historic neglect in considering this region a factor in headache etiology. Modern techniques employed in the workup of sinusitis, namely the use of rigid nasal endoscopes and coronal-plane CT scanning, have greatly enhanced the clinician's ability to evaluate and diagnose pathology in this area. This report describes a series of patients presenting with various primary headache syndromes without significant nasal or sinus symptoms who failed to respond to conventional antiheadache therapy. On nasal endoscopic and coronal CT examinations, various intranasal and sinus abnormalities were found (either anatomic variations or subclinical inflammation). Medical and/or surgical therapy addressing the sinonasal pathology resulted in improvement in every case, ranging from decreased severity of attacks to total resolution of headaches. A model explaining the possible mechanism of referred vascular-type headache from sinus and nasal origin is proposed.

Topics: Adolescent; Adult; Chronic Disease; Endoscopy; Female; Headache; Humans; Male; Middle Aged; Nose; Paranasal Sinuses; Sinusitis; Tomography, X-Ray Computed

The present study was performed to estimate changes of middle ear pressure (ME-P) during actions of daily life such as nose blowing and sniffing. ME-P was measured in 18 patients with perforation of the eardrum. They were asked to perform actions which included nose blowing and sniffing. Eustachian catheterization and politzerization were also applied. Change of ME-P before and after these actions was recorded using a pressure monitor. Results showed that changes of ME-P after nose blowing with both nostrils closed were large and rapid. The mean value of ME-P after nose blowing was 252 mmH2O. In our previous study, the mean value of cerebrospinal fluid pressure (CSF-P) after nose blowing was 388 mmH2O. Therefore, the pressure gradient across the cochlear windows is about 130 mmH2O during nose blowing. The cochlear windows may have been pressed toward the middle ear side. After sniffing, ME-P was unchanged. These results suggest that nose blowing may be an important cause of perilymphatic fistula (PLF) via the "explosive route", while sniffing is not likely to cause PLF.

Topics: Activities of Daily Living; Adolescent; Adult; Aged; Catheterization; Cerebrospinal Fluid Pressure; Chronic Disease; Cochlea; Ear Diseases; Ear, Middle; Eustachian Tube; Female; Fistula; Humans; Male; Middle Aged; Nose; Otitis Media; Otitis Media with Effusion; Perilymph; Pressure; Transducers, Pressure; Tympanic Membrane

To assess nasal resistance in the treated as well as decongested states, two custom-built rhinomanometers (Rhino-Comp, manufactured by Cintec, Sweden, and Rhinomanometer 200, manufactured by Atmos, Germany) were sequentially employed in 53 non-selected consecutive patients referred for chronic or recurring nasal obstruction complaints, using the same active anterior rhinomanometric method. Final mean results from both equipments were submitted to paired statistical analysis. No correlation was found between the R150 results provided by the two rhinomanometers, albeit a 1.26 to 1.30 difference was encountered in the Rhinomanometer 200/Rhino-Comp ratio when the averaged mean values of all R150 results from both equipments were compared, suggesting that the discrepancy could be due to technical specificities intrinsic to each apparatus, with a tendency to produce systematic R150 differences. When the graphic aspect of the curves from both equipments were compared using the Broms system parameter V2 values, a remarkable correlation was seen between Rhino-Comp and Rhinomanometer 200 in expiratory (but not inspiratory) results, suggesting that the expiratory curves produced by the two equipments are graphically similar, at least until the Broms system radius 2 interception. Enough data was also found to support the possibility that the manufacturer's option to use a nose adaptor instead of adhesive tape for anterior nares occlusion with the Rhinomanometer 200 equipment could interfere with nasal vestibular function and thus artificially affect resistance measurements. Finally, patients' preference for either equipment examination procedures are discussed.

Topics: Adolescent; Adult; Aged; Airway Resistance; Child; Chronic Disease; Equipment Design; Female; Humans; Male; Manometry; Microcomputers; Middle Aged; Nasal Obstruction; Nose; Oxymetazoline; Patient Satisfaction; Pulmonary Ventilation; Recurrence; Respiration; Signal Processing, Computer-Assisted

Intranasal sphenoethmoidectomy was originally used primarily for the provision of adequate drainage of acute and subacute bacterial sinusitis. However, the spectrum of inflammatory sinus disease has changed dramatically since the popularization of broad-spectrum antibiotics, and chronic hyperplastic rhinosinusitis has replaced acute sinusitis as the primary indication for ethmoidectomy. In such cases total or almost total disease removal is crucial to providing long-term drainage and ventilation. We describe several modifications of the Yankauer sphenoethmoidectomy technique that enable the sinus surgeon to provide clearance of disease and excellent drainage for all sinuses by complete marsupialization of the sphenoid, ethmoid, and maxillary sinuses. These modifications include (1) complete rather than partial removal of the middle turbinate, (2) extended middle meatal antrostomy with palatine bone resection to the pterygoid process with delineation of the inferior and medial orbital wall, and (3) introduction of operative endoscopes as adjunctive tools in areas inaccessible to conventional visualization. The current technique and results in nearly 2000 procedures are described.

Topics: Chronic Disease; Drainage; Endoscopy; Ethmoid Sinus; Follow-Up Studies; Humans; Hyperplasia; Maxillary Sinus; Nasal Polyps; Nasal Septum; Nose; Orbit; Palate; Postoperative Complications; Recurrence; Rhinitis; Sinusitis; Sphenoid Bone; Sphenoid Sinus; Turbinates

Mycoplasma pulmonis or Myc. pneumoniae were inoculated intranasally to C.B-17 scid/scid mice (severe combined immunodeficient (SCID) mice). Immunocompetent C.B-17 mice were inoculated as controls. During the observation period of 5 weeks the mice were killed and necropsied. Mycoplasma pulmonis was recovered from all of the inoculated mice, and dissemination to various tissues increased with time. SCID mice, unlike immunocompetent mice, did not show lung lesions but exhibited severe inflammatory changes of the joints. Mycoplasma pulmonis, however, was isolated both from the lungs and the articular lesions. In addition, SCID mice infected for more than 3 weeks suffered from a pronounced loss of weight and emaciation. In the experiment with Myc. pneumoniae the agent could be reisolated, but lesions were not found in any of the infected mice. Mycoplasma pulmonis infection in SCID mice may be useful as a model of arthritis in immunodeficient humans.

Topics: Administration, Intranasal; Animals; Arthritis, Infectious; Chronic Disease; Disease Models, Animal; Immunocompetence; Male; Mice; Mice, SCID; Mycoplasma; Mycoplasma Infections; Nose

Chronic sinusitis, in contrast to acute sinusitis, often presents with nonspecific symptoms that may be confused with other disease entities. Due to the cost of computerized tomography and the difficulty in interpreting sinus radiographs in certain children, a search for a simpler screening tool for chronic sinusitis in children was undertaken.. This study was undertaken to provide a quantitative comparison between the methods of wax paper blow and Rhinoprobe scraping for nasal cytology in screening for chronic sinusitis while minimizing selection bias.. Twenty serially selected patients (13 males and seven females) with a mean age of 11 years (range 6-16) were enrolled. Nasal cytology was obtained via two methods: scraping of the turbinate with a Rhinoprobe (Synbiotics Inc.,) and wax paper blow.. The results showed that > or = 5 neutrophils per high power field on Rhinoprobe cytology significantly correlated with radiographic sinusitis (P < .05 by Chi-square and P < .056 by Fisher's exact test). The sensitivity and specificity for > or = 5 neutrophils per high power field were 100% and 53%, respectively. Counts of other nasal cells, such as eosinophils, bacteria, and epithelial cells, did not yield significant correlations with radiographic sinusitis.. We feel that the Rhinoprobe, with criteria of > or = 5 neutrophils per high power field, may be useful as a screen for occult chronic sinusitis in childhood asthma. Confirmation of sinusitis via X-ray is still necessary if neutrophils are present on Rhinoprobe nasal cytology.

Topics: Adolescent; Asthma; Child; Chronic Disease; Female; Humans; Leukocyte Count; Male; Nasal Mucosa; Neutrophils; Nose; Sensitivity and Specificity; Sinusitis; Tomography, X-Ray Computed

Pulse delivery (PD) of oxygen was compared with continuous flow (CF) utilizing transtracheal oxygen catheter (TTO) and nasal cannula (NC) in 20 stable patients with chronic hypoxemia. Oxygen saturation, respiratory rate, and accuracy of pulsed oxygen delivery were measured during sleep studies and these parameters, as well as arterial blood gases, were evaluated during rest and exercise. Additionally, bulk liquid oxygen use was measured under each condition, for a period of 1 month. Pulse delivery NC was evaluated in six subjects, CF NC in 14 subjects, and PD and CF TTO in 20 subjects over the 1-month period. Results showed that, as a group, patients were adequately oxygenated when utilizing the PD with both NC and TTO as assessed by arterial blood gases, oximetry, and hematocrit. However, four subjects could not be adequately oxygenated on PD NC during exercise even at the maximum liter per minute setting and could not be studied with this mode of therapy. The PD settings in the remaining subjects were equivalent to continuous flow settings for TTO and NC as assessed by PaO2 for rest and SaO2 for exercise and sleep. Compared with standard CF NC, the daily bulk oxygen use was decreased by 29.4 percent with CF TTO, by 48.2 percent with PD NC, and by 49.9 percent with PD TTO. We conclude that, compared with CF NC, PD of oxygen via TTO or NC by this method appears to be a safe, reliable, effective, and cost-effective method of oxygen delivery in the majority of subjects when used with proper screening.

Topics: Aged; Analysis of Variance; Bronchiectasis; Catheterization; Chronic Disease; Evaluation Studies as Topic; Exercise Test; Female; Humans; Hypoxia; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen Inhalation Therapy; Polysomnography; Trachea

To examine possible risk factors for relapse, including chronic nasal carriage of Staphylococcus aureus and serial antineutrophil cytoplasmic antibody (ANCA) determinations in patients with Wegener granulomatosis.. Observational cohort study.. Outpatient clinic at a university-affiliated hospital.. Consecutive patients (n = 71) with biopsy-proven Wegener granulomatosis who were seen during follow-up at the outpatient clinic from January 1988 to July 1991. Fourteen patients were ineligible or dropped out; 57 patients were analyzed.. Serial ANCA determinations and swab cultures of both anterior nares for S. aureus taken at each visit every 4 to 6 weeks. Occurrence of infections and relapses of Wegener granulomatosis were identified according to strict, predefined criteria.. Thirty-six of the 57 patients (63%; 95% CI, 49% to 76%) were found to be chronic nasal carriers of S. aureus (> or = 75% of nasal cultures positive for S. aureus). Proportional-hazards regression analysis identified chronic nasal carriage of S. aureus (adjusted relative risk, 7.16; CI, 1.63 to 31.50), creatinine clearance above 60 mL.min-1 (adjusted relative risk, 2.94; CI, 1.27 to 6.67), and a history of previous relapses of Wegener granulomatosis (adjusted relative risk, 1.33; CI, 0.98 to 1.78) as independent risk factors for relapse. Twenty-two of 33 patients persistently or intermittently positive for ANCA had a relapse as opposed to only 1 of 21 persistently negative patients. Relapses of Wegener granulomatosis were not related to diagnosed infections.. Chronic nasal carriage of S. aureus identifies a subgroup of patients with Wegener granulomatosis who are more prone to relapses of the disease, suggesting a role for S. aureus in its pathophysiology and a possible clue for treatment.

Topics: Adult; Aged; Antibodies, Antineutrophil Cytoplasmic; Autoantibodies; Biomarkers; Carrier State; Chronic Disease; Cohort Studies; Female; Granulomatosis with Polyangiitis; Humans; Male; Middle Aged; Nose; Proportional Hazards Models; Recurrence; Risk Factors; Staphylococcal Infections

Topics: Chronic Disease; Humans; Nose; Paranasal Sinuses; Rhinitis; Sinusitis

Functional endonasal sinus surgery (FESS) is becoming the procedure of choice for the surgical treatment of chronic and recurrent sinusitis in adults and children. Retrospective analysis of the charts of 513 adult and 260 pediatric patients who underwent FESS after failing to respond to optimal medical treatment revealed an improvement rate of approximately 80% for both age groups. Although high response rates and low complication rates were found for both groups, there were significant differences in indications, preoperative evaluation, operative technique, and methods of postoperative follow-up for children.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Chronic Disease; Endoscopes; Epistaxis; Female; Follow-Up Studies; Humans; Infant; Male; Middle Aged; Nose; Postoperative Complications; Radiography; Recurrence; Reoperation; Retrospective Studies; Sinusitis; Surgical Instruments; Tissue Adhesions

Functional endoscopic sinus surgery (FESS) is being advocated to treat children with chronic sinusitis. The surgeon performing FESS needs an intimate understanding of the anatomy to adequately treat disease and avoid complications. One hundred thirty-six patients who had endoscopic sinus surgery were reviewed. Preoperative direct coronal computed tomography scans were available for review in 114 patients. Several nasal and paranasal sinus anomalies were uncovered during this evaluation. The most common was hypoplasia of the maxillary sinuses. All hypoplastic maxillary sinuses had diseased mucosa. Eleven patients were found to have a laterally deviated uncinate process and abnormal anatomy of the maxillary ostia. Other anomalies such as concha bullosa, Haller's cells, and paradoxic curvature of the middle turbinate were found, and their respective frequencies in this population were determined.

Topics: Adolescent; Adult; Cartilage; Child; Child, Preschool; Chronic Disease; Endoscopy; Female; Humans; Infant; Male; Maxillary Sinus; Maxillary Sinusitis; Mucous Membrane; Nasal Mucosa; Nose; Paranasal Sinuses; Retrospective Studies; Sinusitis; Tomography, X-Ray Computed; Turbinates

The value of pernasal swabs and direct adenoid swabs in chronic adenoid and adenotonsillar disease was assessed in 175 patients. Prior to adenoidectomy (53 patients) or adenotonsillectomy (122 patients), pernasal and direct adenoid swabs were taken. Adenoid currettings and tonsil tissue were cultured. Haemophilus influenzae was the bacterium most frequently isolated from adenoid currettings and from the centre (core) of the resected tonsil. There was a close relationship between the bacteriology of the pernasal swab and the adenoid tissue and tonsil core in 72 and 71% of patients, respectively. There was an identical profile of pathogens in 52 and 49%, respectively. We suggest that in children with adenoiditis or adenotonsillitis and hypertrophy of the adenoid, a pernasal swab should be used in preference to a throat swab in selecting appropriate antimicrobial therapy. Penicillin and ampicillin are not appropriate blind therapy in chronic adenoid and adenotonsillar infections because of the prevalence of beta-lactamase-producing aerobes (40%) in adenoid and tonsil core in these conditions.

Topics: Adenoidectomy; Adenoids; Adolescent; Ampicillin; Bacteriological Techniques; beta-Lactamases; Child; Child, Preschool; Chronic Disease; Contraindications; Culture Techniques; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Hypertrophy; Male; Nose; Palatine Tonsil; Penicillins; Pharynx; Pneumococcal Infections; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Tonsillectomy; Tonsillitis

The purpose of this study was to determine the frequency of immunoglobulin deposition in the haired skin, footpads, and nasal planums of 10 WHV-infected woodchucks with chronic hepatitis and hepatocellular carcinoma and compare these results with those reported in humans. Immunoglobulin deposition was detected in the skin samples of 3 of 10 woodchucks. Granular deposits were revealed in the superficial dermal blood vessels of the nasal planum, lateral thoracic skin, and footpads in 1 animal each. In 1 of these animals, (lateral thorax) immunoglobulin deposition was concurrently present at the basement membrane zone.

Topics: Animals; Biopsy, Needle; Carcinoma, Hepatocellular; Chronic Disease; Disease Models, Animal; Female; Fluorescent Antibody Technique; Foot; Hair; Hepadnaviridae; Hepatitis, Viral, Animal; Immunoglobulins; Liver Neoplasms; Male; Marmota; Nose; Skin

Topics: Chronic Disease; Endoscopy; Ethmoid Sinus; Humans; Nose; Postoperative Complications; Sinusitis

This paper describes the use of a nasal mask to deliver intermittent positive pressure ventilation to treat chronic respiratory failure in one patient with severe kyphoscoliosis. After two months of overnight nasal ventilation at home the patient achieved normal blood gases, showed improved inspiratory muscle strength, effort tolerance and was able to return to work. Intermittent nasal ventilation is a safe and effective ventilatory support modality for some patients with hypercapnic respiratory failure.

Topics: Adult; Chronic Disease; Follow-Up Studies; Humans; Hypercapnia; Inspiratory Capacity; Lung; Male; Masks; Nose; Positive-Pressure Respiration; Pressure; Respiratory Insufficiency; Respiratory Mechanics; Tidal Volume

Topics: Ambulatory Care; Chronic Disease; Endoscopy; Humans; Nose; Nose Diseases; Paranasal Sinus Diseases

An experimental study was designed to compare the effects of enlargement of the maxillary ostium to inferior meatal antrostomy. In 10 rabbits, the sinus ostium was enlarged (osteoplasty group), and in 10 other animals, a window of the same size was created far from the ostium (antrostomy group). The control groups were 7 rabbits in which no surgery was performed and 6 rabbits in which only the surgical approach was performed. At reexploration 14 and 84 days after surgery, it was observed that rabbits in the osteoplasty group had significantly more infections of the sinuses than the antrostomy group and both control groups (P less than .05). Possible reasons for the difference in infection rate are discussed. These data indicate that, in normal maxillary sinuses of rabbits, disruption of the ostium results in an increased incidence of infection.

Topics: Animals; Chronic Disease; Female; Incidence; Male; Maxillary Sinus; Maxillary Sinusitis; Nose; Osteotomy; Postoperative Complications; Rabbits

In 169 children with a runny nose the difference between the group with rhinitis and those diagnosed as having sinusitis was indistinct. History and examination, and the results of radiology, ultrasound, the appearance of the sinus washings, the number of leucocytes in the washings, and the presence of pathogenic bacteria in the culture of the secretion from the nose and sinuses had little correlation with each other or with the clinical picture. In our view there is no marked difference between rhinitis and simple sinusitis, that is, mucosal inflammation of the maxillary sinus. This difference is also of no therapeutic relevance, and both diseases may be regarded as part of an upper airway infection. It is important to distinguish between sinusitis with and without empyema, because empyema must be treated differently. The latter disease produces distinct symptoms in the acute stage resembling ethmoiditis in children or maxillary and frontal sinusitis in adults. This type of sinusitis did not occur in our patients. Further investigation in children with a runny nose is indicated only in those with typical symptoms of an empyema.

Topics: Bacteria; Bacteriological Techniques; Child; Child, Preschool; Chronic Disease; Diagnosis, Differential; Female; Humans; Male; Maxillary Sinusitis; Nose; Paranasal Sinuses; Radiography; Rhinitis; Ultrasonography

A systematic evaluation of the most common parameters used in active anterior rhinomanometry was made with artificial tube and cadaver models and patient recordings. The clinical suitability of the parameters was judged on their calculability, reproducibility and power to separate the recordings into meaningful degrees of patency. It was shown that resistance at 150 Pa was not calculable in 30% of the measurements because such a high pressure gradient was not achieved during quiet breathing. The power to separate the grades of obstruction was good with all the models but in the test-retest analysis, it was shown that the power to detect +/- 20% variation in repeated measurement in the same person with a decongested nose was not sufficient with the resistance at 150 ml/s and at radius 100. The coefficient of resistance W = P/V2 at peak flow and resistance at radius 200 showed good capability to separate the grades of obstruction, they are measurable in all recordings, their reproducibility is good and thus, they are recommended for clinical practice.

Topics: Adolescent; Adult; Airway Resistance; Chronic Disease; Evaluation Studies as Topic; Female; Humans; Male; Manometry; Masks; Middle Aged; Models, Anatomic; Models, Biological; Nasal Obstruction; Nasal Provocation Tests; Nasal Septum; Nose; Pressure; Pulmonary Ventilation; Reproducibility of Results; Rhinitis

In this study, cephalometric and dental cast variables relating to 30 male and 20 female children, 8 to 13 years old with chronic nasal mucosal swelling, were compared with those relating to age- and sex-method controls. These controls were orthodontically untreated subjects with no histories of airway obstruction. The children with chronic nasal mucosal swelling had been referred because of chronic difficulties with nasal breathing to the Department of Otolaryngology Airflow Laboratory at the Hospital for Sick Children in Toronto. Previously active posterior rhinomanometry with a head-out volume displacement plethysmograph had been used to measure nasal resistance in 1000 consecutive subjects. Participants in the study reported here were selected from subjects whose nasal resistance fell markedly following administration of a decongestant spray. The subjects selected were found to have significantly (p less than 0.001) more mandibular incisor crowding, significantly (p less than 0.01) smaller mandibular arch widths than the controls, and significantly (p less than 0.001) smaller maxillary arch widths than the controls. The male subjects had significantly (p less than 0.01) smaller mandibular arch widths than the male controls.

Topics: Adolescent; Airway Resistance; Child; Chronic Disease; Dental Arch; Female; Humans; Incisor; Male; Malocclusion; Mandible; Maxilla; Nasal Decongestants; Nasal Mucosa; Nasal Obstruction; Nose; Pulmonary Ventilation; Rhinitis

A 57 year old man with chronic bronchitis sought a consultation for dyspnoea at rest associated with an absolute inability to lie flat. Examination revealed paradoxical respiration and respiratory function testing revealed a mixed ventilation disturbance, which was predominantly obstructive and was aggravated in the dorsal decubitus position. Radiology revealed bilateral diaphragmatic paralysis, which was confirmed on measurement of transdiaphragmatic pressure. The patient benefited from assisted ventilation by the nasal route with an excellent result in both the short and the medium term. Investigation into the cause was negative, in particular there was no evidence of any neuromuscular abnormality. This case recalls the role of the diaphragm in acute respiratory failure and shows the value of mechanical ventilation by the nasal route in the treatment of certain types of diaphragmatic paralysis.

Topics: Bronchitis; Chronic Disease; Humans; Lung Diseases, Obstructive; Male; Masks; Middle Aged; Nose; Respiration, Artificial; Respiratory Insufficiency; Respiratory Mechanics; Respiratory Paralysis

Nasal mucociliary clearance is a first line of defence mechanism of the respiratory system against inhaled particles. It transports particles depositing into the nasal passages to the pharynx to be swallowed or expectorated, thus protecting the respiratory system from injury. Clearance function is affected by many factors such as the chronic inflammation of the paranasal sinuses. A group of 13 healthy volunteers (controls) and a group of 17 patients suffering from chronic sinusitis was investigated in the Department of Otolaryngology of Taichung Veterans General Hospital between June and October of 1990. A radioisotope method was used to measure the velocity of nasal mucociliary transport in the participants. This involved the use of radioisotope Tc99m combined with albumin particles and measurements were made in one nasal chamber at a time. The sinusitis patients were then surgically treated and they all improved. In all 25 tests were made in the control group and the mean velocity of their mucociliary transport was found to be 4.56mm/min. In the patients 28 measurements were made and their mean velocity was found to be 2. 67mm/min before the operation and 4.03mm/min after the operation. The difference between pre- and post-operative velocities was statistically significant as was the difference between the pre-operative velocities of the patients and those of the controls. The difference between controls and patients after the operation was not significant.

Topics: Adolescent; Adult; Aged; Chronic Disease; Female; Humans; Male; Middle Aged; Mucociliary Clearance; Nose; Sinusitis

We reviewed the Mayo Clinic experience with nocturnal nasal ventilation (NNV) and retrospectively assessed the clinical benefits, patient compliance, and complications. NNV had been instituted in 26 patients with daytime hypercapnia and nocturnal hypoventilation due to neuromuscular diseases or chronic obstructive pulmonary disease. After initiation of NNV, 21 of 26 patients continued to use this treatment regularly (81% compliance rate) and considered their life-style improved. In this subset of patients, the arterial partial pressure of carbon dioxide during unassisted breathing decreased from 64 +/- 13 to 51 +/- 7 mm Hg, and the arterial partial pressure of oxygen increased from 58 +/- 12 to 68 +/- 8 mm Hg. No significant change was noted in the forced vital capacity or maximal respiratory pressures. Four of the five patients in whom NNV had been discontinued cited discomfort related to the mask or severity and poor prognosis of the underlying illness as reasons for cessation of treatment. We conclude that NNV is well tolerated by most patients and may improve alveolar ventilation and arterial oxygenation in patients with chronic respiratory failure.

Topics: Adolescent; Adult; Aged; Carbon Dioxide; Chronic Disease; Female; Humans; Hypercapnia; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen; Patient Compliance; Positive-Pressure Respiration; Pulmonary Gas Exchange; Respiratory Insufficiency; Respiratory Muscles; Retrospective Studies

To better understand the factors involved in chronic sinusitis in childhood, we cultured the sinuses, middle meatus, and nasopharynx in 39 children requiring surgical intervention. Sixty-nine percent of these patients had other medical problems, including asthma (49%) and immunologic compromise (18%). We cultured coagulase-negative staphylococcus in 18 patients, Streptococcus viridans in 14 patients, normal flora in 10 patients, Staphylococcus aureus in nine patients, group D streptococcus in five patients, Corynebacterium in five patients, Haemophilus influenzae in three patients, Neisseria in three patients, and Streptococcus pneumoniae, group A streptococcus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella oxytoca, Propionibacterium acnes, Actinomyces, and an anaerobic gram-negative bacillus in one patient each. Cultures yielded no growth in nine patients. A strong association between cultures of the middle meatus obtained ipsilaterally and cultures of the maxillary (83%) and ethmoid sinuses (80%) occurred. A poor correlation was found between cultures of the nasopharynx and maxillary (45%) and ethmoid sinuses (49%). All seven patients who had both maxillary and ethmoid sinus cultures showed the same organisms in both sinuses. Only 41% of organisms were found on both sides when procedures were performed bilaterally. Cultures of the middle meatus appear to be sensitive and specific for organisms within sinuses. The presence of predominantly nonvirulent organisms in low titers suggests that additional factors other than bacterial overgrowth contribute to the pathogenesis of chronic sinusitis in children.

Topics: Adolescent; Bacteria; Child; Child, Preschool; Chronic Disease; Female; Humans; Infant; Male; Nasopharynx; Nose; Paranasal Sinuses; Sinusitis

CT-scan was used to examine rhinosinusitis in the developing sinuses; 196 children aged from 3 to 14 years were selected on the base of their chronic rhinorrhea, nasal congestion and cough. The patients were subdivided into six age groups (3-4, 5-6, 7-8, 9-10, 11-12 and 13-14 years). In the youngest age group, the authors noted maxillary involvement in 63%, ethmoidal involvement in 58%, and even sphenoidal sinus involvement in 29% of the children. Involvement decreased gradually with age, with 10% of ethmoidal and 0% of sphenoidal involvement in the 13-14 years age group. Maxillary sinusitis, however, persisted very frequently in the oldest age group (65%). Frontal involvement seems to become significant at the age of 7-8 years (7%) but it never exceeds 15% (11-12 age group). Septal deviations occurred in 16% of the youngest up to 72% in the oldest age group. The prevalence of bullous conchae increased with age too, although less prominently.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Chronic Disease; Ethmoid Sinusitis; Humans; Maxillary Sinusitis; Nasal Septum; Nose; Sinusitis; Tomography, X-Ray Computed

Snorers represent a heterogenous group that require adequate assessment before recommending surgical treatment. There are unfortunately no specific features either in the history or physical examination that might predict those chronic snorers with obstructive sleep apnoea. We have used trained observation together with pulse oximetry ('sleep screening') and fibreoptic nasendoscopy with Muller manoeuvre in our unit to assess snorers. This combination is a reliable means of distinguishing apnoeic patients from simple snorers and determining the level of the obstructing segment. We report our experience in using these methods in the management of 71 chronic snorers. We stress the value of conservative management, and emphasize that obesity, habitual alcohol ingestion and nasal obstruction should be corrected before embarking on pharyngeal surgery.

Topics: Adult; Aged; Body Weight; Chronic Disease; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Sleep Apnea Syndromes; Snoring

A study involving 69 patients with chronic nonspecific rhinitis who did not benefit from medical treatment and were subjected to cautery to the inferior turbinate. Fifty-one (73.9%) benefited from the procedure with little or no complications. This procedure which is cheap and yet effective is advocated for developing countries where cost of equipment, technical difficulties and complications will influence the choice of surgical treatment by the practitioner.

Topics: Adolescent; Adult; Child; Child, Preschool; Chronic Disease; Electrocoagulation; Female; Humans; Infant; Male; Nigeria; Nose; Rhinitis

To find whether patients with chronic rhinitis might be congested because of hyporesponsiveness to adrenergic vasoconstrictive influences, we measured nasal airway resistance (NAR) in normals and allergic and non-allergic rhinitics during intravenous infusion of graded doses of phenylephrine. All responded with decreases in NAR and first evidences of NAR fall appeared no later in those with rhinitis than in normals. Nasal congestion and response were asymmetrical; absolute NAR in the low resistance side was similar in all groups and there was little response to phenylephrine. In the high resistance side, NAR reached its minimum by the time the total infused dose was 1400 mcg, indicating maximum response to drug was achieved within the dose range studied. Minimum NAR achieved on the high resistance side was higher in rhinitics suggesting residual vascular engorgement resistant to phenylephrine or non-vascular mucosal swelling. Resistance to adrenergic vasoconstriction does not appear to be the primary contributor to mucosal swelling in chronic rhinitis.

Topics: Airway Resistance; Chronic Disease; Humans; Nose; Phenylephrine; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Disturbance of ciliary function are considered as a significant factor in the outcome of chronic respiratory afflictions. Thanks to a simple method of stroboscopic lighting, the ciliary beat frequency was studied on 40 nasal mucus smears obtained by swabbing in 28 children and 12 adults with chronic respiratory failure or recurrent disease. The 28 children were divided into three groups: group A (n = 10), pulmonary disease (broncho-pneumonia); group B (n = 3), Kartagener syndrome; group C (n = 15) pure otorhinolaryngological (ORL) disease (rhino-opharyngitis, sinusitis, otitis). Twelve adults with chronic ORL pathology (vaso-motor rhinitis) made up group D. A cytological control was carried out on each smear and showed the presence of ciliated cells in 92.5% of samples. In three group B cases (Kartagener's syndrome) no ciliary movement was observed. The results in groups A (9.3 +/- 1.46 Hz) and C (8.98 +/- 2.23 Hz) show that the level of respiratory infection (pulmonary or ORL) did not influence the ciliary beat frequency (p greater than 0.05). On the other hand, there was a significant difference (p less than 0.001) between the beat frequency in the group of children in group A (9.3 +/- 1.46 Hz) and C (8.98 +/- 2.23 Hz) and those of adults in group D (11.32 +/- 1.89 Hz). Two hypotheses might explain these facts: The existence of a differing physiological response in children and adults. Different mechanisms during chronic ORL infections in adults (vasomotor phenomena) and in the child (bacterial infection). The average frequencies measured were comparable to those previously published in human respiratory cilia using other methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aging; Bronchopneumonia; Chronic Disease; Cilia; Ciliary Motility Disorders; Kartagener Syndrome; Nose; Otorhinolaryngologic Diseases; Respiratory Tract Diseases

Topics: Aged; Chronic Disease; Female; Humans; Nose; Nose Diseases; Syphilis

In 9 patients with recurrent attacks of acute or chronic frontal sinusitis, interfrontal sinus septum resection was performed. In 5 patients there was unilateral disease and in 4 bilateral. As all patients had previously had their frontal sinus trephined, pre- and post-operative naso-frontal duct function tests were performed. Pre-operatively, of 11 naso-frontal ducts tested (2 patients bilaterally) not one showed air flow on spontaneous respiration. Passage of air was obtained at forced inspiration and expiration in one patient and by Valsalva's manoeuvre in 6. No flow of air whatsoever was obtained in 4 of the ducts, whatever the method used. At follow-up performed 1-8 years post-operatively 7 out of the 9 patients had no frontal sinus problems. The remaining 2 patients, who both had nasal allergy, were improved. Post-operative testing of the 9 patients showed flow of air on spontaneous respiration in 4 patients, whereas 4 needed forced inspiration or expiration and only one patient Valsalva's manoeuvre. The sinus septum resection, which is very simple to perform, is a good alternative to more extensive frontal sinus surgery but may be of less value in patients with nasal allergy.

Topics: Acute Disease; Adult; Chronic Disease; Female; Follow-Up Studies; Humans; Male; Methods; Middle Aged; Nasal Septum; Nose; Postoperative Period; Pulmonary Ventilation; Recurrence; Sinusitis

Total inferior turbinectomy has been proposed as a treatment for chronic nasal airway obstruction refractory to other, more conservative, methods of treatment. Traditionally, it has been criticized because of its adverse effects on nasophysiology. In this study, patients who had previously undergone total inferior turbinectomy were evaluated with the use of an extensive questionnaire. It confirms that total inferior turbinectomy carries significant morbidity and should be condemned.

Topics: Adult; Airway Obstruction; Chronic Disease; Evaluation Studies as Topic; Follow-Up Studies; Humans; Nose; Nose Diseases; Olfaction Disorders; Postoperative Complications; Rhinitis; Rhinitis, Atrophic; Turbinates

Nasal tissues can be affected by a greater variety of stimuli than is generally considered, stimuli which can produce many different diseases. The manner in which the nose can respond symptomatically and physically is limited so that symptoms and findings in different diseases frequently overlap and the conditions may be difficult to diagnose. An understanding of nasal diseases is only in its infancy. This report outlines some of these diseases and speculates about the presence of others. Classification of nasal disease is presented based on the suspected presence or absence of an immunological mechanism.

Topics: Chronic Disease; Humans; Hypersensitivity, Delayed; Hypothyroidism; Nasal Mucosa; Nasal Polyps; Nose; Nose Diseases; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Respiratory distress, apnea, and chronic pulmonary disease since birth were identified in 14 infants who also had symptomatic gastroesophageal reflux. Birth weights varied from 760 to 4,540 gm. All infants had radiographic changes similar to those in bronchopulmonary dysplasia. Cessation of apnea and improvement of pulmonary disease occurred only after medical (8) or surgical (6) control of gastroesophageal reflux. Simultaneous tracings of esophageal pH, heart rate, impedance pneumography, and nasal air flow in five infants demonstrated that reflux preceded apnea. Apnea could be induced by instillation of dilute acid, but not water or formula, into the esophagus. Prolonged monitoring of esophageal pH more than two hours after feeding in 14 other infants less than 6 weeks of age (birth weight 780 to 3,350 gm) without a history of recent vomiting indicated that reflux was not greater than in normal older children.

Topics: Apnea; Chronic Disease; Gastroesophageal Reflux; Heart Rate; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infant, Newborn, Diseases; Lung Diseases; Nose; Pneumonia, Aspiration; Pulmonary Ventilation; Respiratory Distress Syndrome, Newborn

Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Chronic Disease; Epistaxis; Hemorrhagic Disorders; Humans; Nose; Respiratory Tract Infections; Sweden

A number of publications appeared in the sixties claiming success of Vidian neurectomy in patients with chronic vasomotor rhinitis and recurrent polyposis nasi. During the period from October 1970 through February 1975, a total of 27 Vidian neurectomies was performed in 14 patients (seven males and seven females). Two groups of seven patients each were operated on; seven patients with chronic vasomotor rhinitis and seven patients with recurrent polyposis nasi and rhinitis. Symptoms were quantitatively recorded pre- and postoperatively and patients were followed up 15--66 months. The Rotterdam results appear in the long run inferior to those published in the literature.

Topics: Chronic Disease; Denervation; Female; Follow-Up Studies; Humans; Male; Nasal Polyps; Nose; Postoperative Complications; Recurrence; Rhinitis; Rhinitis, Vasomotor

Topics: Adolescent; Airway Obstruction; Child; Chronic Disease; Female; Humans; Male; Nose; Nose Deformities, Acquired; Nose Diseases

A transnasal approach to the maxillary sinus as a standard operation in chronic maxillary sinusitis is described. A mucosal flap in the lower nasal meatus is electrically circumcised, and a window of appropriate size is formed by osteotomy. The removal of pedicled polyps and cysts from the cavity is controlled by endoscopy, while most parts of the thickened mucosa remain in place and may recover and also line the uncovered areas. If necessary, an opening in the facial wall of 5 mm diameter is established for endoscopical control or manipulations. The preliminary results of 56 endonasal sinutomies are reported, which are satisfactory. The avoidance of postoperative dysesthesia or neuralgia is a marked advantage of the procedure.

Topics: Chronic Disease; Endoscopy; Humans; Maxillary Sinus; Nasal Polyps; Nose; Nose Neoplasms; Sinusitis

144 industrial workers were investigated for the presence of Staphylococcus aureus in the upper respiratory tract because 53 of them had complained of chronic throat discomfort. Significantly more patients with subjective throat complaints harboured Staph. aureus in the nose (49.1%) and throat (32.1%) than patients without such symptoms (27.4% and 9.9%, respectively). No Staph. aureus were found in throat swab cultures from 21 randomly selected individuals working in a similar factory where no chronic throat discomfort was reported and only 2 throat carriers of Staph. aureus were found among 66 medical undergraduates investigated. The staphylocci belonged to several different phage type patterns and could not be recovered on sedimentation plates or from machines or products. In the light of these and other findings it was suggested that the staphylocci accentuated an already existing damage of the mucous membrane of the throat, but seemed not to be the primary cause of the discomfort.

Topics: Air Pollution; Bacteriological Techniques; Chronic Disease; Female; Humans; Male; Nose; Occupational Medicine; Pharynx; Respiratory Tract Infections; Staphylococcus aureus

Cryotherapy is used in treatment of chronic rhinitis and pharyngitis. The effect of cryotherapy on the qualitative and quantitative composition of the microflora was studied. Staphylococci prevailed in the rhinitis patients, streptococci, Clebsiella and Neisseria being registered more rarely. The staphlococcal isolates were highly sensitive to monomycin, neomycin, erythromycin and levomycetin. The results of the dynamic study showed that the flora composition did not significantly change during cryotherapy and the sensitivity level of the staphylococcal isolates to the antibodies remained unchanged.

Topics: Anti-Bacterial Agents; Bacteria; Chronic Disease; Cryosurgery; Humans; Nasal Cavity; Nose; Rhinitis

Topics: Adolescent; Chronic Disease; Foreign Bodies; Granuloma; Humans; Male; Nose; Nose Diseases

The authors make a comparative study in 55 CNLSD children and 10 healthy children. In all those children, provocation tests were performed as wel at the level of the skin, as at the level of the lung and nose. The provocation tests were performed with the following allergens: house dust, mites, human dander and pollen, and with histamine. Only in the control group (10 healthy children) no lung provocations with histamine were done. From the investigation follows that skin tests are not always reliable. Furthermore, in many cases a nose provocation test (combination of aerosole. Furthermore, in many cases a nose provocation test (combination of aerosol provocation with a allergen and PAR rhinomanometry) can replace a lung provocation test.

Topics: Allergens; Child; Chronic Disease; Dust; Histamine; Humans; Lung; Mites; Nose; Pollen; Respiratory Hypersensitivity; Skin Tests

The fine structure of human nasal blood vessels was studied in 15 chronic allergic patients. The venules showed gaping of the interendothelial junctions and lamination of the basal lamina. The capillaries displayed numerous endothelial cytoplasmic processes. The arteriolar walls showed thinning and destructive changes. A reciprocal relation between the vascular endothelium and its basal lamina was deduced.

Topics: Adolescent; Adult; Blood Vessels; Capillaries; Chronic Disease; Female; Humans; Male; Nose; Rhinitis, Allergic, Seasonal

Topics: Chronic Disease; Dacryocystitis; Follow-Up Studies; Humans; Lacrimal Apparatus; Nose

This publication describes a relatively simple transnasal and trans-septal surgical approach to the sphenoid sinus, that assists in the diagnosis of pathology in this region and in some circumstances permits the correct treatment. Eight patients on whom this technique was used, are briefly reported. The importance of adequate radiological assessment of this area is illustrated.

Topics: Adolescent; Adult; Aged; Chronic Disease; Female; Humans; Male; Middle Aged; Nasal Septum; Nose; Otolaryngology; Radiography; Respiratory Tract Diseases; Sphenoid Sinus; Turbinates

Topics: Allergens; Chronic Disease; Female; Humans; Manometry; Nose; Pulmonary Ventilation; Rhinitis, Allergic, Seasonal; Seasons; Skin Tests

Topics: Child, Preschool; Chronic Disease; Diarrhea, Infantile; Digestive System; Duodenum; Escherichia coli; Female; Gastric Juice; Humans; Hydrogen-Ion Concentration; Infant; Intestinal Secretions; Intestines; Male; Neisseria; Nose; Pharynx; Postoperative Complications; Stomach; Streptococcus

Topics: Animals; Catheterization; Chronic Disease; England; France; Hemodynamics; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Lung Diseases, Obstructive; Masks; Nose; Oxygen; Oxygen Inhalation Therapy; Physical Exertion; Respiratory Insufficiency; United States

Topics: Asthma; Cartilage; Child; Child, Preschool; Chronic Disease; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Otitis Media; Postoperative Complications; Pulmonary Ventilation; Respiratory Insufficiency; Rhinitis, Allergic, Seasonal; Rhinoplasty; Speech Disorders; Time Factors; Tonsillitis

Topics: Adolescent; Airway Resistance; Anesthesia, Local; Asthma; Bronchi; Child; Chronic Disease; Cold Temperature; Female; Humans; Humidity; Lidocaine; Male; Nose; Pharynx; Pulmonary Ventilation; Sensory Receptor Cells; Spirometry; Temperature; Thermosensing; Ventilation-Perfusion Ratio; Vital Capacity

Topics: Air Pollution; Child; Chronic Disease; Endoscopy; Humans; Japan; Nose; Pharyngitis; Rhinitis; Rhinitis, Allergic, Seasonal; Smell

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Chronic Disease; Dacryocystitis; Female; Hemorrhage; Humans; Lacrimal Apparatus; Male; Methods; Middle Aged; Nasal Mucosa; Nose; Postoperative Care; Postoperative Complications; Preoperative Care; Suture Techniques; Tendons

Topics: Adolescent; Adult; Chronic Disease; Female; Humans; Male; Middle Aged; Nose; Palatine Tonsil; Rhinitis, Allergic, Seasonal; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus; Tonsillectomy; Tonsillitis

Topics: Acute Disease; Adolescent; Antibody Formation; Asthma; Child; Chronic Disease; Exocrine Glands; Female; Hemagglutination Inhibition Tests; Humans; Immunization; Immunoglobulin A; Immunoglobulins; Influenza Vaccines; Injections; Injections, Subcutaneous; Male; Neutralization Tests; Nose; Orthomyxoviridae

Topics: Adult; Aged; Child; Chronic Disease; Epistaxis; Female; Hemostasis; Humans; Male; Maxillary Artery; Methods; Middle Aged; Nose

Topics: Chronic Disease; Humans; Lacrimal Apparatus; Nasal Polyps; Nose; Palate

Topics: Adult; Aged; Arteries; Bronchitis; Carbon Dioxide; Catheterization; Chronic Disease; Humans; Methods; Middle Aged; Nose; Oxygen; Oxygen Inhalation Therapy; Spirometry; Time Factors

Topics: Adolescent; Adult; Age Factors; Aged; Bacteria; Carrier State; Child; Child, Preschool; Chronic Disease; Diphtheria; Factor Analysis, Statistical; Female; Humans; Larynx; Male; Middle Aged; Mouth; Nasopharynx; Nose; Rhinitis; Rhinitis, Atrophic; Sex Factors

Topics: Animals; Brain; Chronic Disease; Cryptococcosis; Kidney; Mice; Nose; Skin; Tail

Topics: Animals; Antibodies; Bronchitis; Chronic Disease; Guinea Pigs; Humans; Immune Sera; Neutralization Tests; Nose; Pharynx; Respirovirus; Rhinovirus; Serotyping; Simplexvirus; Sputum; Virus Cultivation

Topics: Chronic Disease; Humans; Hydrogen-Ion Concentration; Hyperplasia; Maxillary Sinus; Methods; Nasal Mucosa; Nose; Proteus; Pseudomonas aeruginosa; Rhinitis, Atrophic; Sinusitis; Staphylococcus

Topics: Adolescent; Biomedical Research; Chronic Disease; Geriatrics; Humans; Hypersensitivity; Mucous Membrane; Nose; Palatine Tonsil; Paranasal Sinuses; Pathology; Pharyngitis; Pharynx; Surgical Procedures, Operative

Topics: Chronic Disease; Fatty Acids; Fatty Acids, Essential; Humans; Nose; Nose Diseases; Pantothenic Acid; Rhinitis; Rhinitis, Allergic, Seasonal; Rhinitis, Atrophic; Vitamin A; Vitamin E

Topics: Chronic Disease; Headache; Humans; Nose; Nose Neoplasms; Otolaryngology; Pain; Paranasal Sinus Neoplasms; Paranasal Sinuses; Rhinitis; Rhinitis, Atrophic; Sinusitis; Syphilis; Tuberculosis

Topics: Adult; Chronic Disease; Humans; Nose; Sinusitis

Topics: Chronic Disease; Humans; Medical Records; Nasal Polyps; Neoplasms; Nose; Paranasal Sinus Neoplasms; Paranasal Sinuses; Polyps

Topics: Cataract; Chronic Disease; Curettage; Disease; Humans; Maxillary Sinus; Maxillary Sinusitis; Nasal Cavity; Nose; Trephining

Topics: Chronic Disease; Humans; Nose; Otitis Media; Sinusitis

Topics: Chlortetracycline; Chronic Disease; Nose; Penicillins; Sinusitis

Topics: Chronic Disease; Humans; Nose; Paranasal Sinuses

Topics: Bacteria; Chronic Disease; Humans; Moraxella; Nose; Paranasal Sinuses; Sinusitis

Topics: Animals; Cats; Chronic Disease; Nose; Sinusitis; Streptomycin; Therapies, Investigational

Topics: Chronic Disease; Humans; Nose; Paranasal Sinuses; Sinusitis

The sulfonamides and antibiotics have been of great value in reducing the duration and severity of acute sinusitis in children.Chemotherapy, in the acute case, will probably prevent much chronic sinusitis of the infectious type. The most common variety of chronic sinus disease is due to a primary allergic condition plus secondary infection. It is impossible to treat these cases successfully without treating the allergy as well as the infection. The home use of any nose drop preparation is of very little value in the treatment of chronic sinusitis of any type or localization. The local nasal use of sulfonamides or antibiotics is not based upon rational principles. Their clinical value is negligible. They may, moreover, be decidedly irritating to the nasal mucosa. One should not hesitate to resort to rational surgical procedures to improve nasal ventilation in a child with sinusitis. While the advent of chemotherapeutic, antibiotic and antihistaminic drugs has been of inestimable value in the treatment of chronic sinusitis, we must not neglect to surgically correct anatomical defects and irreversible pathological mucosal changes which interfere with proper nasal physiological processes.

Topics: Anti-Allergic Agents; Anti-Bacterial Agents; Child; Chronic Disease; Disease; Edema; Humans; Hypersensitivity; Mucous Membrane; Nasal Mucosa; Nose; Paranasal Sinus Diseases; Paranasal Sinuses; Respiration; Sinusitis

Topics: Anaphylaxis; Chronic Disease; Disease; Humans; Hypersensitivity; Nose; Nose Diseases; Paranasal Sinuses