phenylephrine-hydrochloride and Nasal-Polyps

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

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease with a treatment goal of controlling symptoms and limiting disease burden. While endoscopic sinus surgery is effective for removing polyps and aerating sinuses, proper medical management remains necessary for reducing inflammation and limiting polyp recurrence.. This article aims to summarize the literature regarding medical treatment of chronic rhinosinusitis with nasal polyposis, with a specific focus on developments in the past 5 years.. We conducted a literature review using PubMed to identify studies assessing medical treatment strategies for patients with CRSwNP. Articles focusing on chronic rhinosinusitis without nasal polyposis were excluded unless specifically stated. Surgical treatment and biologic therapies for CRSwNP will be covered in subsequent chapters and are therefore not included.. Intranasal saline irrigations and topical steroids are mainstays of CRSwNP treatment in the pre-surgical, post-surgical, and maintenance phases of the disease. Alternative steroid delivery methods and adjunctive treatments with antibiotics, anti-leukotrienes, and other topical therapies have been investigated and may benefit certain patient populations, but convincing evidence does not exist to warrant addition of these treatments to the standard of care for CRSwNP.. Topical steroid therapy is clearly effective for CRSwNP, and recent studies demonstrate the safety and efficacy of high-dose nasal steroid rinses. Alternate delivery methods for local steroids may be useful for patients who are not responding to or who are noncompliant with conventional intranasal corticosteroid sprays and rinses. Future studies are needed to clarify if oral or topical antibiotics, oral anti-leukotrienes, or other novel therapies are significantly effective in decreasing symptoms and improving the quality of life in patients with CRSwNP.

Topics: Anti-Bacterial Agents; Humans; Nasal Polyps; Nasopharyngeal Neoplasms; Nose; Quality of Life

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

Pai syndrome is a rare form of frontonasal dysplasia, first described in 1987. It is a triad consisting of midline cleft of the upper lip, facial skin polyps and central nervous system lipomas. Only 14 cases have been reported in the literature. The authors describe the clinical features, diagnostic workup and treatment of two patients. A review of all cases reported in literature is presented to show the phenotypic variability of this rare syndrome.

Topics: Abnormalities, Multiple; Bone Diseases, Developmental; Child, Preschool; Cleft Lip; Female; Humans; Infant; Infant, Newborn; Labial Frenum; Nasal Cartilages; Nasal Polyps; Nasal Septum; Nose; Syndrome; Treatment Outcome

Pediatric sinonasal anatomy changes and develops from birth to adolescence. This article elucidates the normal anatomy and patterns of development in the pediatric population. Issues in pediaric sinusitis include indications for imaging, the nonspecificity of sinus opacification, and the importance of clinical information. Sinonasal physiology is briefly discussed to offer insight into the interpretation of radiographic findings. Cystic fibrosis, polyps, and choanal atresia, representing the spectrum of common pediatric sinonasal inflammatory disorders are illustrated, and the spectrum of orbital and intracranial complications of sinusitis is reviewed.

Topics: Adolescent; Child; Child, Preschool; Choanal Atresia; Cystic Fibrosis; Diagnostic Imaging; Humans; Infant; Infant, Newborn; Nasal Polyps; Nose; Paranasal Sinuses; Polyps; Rhinitis; Sinusitis

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

The etiopathogenesis of nasal allergic polyps is poorly understood; an immunological mediated mechanism is commonly admitted. A clinic-pathological study of 92 cases of nasal polyps is reported. The occupational and or environmental background of the patients was recorded. Appropriate histochemical techniques were applied to identify pollutants within the lesions. Iron, wood, cement, cork, paper, glass, tobacco, textile fibres and chalk could be identified. The follow-up of patients at 12 years after excision of polyps revealed a decrease in recurrence whenever exposure to pollutants was discontinued. The etiology of nasal allergic polyps is probably related to the inhalation of some foreign materials reported.

Topics: Environmental Exposure; Humans; Nasal Polyps; Nose; Respiratory Hypersensitivity; Time Factors

Implicit in all types of nasal surgery is the potential for worsening of olfactory function. Not only can injury occur to the delicate olfactory neuroepithelium itself, but also more indirect disturbances are engendered by pharmacologic agents, distortions of intranasal anatomy, persistent mucosal edema or crusts, and other processes. This study examined 93 patients undergoing various types of nasal surgery, including ethmoidectomy, polypectomy, Caldwell-Luc procedure, open reduction of nasal fracture, closed reduction of nasal fracture, rhinoplasty, and septoplasty. Factors considered as contributing to loss of olfactory acuity were age, gender, use of general anesthesia, and type of operation. The University of Pennsylvania Smell Identification Test (UPSIT), a 40-item, microencapsulated scratch-and-sniff procedure, was used to ascertain olfactory ability. Sixty-one patients (66%) had either improved or unchanged UPSIT scores after surgery; the remaining 32 patients (34%) had a decline in score. One patient (1%) became anosmic. Statistical treatment of outcome data using analysis of covariance with repeated measures showed no effect of age, gender, type of operation, or anesthetic.

Topics: Adolescent; Adult; Age Factors; Aged; Anesthesia, General; Anesthesia, Local; Ethmoid Bone; Female; Fractures, Bone; Humans; Male; Middle Aged; Nasal Bone; Nasal Polyps; Nasal Septum; Nose; Olfaction Disorders; Postoperative Complications; Prospective Studies; Rhinoplasty; Risk Factors; Sex Factors; Smell

Three principles about pediatric nasal surgery should be borne in mind. 1) Surgical resection may not interfere with nasal growth. 2) Aesthetic defects without functional impairment should be corrected at the end of adolescence. 3) When classical treatments fail, functional endoscopic procedures (F.E.S.S.) intended to ensure drainage and ventilation of the sinuses as well as to improve nasal conductivity, by partial inferior turbinate resection have to be proposed.

Topics: Adenoidectomy; Adolescent; Age Factors; Child; Child, Preschool; Humans; Infant; Nasal Obstruction; Nasal Polyps; Nose; Paranasal Sinuses; Rhinoplasty; Tonsillectomy

After a short historical and literature review the authors present their definition of nasal polyposis. The importance of CT scanning is stressed and the results of a CT-scan study of 350 patients with nasal complaints is presented. The authors discuss the incidence of sinusitis, presence of polypi and nasal anomalies in this population. Furthermore 111 biopsies of nasal polypi were studied and the cellular content, the ducts, glands, veins, aspect of the basal membrane and epithelial layer were described. As an oral ASA provocation test can be hazardous, the authors tested a nasal provocation test with acetylsalicylic acid. Although the test showed some interesting results, the reproducibility was poor. Finally the authors conclude that endoscopy and CT-scanning enable the diagnosis of nasal polyposis in an early stage of the disease.

Topics: Aspirin; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Nasal Polyps; Nasal Provocation Tests; Nose

Topics: Allergens; Humans; Nasal Mucosa; Nasal Polyps; Nose; Pollen; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Sinusitis; SRS-A

Topics: Adult; Asthma; Child; Humans; Nasal Polyps; Nose; Nose Diseases; Otitis Media; Respiratory Hypersensitivity; Rhinitis; Seasons; Sinusitis

Inverted papillomas which arise from the lining membranes of the nose and paranasal sinuses are relatively unfamiliar lesions which have been reported in the literature under a variety of titles. The uncertainly surrounding their etiology, their relationship to nasal polyps and their malignant potential have resulted in an ill-defined clinical approach to their management. The designation Inverted Schneiderian Papilloma is suggested as an appropriate title that best conveys the qualities of inversion, location and distinctiveness of character. The characteristic microscopic feature is the increase in thickness of the covering epithelium with extensive invasion of this hyperplastic epithelium into the underlying stroma. In the absence of a better explanation of the origin, the tumor should be considered a true epithelial neoplasm. The clinical features in 24 previously unreported cases are presented. The most common presenting complaints are nasal obstruction and epistaxis. The common site of origin is the lateral nasal wall in the region of the middle meatus and ethmoid cells. In no instance was an isolated lesion of the maxillary, frontal or sphenoid sinus present. The most characteristic attributes of the tumor were its tendency to recur, its destructive capacity and its propensity to be associated with malignancy. The common radiographic abnormality on routine sinus films was unilateral opacification of the sinuses and nasal airway. Tomography is helpful in defining the extent of the lesion and in selecting an appropriate surgical approach. A philosophy of management has evolved based on the experiences gained from these 24 patients, combined with a review of the experience of others and a study of the regional anatomy. Surgical excision is the treatment of choice. A bold surgical approach has been used for tumors involving the lateral nasal wall and paranasal sinuses. A lateral rhinotomy incision is employed and when necessary, this exposure is increased by extending the incision of split the upper lip and reflect the cheek flap as is customarily done with the Weber-Ferfusson incision. Fifteen patients have been followed for more than two years and the results have been excellent with the exception of one patient who later developed an invasive squamous carcinoma. An associated malignancy was found in 12.5 percent of the cases.

Topics: Adult; Aged; Airway Obstruction; Carcinoma, Squamous Cell; Epistaxis; Female; Humans; Hypersensitivity; Male; Maxillary Sinus; Middle Aged; Nasal Polyps; Nose; Nose Neoplasms; Papilloma; Paranasal Sinus Neoplasms; Paranasal Sinuses; Recurrence; Sex Factors; Terminology as Topic; Tomography, X-Ray; Virus Diseases

Topics: Cysts; Ethmoid Bone; Ethmoid Sinus; Frontal Sinus; Granulation Tissue; Humans; Inflammation; Maxillary Sinus; Methods; Nasal Polyps; Nose; Paranasal Sinus Neoplasms; Paranasal Sinuses; Postoperative Complications; Radiography; Sinusitis; Wound Healing

Topics: Blood Protein Electrophoresis; Cilia; Diagnosis, Differential; Granuloma; Granuloma, Lethal Midline; Granulomatosis with Polyangiitis; Herpes Simplex; Humans; Kidney Transplantation; Leishmaniasis, Mucocutaneous; Leprosy; Lysosomes; Microscopy, Electron; Mycoses; Nasal Polyps; Nose; Postoperative Complications; Prognosis; Respiratory Tract Diseases; Rhinitis; Rhinoscleroma; Sarcoidosis; Syphilis; Transplantation, Homologous; Tuberculosis; Tuberculosis, Laryngeal

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

Recently, we demonstrated that acoustic rhinometry (AR) measurements correlated with nasal cavity volumes in patients with nasal polyposis (NP). The aim of the present study was to evaluate whether AR and nasal nitric oxide (nNO) are useful methods in monitoring and follow-up of medical treatment of NP.. Patients with severe nasal polyps were randomized into two groups after a 4-week steroid washout period (w0): a treatment group received oral prednisone for 2 weeks (w2) and intranasal budesonide for 12 weeks (w12) while the control group received no steroid treatment. Nasal volume (Vol 0-6), minimum cross-sectional area (mCSA), nNO, peak nasal inspiratory flow (PNIF), nasal obstruction, and smell loss were evaluated.. At w2, the treatment group showed a significant increase of vol 0-6 compared to w0 and the control group. The mCSA area also increased compared to w0 and the control group. At w12, the improvement in vol 0-6 and mCSA was maintained after intranasal steroids compared to w0. At w2, the treatment group showed a paradoxical increase of nNO compared to w0 and the control group. At w12, this increase was maintained by intranasal steroids.. Both oral and intranasal steroid treatments improve nasal patency and paradoxically increase nNO, by opening the ostiomeatal complex. This suggests that AR and nNO are useful methods in the monitoring and follow-up of patients with NP.

Topics: Administration, Intranasal; Administration, Oral; Adult; Aged; Aged, 80 and over; Budesonide; Female; Glucocorticoids; Humans; Male; Middle Aged; Nasal Polyps; Nitric Oxide; Nose; Prednisone; Rhinometry, Acoustic; Tomography, X-Ray Computed

We assessed the efficacy of different forms of fluticasone propionate in the treatment of bilateral nasal polyposis in adult patients.. This double-blind, randomized, parallel group study included 34 patients, aged 16 years or over, with a diagnosis of bilateral nasal polyposis. The patients were randomized to three groups to receive fluticasone propionate in the form of aqueous nasal spray 100 microg twice daily, or nasal drop preparation 400 microg once or twice daily for 12 weeks. Once every four weeks, nasal volumes were measured by acoustic rhinometry and polyp size was assessed by a 4-mm rigid endoscope. Clinical symptom scores were assessed once a week.. The mean nasal polyp scores decreased significantly in all the groups (p<0.005). Total nasal volume did not improve significantly with the nasal spray. Although single daily nasal drop application increased total nasal volume significantly only at the end of treatment (p<0.05), increases with twice daily application were significant at 4, 8, and 12 weeks, compared to the baseline values and corresponding values of the other two groups (p<0.005). Nasal blockage and rhinitis symptom scores improved in all the groups (p<0.05), but the difference from the baseline was highest with twice daily nasal drop application. Smelling showed a significant improvement only with twice daily nasal drop application (p<0.05). In none of the groups did nasal discomfort scores differ significantly from the baseline at the end of treatment.. Nasal drop preparation of fluticasone propionate given twice daily showed the highest efficacy in increasing total nasal volume, decreasing nasal polyp size, and improving smelling and nasal blockage.

Topics: Administration, Intranasal; Adult; Aerosols; Aged; Androstadienes; Anti-Inflammatory Agents; Double-Blind Method; Endoscopy; Female; Fluticasone; Humans; Male; Middle Aged; Nasal Obstruction; Nasal Polyps; Nose; Prospective Studies; Rhinitis; Rhinometry, Acoustic; Smell; Treatment Outcome; Young Adult

The efficacy of topical nasal furosemide treatment has been shown in the protection of nasal polyp recurrence. The aim of the study was to compare the effect of oral steroid, as standard preoperative treatment, and inhaled furosemide, as alternative treatment, for 7 days preoperatively in terms of subjective improvement of nasal symptoms, polyp size reduction, inflammation in the polyp tissue, and intraoperative blood loss. A group of 40 patients with nasal polyposis entered the study and they were randomly allocated to 7-day preoperative treatment with either oral methylprednisolon (1 mg/kg/day) or topical furosemide by inhalation (6.6 mmol/l solution). Subjective scores of rhinosinusitis symptoms, polyp scores at endoscopy, and biopsy of the most superficial polyp were taken at inclusion. All procedures were repeated on day 7. Intraoperative blood loss was estimated (scores 0-10) by the surgeon at the operation. Eosinophils, mastocytes, and oedema were quantified by histomorphometry. Subjective symptoms and endoscopy scores did not differ significantly between the groups after the treatment although improvement of olfaction was insignificantly better in the steroid group. Steroid treatment significantly reduced eosinophil count, with no effect on mastocytes and oedema. Furosemide treatment did not affect inflammatory cells count significantly, but it has significantly reduced oedema in previously unoperated patients. No difference in intraoperative bleeding was observed between the groups.

Topics: Administration, Inhalation; Administration, Oral; Administration, Topical; Adolescent; Adult; Aged; Diuretics; Female; Furosemide; Glucocorticoids; Humans; Magnetic Resonance Imaging; Male; Methylprednisolone; Middle Aged; Nasal Polyps; Nose; Postoperative Complications; Preoperative Care; Secondary Prevention; Tomography, X-Ray Computed; Treatment Outcome

The objective of this study was to determine the influence of individual anatomical differences on intranasal drug deposition. The data of a comparison of seven different administration techniques in ten healthy volunteers was used in this single-blind crossover pilot study. After intranasal administration of a dyed test formulation, endoscopic video imaging was done on seven non-sequential days. The deposition pattern per individual around the head of the middle turbinate was analyzed for each technique and correlated with the individual anatomy. Decreased deposition of dyed test formulation in the target area around the head of the middle turbinate was observed in the presence of minor septal deviations, narrow nasal valve areas, or inferior turbinate hypertrophy; a lateral head position helps to bypass a minor septal deviation. Although results are preliminary, we conclude that anatomy and head position are important factors in the deposition of topical nasal drugs and may be the key to improving individual local nasal (steroid) treatment.

Topics: Administration, Intranasal; Adult; Aerosols; Androstadienes; Anti-Inflammatory Agents; Cross-Over Studies; Endoscopy; Female; Fluticasone; Humans; Male; Nasal Polyps; Nose; Pilot Projects; Posture; Rhinitis; Single-Blind Method; Sinusitis; Treatment Outcome; Turbinates; Videotape Recording

Nasal obstruction causes abnormal breathing patterns during sleep which often result in hypoxaemia. We studied the effect of nasal obstruction on arterial oxygen saturation in 20 healthy patients undergoing elective surgery which required bilateral nasal packing. Ten patients were subject to complete nasal obstruction while the remaining half had the obstruction relieved by the insertion of nasal cannulae. We found that nasal obstruction did not have any detrimental effect on the already low incidence of oxygen desaturation. There was no effect of the cannulae on the degree or frequency of hypoxaemia, although they did appear to improve the quality of sleep during the first postoperative night. They were more comfortable by day than simple packing alone and no adverse effects were observed.

Topics: Adolescent; Adult; Bandages; Catheterization; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nasal Polyps; Nasal Septum; Nose; Oxygen; Postoperative Period; Sleep

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

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

Topics: Humans; Inflammation; Nasal Polyps; Nitric Oxide; Nose; Sinusitis

Topics: Cerebrospinal Fluid Rhinorrhea; Ethmoid Sinus; Humans; Nasal Polyps; Nose

Hippocrates, a Greek physician during the fifth century BC., is often considered the father of medicine. The Corpus Hippocraticum comprising of 58 volumes was writing between 450 and 150 BC. The objective of our study was to detail the management of nasal polyps during this period. We read and analyzed all volumes of the Corpus Hippocraticum in French translation and extracted all passages dealing with nasal polyps (n = 6). Surgical procedures in the Corpus Hippocraticum are described in great detail. The first surgical strategy for the removal of nasal polyps was by mini-invasive nasal approach: the lopping method and the sponge method. We explain the two mini-invasive nasal approaches with drawings. The meticulously detailed observations of the corpus give us a precious insight into the early perception of diseases, their progression and early attempts of treatment.

Topics: Humans; Nasal Polyps; Nasal Surgical Procedures; Nose

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

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

Topics: Humans; Nasal Polyps; Nose; Otolaryngology; Pharynx; Rhinitis

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

Topics: Endoscopy; Humans; Nasal Polyps; Nasal Surgical Procedures; Nose

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

Despite the close linkage between rhinitis, chronic rhinosinusitis (CRS) and asthma, relevant biomarkers of both upper and lower airway inflammation are rare.. Patients with asthma (without upper airway disease [UAD; n = 24], with rhinitis [n = 25], CRS [n = 24], and nasal polyps [n = 2]), isolated rhinitis (n = 13), isolated CRS (n = 13), and 10 healthy controls were prospectively recruited. Fractional exhaled nitric oxide (NO) levels at 50 mL/s (FeNO. Asthma was associated with higher FeNO. Higher nasal NO levels reflect the presence of AR, irrespective of asthma concomitance. Higher FeNO

Topics: Adult; Aged; Asthma; Breath Tests; Exhalation; Female; Humans; Male; Middle Aged; Nasal Polyps; Nitric Oxide; Nose; Respiratory Function Tests; Rhinitis; ROC Curve; Sinusitis; Tomography, X-Ray Computed

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

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

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

Interleukin (IL)-25 has been shown to play an important role in the pathogenesis of chronic rhinosinusitis with nasal polyps. Nasal polyps are associated with chronic inflammation of the mucous membranes in the paranasal sinuses and are involved in extracellular matrix (ECM) accumulation. The aim of this study is to evaluate the effects of IL-25 on myofibroblast differentiation, ECM production and the expression of matrix metalloproteinases in nasal polyp derived fibroblasts (NPDFs) and to determine the molecular mechanism underlying these processes.. A total of 40 patients were enrolled in this study for Immunofluorescence studies. Expression of IL17 receptor B was evaluated by real time reverse transcription polymerase chain reaction (PCR) in NPDFs. NPDFs were stimulated with IL-25 for 48 h in the presence or absence of mitogen-activated protein kinase (MAPK) and NF-κB inhibitors or small interfering RNAs (siRNA). The protein levels of fibrosis active mediators were examined using western blotting. Fibroblast migration was evaluated with a scratch assay. The total collagen amount was analyzed with the Sircol collagen assay.. IL-25 induced α-SMA, fibronectin, and MMP-1 and -13, which were dependent on IL-17RB. IL-25 also induced activation of NF-κB and mitogen-activated protein kinase (MAPKs). By using the specific inhibitor of ERK, p38, JNK and NF-κB (U, SB, SP and Bay), we found that IL-25-induced expressions of α-SMA, fibronectin, and MMPs was regulated by the signaling pathways of MAPKs and NF-κB. IL-25 also induces α-SMA, fibronectin, and MMPs expression through IL-17RB-dependent pathways in NPDFs. The increased migration ability induced by IL-25 was suppressed by the specific inhibitors of MAPKs and NF-κB.. Our data indicate that IL-25 induced myofibroblast differentiation, fibronectin production, and MMP-1 and -13 expressions through the signaling pathways of MAPKs and NF-κB. in NPDFs and increased expression of IL-25 were also involved in the pathogenesis of nasal polyposis by affecting nasal fibroblasts in chronic rhinosinusitis with nasal polyps.

Topics: Actins; Adult; Cell Differentiation; Cell Movement; Enzyme Activation; Female; Fibroblasts; Fibronectins; Gene Expression Regulation, Enzymologic; Humans; Interleukin-17; Male; Matrix Metalloproteinase 1; Matrix Metalloproteinase 13; Middle Aged; Mitogen-Activated Protein Kinases; Nasal Polyps; NF-kappa B; Nose; Receptors, Interleukin; Receptors, Interleukin-17; Signal Transduction; Sinusitis

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

Topics: Hemangioma, Cavernous; Humans; Magnetic Resonance Imaging; Maxillary Sinus; Nasal Polyps; Nose; Polyps; Retrospective Studies; Tomography, X-Ray Computed

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

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

To assess the effectiveness and usefulness of transnasal prelacrimal recess approach (TPRA) in patients with recurrent antrochoanal polyps.. Twelve patients with antrochoanal polyp recurrence underwent surgery with a transnasal endoscopic prelacrimal recess approach. Success for visualization of the origin of the polyps, surgical complications, and recurrence was evaluated.. Transnasal prelacrimal recess approach was successful in 83% of the patients (10/12); polyps that originated from a posterior location (2 patients) were excised using the middle meatal approach. Nasolacrimal duct injury occurred in 2 patients but neither had epiphora postoperatively. Three patients (3/12; 25%) had synechia formation between the lateral nasal wall and septum just superior to the inferior turbinate. One of the 3 patients (1/12; 8.3%) with synechia was symptomatic and required surgical treatment under local anesthesia. During a mean follow-up period of 14.2 months (range, 8-21 months) no recurrence had developed.. In experienced hands, TPRA is a novel, reliable, and useful method for the treatment of recurrent antrochoanal polyps. It ensures good exploration of the maxillary antrum and easy access to the polyp origin on the maxillary wall without the need of additional approaches.

Topics: Adolescent; Adult; Female; Humans; Male; Maxillary Sinus; Nasal Polyps; Nasolacrimal Duct; Natural Orifice Endoscopic Surgery; Nose; Postoperative Period; Recurrence; Tomography, X-Ray Computed; Young Adult

Topics: Airway Resistance; Case-Control Studies; Endoscopy; Female; Humans; Male; Nasal Cavity; Nasal Obstruction; Nasal Polyps; Nose; Postoperative Period; Rhinitis; Rhinomanometry; Rhinometry, Acoustic

This study aimed to assess the long-term outcome of functional endoscopic sinus surgery for Samter's triad patients using an objective visual analogue scale and nasal endoscopy.. Using a retrospective database, 33 Samter's triad patients who underwent functional endoscopic sinus surgery were evaluated pre- and post-operatively between 1987 and 2007 in Hospital of La Chaux-de-Fonds, Switzerland.. A total of 33 patients participated in the study, and the mean follow-up period was 11.6 years (range 1.2-20 years). Patients were divided into two groups based on visual analogue scale scores of the five parameters with the greatest difference in intensity of symptoms between the beginning and end of follow up. Group 1 included patients with a mean visual analogue scale score of 6 and below at the end of follow up and group 2 included patients with a mean visual analogue scale score of more than 6. The only statistically significant difference noted between the two groups was the endonasal findings: stage III-IV polyposis was present in 1 out of 24 patients (4 per cent) in group 1 and in 5 out of 9 patients (56 per cent) in group 2.. The results of our study indicate that functional endoscopic sinus surgery helps stabilise disease progression. Stage III-IV polyposis had a significant adverse effect on long-term outcome.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Asthma; Drug Hypersensitivity; Female; Follow-Up Studies; Forecasting; Humans; Male; Nasal Polyps; Natural Orifice Endoscopic Surgery; Nose; Otorhinolaryngologic Surgical Procedures; Pain Measurement; Pain, Postoperative; Retrospective Studies; Tomography, X-Ray Computed

The expression of C/EBPα, CK10 in nasal inverted papilloma (NIP) were detected in the study. Further discussed their significance in genesia, development and recurrence of NIP.. Three groups including nasal cavity mucosae (NM 10 cases), nasal polyp (NP 20 cases) and NIP (30 cases) were selected in the study. Expretion of C/EBPα, CK10 were detected by immunohistochemisty PV-6000 method.. (1) The different expression of C/EBPα and CK10 in the group of NM, NP and NIP was statistically significant (P < 0.05). (2) The different expression of C/EBPα, CK10 in the group of benign NIP and NIP with atypical hyperplasia was statistically significant (P < 0.05). (3) The different expression of C/EBPα and CK10 in the group of NIP with recurrence and NIP with no recurrence was statistically significant, P < 0.05, respectively. (4) Our result indicate that the relationship of C/EBPα and CK10 (r = 0.578, P < 0.01) was direct correlation. The difference was statistically significant.. In conclusion, the present results describe C/EBPα, CK10 expression in NIP and their possible implication in the regulation of tumor growth and differentiation. C/EBPα and CK10 production may prove useful in terms of a prognostic marker for the recurrence in nasal inverted papilloma.

Topics: CCAAT-Enhancer-Binding Proteins; Humans; Keratin-10; Nasal Polyps; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Papilloma, Inverted

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

To explore the effects of allergic factores in eosinophilic nasal polyps.. Clinical characters of 67 eosinophilic nasal polyps patients and 26 lymphocyte nasal polyps patients were restrospeetively analyzed. Allergic factors, allergens and nasal anatomic variations were compared between two groups.. Allergic factors are proned to present in eosinophilic nasal polyps group compared with lymphocyte nasal polyps group; The positive rates of allergen skin test between eosinophilic nasal polyps group and lymphocyte nasal polyps group showed significant difference; Allergens in eosinophilic nasal polyps group are different from lymphocyte nasal polyps group; Nasal anatomic variations are different between two groups.. Different pathogenesis maybe exist in different pathological type nasal polyps. Allergic factors are closely relative to eosinophilic nasal polyps and nasal anatomic variations play a more important role in the formation of lymhocyte nasal polyps.

Topics: Allergens; Eosinophils; Humans; Hypersensitivity; Nasal Polyps; Nose; Skin Tests

The authors report a case of paraganglioma of the skull base presenting as nasal polyps. A 29-year-old patient presented with epistaxis and was found to have nasal polyps. The patient underwent a nasal polypectomy. After pathology showed an unusual appearance, the mass was subsequently excised endoscopically using radiofrequency coblation, and it was found to be originating from the skull base. The diagnosis was made using a combination of clinical findings, radiology, and histopathology examination. It is important to consider paraganglioma in the differential diagnosis of unusual tumors of the nose and skull base.

Topics: Adult; Diagnosis, Differential; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Male; Nasal Polyps; Nose; Paraganglioma; Paranasal Sinuses; Skull Base Neoplasms; Tomography, X-Ray Computed

The authors report a case of nasal malignant melanoma involving the septum, nasal turbinates and nasopharynx which was approached by lateral rhinotomy combined with an anterior transantral approach with excision of the septum and the lateral wall of the nasal cavity for wide exposure of the tumour. Using this technique complete surgical resection of a large nasal malignant melanoma was achieved with minimal morbidity and good aesthetics.

Topics: Aged; Epistaxis; Esthetics; Humans; Male; Maxillary Sinus; Melanoma; Nasal Cavity; Nasal Mucosa; Nasal Obstruction; Nasal Polyps; Nasal Septum; Nasopharyngeal Neoplasms; Nose; Nose Neoplasms; Sphenoid Sinus; Turbinates

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

Nitric oxide is believed to play a central role in nonspecific defense of upper airways. Patients with primary ciliary dyskinesia have very low concentration of nasal nitric oxide, which may contribute to the chronic upper airway diseases encountered by these patients. The mechanisms underlying this drop of nasal nitric oxide in primary ciliary dyskinesia are still unknown. The goal of the present work was to study nitric oxide synthases expression in upper airway tissues from patients with primary ciliary dyskinesia. For this purpose, 5 patients with primary ciliary dyskinesia and 10 nonallergic age-matched patients without primary ciliary dyskinesia undergoing nasal polypectomy were included. Nasal nitric oxide concentration was measured before polypectomy, and nitric oxide synthase expression and function were studied in nasal polyps. The nasal nitric oxide in patients with primary ciliary dyskinesia was lower than that in patients without primary ciliary dyskinesia (13 [9-16] ppb versus 210 [167-254] ppb, P < .0001). Nitric oxide synthase 2 immunostaining was prominent at the apical part of the ciliated epithelial cells and was similar in both groups. Nitric oxide synthase 3 staining was restricted to endothelial cells in both groups. In addition, reduced nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase activity was superimposable to nitric oxide synthases 2 and 3 immunostaining, suggesting a preserved NADPH-activity of nitric oxide synthase. We therefore conclude that the drop in nasal nitric oxide in patients with primary ciliary dyskinesia is not secondary to the loss of nitric oxide synthase expression.

Topics: Adolescent; Adult; Case-Control Studies; Child; Demography; Ethidium; Fluorescent Dyes; Gene Expression Regulation, Enzymologic; Humans; Kartagener Syndrome; Middle Aged; NADPH Dehydrogenase; Nasal Polyps; Nitric Oxide; Nitric Oxide Synthase Type II; Nitric Oxide Synthase Type III; Nose; Reactive Oxygen Species; Young Adult

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

Antrochoanal polyp (ACP) originates in the maxillary sinus. To diminish the regrowth rate of choanal polyp, a complete removal of the antral portion and its attachment is necessary. There are several methods for this purpose, but in this study two techniques were comparatively investigated. This retrospective study was conducted by analyzing the database of 40 operated patients for ACP, 19 of whom underwent an endoscopic endonasal removal of polyps and 21 experienced endoscopic endonasal surgery with mini-Caldwell operation. The two techniques were compared with regard to their complications and regrowth rate. It emerged that post-operative complications (bleeding, synechia, ostia stenosis) in both groups were mild and there was not any significant difference between the two groups. Out of 19 cases in the endoscopic endonasal surgery group, 4 had recurrences, while in the mini-Caldwell group we had no recurrence. (P = 0.042)). This result implies that, in order to prevent incomplete excision and recurrences, combined approaches (endoscopic endonasal surgery and mini-Caldwell) should be considered, particularly when the attachment site of the antral part of ACP is undetected.

Topics: Adolescent; Adult; Aged; Child; Endoscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasal Polyps; Nose; Otorhinolaryngologic Surgical Procedures; Retrospective Studies; Treatment Outcome; Young Adult

The indications, management, and results are discussed in 45 patients who underwent the concurrent functional endoscopic sinus surgery (FESS) and rhinoplasty.. Retrospective clinical study.. There were 27 women and 18 men with a mean age of 28 years. 28 patients had chronic rhinosinusitis and 17 patients had nasal polyposis refractory to medical therapy underwent the combined procedure by the same otolaryngologist.. A review of our 45 combined procedure performed between 2000 and 2005. There were no life-threatening severe complications noted in this population. The patients were also satisfied with the aesthetic outcome.. Combined rhinoplasty and endoscopic sinus surgery can be performed safely, cost- effectively and with perfect results in selected patients.

Topics: Adult; Endoscopy; Female; Humans; Male; Nasal Polyps; Nose; Otorhinolaryngologic Surgical Procedures; Paranasal Sinuses; Patient Selection; Retrospective Studies; Rhinitis; Rhinoplasty; Sinusitis

To determine the efficacy of the Gyrus diego microdissector at increasing oscillation speeds, using an in vitro tissue model.. It had not previously been established whether microdissectors were more efficient at higher or lower speeds.. We investigated the effect of varying microdissector oscillation speeds on the weight of material aspirated in a given time. A 4 mm straight blade was used with constant suction strength. Jelly and liver were used to simulate polyps and muscle plus connective tissue, respectively. Water was used as a control. Repeat readings were taken at speeds of 1000, 2000, 3000, 4000 and 5000 rpm. Data were analysed using linear bivariate regression.. The results showed significant linear trends in the cases of liver and jelly, with faster cutter speeds being associated with higher aspiration rates.. These results suggest that microdissector efficacy increases with speed, up to 5000 rpm.

Topics: Humans; Liver; Microdissection; Models, Biological; Nasal Polyps; Nose; Otorhinolaryngologic Surgical Procedures

Nasal surgery is frequently performed. Predictors of surgical outcome in terms of chemosensory function are not clear. A total of 64 patients were included in this prospective study (41 men, 23 women; age range 22-67 years). Prior to surgery, patients received a detailed otorhinolaryngological examination including nasal endoscopy, and CT scans used to establish the Lund-Mackay score. Olfactory function was analyzed using a custom-built odor identification test which allowed separation of chemosensory function into "olfactory" and "trigeminal" portions. Retest was performed 6 months after surgery. In terms of the sense of smell, nasal surgery produced the highest success rates in women, high degree of polyposis, and aspirin-intolerance. Neither age, presence of asthma, nor the number of preoperative surgical interventions had a significant impact on the outcome of surgery in terms of chemosensory function. Although "trigeminal scores" changed to a lesser degree than "olfactory scores", the present results indicated that nasal surgery may also improve trigeminal function, although this needs further corroboration. Improvement of olfactory function following nasal surgery appears to last, on average, for at least 6 months. While the present results may be seen as an encouraging step towards the description of more detailed prognostic factors related to nasal surgery, results from the present investigation also point towards the idea that nasal polyposis is due to a multifactorial process that, so far, is not adequately addressed by current research. Future work is needed to identify further predictors of postoperative outcome in terms of olfactory function.

Topics: Adult; Aged; Endoscopy; Female; Frontal Sinus; Humans; Male; Middle Aged; Nasal Polyps; Nose; Olfaction Disorders; Olfactory Perception; Postoperative Complications; Smell

Nasal polyposis is a very common and multifactorial disease. Whereas eosinophil-dominated polyps often are sensitive to anti-inflammatory treatment like corticosteroids, the therapy of polyps without eosinophils is more difficult and disappointing. We report the clinical course of a 29-year-old albino patient suffering from a extreme manifestation of Woakes' syndrome, which is characterized by severe recurrent nasal polyps, often without eosinophils on histological examination and with broadening of the nose. In this case, the recurrent fibrotic polyps without eosinophils were resistant to conventional medical and surgical treatment and required further treatment with radiotherapy with awareness of all possible future sequelae. The pathoetiology and treatment of Woakes' syndrome as well as of albinism were discussed.

Topics: Adult; Albinism; Black People; Ethmoid Sinus; Ethmoid Sinusitis; Humans; Hypertelorism; Male; Nasal Polyps; Nose; Nose Deformities, Acquired; Recurrence; Reoperation; Syndrome; Tomography, X-Ray Computed

Bilateral nasal polyposis (NP) is characterized by high concentrations of IgE in NP tissue, which show no relation to the atopic status. We aimed to study the relationship between systemic and local IgE formation, nasal carriage of Staphylococcus aureus and nasal polyposis.. In serum and nasal tissue homogenates from 24 NP patients and 12 controls, we determined concentrations of total IgE and IgE antibodies to inhalant allergens and S. aureus enterotoxins (SAEs; A,B,C,D,E,TSST) by ImmunoCAP. Tissue cryosections were stained for CD3, CD20, CD38, CD23, FcepsilonRI, IgE and SEA/SEB.. We demonstrated a higher incidence of S. aureus colonization (17/24) and IgE antibodies to SAEs in NP tissue (12/24) compared with controls (3/12 and 0/12, respectively). Total IgE and IgE antibodies in serum and NP tissue were dissociated because of local polyclonal IgE formation in NP tissue. Staining of NP tissue revealed follicular structures characterized by B and T cells, and lymphoid accumulations with diffuse plasma cell infiltration.. We demonstrated the organization of secondary lymphoid tissue in polyp tissue and a polyclonal hyper-immunoglobulinemia E associated with the presence of IgE antibodies to SAEs, colonization with S. aureus, and tissue eosinophilia in a relevant subgroup of polyp patients.

Topics: Adult; Aged; Antigens, CD; B-Lymphocytes; Colony-Forming Units Assay; Enterotoxins; Eosinophilia; Female; Humans; Immunoglobulin E; Immunohistochemistry; Lymphoid Tissue; Male; Middle Aged; Nasal Polyps; Nose; Receptors, IgE; Staphylococcus aureus; T-Lymphocytes

Rhinosurgery in children and adolescents meets special requirements: Limited cooperation and reduced limits for the organ dose for ionizing radiological examinations aggravate diagnostics. On the other side, bone sutures and bone growth areas have to be respected intraoperatively, and regions of bones not yet calcified have to be distinguished from possible tumor infiltration. Computer assisted surgery (CAS) can help to identify these areas safely.. 5 patients, from the first to the 20 (th) year of life, suffering from tumors, malformation syndromes or therapy resistant nasal polyposis were treated with CAS in rhinosurgery.. In addition to radiological diagnostics, we performed 3D computed tomography of the skull for CAS. CAS enabled us to intraoperatively respect possible areas of bone growth, to identify regions with thin, not bonily developed cranial vault and to safely distinguish bone sutures from ethmoidal cells. CAS helped the surgeon to navigate in the not yet developed paranasal sinus system.. CAS is a useful complementary method in rhinosurgery of the developing skull of the child. In spite of the additional 3D computed tomography, the calculated organ dose of the ocular lense amounted to 5 millisievert, so a recommended maximal organ dose for the ocular lense of 15 millisievert was not exceeded.

Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Choanal Atresia; Craniofacial Dysostosis; Down Syndrome; Female; Fibroma; Humans; Imaging, Three-Dimensional; Infant; Male; Nasal Polyps; Nasopharyngeal Neoplasms; Nasopharynx; Nose; Nose Diseases; Sinusitis; Skull; Surgery, Computer-Assisted; Tomography, X-Ray Computed

Glucocorticoids are known to be effective in the treatment of nasal polyps (NPs). To examine the mechanisms of their effect, we evaluated 1) the ability of glucocorticoids to induce the apoptosis of eosinophils and T lymphocytes in NPs, and 2) the ability of dexamethasone to down-regulate epithelial cell functions that relate to eosinophilic inflammation. In vitro and in vivo, glucocorticoids increased the apoptosis of both eosinophils and T lymphocytes in NPs. Dexamethasone inhibited the production of granulocyte-macrophage colony-stimulating factor (GM-CSF) from both NP epithelial cells that were unstimulated and NP epithelial cells that were stimulated with interleukin-4 or tumor necrosis factor alpha. These results suggest that the clinical efficacy of glucocorticoids on NPs may be due to 1) induction of apoptosis in both eosinophils and T lymphocytes that infiltrate NPs, and 2) down-regulation of epithelial GM-CSF production, which prolongs eosinophil survival.

Topics: Adult; Apoptosis; Cells, Cultured; Dexamethasone; Eosinophils; Epithelial Cells; Female; Glucocorticoids; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Immunohistochemistry; In Situ Nick-End Labeling; Interleukin-4; Male; Middle Aged; Nasal Polyps; Nose; T-Lymphocytes; Tumor Necrosis Factor-alpha

Topics: Endoscopy; Female; Humans; Maxillary Sinusitis; Middle Aged; Mucociliary Clearance; Nasal Mucosa; Nasal Polyps; Nose

A 17-year-old previously unreported patient with Pai syndrome is described. The boy had median cleft of upper lip, a polypoid skin mass over the columella, a minimal cleft of the upper central incisors, frontal alopecia of the anterior hairline, and bifid nose. Magnetic resonance imaging showed pericallosal lipoma. No mental retardation was present, and a chromosomal study showed normal male 46, XY karyotype.

Topics: Adolescent; Alopecia; Brain Neoplasms; Cleft Lip; Corpus Callosum; Humans; Lipoma; Magnetic Resonance Imaging; Male; Nasal Polyps; Nose; Syndrome

Intraoperative bleeding is one of the major problems in endoscopic surgery of sinuses. In the case of the expanded process, still more numerous interventions are performed with general anesthesia. The objective of research is to compare intraoperative hemorrhage and the visibility of the operative field during normotension and hypotension anesthesia caused by nitroglycerin and captopril when performing endoscopic operations of accessory nasal sinuses. Fifty-two patients of physical health state 1-2 according to ASA were examined: for 32 the controlled hypotension (Group H) was applied, 20 patients underwent operations in normotension (Group N). All patients on the eve of the operation were premedicated with diazepam; Group H patients on the day of operation received 6.25 mg of captopril. Anesthesia was carried out with fentanyl and halothane steam in the 50:50% mixture of oxygen and laughing gas. In Group H arterial blood pressure was lowered by nitroglycerin infusion. The average arterial blood pressure was maintained in GroupH within the limits of 50-60 mmHg. Hypotension was coordinated with the rising of the head-bed of the operating table at 5 degrees. Hemorrhage was measured by collecting blood with the pump graded with the precision of 25 ml. The visibility of the operative field was evaluated subjectively every 15 minutes according to the scale of 5 points proposed by Fromm. In both groups the average arterial blood pressure values as well as the values of the frequency of heart contractions differed statistically significantly. In the hypotensive group, hemorrhage during operation was less, on the average, (208 ml) than in Group N (349.2 ml). The visibility of the operative field was by one point, on the average, better than in Group H. No anesthetic complications were observed during investigation. In summary, it is possible to state that the controlled arterial hypotension caused by captopril and nitroglycerin reduced significantly intraoperative hemorrhage and improved the visibility of the operative field in endoscopic rhinosurgery.

Topics: Adjuvants, Anesthesia; Adolescent; Adult; Anesthesia; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Blood Loss, Surgical; Captopril; Data Interpretation, Statistical; Diazepam; Endoscopy; Female; Humans; Hypotension, Controlled; Male; Middle Aged; Nasal Polyps; Nitroglycerin; Nose; Paranasal Sinuses; Time Factors; Vasodilator Agents

The angiomatous polyp corresponds to the vascular compromised nasochoanal part of a sinochoanal polyp. We describe the MRI characteristics of such lesions in four patients. All patients had an angiomatous polyp, in three cases as part of an antrochoanal polyp, and in one case as part of a sphenochoanal polyp. The unenhanced MR images depicted the typical appearance of a sinochoanal polyp, hypointense on T1-weighted and hyperintense on T2-weighted images. On gadolinium-enhanced MR images, the sinusal part showed little or no peripheral enhancement; however, the nasochoanal part, corresponding to the angiomatous polyp, showed strong enhancement. An angiomatous polyp mimics a hypervascular mass lesion on enhanced MR studies. The anatomic location and association with a sinusal polyp allows the correct diagnosis.

Topics: Adolescent; Adult; Angiofibroma; Diagnosis, Differential; Female; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Maxillary Sinus; Maxillary Sinus Neoplasms; Nasal Polyps; Nasopharynx; Nose; Nose Neoplasms

Topics: Endoscopy; Humans; Nasal Cavity; Nasal Polyps; Nose; Nose Neoplasms

Nasal endoscopy was carried out in 83 patients with perennial allergic rhinitis to evaluate endonasal anatomic variation and to find the correlation between the symptoms of patients and the endoscopic findings. All of the patients had nasal symptoms, 7.2% of the patients were runner, 7.2% were blocker and 85.6% were both. 86.75% of the patients had allergy-related symptoms, i.e. throat symptoms (73.5%), sinus headache (50.6%), and smell disturbance (10.8%). 95.2% of patients had abnormal endoscopic findings, i.e. deviated nasal septum (72.3%), abnormal middle turbinate (49.4%), narrowing of the entrance into the frontal recess (30.1%), septal spur (25.3%), obstruction of the entrance into the frontal recess (19.3%), nasal polyps (15.7%), mucopurulent discharge (14.5%), inferior turbinate hypertrophy (10.8%), abnormal uncinate process (9.6%), abnormal ethmoid bullae (7.2%), and enlargement of aggar nasi cells (2.4%). There was no significant correlation between each symptom and each endoscopic finding. However, there was a significant correlation between sinus headache and all of the combined abnormal endoscopic findings (P<0.05). These findings suggested that variations in endonasal anatomy was not by itself a pathology or a cause of symptoms. However, a combination of these variations may narrow the cleft of the ostiomeatal unit and cause contact area or stenosis, which predisposed patients to persistent symptoms, recurrent infection or resistance to therapy in patients with perennial allergic rhinitis. The endoscope might be a very useful tool for allergists, immunologists, and rhinologists, who work in the nose to deal with these cases.

Topics: Adolescent; Adult; Aged; Chi-Square Distribution; Child; Endoscopy; Female; Headache; Humans; Male; Middle Aged; Nasal Obstruction; Nasal Polyps; Nasal Septum; Nose; Rhinitis, Allergic, Perennial; Turbinates

Topics: Adult; Diagnosis, Differential; Disease-Free Survival; Esophagoscopy; Female; Foreign Bodies; Humans; Nasal Polyps; Nasopharyngeal Diseases; Nose; Stethoscopes

Topics: Angiofibroma; Diagnosis, Differential; Epistaxis; Female; Humans; Middle Aged; Nasal Polyps; Nasopharynx; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Paranasal Sinuses

An antrochoanal polyp, a common clinical entity, with a rare presentation is being reported. A 12 year old boy was brought to Accident and Emergency department with an unusual sudden presentation of polypoidal mass filling the oral cavity up to his incisors as a result of which he could not swallow and speak. Prior to this episode he had no complaints of the disease. An emergency removal was planned and only during the operation could it be diagnosed as a antrochoanal polyp because of its pedicle in the lateral wall of the nose, which was confirmed by histopathological examination.

Topics: Aphonia; Child; Deglutition Disorders; Diagnosis, Differential; Emergencies; Humans; Male; Nasal Polyps; Nose

Three-dimensional (3-D) computed imaging was applied before surgery in 16 patients with nasal or paranasal disease. The images obtained by computed tomography (CT) were scanned by a personal computer. The contours of the organs were outlined on the scanned images, and the images were then reconstructed using 3-D imaging software. The resulting 3-D images were evaluated and compared with actual surgical images. The 3-D images were found to be useful for surgical procedures, because they facilitated recognition of the topologic relation between structure and lesion. Although this method requires a personal computer and an image scanner, it is cheaper than, and in some respects even superior to, a 3-D CT system.

Topics: Adult; Computer Graphics; Cysts; Humans; Image Interpretation, Computer-Assisted; Male; Microcomputers; Middle Aged; Nasal Polyps; Nose; Orbital Diseases

The aim of our study was to investigate the prevalence of surgery on the nose prior to first time diagnosis of nasal polyps. We interviewed 60 patients who presented to the ENT Department at the Royal South Hants Hospital Southampton and were diagnosed as suffering from nasal polyps for the first time. Patients who suffered from cystic fibrosis or known primary ciliary dyskinesia were excluded. The average length of time of nasal blockage as the main symptom prior to the diagnosis of nasal polyps was less than two years. Out of the 60 patients six (10 per cent) had had previous nasal surgery. Out of these six patients, only four patients had a previous procedure on the nose that could be considered to be related to the later diagnosis of nasal polyps. Only one patient had had radiological investigation of his sinuses in the past. We conclude that polypoid nasal disease is a de novo diagnosis with a relatively short history in the majority of patients and not preceded by a long history of ENT investigations nor surgery on the nose.

Topics: Adult; Aged; Aged, 80 and over; Asthma; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nasal Polyps; Nose

Middle meatal antrostomy under nasal endoscope, a functional procedure which conforms to paranasal sinus physiology, has provided a new approach to reestablishing the ventilation and drainage of nasal cavity and paranasal sinus. A 3-15 month's follow-up of 75 patients with chronic sinusitis and polyps who had undergone endoscopic sinus surgery shows a higher patency rate of 86.7% and a lower closure rate of 13.3%. While for patients who received inferior meatal antrostomy the patency rate was 54.7% and the closure rate 45.3%. There was a significant difference (P < 0.01) between the two groups in patency rate and closure rate respectively. So the antrostomy of middle meatus appears to be better than that of inferior meatus. The clinical significance of middle meatal antrostomy on the basis of anatomy and physiology of paranasal sinus is emphasized in discussion.

Topics: Adolescent; Adult; Aged; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Polyps; Nose; Sinusitis; Surgical Procedures, Operative

During a period of two years, 24 cases of antrochoanal polyps were diagnosed by clinical examination, nasal endoscopy and computerized tomography. Surgery started with endoscopic transnasal removal of the polyp. Every attempt was made to remove the antral portion of the polyp through the wide ostium. Then transcanine sinuscopy was performed. Remnants of the polyp were detected and removed in five cases. One or more other cysts were found and extirpated in 11 cases. Endoscopic follow-up for 18 months to three years revealed no recurrence. It is recommended that endoscopic middle meatal surgery should be combined with transcanine sinuscopy to ensure complete removal of antrochoanal polyps.

Topics: Adolescent; Adult; Child; Endoscopy; Female; Humans; Male; Maxillary Sinus; Middle Aged; Nasal Polyps; Nose

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

Reported cases of toxic shock syndrome (TSS) following nasal surgery or functional endonasal sinus surgery (FESS) are uncommon. Classic TSS is a serious multisystem disorder resulting from Staphylococcus aureus phage I toxic shock syndrome toxin 1 (TSST-1), and it is characterized by fever, rash, hypotension, mucosal hyperemia, vomiting, diarrhea, and laboratory evidence of multisystem organ dysfunction. TSS cases following nasal surgery have been associated with nasal packing, mucosal barrier violation, prior S aureus phage I colonization, as well as low antitoxin antibody levels. Of the 1700 FESS procedures performed at our institution, 3 cases were complicated by classic TSS, with 2 additional patients having a postsurgical course compromised by a milder degree of TSS. Diagnostic criteria, clinical presentation, management, and etiology are discussed, and the possibility of a continuum from mild-to-classic TSS is addressed.

Topics: Adolescent; Adult; Child; Female; Humans; Male; Maxillary Sinus; Mucocele; Nasal Polyps; Nasal Septum; Nose; Paranasal Sinus Diseases; Postoperative Complications; Shock, Septic; Sinusitis; Sphenoid Sinus; Staphylococcal Infections; Tampons, Surgical

The distribution and abundance of mast cells in nasal polyps, the maxillary sinus mucosa of patients with sinusitis and the turbinate mucosa of allergic rhinitis was microscopically examined using different methods of fixation. In the epithelium of the surface and the ducts of nasal polyps (n = 8), the mean number of mast cells was over 20,000 per mm3 using Mota's fixation and the increase was correlated with the epithelial thickness (P < 0.05). On the other hand those of the maxillary sinus mucosa (n = 6) and the nasal turbinate mucosa (n = 7) were less than 6,000 per mm3. In the subepithelial layer or areas deeper than the area with the glands, however, mast cell counts were less than 3,200 per mm3 in all diseases. More than 70-90 per cent of all mast cells in the epithelium of the mucosal surface and the ducts of the polyp, the maxillary sinus mucosa and nasal turbinates were formalin sensitive. Most of the mast cells in the subepithelial and deeper areas were formalin resistant in all diseases. These results suggest that conditions for mast cell growth differ between polyps and the other diseases, and that the conditions which affect mast cells may contribute to polyp development.

Topics: Adolescent; Adult; Cell Count; Epithelium; Humans; Mast Cells; Maxillary Sinusitis; Middle Aged; Nasal Mucosa; Nasal Polyps; Nose; Respiratory Tract Infections; Rhinitis; Turbinates

Topics: Adenoids; Foreign Bodies; Humans; Nasal Obstruction; Nasal Polyps; Nasal Septum; Nose; Nose Neoplasms; Otitis Media; Patient Education as Topic; Rhinitis; Sleep Deprivation; Tooth Abnormalities

Topics: Adult; Eosinophils; Female; Humans; Male; Middle Aged; Nasal Polyps; Nose; Therapeutic Irrigation

Seventy patients with nasal polyps were studied. Forty-seven of these had pre-operative sinus radiographs and all seventy patients had antral washouts at the time of nasal polypectomy. One hundred and seventeen antral aspirates were sent for culture and microscopy. The naked eye appearance of aspirates were turbid in 34 patients. Bacteria were cultured from 15 of the specimens in 10 patients. It was concluded that antral washout should be recommended in all patients who have nasal polypectomy and that there is no need for sinus radiographs in those patients who have uncomplicated nasal polyps.

Topics: Adolescent; Adult; Aged; Female; Humans; Male; Maxillary Sinus; Maxillary Sinusitis; Middle Aged; Nasal Polyps; Nose; Radiography; Retrospective Studies; Therapeutic Irrigation

A case-control study on cancer of the nose and paranasal sinuses, and several risk factors including previous nasal diseases and symptoms, was performed in France from January 1986 through February 1988. The frequency of previous nasal diseases and symptoms was analyzed by histologic type of cancer. Different results were observed for squamous cell carcinomas and adenocarcinomas. In men, there were statistically significant associations between squamous cell carcinomas and sinusitis, bleeding from the nose, polyps, rhinitis, and trauma to the nose; and between adenocarcinomas, bleeding from the nose, and rhinitis. In women, there was an association between squamous cell carcinomas and nasal polyps.

Topics: Adenocarcinoma; Aged; Carcinoma, Squamous Cell; Case-Control Studies; Epistaxis; Female; France; Humans; Male; Middle Aged; Nasal Polyps; Nose; Nose Diseases; Nose Neoplasms; Paranasal Sinus Neoplasms; Rhinitis; Risk Factors; Sex Factors; Sinusitis; Time Factors

Topics: Adolescent; Adult; Aged; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Polyps; Nasal Septum; Nose; Nose Diseases; Paranasal Sinuses

The AA. expose their experience drawn out from 150 cases of naso-sinusal pathology, treated through endoscopic surgery after the Messerklinger-Stammberger technique. They emphasize either the advantages of the procedure, in comparison with the classic methods, and the postoperative pitfalls. This procedure call for an exact knowledge of the endoscopic anatomy of the ethmoidal area, which can be gained only through corpses training.

Topics: Endoscopy; Humans; Mucocele; Nasal Polyps; Nose; Paranasal Sinuses; Postoperative Complications; Reoperation; Sinusitis; Surgical Procedures, Operative

The anatomy, surgical technique, and difficulties of endoscopic vidian neurectomy are described. The procedure was carried out on 12 patients: 8 had resistant secretomotor rhinopathy and 4 had recurrent nasal polyposis. This technique is a minor surgical procedure with symptomatic relief and minimal postoperative morbidity.

Topics: Endoscopy; Female; Humans; Male; Methods; Nasal Polyps; Nose; Peripheral Nerves; Postoperative Complications; Rhinitis, Vasomotor

Primary cultures of respiratory epithelium were produced as outgrowths from human fetal and adult tracheal and nasal polyp explants. Video recordings of the epithelial cell outgrowths were carried out after 5 days of culture and the ciliary beating frequency was analyzed by using a video technique. Uniform fields of differentiated ciliated cells were observed near the edge of the explant. In the transition region of the outgrowth from the explant to the outgrowth periphery, isolated ciliated cells were present, as well as cells with fused cilia. The ciliary beating frequency of the outgrowth of well-differentiated ciliated cells (13.5 +/- 1.4 Hz) was significantly higher (p less than 0.001) than the beating frequency of both the explant (11.9 +/- 0.7 Hz) and the ciliated cells with fused cilia (9.8 +/- 1.7 Hz). The same differentiation stages and functional activities were observed in the outgrowth cultures, whatever their origin. These in vitro models are comparable with each other and therefore could be useful for studying the ciliogenesis and functional activity of the human respiratory epithelium.

Topics: Cilia; Culture Techniques; Epithelium; Humans; Microscopy, Electron, Scanning; Movement; Nasal Polyps; Nose; Trachea; Video Recording

Topics: Adult; Drugs, Chinese Herbal; Humans; Nasal Polyps; Nasal Septum; Nose; Rhinoplasty

This paper summarizes an ENT surgeon's view of allergic rhinitis and deals with the presenting complaints and symptoms of allergic and non-allergic rhinitis, suggests the important features of the history and examination and indicates the more important special investigations; the medical and surgical treatments available to deal with the symptoms of rhinitis are discussed.

Topics: Adult; Humans; Nasal Polyps; Nose; Nose Diseases; Physical Examination; Respiratory Hypersensitivity; Rhinitis, Allergic, Perennial; Sinusitis

Despite the complex embryological development of the nose and surrounding structures, significant developmental nasal anomalies are rare. We therefore present our experience in the management of such anomalies (excluding choanal atresia) over the past 10 years. Fifty cases were surgically treated; two nasopharyngeal cysts, four hairy polyps, two meningoencephalocoeles, seven gliomata, 20 dermoids, two capillary haemangiomata, four fibromas, one fibromyxyoma, one mucocoele, one granuloma, one lipoma, two nasal aplasias, two nasal clefts and one nasal web. All cases presented with nasal obstruction and/or as a nasal mass. Computerized tomography and magnetic resonance imaging aided diagnosis determining the extent of intracranial involvement. Various surgical techniques were used ranging from simple excision to the lateral rhinotomy and Goodman's external rhinoplasty approach. Only five patients (10 per cent) suffered complications; two CSF leaks and three recurrences, all treated successfully.

Topics: Child; Cysts; Dermoid Cyst; Encephalocele; Female; Glioma; Hemangioma; Humans; Infant; Infant, Newborn; Male; Meningocele; Nasal Polyps; Nasopharyngeal Diseases; Nose; Nose Neoplasms; Skull

Release of high molecular weight-neutrophil chemotactic activity from human tissues, cells and secretion was studied in vivo and in vitro. Lung, nasal turbinate, nasal polyps, skin of neurofibromatosis, basophils from chronic myeloid leukemia and cultured basophilic cells from cord blood released this mediator following calcium ionophore, antigen, anti-IgE or homogenization in vitro. Its release was also demonstrated in human nasal secretions from patients with allergic rhinitis following antigen challenge. Regarding mononuclear cells no release of this mediator was observed from normal donors or asthmatic patients having no active attack upon challenge with calcium ionophore, phytohemagglutinin or antigen. Homogenized duodenum released high molecular weight-neutrophil chemotactic activity but less activity in comparison with other tissues or cells mentioned above.

Topics: Asthma; Basophils; Chemotactic Factors; Chemotaxis, Leukocyte; Duodenum; Humans; Leukocytes, Mononuclear; Lung; Nasal Polyps; Nasal Provocation Tests; Neurofibromatosis 1; Neutrophils; Nose; Rhinitis, Allergic, Perennial

We believe that complete intranasal sphenoethmoidectomy is the procedure of choice for massive nasal polyposis and polypoid sinusitis. The anatomy is complex, visualization with conventional matters is limited, and the potential complications can be severe. Nevertheless, with thorough underlying knowledge of the anatomy and proper training consisting of cadaver dissection and supervised surgery, a safe, effective technique can be mastered. Two hundred and thirty sphenoethmoidectomies done in 87 patients over the past 10 years are reviewed. The initial recurrence rate was 25%. There was a 3% incidence of serious complications. These results are comparable to those in the literature. While recognizing the potential complications of this difficult procedure, we believe that it can be performed safely and effectively by properly trained surgeons and that an effort should be made to extend proper instruction to otolaryngology residents.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ethmoid Sinus; Female; Humans; Intraoperative Complications; Male; Middle Aged; Nasal Polyps; Neoplasm Recurrence, Local; Nose; Postoperative Complications; Reoperation; Retrospective Studies; Sphenoid Sinus

Thirty cases of inverting papilloma were reviewed retrospectively. The histology was reviewed and correlated with the clinical findings. The histology, site and clinical course allow these papillomas to be divided into three types: solitary nodular inverting papilloma, multilocalized nodular inverting papilloma, and myxoid inverting papilloma. Every group has its own prognosis. This separation makes it possible to decide the therapy, particularly the extent of the operation.

Topics: Cell Transformation, Neoplastic; Epithelium; Humans; Mitosis; Nasal Polyps; Neoplasms, Multiple Primary; Nose; Nose Neoplasms; Papilloma; Paranasal Sinus Neoplasms; Paranasal Sinuses

Topics: Adrenal Cortex Hormones; Histamine H1 Antagonists; Humans; Mast Cells; Nasal Polyps; Nose; Rhinitis, Allergic, Seasonal

My experience with 250 intranasal laser surgical procedures performed with the carbon dioxide laser and the surgical microscope are described. Procedures include excision and vaporization of polyps, turbinates, tumors, telangiectasias, synechiae, nasal stenoses, intranasal cysts, papillomas, and septal spurs. Avoidance of technical problems is emphasized in this article since intranasal laser surgery is, in some respects, difficult to perform. Included are practical suggestions about patient positioning, use of protective devices, and patient selection.

Topics: Granuloma; Hemangioma; Hemorrhage; Humans; Laser Therapy; Lasers; Methods; Microscopy; Nasal Polyps; Nasopharyngeal Neoplasms; Nose; Nose Diseases; Papilloma; Postoperative Complications; Turbinates; Volatilization

Considerable interest and research have resulted from the finding that squamous cell carcinomas, polypoid adenomas, and a small number of other nasal neoplasms occurred in F-344 rats following chronic inhalation exposure to formaldehyde. These tumors were reported to originate in the anterior portion of the nasal cavity but their precise location in the nose was not determined. Histologic sections from the nasal passages of these rats have been reexamined and the location of each tumor has been recorded. The majority of squamous cell carcinomas occurred on the anterior portion of the lateral aspect of the nasoturbinate and adjacent lateral wall (57%) or the midventral nasal septum (26%). Polypoid adenomas were confined to a small region of the anterior nasal cavity and were restricted to the free margins of the naso-and maxilloturbinates and lateral wall adjacent to these margins. One neoplasm, considered to be the malignant counterpart of the polypoid adenoma, originated on the dorsal margin of the maxilloturbinate in the same region of the nose. Remaining neoplasms were generally too large or too poorly preserved for assessment of their site of origin. Mechanistic studies directed toward a better understanding of the nasal carcinogenicity of formaldehyde, or other nasal carcinogens. should take into account the anatomic sites of origin of the neoplasms whenever this can be determined.

Topics: Animals; Carcinoma, Squamous Cell; Female; Formaldehyde; Gases; Male; Nasal Polyps; Nose; Nose Neoplasms; Rats; Rats, Inbred F344

Topics: Adult; Histiocytoma, Benign Fibrous; Humans; Male; Nasal Polyps; Nose; Nose Neoplasms

Report on 22 cases of inverted papilloma. The common site of origin of the tumours is the lateral nasal wall and with a few exceptions they are benign. They become dangerous if they invade the bony structures of the face skeleton, especially the hard palate and the orbit. The therapy of choice is lateral rhinotomy with an "en bloc" resection of the lateral wall of the nose and the ethmoid of the invaded side. In that case the prognosis is good. The classifications by Schneider and Skolnik only define the size of the tumour but do not give an indication of prognosis; they are, therefore, unnecessary.

Topics: Adult; Aged; Diagnosis, Differential; Epithelium; Female; Humans; Male; Middle Aged; Mucous Membrane; Nasal Polyps; Nose; Nose Neoplasms; Papilloma; Paranasal Sinus Neoplasms; Paranasal Sinuses

Topics: Female; Hemangiopericytoma; Humans; Maxillary Sinus Neoplasms; Middle Aged; Nasal Polyps; Nose; Nose Neoplasms

Vidian neurectomy is a useful procedure in relieving the symptoms of vasomotor rhinitis. However, the nerve is difficult to approach because of its deep location in the pterygopalatine fossa. A direct transnasal approach to the pterygopalatine fossa, passing through the sphenopalatine foramen in the lateral wall of the nose, is described and its merits are discussed. We have operated upon 247 cases by this approach over the past four years without any significant complications.

Topics: Adult; Autonomic Fibers, Preganglionic; Female; Humans; Lacrimal Apparatus Diseases; Male; Methods; Nasal Polyps; Nose; Parasympathetic Nervous System; Postoperative Complications; Rhinitis, Vasomotor

"Triad" asthmatics often have sinus disease, nasal polyps, and obstructive airways disease. This presentation is reminiscent of the symptoms of persons afflicted with various forms of ciliary dyskinesia. Therefore, we examined tissues from seven "triad" asthmatic patients for ciliary structural or functional abnormalities. Transmission and scanning electron microscopy revealed no specific abnormalities. Cultures of nasal epithelia were maintained for up to 20 weeks. They showed normal ciliary activity which was not influenced by perfusing the tissue with medium containing aspirin. In contrast, control tissue from a patient with situs inversus and sinusitis showed the expected structural and functional ciliary abnormalities. In culture, the ciliary function of tissue from this patient could be partly restored by perfusion with ATP or ATPase.

Topics: Adenosine Triphosphatases; Adenosine Triphosphate; Adolescent; Adult; Aspirin; Asthma; Cells, Cultured; Cilia; Drug Hypersensitivity; Epithelium; Female; Humans; Male; Microtubules; Nasal Polyps; Nose

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

Topics: Adolescent; Adult; Aged; Ethmoid Bone; Female; Humans; Male; Middle Aged; Mucocele; Nasal Polyps; Nose; Tomography, X-Ray Computed

Topics: Child; Dermoid Cyst; Encephalocele; Foreign Bodies; Glioma; Histiocytoma, Benign Fibrous; Humans; Nasal Polyps; Nasopharyngeal Neoplasms; Nose; Nose Neoplasms

A short anatomical and physiological review of the vidian nerve is presented. The authors have described the surgical technique they use which is somewhat similar to the one described by Nomura. Eight cases are presented which had been unsuccessfully treated by multiple radical nasal polypectomies. The results are comparable to those published in the literature and it appears that vidian neurectomy has merit in the treatment of recurrent nasal polyposis but must be used in association with radical polypectomy.

Topics: Denervation; Humans; Nasal Polyps; Nose; Postoperative Care

The antrochoanal polyp, a benign solitary polypoid lesion, usually arises in a maxillary sinus, opacifying and enlarging the sinus cavity without bone destruction. It passes through the ostium of the sinus into the choana, and from there into the posterior nasopharynx. The soft tissue mass does not erode or destroy contiguous soft tissue or bony structures. In this sequence of events, its radiologic findings are characteristic. Five case reports are presented, and the differential diagnosis is discussed.

Topics: Child; Diagnosis, Differential; Female; Histiocytoma, Benign Fibrous; Humans; Male; Maxillary Sinus; Nasal Polyps; Nasopharyngeal Neoplasms; Nose; Radiography; Sinusitis

The ocular motility problem of two patients following intranasal surgery is examined. The patients were studied by eye movement records and ultrasonography. Surgery in both cases revealed a defect of the medial orbital wall with scar tissue incarcerated in the defect.

Topics: Aged; Diplopia; Ethmoid Bone; Humans; Middle Aged; Nasal Polyps; Nose; Oculomotor Muscles; Ophthalmoplegia; Orbit; Postoperative Complications; Strabismus

Severe medial rectus injury occurred in two cases following intranasal sinus surgery. In the first case a scarred medial rectus muscle was found at the time of corrective surgery. Reexamination of the surgical specimen in the second case confirmed our finding of medial rectus transection. Both patients had good cosmetic and functional improvement by means of vertical recti transposition to correct their large angle, fixed exotropias. A review of the literature indicates that this is, to our knowledge, a previously unreported complication of intranasal sinus surgery.

Topics: Adult; Diplopia; Ethmoid Bone; Female; Humans; Middle Aged; Nasal Polyps; Nose; Oculomotor Muscles; Ophthalmoplegia; Orbit; Postoperative Complications; Strabismus

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

Usually, nasal polyposis in early childhood (children aged less than 5 years) is caused by cystic fibrosis of Kartagener's syndrome. In later age groups, recurrent sinus infections, allergy and ASA disease (asthma, aspirin intolerance and nasal polyps) have to be taken into consideration. Four cases of early childhood polyposis are reported which fit into none of these etiological groups. This newly defined Woakes' syndrome comprises recurrent nasal polyposis with broadening of the nose, frontal sinus aplasia, bronchiectasis, and dyscrinia (production of highly viscous mucus). The disease seems to be hereditary. The possible origins of the disease are discussed.

Topics: Bronchiectasis; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Nasal Polyps; Nose; Nose Neoplasms; Syndrome

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

Topics: Aged; Foreign Bodies; Humans; Male; Maxillary Sinus; Nasal Cavity; Nasal Polyps; Nose; Time Factors

Indications and results of 125 Vidian neurectomies done in 64 patients have been presented. The indications were grouped as: Rhinorrhoea (37.5%), Nasal Polyposis (3.12%); Headaches and Faceaches (45.32%); and Bronchial Asthma (14-06%). Four initial Vidian neurectomies were done unilaterally and produced only partial relief in symptoms. Bilateral Vidian neurectomy relieved completely all the rhinorrhoea cases, all the nasal polyposis cases, 79-3% of headache and faceache cases and 55-5% of bronchial asthma cases.

Topics: Asthma; Denervation; Headache; Humans; Nasal Polyps; Nose; Nose Diseases; Rhinitis

The clinical, microscopical, and gross pathological features of 14 cases of intranasal and paranasal sinus polyposis with unusual stromal cell atypia are described. In gross appearance, the lesions were polypoid, translucent masses, similar to the usual nasal polyp. Although clinically the lesions were indicative of allergic and inflammatory nasal polyposis, microscopical examination showed numerous large, often pleomorphic histiocytes or facultative fibroblasts that were suggestive or sarcomatous, malignant degeneration. Diagnoses by the original contributing pathologists included embryonal rhabdomyosarcoma, stromal neoplasia, and juvenile masopharyngeal angiofibroma. Follow-up data showed no evidence of neoplasia, despite the remarkable cytological changes found in the stroma. The stromal atypia most likely represents a reactive phenomenon secondary to inflammation.

Topics: Adolescent; Adult; Child; Child, Preschool; Diagnosis, Differential; Female; Histiocytoma, Benign Fibrous; Humans; Male; Nasal Cavity; Nasal Polyps; Nose; Paranasal Sinus Neoplasms; Paranasal Sinuses; Rhabdomyosarcoma

An unusual presentation and treatment of an intranasal Schwannoma are discussed. The clinical and pathological features are also reviewed.

Topics: Humans; Middle Aged; Nasal Polyps; Nasopharyngeal Neoplasms; Neurilemmoma; Nose; Palate; Turbinates

The author presents his experience with vidian neurectomy. 30 cases have been operated; 18 had bilateral nasal-sinus polyposis and 12 vasomotor rhinitis. The results are presented. The patients with bilateral nasal-sinus-polyposis were operated by bilateral polypectomy cleaning the sinuses according to the Ermiro de Lima technique and unilateral vidian neurectomy was simultaneously performed. On this side the results obtained were excellent in comparation with the other one. The surgical technique is explained and some pathogenetic considerations are discussed.

Topics: Denervation; Humans; Nasal Cavity; Nasal Mucosa; Nasal Polyps; Nose; Paranasal Sinus Neoplasms; Rhinitis, Allergic, Seasonal

Topics: Cerebrospinal Fluid Rhinorrhea; Cryosurgery; Epistaxis; Fractures, Bone; Histiocytoma, Benign Fibrous; Humans; Mucous Membrane; Nasal Polyps; Nasopharyngeal Neoplasms; Nose; Nose Deformities, Acquired; Nose Diseases; Nose Neoplasms; Rhinitis; Rhinoplasty; Rosacea; Skin Neoplasms

Topics: Catheterization; Dacryocystitis; Dacryocystorhinostomy; Eye Neoplasms; Fistula; Hemorrhage; Humans; Lacrimal Apparatus; Nasal Mucosa; Nasal Polyps; Nose; Postoperative Complications; Skull Fractures; Suture Techniques

Topics: Carcinoma in Situ; Carcinoma, Transitional Cell; Diagnosis, Differential; Ethmoid Sinus; Frontal Sinus; Humans; Male; Maxillary Sinus; Middle Aged; Nasal Polyps; Neoplasm Recurrence, Local; Nose; Nose Neoplasms; Papilloma; Paranasal Sinus Neoplasms

Topics: Child; Hemangiopericytoma; Humans; Male; Microscopy, Electron; Nasal Polyps; Neoplasm Recurrence, Local; Nose; Nose Neoplasms

Topics: Adolescent; Adult; Denervation; Female; Histamine; Humans; Male; Methods; Middle Aged; Nasal Mucosa; Nasal Polyps; Nose; Palate; Parasympathetic Nervous System; Rhinitis, Allergic, Seasonal; Stomatitis

Topics: Adolescent; Adult; Aged; Calculi; Carcinoma, Squamous Cell; Child; Cysts; Diagnosis, Differential; Female; Fibrous Dysplasia of Bone; Headache; Humans; Male; Middle Aged; Mucocele; Nasal Polyps; Neck; Nose; Paranasal Sinus Neoplasms; Radiography; Respiratory Tract Diseases; Sinusitis; Sphenoid Sinus

Topics: Adolescent; Adult; Carcinoma, Squamous Cell; Connective Tissue; Edema; Ethmoid Sinus; Female; Frontal Sinus; Humans; Male; Methods; Middle Aged; Nasal Polyps; Nasal Septum; Nose; Nose Neoplasms; Osteomyelitis; Scalp; Sinusitis; Skull

Topics: Adjuvants, Anesthesia; Adult; Aged; Anesthesia, Local; Blood Pressure; Cognition; Diazepam; Female; Hemorrhage; Humans; Male; Maxillary Sinus; Memory; Middle Aged; Nasal Polyps; Nose; Turbinates

Topics: Adenoids; Airway Obstruction; Ephedrine; Foreign Bodies; Hematoma; Histamine H1 Antagonists; Humans; Hypersensitivity; Hypertrophy; Mucus; Nasal Polyps; Nasal Septum; Nose; Nose Diseases; Nose Neoplasms; Rhinitis

Topics: England; Eponyms; Ethmoid Bone; History, 19th Century; History, 20th Century; Humans; Nasal Polyps; Necrosis; Nose; Osteitis; Recurrence

Topics: Adenoids; Mouth Breathing; Nasal Polyps; Nose; Nose Neoplasms; Respiration; Rhinitis

Topics: Adult; Aged; Diagnosis, Differential; Facial Neoplasms; Female; Humans; Male; Middle Aged; Nasal Polyps; Nose; Papilloma

Topics: Endoscopy; Ethmoid Sinus; Humans; Hyperplasia; Inflammation; Nasal Polyps; Nose; Nose Diseases; Paranasal Sinuses; Rhinitis; Sinusitis; Turbinates

Topics: Humans; Methods; Nasal Polyps; Nose

Topics: Animals; Cattle; Collagen; Dogs; Glycosaminoglycans; Histocytochemistry; Humans; Lipids; Microscopy, Electron; Nasal Mucosa; Nasal Polyps; Nose; Papio; Rabbits; Sheep; Staining and Labeling; Swine; Water

Topics: Denervation; Epistaxis; Humans; Maxillary Artery; Methods; Nasal Polyps; Neuralgia; Nose; Otorhinolaryngologic Diseases; Palate; Postoperative Complications; Sphenoid Bone; Surgical Instruments; Sutures

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

Topics: Anesthesia, Local; Cocaine; Humans; Methods; Nasal Polyps; Nasal Septum; Nose; Turbinates

Topics: Humans; Nasal Polyps; Nasal Septum; Nose; Rhinitis

Topics: Drainage; Female; Humans; Methods; Middle Aged; Nasal Polyps; Nose; Preoperative Care; Sinusitis

Topics: Adolescent; Aerosols; Anti-Bacterial Agents; Cystic Fibrosis; Deoxyribonuclease I; Diagnosis, Differential; Drug Therapy; Humans; Lung Diseases; Nasal Polyps; Nose; Nose Deformities, Acquired; Sinusitis; Steroids; Streptodornase and Streptokinase; Streptokinase; Trypsin

Topics: Adenoids; Child; Diagnosis, Differential; Endoscopy; Humans; Hyperplasia; Hypertrophy; Infant; Nasal Mucosa; Nasal Obstruction; Nasal Polyps; Nasopharynx; Nose; Nose Neoplasms; Respiratory Insufficiency; Rhinitis; Rhinitis, Atrophic

Topics: Aerosols; Humans; Imidazoles; Imidazolines; Nasal Decongestants; Nasal Polyps; Nose; Rhinitis; Rhinitis, Allergic, Seasonal; Sinusitis; Vasoconstrictor Agents

Topics: Humans; Nasal Polyps; Nose

Topics: Humans; Nasal Bone; Nasal Polyps; Nasopharyngeal Neoplasms; Nose; Nose Deformities, Acquired; Paranasal Sinus Neoplasms; Paranasal Sinuses; Polyps

Topics: Abscess; Adenoids; Foreign Bodies; Hematoma; Humans; Nasal Obstruction; Nasal Polyps; Nasal Septum; Nasopharyngeal Neoplasms; Nose; Nose Deformities, Acquired; Rhinitis; Rhinitis, Allergic, Seasonal; Rhinitis, Atrophic

Topics: Craniofacial Dysostosis; Humans; Nasal Bone; Nasal Polyps; Nose; Nose Deformities, Acquired; Nose Neoplasms; Paranasal Sinus Neoplasms

Topics: Asthma; Edema; Eosinophilia; Humans; Hypersensitivity; Nasal Polyps; Nose; Paranasal Sinuses; Rhinitis, Allergic, Seasonal; Sinusitis

Topics: Adenocarcinoma; Adenocarcinoma, Papillary; Carcinoma, Transitional Cell; Humans; Nasal Polyps; Neoplasms; Nose; Nose Neoplasms; Papilloma; Paranasal Sinus Neoplasms; Paranasal Sinuses

Topics: Humans; Nasal Polyps; Nose; Papilloma; Paranasal Sinus Neoplasms; Paranasal Sinuses

Topics: Humans; Medical Records; Nasal Polyps; Nose; Nose Neoplasms; Polyps

Topics: Disease; Ethmoid Bone; Humans; Nasal Polyps; Nose

Topics: Humans; Hypersensitivity; Nasal Polyps; Nasal Surgical Procedures; Nose; Paranasal Sinuses; Rhinitis; Sinusitis

Topics: Humans; Nasal Polyps; Nasal Surgical Procedures; Nose; Polyps; Sinusitis

Topics: Cortisone; Humans; Nasal Polyps; Nose

Topics: Humans; Medical Records; Mycoses; Nasal Polyps; Nose; Nose Diseases; Nose Neoplasms

Topics: Body Fluids; Edema; Humans; Nasal Polyps; Nose; Polyps

Topics: Disease Management; Humans; Nasal Polyps; Nasal Surgical Procedures; Nose; Polyps

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

Topics: Humans; Meningitis; Nasal Polyps; Nasal Surgical Procedures; Nose; Polyps

Topics: Ethmoid Bone; Ethmoid Sinus; Humans; Nasal Polyps; Nasal Surgical Procedures; Nose; Polyps

Topics: Ethmoid Bone; Humans; Nasal Polyps; Nasal Surgical Procedures; Nose; Orthopedic Procedures; Polyps

Topics: Foreign Bodies; Humans; Maxillary Sinus; Medical Records; Nasal Polyps; Nose; Paranasal Sinus Diseases

Topics: Colorectal Neoplasms; Humans; Nasal Polyps; Nasopharyngeal Neoplasms; Nose

Topics: Dental Caries; Humans; Nasal Polyps; Nose

Topics: Frontal Sinus; Humans; Nasal Polyps; Nasal Surgical Procedures; Nose; Paranasal Sinuses

Topics: Body Constitution; Humans; Nasal Cavity; Nasal Polyps; Neoplasms; Nose; Paranasal Sinus Neoplasms; Rhinitis

Topics: Ethmoid Bone; Humans; Nasal Polyps; Nasal Surgical Procedures; Nose; Orthopedic Procedures; Polyps

Topics: Humans; Nasal Polyps; Nose

Topics: Humans; Nasal Polyps; Nose

Topics: Humans; Nasal Cavity; Nasal Polyps; Neoplasms; Nose; Paranasal Sinus Neoplasms

Topics: Humans; Nasal Polyps; Nose

Topics: Exophthalmos; Humans; Nasal Polyps; Nasopharyngeal Neoplasms; Nose

Topics: Humans; Nasal Polyps; Nose

Topics: Humans; Nasal Polyps; Nose; Rhinitis, Allergic; Skin Tests

Topics: Humans; Nasal Polyps; Neoplasms; Nose; Polyps

Topics: Humans; Nasal Polyps; Nose; Penicillin G Procaine; Penicillins

Topics: Face; Gastrointestinal Tract; Humans; Mouth; Nasal Polyps; Nose; Palate, Hard

Topics: Humans; Nasal Polyps; Nose

Topics: Humans; Nasal Polyps; Neoplasms; Nose; Polyps; Recurrence

Topics: Child; Humans; Nasal Polyps; Nose

Topics: Humans; Nasal Polyps; Neoplasms; Nose; Polyps; Postoperative Period; Radium; Recurrence; Zinc

Topics: Humans; Nasal Polyps; Nose; Polyps

Topics: Humans; Nasal Polyps; Nose; Polyps; Radium; Recurrence

Topics: Bronchiectasis; Constitution and Bylaws; Humans; Nasal Polyps; Neoplasms; Nose; Nose Neoplasms; Viscera

Topics: Humans; Maxillary Sinus; Maxillary Sinus Neoplasms; Nasal Polyps; Nasopharynx; Neoplasms; Nose; Nose Neoplasms; Polyps