American journal of rhinology最新文献

Background: The purpose of this study was to assess the relationships between rhinitis, exposure to workplace air contaminants, and occupational characteristics in greenhouse flower and ornamental plant (OP) growers.

Methods: A random sample of growers cultivating such crops and participating in the European Farmers' Study was selected for a cross-sectional assessment of (1) rhinitis in the last year, (2) sensitization to workplace allergens, and (3) occupation characteristics. Associations between variables were assessed through univariate and multivariate analyses.

Results: Thirty-nine greenhouse flower and OP growers participated in the study (mean, 48.6; SD, 10.2 years; 35 men). Rhinitis was reported by 12 (31%) of them and was significantly related to sensitization to workplace allergens (odds ratio [OR], 13.20; 95% confidence interval [CI], 2.59-67.23) and pesticide application by hand pump (OR, 12.50; 95% CI, 2.00-78.05). After adjustment for these variables rhinitis emerged as significantly related to number of hours worked inside the greenhouse per day (OR, 1.85; 95% CI, 1.05-3.23).

Conclusion: Rhinitis is often reported by greenhouse flower and OP growers and is related to sensitization to workplace allergens and pesticide application by hand pump. The disease shows a dose-response relationship with the number of hours spent inside the greenhouse per day, a finding supporting a causal link with greenhouse exposure.

Background: Vascular endothelial growth factor (VEGF), a pleiotropic polypeptide that mediates endothelial cell-specific responses such as induction of angiogenesis and vascular leakage, is hyperproduced in a variety of inflammatory disorders. In asthma, VEGF hyperproduction promotes mucosal edema by enhancing vascular leakage. However, in allergic rhinitis, details of the pathophysiological importance remain unclear. This study was designed to investigate and discuss the pathophysiological significance of VEGF in nasal secretions from perennial allergic rhinitis sufferers.

Methods: Seven allergic rhinitis patients sensitized with house-dust mites and 12 chronic rhinosinusitis patients were enrolled. Nasal secretion VEGF was quantified and compared between groups. In allergic rhinitis cases, nasal lavage VEGF was estimated before and after the antigen provocation. Nasal gland VEGF was immunohistochemically investigated. VEGF messenger RNA (mRNA) levels in serous and mucous acini were analyzed by laser microdissection and light cycler-polymerase chain reaction.

Results: VEGF levels in nasal secretions and nasal lavage from allergic rhinitis were higher than in nonallergic rhinosinusitis, after rather than before antigen provocation. VEGF mRNA expression was higher in serous versus mucous acini. These results are consistent with the immunohistochemistry results.

Conclusion: In allergic rhinitis, there was significant VEGF production in serous acini, which was hypersecreted after antigen provocation. VEGF may play an important role in pathophysiology of allergic rhinitis.

Background: Since acoustic rhinometry was described there has been a lack of normal values for minimal cross-sectional area (MCA), especially for children. There has also been debate about factors influencing normal values. The purpose of this study was to find the normal values for children in a Finnish population and whether there is any correlation between age or body surface area (BSA) and MCA.

Methods: We measured 74 children (age, 1-12 years) with an acoustic rhinometer. The values of MCA were compared with age and BSA determined from height and weight.

Results: The mean of unilateral MCA was 0.225 cm2 (SD, 0.041). We found positive correlation between unilateral volume on the left side and age and between MCA from the right side and age or BSA as a constant predictor. As much as 28.4% of the measurements had to be rejected because of acoustic leakage between nostril and nosepiece. Only 6.8% had to be rejected because of a lack of cooperation.

Conclusion: It is possible to find normal values for children. Acoustic rhinometry is well tolerated among children. The method is rapid, reliable and noninvasive, and minimal cooperation is required. The measurements must be performed in a standard way, and some important causes of errors must be kept in mind.

Background: The olfactory loss in patients with chronic rhinosinusitis has been measured by different methods. However, the results have been variable and it is not clear whether functional endoscopic sinus surgery (FESS) significantly improves olfactory function. This study was performed to evaluate the influences of FESS on olfactory function in patients with chronic rhinosinusitis using three different types of olfactory tests.

Methods: Seventy patients with chronic rhinosinusitis were administered the University of Pennsylvania Smell Identification Test (UPSIT), a single staircase phenyl ethyl alcohol odor detection threshold test (STT), and a short-term odor memory/discrimination test a day before and 6 months after FESS. A questionnaire inquiring about the patients' self-perception of olfactory function was administered also. Independent ratings of the severity of chronic rhinosinusitis before FESS were established from CT scans.

Results: Fifty-two (74.3%) of the patients reported that their olfactory function was impaired before surgery, and 68.6% of the patients reported impaired olfactory function after surgery, a difference that was not significant. No meaningful changes in any of the olfactory test scores were noted 6 or more months after FESS. Preoperatively, small correlations between CT scores and the symptom scores (r = 0.278; p = 0.024), threshold scores (r = -0.27; p = 0.031), and UPSIT scores (r = -0.36; p = 0.003) were observed.

Conclusion: In patients with severe rhinosinusitis, FESS had little impact on the ability to smell, regardless of the method for assessing smell function. Subtle associations between olfactory function and the severity of chronic rhinosinusitis determined by CT were observed, however, preoperatively. The olfactory test measures were correlated with one another both pre- and postoperatively.

Background: Chronic rhinosinusitis (CRS) is a common disease that can significantly impact health. The mainstay of medical treatment is topical steroids and oral antibiotics, but little is known about the efficacy of topical antibiotics. The purpose of this study was to identify evidence for the use of topical antibiotics in the treatment of CRS and exacerbations of CRS.

Methods: Systematic review of literature with a search of the MEDLINE, EMBASE, and CINAHL databases; Cochrane Central Register of Controlled Trials (Third Quarter 2007); and Cochrane Database of Systemic Reviews (3rd Quarter 2007) databases were performed. The dates of search were from December 1, 1949 to September 30, 2007.

Results: Fourteen studies that fulfilled the inclusion criteria were identified: seven were controlled trials and of these, five were double blinded and randomized. Only one of the randomized studies showed a positive outcome. Overall, there was low-level corroborative evidence for the use of antibacterials. No definite conclusions could be made regarding the use of antifungals. Currently, there is evidence for the use of nasal irrigation or nebulization rather than delivery by nasal spray. For the antibacterial studies, the highest level of evidence currently exists for studies that have used postsurgical patients and culture-directed therapy. Both stable and acute exacerbations of CRS appear to benefit from topical antimicrobials.

Conclusion: Topical antibiotics appear effective in the management of CRS. Given the combination of low-level evidence (level III, with inherent potential confounders of natural progression of disease and placebo effect) and the level IIb evidence being limited to the cystic fibrosis group of patients, topical antibiotics should not be first-line management but may be attempted in patients refractory to the traditional topical steroids and oral antibiotics. Larger and better-designed randomized double-blind placebo-controlled trials are required to more fully evaluate this emerging modality of treatment.

Background: Matrix metalloproteinase (MMP) 2 and MMP-9 are known to cleave specifically type 4 collagen, which is a major structural component of basement membrane. This is an early step of inflammation. Because of this property they have been studied in chronic sinonasal disorders. The aim of this study was to determine the MMP-2 and MMP-9 expressions in an antrochoanal polyp (ACP).

Methods: We examined tissue samples from 10 ACPs, 10 diffuse nasal polyps, and 10 control nasal mucosa (CM) by immunohistochemistry for MMP-2 and MMP-9 expression.

Results: Most of epithelial and endothelial cells showed positive immunostaining for MMP-2 and MMP-9 in all tissue samples. MMP-2 staining of inflammatory cells showed no difference among the groups (p > 0.05). On the other hand, MMP-9+ inflammatory cells were found to be significantly increased in ACP and diffuse nasal polyps when compared with CM (p < 0.05).

Conclusion: MMP-9-expressing inflammatory cells could play a role in the pathophysiology of ACP as well as nasal polyps.

Background: The purpose of this study was to elucidate histological and immunologic features of mouse models of bacterial chronic rhinosinusitis (BCRS) and allergic chronic rhinosinusitis (ACRS).

Methods: A BCRS mouse model was established using Streptococcus pneumoniae inoculation plus Merocel (Medtronic, Jacksonville, FL) ostiomeatal obstruction for 12 weeks. An ACRS mouse model was developed by means of ovalbumin (OVA) i.p. injection and subsequent repeated OVA intranasal challenge for 12 weeks. Histological changes of sinonasal mucosa of both models were examined by means of hematoxylin and eosin staining for general morphology and inflammatory cell, periodic acid-Schiff staining for goblet cell, and Masson-trichrome staining for collagen. Enzyme-linked immunosorbent assay was used to detect the concentrations of various cytokines in nasal lavage fluid.

Results: Polymorphonuclear neutrophil infiltration in lamina propria was more obvious in the BCRS model, whereas eosinophil infiltration was more apparent in the ACRS model. Significant goblet cell and subepithelial gland hyperplasia, subepithelial fibrosis, epithelial thickening, and mononuclear cell infiltration were shown in both models with more severe extent found in the ACRS model. Interleukin (IL)-6 and tumor necrosis factor alpha levels in NLF from both models were increased and peaked at 1 week. Interferon gamma levels were also up-regulated in both models but reached maximum at 1 week in the BCRS model and 4 weeks in the ACRS model. IL-8 (CXCL8) levels were only increased in BCRS mice and peaked at 1 week, whereas IL-5, IL-13, and eotaxin (CCL11) levels were only enhanced in ACRS mice and peaked at 1 week. The Th1/Th2 ratio in BCRS mice was significantly higher than that in ACRS mice (6.68 +/- 2.33 versus 1.37 +/- 0.86; p < 0.01).

Conclusion: Histological and immunologic features of BCRS and ACRS mouse models were similar to those of human noneosinophilic and eosinophilic CRS, respectively. BCRS and ACRS mouse models have distinct immunologic characteristics and are applicable for CRS research.

Background: Glycoproteins are responsible for the rheological properties of the mucus. Changes in mucus viscosity may interfere with mucociliary clearance, leading to stasis and aggravation of chronic rhinosinusitis (CRS). The purpose of this study was to assess the composition and concentration of various sinus mucosa glycoproteins in normal and chronically inflamed sinuses.

Methods: A semiquantitative scoring system was used to express the binding intensity of 10 lectins to 6 carbohydrates (galactose, sialic acid, N-acetylglucosamine, N-acetylgalactosamine [GalNac] [corrected], fucose, mannose) residing in the sinus mucosa of patients with CRS (N = 20) and normal controls (N = 10).

Results: The mean CT score, compatible with extensive sinus disease, was 13.9 +/- 6.7. All six carbohydrates were found in the epithelium and submucosal glands of patients and controls. Peanut agglutinin staining showed significantly higher concentration of disaccharide galactose beta 1,3 GalNac [corrected] in epithelial goblet cells and in submucosal mucous and mixed glands of patients compared with that of controls (p = 0.01, p = 0.03, and p = 0.018, respectively). The epithelial glycocalyx of patients was also significantly more abundant in fucose and in GalNac [corrected] (p = 0.015, and p < 0.001, respectively).

Conclusion: Glycoconjugate expression of the sinus mucosa in CRS is markedly altered in extensive inflammatory conditions. The increased concentration of galactose beta 1,3 GalNac [corrected] in CRS probably contributes to the high viscosity of the nasal mucus and interferes with normal mucociliary clearance. Exposed peripheral galactose residues may serve as attachment receptor sites for pathogenic bacteria. Means interfering with the ability of bacteria to adhere to specific receptors on host tissues warrant additional research.

Background: Patients with nasal obstruction from septal deviation commonly undergo septoplasty to improve nasal airflow. Some patients suffer from persistent obstruction after their primary septoplasty and may undergo a revision septoplasty to improve their nasal passageway. Our objective was to identify patients who underwent revision septoplasty and to identify their sources of persistent nasal obstruction.

Methods: Patients who underwent septoplasty at our institution between 1995 and 2005 were reviewed. Data is collected on demographics, comorbidities, age at septoplasty, associated and concomitant procedures, surgical approach, and anatomic site of obstruction.

Results: Five hundred forty-seven patients met inclusion criteria including 477 who underwent primary septoplasty and 70 who underwent revision surgery. Nineteen percent of nonrevision patients underwent nasal valve surgery along with their primary septoplasty versus 4% of patients in the revision group. Fifty-one percent of revision patients had nasal valve surgery at revision surgery. Patients who underwent sinus surgery along with primary septoplasty were less likely to undergo revision septoplasty. History of facial trauma, obstructive sleep apnea, site of deviation, and performance of inferior turbinate surgery did not affect the likelihood of revision septoplasty.

Conclusion: A significant number of patients who undergo revision septoplasty also have nasal valve collapse. We recommend that in addition to septal deviation and inferior turbinate hypertrophy, nasal valve function be fully evaluated before performing septoplasty. This will help to ensure a complete understanding of a patient's nasal airway obstruction and, consequently, appropriate and effective surgical intervention.

Background: Clara cell 10-kDa protein (CC10) is an anti-inflammatory molecule and has been implicated in the involvement of the pathogenesis of asthma and chronic rhinosinusitis (CRS). A single nucleotide polymorphism (SNP) in CC10 gene (A + 38G) was previously shown to be associated with asthma and plasma CC10 levels. The purpose of this study is to examine whether there is an association between the CC10 A + 38G SNP, plasma CC10 levels, and CRS in a central Chinese population of Han nationality.

Methods: The CC10 A + 38G SNP was analyzed by means of polymerase chain reaction with restriction fragment length polymorphism and plasma CC10 levels were measured using enzyme-linked immunosorbent assay in 220 patients with CRS (90 patients with nasal polyps [NPs] and 130 patients without NPs) and 180 healthy control subjects. Among 220 patients with CRS, 108 patients were atopic subjects. Severity of disease was determined by coronal computed tomography (CT) scan in CRS patients, which was graded according to Lund and Mackay.

Results: The frequency of the A allele was 0.394, which was not significantly higher than the frequencies of other reported ethnic groups except for German. No association between the CC10 A + 38G SNP and CRS, any subgroup of CRS, or CRS severity could be found. Although subjects carrying the AA genotype had a significantly lower plasma CC10 concentration than those carrying the GG and GA genotypes in both CRS and control groups (p = 0.00 for all), no association was found between the plasma CC10 levels and CRS phenotype.

Conclusion: The CC10 A + 38G SNP may not exert a substantial influence on the development of CRS in the Chinese Han population.