American journal of rhinology最新文献

Background: Topical delivery of nebulized antibiotics to the paranasal sinuses has been shown to improve clinical outcomes in patients with chronic sinus disease after functional endoscopic sinus surgery (FESS). The most efficient method for delivering nebulized particles to the sinuses, however, has not been established. This study investigates how the size of nebulized particles influences the efficiency of deposition in the maxillary sinus of human cadavers after FESS.

Methods: Endoscopic maxillary antrostomy was performed on eight sides in four cadavers. Each cadaver's nasal vault was nebulized with technetium99m-labeled sulfur colloid particles of three size ranges. Anterior-posterior and left lateral static gamma-camera images of the head were captured with an acquisition cutoff limit of 30,000 gamma-count. Regions of interest were defined for the left and right maxillary sinus and gamma-photon counts were recorded. Analysis of variance (ANOVA) for repeated measures and paired t-test were used to determine statistical significance.

Results: Mean diameter of particles generated was 6, 0.99, and 0.67 microm. There was a statistically significant difference in deposition between the largest particle size and the two smaller sizes, with a mean gamma-photon count of 254 for 6-microm particles versus 811 for 0.99-microm particles and 835 for 0.67-microm particles (ANOVA, p = 0.002).

Conclusion: Particles in the 0.67- to 0.99-microm range had improved efficiency of deposition in the maxillary sinus compared with larger particles after maxillary antrostomy. Larger particles appeared to deposit directly in the nasal vault while smaller particles were more likely to reach the maxillary sinus.

Background: Elevated nasal resistance and obesity predispose to obstructive sleep apnea (OSA). Weight loss has been shown to result in an alleviation of OSA, but its effect on nasal airflow has not been studied.

Methods: This study was a prospective, randomized, controlled study with two parallel groups. A total of 52 adult overweight patients (body mass index [BMI], 28-40 kg/m2) with mild obstructive sleep apnea (apnea-hypopnea index (AHI), 5-15) were randomized into two study groups. The intervention group (n = 26) followed a very low calorie diet with a supervised lifestyle intervention while the control group (n = 26) received routine lifestyle counseling. The changes in BMI, total nasal resistance, total nasal volume, and quality of life scores (Mini Rhinoconjunctivitis Quality of Life Questionnaire, MiniRQLQ) were assessed at baseline and after the intervention at 3 months.

Results: The reduction in BMI in the intervention group was significantly greater than that achieved by patients in the control group (5.4 kg/m2 versus 0.5 kg/m2). Accordingly, AHI was reduced by 3.2 events/hour in the intervention group and by 1.3 in the control group. However, there were no significant changes in rhinometric measurements despite significant weight loss. There was no correlation between the reduction of BMI and the change in nasal resistance or MiniRQLQ scores.

Conclusion: Weight reduction does not seem to have any effect on nasal resistance or volume in overweight patients with mild OSA. Patients with OSA and impaired nasal breathing need specific medical or surgical treatment to restore nasal airflow.

Background: Nasal douching is common practice in treatment of chronic sinusitis and after endoscopic sinus surgery. Current nasal delivery techniques show inconsistent sinus penetration. The aim of this study was to compare sinonasal penetration of nasal douching to an optimized nasal nebulizer in an operated cadaver model.

Methods: Fourteen preserved cadavers were used receiving complete sphenoethmoidectomies with a Draf III, wide maxillary antrostomy, or medial maxillectomy. Seven control cadavers received nasal douching with one standardized squeeze bilaterally of a 200-mL nasal irrigation bottle and seven intervention cadavers were nebulized with 3 minutes of the PARI sinus device bilaterally. Douching solutions were stained with methylene blue. Independent observers documented sinonasal anatomy, staining intensity, and percentage area covered by dye using standardized grading protocols.

Results: Combined data showed a significant increase in intensity of stain (2.06 versus 0.26, p < 0.001), percentage of stain (49.96% versus 4.19%, p < 0.001), and circumference stained (76.59% versus 12.7%, p < 0.001) with the plastic nasal irrigation squeeze bottle versus PARI device. Analysis of individual sinuses consistently showed significant increases in indices of nasal douching relative to nebulization. The PARI sinus nebulizer was noted to reach the ethmoids regularly (92% incidence), whereas the other sinuses were not reached as regularly with incidences noted at frontal (43%), maxillary (46%), and sphenoid (54%). This compares to 96% of all sinuses being stained by the squeeze bottle.

Conclusion: In all measured indices, the nasal douching method with the squeeze bottle was superior to the PARI sinus nebulizer in highly dissected sinonasal cadaver models.

Background: The purpose of this study was to determine if bulb syringe irrigators are a potential source for bacterial contamination in patients with chronic rhinosinusitis.

Methods: Standard 3-oz bulb syringe irrigators (n = 24) were each flushed with the following solutions twice daily: A (n = 8), sterile isotonic saline; B (n = 8), prepared hypertonic saline (3 tsp table salt/L of sterile water); and C (n = 8), prepared baking soda/saline (1 tsp table salt + 1 tsp baking soda/L of commercial sterile water). Syringes were stored on a residential bathroom counter, and two from each group were harvested for culture weekly for 4 weeks.

Results: There was no growth from syringes irrigated with any of the three solutions after the first 7 days of irrigation. After the entire 4-week study period, potential pathogens were recovered from 6/8 (75%) bulbs from group A, 0/8 bulbs from group B, and 1/8 bulbs (12.5%) from group C. All positive cultures revealed growth by 1-2 days postinoculation (p = 0.002). The organism recovered from syringes in group A was Pseudomonas fluorescens in all six specimens. The one positive culture in group C represented a single colony of Gram-positive cocci.

Conclusion: Under realistic conditions, bulb syringes are susceptible to contamination with potential bacterial pathogens, particularly when using unbuffered isotonic saline.

Background: The purpose of this study was to investigate the presentation pattern, sinonasal symptoms, and quality of life (QOL) in patients with Churg-Strauss syndrome (CSS) vasculitis.

Methods: A cross-sectional study was performed. Twenty-five patients with CSS belonging to a patient self-help group participated. Main outcome measures included mode of initial presentation, treatment, rhinologic symptoms, and disease-specific QOL (Sinonasal Outcome Test [SNOT-22] scores) and comparisons were made with general rhinosinusitis and other nasally affected vasculitis patients (Wegener's granulomatosis [WG]).

Results: Overall, 80% of CSS patients had active sinonasal symptoms at the time of the study. Twenty-eight percent of CSS patients reported worsening of their nasal symptoms as the main event leading to their diagnosis. Forty-eight percent of CSS patients had undergone nasal surgery. Nasal symptoms that are of particular relevance to this patient group are nasal obstruction (95%), rhinorrhea (95%), anosmia (90%), and excessive sneezing (80%). Other symptoms included nasal crusting (75%), purulent nasal discharge (65%), and epistaxis (60%). SNOT-22 scores were significantly higher than normal, reaching average values similar to those of patients from the general rhinosinusitis population.

Conclusion: Sinonasal symptoms are common at initial presentation of CSS, emphasizing the role of otolaryngologists in its diagnosis. Overall, CSS-related sinonasal morbidity is significant and comparable with that of the general rhinosinusitis population. It predominantly results from symptoms of allergic rhinitis, but a significant proportion of CSS patients also report milder forms of crusting, epistaxis, and of purulent sinusitis, symptoms which are more commonly attributed to patients with WG.

Background: Menthol is a natural herbal compound. Its isomer l-menthol presents the characteristic peppermint scent and is also responsible for the cooling sensation when applied to nasal mucosal surfaces because of stimulation of trigeminal cold receptors. The aim of this study was to assess the effect of menthol inhalation on end-inspiratory nasal mucosa temperature and nasal patency.

Methods: Eighteen healthy volunteers with a mean age of 30 years were enrolled in this study. Objective measurements included the septal mucosal temperature within the nasal valve area by using a miniaturized thermocouple as well as active anterior rhinomanometry before and after inhalation of l-menthol vapor. All subjects completed a visual analog scale (VAS; range, 1-10) evaluating nasal patency before and after menthol.

Results: The mean end-inspiratory mucosal temperature ranged from 27.7 degrees C (+/-4.0) before menthol inhalation to 28.5 degrees C (+/-3.5) after menthol inhalation. There were no statistically significant differences between the temperature values before and after menthol inhalation (p > 0.05). In addition, no statistically significant differences between the rhinomanometric values before and after menthol inhalation were observed. Sixteen of the 18 subjects reported an improvement of nasal breathing after menthol inhalation by means of the VAS.

Conclusion: Menthol inhalation does not have an effect on nasal mucosal temperature and nasal airflow. The subjective impression of an improved nasal airflow supports the fact that menthol leads to a direct stimulation of cold receptors modulating the cool sensation, entailing the subjective feeling of a clear and wide nose.

Background: Fatigue is a common symptom of chronic rhinosinusitis (CRS), but the response of fatigue to endoscopic sinus surgery (ESS) is rarely studied.

Methods: A prospective, open cohort of adult patients undergoing ESS for CRS was studied using 10-cm fatigue visual analog scales (VASs), Lund-MacKay computed tomography (CT), and Lund-Kennedy nasal endoscopy scoring.

Results: Two hundred seventy-two patients, followed for a mean (+/-SD) of 16.5 +/- 8.5 months after ESS, noted significant fatigue improvement with an effect size defined as large by Cohen (0.8 [95% CI, 0.5-1.3]). Neither preoperative CT scores nor preoperative endoscopy scores correlated with preoperative fatigue severity. Compared with the mean preoperative fatigue score (6.1 +/- 2.9 cm), preoperative fatigue was more severe in women (6.9 +/- 2.6 cm; p < 0.001) patients with depression (7.7 +/- 2.4 cm; p < 0.001) and patients with fibromyalgia (7.9 +/- 2.2 cm; p = 0.013), but less severe in patients with nasal polyposis (5.4 +/- 3.2 cm; p = 0.009). Significantly greater postoperative reduction in fatigue was noted in patients with fibromyalgia when compared with study patients without fibromyalgia (effect size = 1.8 [95% CI, 1.6-2.2]; p > 0.001) with final fatigue severity scores similar to the entire study group. Similarly, patients with severe fatigue (n = 112; mean VAS score, 8.8 +/- 0.8 cm) showed a more pronounced improvement than patients less severely fatigued (n = 160; mean VAS score 4.2 +/- 2.4 cm; effect size = 2.2 [95% CI, 2.0-2.9]; p > 0.001).

Conclusion: Fatigue improves after ESS, with significantly greater improvement in patients with fibromyalgia and in patients that are more severely fatigued at presentation.

Background: Limited clinical research exists concerning surgical outcomes for patients with chronic rhinosinusitis (CRS) and comorbid fibromyalgia. The aim of this study was to determine whether patients with CRS and concurrent fibromyalgia experience quality-of-life (QOL) improvement after endoscopic sinus surgery (ESS) and whether this improvement is similar to that seen in patients without fibromyalgia.

Methods: An adult (> or =18 years of age) population (n = 283) with medically refractory CRS was assessed using two disease-specific QOL instruments: the Rhinosinusitis Disability Index (RSDI) and the Chronic Sinusitis Survey (CSS). A nested case-control analysis of matched subjects (n = 18) with and without fibromyalgia was performed to compare pre- and postoperative QOL.

Results: Improvement in postoperative QOL was found in patients with CRS and comorbid fibromyalgia (p < or = 0.004). After controlling for age, gender, and disease severity, this improvement was similar to that seen in patients without fibromyalgia for all RSDI subscales as well as the CSS total and CSS symptom subscales. Patients with fibromyalgia reported significantly less improvement on the CSS medication subscale than patients without fibromyalgia (p = 0.027).

Conclusion: Patients with CRS and comorbid fibromyalgia showed similar improvements in QOL after ESS when compared with patients without fibromyalgia when controlling for age, gender, and disease severity.

Background: The purpose of this study was to evaluate long-term outcomes of an outpatient-based diode laser inferior turbinate reduction (ITR) in therapy-refractory rhinitis medicamentosa (RM).

Methods: In a prospective clinical investigation, 42 consecutive RM patients underwent videoendoscopic ITR with a diode laser after topical anesthetic preparation. Intra- and perioperative details were recorded including the occurrence of bleeding, crusting, pain, or discomfort. Treatment efficiency was assessed by follow-ups 1 and 6 weeks as well as 6 and 12 months after surgery. Subjective pre- and posttherapeutic nasal airflow (NA) and patient satisfaction were rated on visual analog scales (VASs). Assessment of the long-term objective clinical effectiveness was based on rhinomanometry, IT photodocumentation, and the recurrent need for decongestants.

Results: Preoperative addiction to decongestants lasted 5 +/- 2 years (mean +/- SD). There was no major bleeding requiring nasal packing, and there were no other perioperative complications. Postoperative edema disappeared within the 1st week and crusting within 6 weeks after surgery. VAS was characterized by very low values for intraoperative pain and discomfort and high postoperative patient satisfaction. After 6 months, NA data revealed a significant improvement of subjective VAS and objective rhinomanometry (250.4-413.9 cm3/s inspiration at 150 Pa). A total of 88% of patients managed to successfully stop decongestant abuse after 6 months (74% after 1 year).

Conclusion: In therapy-refractory RM, outpatient diode laser ITR of hyperplastic IT represents a highly effective, safe, and well-tolerated treatment option that provides long-lasting recovery by markedly improving NA and stopping addiction to nasal decongestants.

Background: The association between intestinal-type sinonasal adenocarcinoma and the occupational exposure to leather dusts has been widely documented, but the identification of precursor lesions in exposed workers has remained controversial. The purpose of this study was to investigate the histological changes and modifications in the phenotype of epithelial cells in nasal mucosa of leather workers.

Methods: Biopsy specimens of the mucosa of the middle turbinate were obtained from 139 subjects who had been employed in leather factories for 10-48 years (median, 29 years). Tissue fragments were routinely processed for histological examination and immunostainings for cytokeratin 20, CDX-2, and MUC-2 were performed.

Results: Regarding the surface epithelium, the most common histopathological finding was the presence of squamous metaplasia (64.7%), which was associated with mild to moderate dysplasia in 37 cases (41.1%), and goblet cell hyperplasia was identified in 30 biopsy specimens (21.6%). Positivity for MUC-2 was detected in goblet cells of 20 of the 30 samples with goblet cell hyperplasia (66.6%), whereas no immunostaining was observed for cytokeratin 20 and CDX-2. Presence of goblet cell hyperplasia was significantly associated with longer occupational exposure in leather tanning activities (p = 0.03). None of the alterations observed (squamous metaplasia, dysplasia, or goblet cell hyperplasia) showed correlation with smoking habits. Similarly, there was no correlation between squamous metaplasia with or without dysplasia and type and duration of occupational exposure.

Conclusion: Our data identify goblet cell hyperplasia as possible work-related alterations of nasal mucosa in leather workers. Additional investigations are needed to clarify the significance of these findings in the development of sinonasal intestinal-type carcinoma.