American journal of rhinology最新文献

Background: In modern rhinological practice and research, rhinomanometry and acoustic rhinometry are widely used. The goal of this study was to determine whether there is correlation between rhinomanometrically derived nasal airflow resistances and acoustic rhinometrically derived nasal airway volumes.

Methods: To achieve the goal, a prospective cross-sectional study of a total of 316 patients complaining of nasal obstruction was performed. Resulting data were compared by means of Spearman rank correlations of the total number of patients and of subgroups.

Results: The total number of patients, and most subgroups, in both their untreated and decongested states showed significant negative correlation unilaterally between nasal airflow resistances and nasal volumes.

Conclusion: Rhinomanometric nasal airflow resistances and concurrent acoustic rhinometric nasal airway volumes are closely correlated. The combination of the two objective methods provides insight into nasal airflow physiology and nasal airway anatomy.

Background: Chronic rhinosinusitis (CRS) that is refractory to medical or surgical intervention may involve a particularly resistant form of infection known as a bacterial biofilm. Bacterial biofilms are three-dimensional aggregates of bacteria that often are recalcitrant to antibiotics secondary to physical barrier characteristics. To date, all studies investigating biofilms in CRS have been descriptive in either human or animal tissue. To better understand the interactions of bacterial biofilms with respiratory epithelium, we describe an in vitro model of biofilm sinusitis by establishing mature biofilms on airway epithelial air-liquid interface cultures.

Methods: Airway epithelial cell cultures were grown on collagen-coated semipermeable support membranes as an air-liquid interface on tissue culture inserts. Confluent air-liquid interface cultures were inoculated with the biofilm-forming PAO-1 strain of Pseudomonas aeruginosa and compared with cultures inoculated with two mutant strains (sad-31 and sad-36) unable to form biofilms. Inoculated tissue transwells were incubated for 20 hours, allowing for biofilm growth. The semipermeable membranes were then harvested and imaged with confocal laser scanning microscopy and scanning electron microscopy.

Results: Microscopic analysis revealed the formation of biofilm-forming towers in the PAO-1 inoculated wells. The bacterial biofilms were supported by a viable airway epithelial cell surface monolayer.

Conclusion: This study shows a reliable method for analysis of in vitro interactions of bacterial biofilms and airway epithelium. The experimental manipulation of this air-liquid interface model will help explore novel treatment approaches for bacterial biofilm-associated CRS.

Background: The purpose of this study was to compare the cost-effectiveness of modified quantitative testing (MQT), intradermal dilutional testing (IDT), and in vitro allergy testing as diagnostic methods used in the management of patients with suspected IgE-mediated inhalant allergies.

Methods: A systematic review was conducted to determine key statistics for analysis, such as prevalence of disease, and sensitivity and specificity of each diagnostic modality. Costs were calculated based on charges from distribution companies to providers. A deterministic cost-effectiveness analysis then was conducted using a decision tree model to evaluate the various diagnostic strategies. After identifying results at baseline, we performed a sensitivity and threshold analysis to assess the strength of recommendations.

Results: At an allergic rhinitis prevalence of 20%, MQT dominated IDT and in vitro testing, with 85 people correctly diagnosed at a baseline total cost of $6630 for the 100 patients tested. Although in vitro testing had the highest effectiveness, it had an incremental cost-effectiveness ratio of $3185. The results were sensitive to changes in the prevalence, costs, and sensitivities and specificities of the different modalities.

Conclusion: The prevalence of allergic rhinitis is high and rising according to many studies, leading to a growing population of patients requiring allergy testing. Not only does today's medical community want effective health interventions, but also there is pressure to make health care cost efficient. This study looks at the cost-effectiveness of various diagnostic allergy tests. In our model, we found MQT to be the most cost-effective method of diagnosing allergic disease.

Background: Although maxillary sinus puncture is considered the gold standard for obtaining bacterial cultures, there is an increasing field of evidence indicating that results of endoscopic middle meatal culture correlate well with those of maxillary sinus punctures. However, the subjects of these studies were adults and there was no prior study comparing endoscopic middle meatal culture with maxillary sinus punctures in children with rhinosinusitis. The aims of this study were to compare the results obtained by endoscopic middle meatal culture and maxillary sinus punctures in children with rhinosinusitis.

Methods: A prospective study of children with community-acquired rhinosinusitis was conducted. Results obtained by endoscopic culture were compared with those of maxillary sinus puncture, and the correlation of these 2 techniques was investigated.

Results: There were 41 specimen sets sent for aerobic cultivation. Correlation obtained from the middle meatus with those from the maxillary sinus puncture was demonstrated in 32 of 41 specimens (78.0%). When looking at the diagnostic usefulness of endoscopic middle meatus sampling versus maxillary sinus puncture, endoscopic sampling provided a sensitivity of 75.0%, a specificity of 88.9%, a predictive value of a positive result of 96.0%, a predictive value of a negative result of 50.0%, and an accuracy of 78.0%.

Conclusion: We demonstrated that, when performed in pediatric patients, the correlation between endoscopic middle meatal culture and maxillary sinus puncture was not as favorable as in the case of adult patients.

Background: The nasal lavage (NAL) method is increasingly used to assess changes in upper airways inflammation in the investigation of occupational rhinitis (OR). A good reproducibility of the method is fundamental to accurately assess changes in markers of inflammation in nasal secretions before and after inhalation challenges. The main objective of this study was to assess the short-term reproducibility of cells and cellular markers of inflammation in NAL in the setting of specific inhalation challenge (SIC) investigating OR. An ancillary objective was to assess the reproducibility of NAL in the context of two different SIC methodologies.

Methods: Twenty-five subjects attended the laboratory for 2 separate days of NAL performed within the same week. On the first visit subjects underwent NAL before a SIC sham session and on the second visit before a SIC with the active agent. These prechallenge NAL measurements obtained on both days were used to analyze the reproducibility of the NAL method.

Results: The reproducibility for cell differential counts was satisfactory for neutrophils (intraclass correlation coefficient [ICC] = 0.68), for eosinophils (ICC = 0.95), for macrophages (ICC = 0.77), and for epithelial cells (ICC = 0.73). The reproducibility of total cell counting was poor (ICC = 0.12). The reproducibility of ECP concentrations was satisfactory (ICC = 0.67). Eosinophil counts were reproducible in the context of two different challenge methodologies.

Conclusion: The NAL method was shown to be sufficiently reproducible to be considered useful for the monitoring of upper airways inflammation during the investigation of OR by SIC.

Background: The increasing expertise in the field of transnasal endoscopic surgery recently has expanded its indications to include the management of sinonasal malignancies. We report our experience with the endoscopic management of nasoethmoidal malignancies possibly involving the adjacent skull base.

Methods: A retrospective analysis was performed of patients treated by an exclusive endoscopic approach (EEA) or a cranioendoscopic approach (CEA) from 1996 to 2006 managed by two surgical teams at the Departments of Otorhinolaryngology of the University of Brescia, and the University of Pavia/Insubria-Varese, Italy.

Results: One-hundred eighty-four patients were considered eligible for the present analysis. An EEA was performed in 134 patients and the remaining 50 patients underwent the CEA. The most frequent histotypes encountered were adenocarcinoma (37%), squamous cell carcinoma (13.6%), olfactory neuroblastoma (12%), mucosal melanoma (9.2%), and adenoid cystic carcinoma (7.1%). Overall, 86 (46.7%) patients received some form of adjuvant treatment. The patients were followed up for a mean of 34.1 months (range, 2-123 months). The 5-year disease-specific survival was 91.4 +/- 3.9% and 58.8 +/- 8.6% (p = 0.0004) for the EEA and CEA group, respectively.

Conclusion: To the best of our knowledge, this is the largest series reported to date of malignant tumors of the sinonasal tract and adjacent skull base treated with pure endoscopic or cranioendoscopic techniques. A 5-year disease-specific survival of 91.4% and 58.8% for the EEA and the CEA groups, respectively, seem to indicate that endoscopic surgery, when properly planned and in expert hands, may be a valid alternative to standard surgical approaches for the management of malignancies of the sinonasal tract.

Background: Recent findings indicate that Staphylococcus aureus and its products may be involved in the modification of nasal polyposis. The purpose of this study was to investigate the presence of S. aureus enterotoxin genes and the agr subtype in bacterial DNA of S. aureus strains isolated from the middle meatus of nasal polyp and control patients.

Methods: S. aureus strains were isolated from nasal polyp patients and controls. The strains were screened using PCR for their agr subtype, classic superantigens (SEA, SEB, SEC, SED or TSST-1), the egc cluster (SEG, SEI, SEM, SEN, and SEO and other enterotoxins (SEE, SEH, SEJ, SEK, and SEL) distinct from the egc locus.

Results: Seventy-five percent of S. aureus strains had at least one enterotoxin in their DNA. The egc gene cluster was identified in 27 (67.5%) strains. At least one classic enterotoxin gene was present in 42.5% of the strains. Interestingly, there were no differences in enterotoxin genes between S. aureus strains isolated from controls compared with nasal polyposis patients. In controls, an equal distribution among the four agr groups was found, while 73% of the NPs strains belonged to agr groups I and II.

Conclusion: In this study we found no significant difference between strains from nasal polyp patients and controls in the presence of enterotoxin genes. However, in NPs, a higher number of strains belonged to agr I or II, which are associated with strains causing enterotoxin-mediated disease.

Background: Despite a growing number of studies using acoustic rhinometry (AR) in children, no reference material exists that incorporates the entire age and height interval of preschool children up to puberty for a range of rhinometric variables. The aim of this study is to provide a reference range for nasal volumes and minimum cross-sectional areas (MCAs) in healthy nondecongested children aged 4-13 years old.

Methods: Two hundred fifty-six primary school children (mean, 7.95 years; range, 3.8-13.1 years; 123 boys/133 girls) were measured by AR. Variables were MCA (first, second, and absolute minimum) and nasal volumes from 0 to 4 cm (Vol0-4), 0 to 5 cm (Vol0-5), 1 to 4 cm (Vol1-4), and 2 to 5 cm (Vol2-5) into the nasal cavity. Height and weight were measured and atopic status was determined by skin-prick test. Age and current and past respiratory health were recorded from a questionnaire.

Results: In multiple linear regression models height was the main predictor for all AR variables although weight also was a significant predictor of MCAs. There was no association between any AR variables with sex, atopy, or hay fever but children with current wheeze (within last 12 months) and asthma had decreased nasal patency.

Conclusion: This article presents the most extensive current reference material for AR in nondecongested prepubescent healthy children. The presented reference material will facilitate the interpretation and evaluation of future and present epidemiologic studies based on AR in children.

Background: Olfactory loss is a challenging disease. Although glucocorticoid is sometimes used for the treatment of anosmia, it has been reported that it potentiated neural damage in the early phase of treatment. This study is designed to identify the effect of ginkgo biloba, an antioxidant that acts as a free radical scavenger, in the treatment of olfactory injury aggravated by dexamethasone.

Methods: Anosmia mouse model was induced by i.p. injection of 3-methylindole (3-MI). Twenty-five mice were divided into one control group without anosmia and four anosmia treatment groups (given treatments of dexamethasone and/or ginkgo biloba). The effects of treatment were evaluated by behavioral test, Western blot, and immunohistochemistry 2 weeks after 3-MI injection.

Results: Induction of anosmia was confirmed by behavioral tests. The thickness and cell number of olfactory neuroepithelium were decreased more significantly in the dexamethasone treatment group than in the combination treatment group. The expression of olfactory marker protein (OMP) in olfactory epithelium was more decreased also in the dexamethasone treatment group than in the combination treatment group. The expression of OMP was decreased significantly in the olfactory bulbs of anosmia groups but there were no differences between the anosmia treatment groups.

Conclusion: Dexamethasone treatment was associated with further deterioration of olfactory injury by 3-MI and it was recovered by combination treatment of dexamethasone and ginkgo biloba. The antioxidant effect of ginkgo biloba might play a role in restoration of olfactory loss and it was effective only when oxidative stress is maximized by dexamethasone.

Background: Specific allergy immunotherapy traditionally has been thought of as subcutaneous injection immunotherapy (SCIT). There also are noninjection routes for the administration of immunotherapy. The best-known and studied of these noninjection routes is the sublingual route, usually known as sublingual immunotherapy (SLIT). SLIT has been in use for many decades; however, to this date, it is not well known to the majority of allergy practitioners in this country. The purpose of this study is to help change this perception so that SLIT eventually can be considered one more tool in the allergist's armamentarium.

Methods: A literature review was performed. It included articles from the early American clinicians and present publications that are mostly of European origin.

Results: It will become clear to the reader that the key features of SLIT are its efficacy, great safety, and simplicity of administration.

Conclusion: SLIT is a safe treatment modality that should be considered as a useful additional tool in the therapeutic armamentarium.