Rhinology. Supplement最新文献

Nasal polyposis has to be considered as an advanced form of chronic ethmoiditis requiring surgery. Its proliferation starts in the osteo-meatal complex of the lateral nasal wall, and follows typical routes. Depending on its extension endoscopical partial resections of the ethmoid may be carried out. For diffuse polyposis of all sinuses a complete endonasal ethmoidectomy together with the fenestration of the frontal, sphenoidal and maxillary sinuses (pansinus operation) is indicated. The importance of preoperative imaging by CT or polytomography, and of flanking measures, is stressed. Fair results concerning subjective relief and objective proof of lasting mucosal recovery are reported against the background of a low incidence of surgical complications.

Surgical removal of nasal polyps is associated with discomfort and risks for the patient, but is the treatment of choice to most otorhinolaryngologists. Medical treatment alone has been little investigated. In a prospective clinical trial surgical removal followed by continuous topical steroid treatment has been compared with a single dose of steroid deposit followed by continuous topical steroid treatment. During a study period of one year, expiratory nasal peak flow and sense of smell were monitored. In general, the course in the two groups was alike, with a tendency favouring the medically treated group. In another study the clinical efficacy of this medical regimen was further documented experimentally. By acoustic rhinometry the square area of the nasal passages was measured before and a few days after the injection of the steroid deposit. Increased volume was found, corresponding to the instant clinical improvement. It is concluded that primary treatment of nasal polyps should be medical. Surgery is only recommended in cases, resistant to medical therapy.

After a short historical review a proposal is made for the definition of nasal polyposis. The authors studied 350 CT-scans of patients with nasal complaints. In a high percentage anatomical anomalies were observed. In 57.5% of the CT-scans sinus mucosal disease was visible. In all patients with maxillary sinus disease polyps (rounded structures) could be found; in 31% these polyps were mainly of grade 2. From a retrospective study of 111 biopsies of nasal polyposis (65 patients) it became clear that different polyps from the same patient showed substantial difference in cellular content, i.e. presence of eosinophils, neutrophils, plasma cells, glands, ducti and thickening of the basal membrane. As oral acetylsalicylic acid provocation may be hazardous in ASA-sensitive patients, the authors developed a nasal aspirin provocation test. This nasal ASA test was carried out in 10 normal test subjects, 10 patients with aspecific hyperreactivity, 10 atopic patients and 16 patients with polyposis nasi. The reproducibility of the test, however, was so poor that the nasal ASA challenge test in its present form does not appear to be of any great clinical value. Finally, the authors discuss the physiopathology of nasal polyposis.

Eighty micrograms of the topically active parasympatholytic drug ipratropium were applied intranasally four times daily in 20 adults with perennial rhinitis and severe watery rhinorrhoea in a double-blind controlled cross-over trial. There was a significant reduction in nasal hypersecretion during ipratropium treatment. Fourteen patients preferred the ipratropium period, three the placebo period and three had no preference. There were no systemic or local side effects. Ipratropium was effective also in patients resistant to glucocorticoids, sodium cromoglycate and antihistamines. As the drug works immediately it can also be used before exposure to known provocating factors. It is concluded that continuous use of this new medication is of value in the management of severe rhinorrhoea in patients with perennial rhinitis, and that the occasional use is helpful in subjects with infrequent attacks of nasal hypersecretion.