Symptoms treatment for allergic rhinitis using diode laser: results after 6-year follow-up

The brain functional connectivity alterations in traumatic patients with olfactory disorder after low-level laser therapy demonstrated by fMRI

BACKGROUND

Low-level laser therapy (LLLT) has been clinically accepted to accelerate the nerve regeneration process after a nerve injury or transection. We aimed to investigate the neuronal basis and the influence of LLLT on brain functional networks in traumatic patients with olfactory dysfunction.

METHODS

Twenty-four Patients with traumatic anosmia/hyposmia were exposed to pleasant olfactory stimuli during a block-designed fMRI session. After a 10-week period, patients as control group and patients who had completed the sessions of LLLT were invited for follow-up testing using the same fMRI protocol. Two-sample t-tests were conducted to explore group differences in activation responding to odorants (p-FDR-corrected <0.05). Differences of functional connectivity were compared between the two groups and the topological features of the olfactory network were calculated. Correlation analysis was performed between graph parameters and TDI score.

RESULTS

Compared to controls, laser-treated patients showed increased activation in the cingulate, rectus gyrus, and some parts of the frontal gyrus. Shorter pathlength (p = 0.047) and increased local efficiency (p = 0.043) within the olfactory network, as well as decreased inter-network connectivity within the whole brain were observed in patients after laser surgery. Moreover, higher clustering and local efficiency were related to higher TDI score, as manifested in increased sensitivity to identify odors.

CONCLUSIONS

The results support that low-level laser induces neural reorganization process and make new connections in the olfactory structures. Furthermore, the connectivity parameters may serve as potential biomarkers for traumatic anosmia or hyposmia by revealing the underlying neural mechanisms of LLLT.

Low-intensity diode laser combined with nasal glucocorticoids in the treatment of recurrent epistaxis in children: a randomized controlled trail

BACKGROUND

A painless and effective treatment of childhood epistaxis is needed.

OBJECTIVE

To observe the effectiveness of low-intensity diode (Lid) laser in treating epistaxis complicated with allergic rhinitis in children.

METHODS

Our study is a prospective, randomized, controlled, registry trial (NO. 202001201) involving 44 recurrent epistaxis children (<14 years old) with or without Allergic Rhinitis (AR) in our hospital. They were divided randomly into the Laser and Control groups. The Laser group was treated with Lid laser (wavelength 635 nm, power 15mW) for 10 min after nasal mucosa was moistened with normal saline (NS). The Control group moistened their nasal cavities with NS only. Children in two groups complicated with AR were given nasal glucocorticoids for 2 weeks. The effectiveness of Lid laser in treating epistaxis and AR were compared between the two groups after treatment.

RESULTS

After treatment, the effective rate of the Laser group in epistaxis (23/24, 95.8%) was higher than the Control group (16/20, 80%) (p < .05). The VAS scores of the children complicated with AR in the two groups both improved after treatment, however, the variation of VAS score (3.02 ± 1.50) in the Laser group was greater than the Control group (1.83 ± 1.56) (p < .05).

CONCLUSION

As a safe and efficient method, Lid laser treatment can effectively alleviate epistaxis and inhibit symptoms of AR in children.

High-intensity focused ultrasound leads to histopathologic changes of the inferior turbinate mucosa with allergic inflammation

This study was aimed at understanding the histopathologic changes that occur in the nasal mucosa of patients with perennial allergic rhinitis after high-intensity focused ultrasound (HIFU) treatment. Biopsy specimens of the inferior turbinate mucosa were taken from 11 PAR patients before, immediately after and 1 y after HIFU treatment. Morphometric analysis revealed that the density of eosinophils and other inflammatory cells increased immediately after treatment and then were decreased significantly 1 y post-treatment. Submucosal glands were swollen and venous sinusoids were dilated, but there was no statistically significant change in their density, immediately after treatment. However, both glands and venous sinusoids significantly decreased in number 1 y after HIFU treatment. The ciliated epithelium or basement membrane of the nasal mucosa was well preserved at all stages. In conclusion, HIFU is a tolerable and effective treatment to reduce inflammation of the inferior turbinate mucosa in patients with perennial allergic rhinitis.

Higher dosage of HIFU treatment may lead to higher and longer efficacy for moderate to severe perennial allergic rhinitis

OBJECTIVES

This study was to compare the efficacies and side effects of high intensity focused ultrasound (HIFU) treatment for perennial allergic rhinitis (PAR) with regular and increased dosage.

STUDY DESIGN

A prospectively assembled cohort was retrospectively analyzed through visual analogue scale (VAS).

METHODS

Regular dosage of HIFU treatment was applied to 56 PAR patients in group A. An increased dosage as twice as the regular one was applied to 48 patients in group B. Nasal obstruction, sneezing, rhinorrhea and rhinocnesmus, which were recognized as the four main symptoms of allergic rhinitis (AR), were evaluated before treatment, 3 months after treatment, and 1 year after treatment. The satisfaction of patients was also evaluated at 1 year postoperatively. Biopsy of the inferior turbinate and morphometric analysis were applied to 11 patients in group A and 10 in group B before HIFU treatment and 3 months after treatment.

RESULTS

Comparing the AR symptoms before treatment, There is no statistical difference observed between group A and B (p>0.05). The four main symptoms at 3 months and 1 year after treatment were all significantly improved (p<0.01) in both group A and B. The VAS scores of AR symptoms in Group B were lower than those in Group A at the same stage after treatment, especially at 1 year after treatment (p<0.05). Comparing the results at 3 months and 1 year after treatment, a tendency of recurrence of these symptoms was observed statistically in group A (p<0.05), but not in group B (p>0.05). More cases of nasal dryness and perirhinal swelling were found in group B than those in group A (p<0.05), while all side effects were mild and temporary. Patients in group B were more satisfied than those in group A (p=0.0866 >0.05), though not statistically significant. More reduction of the eosinophils, other inflammatory cells, and the submucosal glands was observed after HIFU treatment in group B than that in group A (p<0.05).

CONCLUSIONS

A proper increment of HIFU dosage may be recommended to meet the needs of more improvement of AR symptoms and less recurrence.

Comparison between rigid and flexible laser supraglottoplasty in the treatment of severe laryngomalacia in infants

OBJECTIVE

Traditionally, laser supraglottoplasty for the treatment of severe laryngomalacia (SLM) is via rigid endoscopy (RE). Potassium-titanyl-phosphate (KTP) laser fiber can pass through a flexible endoscopy (FE) and cauterize tissue. This study is designed to evaluate and compare clinical variables between these two techniques in the treatment of SLM in infants.

METHODS

A retrospective study includes four-year period of consecutive infants who received laser supraglottoplasty. In the first two years (2006-2007), conventional RE CO(2)-laser with general anesthesia and endotracheal intubation were used. In the latter two years (2008-2009), a novel technique of FE KTP-laser with intravenous sedation, nasopharyngeal oxygen and a noninvasive respiratory support (if indicated), without any artificial airway was used immediately after the diagnostic FE. After laser surgery, infants were followed for three months. Clinical variables were analyzed and compared.

RESULTS

A total of 57 infants (27 in RE group, 30 in FE group) were enrolled. Basic variables were similar between both groups. Clinical improvement was comparable with 88.9% and 93.3% in the RE and FE groups, respectively. There are no significant differences in mean number of laser surgery, major complications, duration of post-laser respiratory support and hospitalization days, body weight percentile between the two groups. However, the durations of waiting time, operation, ET intubation and total hospital days were significantly less in the FE group.

CONCLUSIONS

FE technique has similar success rate but more convenient and cost-effective than the RE technique. It may to be a practical alternative therapy for infants with SLM.