Rhino-bronchial syndrome in children: pathogenic correlations and clinical-experimental aspects

Eustachian Tube Dysfunction in Children With Adenoid Hypertrophy: The Role of Adenoidectomy for Improving Ear Ventilation

INTRODUCTION

To our knowledge, few papers have addressed preoperative evaluation of the impact of adenoid hypertrophy (AH) on the pathogenesis of eustachian tube dysfunction (ETD) in children with otitis media with effusion (OME).

AIM

The aim of this study was 2-fold: first, to evaluate ETD using tubomanometry and Eustachian Tube Score 7 (ETS-7), in a group of children having AH; second, to assess the clinical impact of adenoidectomy on the ETD of these patients.

METHODS

Fifty patients, aged 4 to 15 years, underwent adenoidectomy based on various parameters: size of the adenoids causing canal obstruction (grades 1-4), the presence of OME, and recurrent episodes of rhinosinusitis. The function of the eustachian tube was evaluated using ETS-7 before and after surgical treatment. The patients were followed up for 6 months.

RESULTS

Forty children presented ETD. Of these, 36 had a grade 4 AH. The preoperative mean value for ETS-7 was 6.62. The mean postoperative ETS-7 score showed a value of 9.60 with a statistical difference compared to the preoperative value (P = .0015).

CONCLUSIONS

Adenoid hypertrophy has a high impact on the frequency of ETD. In the patients observed in the present study, the ETS-7 score appeared to be a valid tool for assessing ETD both preoperatively and postoperatively. Adenoidectomy seemed to be effective in improving ETD as well as middle ear ventilation.

Analysis of lower airway inflammation in a rabbit model of acute rhinosinusitis

This study aimed to investigate the association of inflammatory changes of upper and lower airways in a rabbit model of acute rhinosinusitis. The study included six adult albino rabbits. The sinuses of one animal were injected with saline solution and the animal was served as sham control. Other animals were implanted with intranasal S. aureus soaked-absorbable gelatin sponge. Acute rhinosinusitis was induced and subjects were sacrificed at the end of the second week. Tissue samples from all levels of the airway were obtained. They were evaluated for the presence of inflammatory changes histologically. A scoring system for airway inflammation was used for quantitative assessment of the degree of inflammation. Structural changes in the epithelial and stromal layers of the upper and lower airway structures were analyzed, as well. The animal of which the sinuses were injected with saline solution developed neither acute rhinosinusitis nor lower airway inflammation. In contrast, the animals in which acute rhinosinusitis was induced demonstrated significant upper and lower airway inflammation histologically. Inflammatory changes ranged from engorgement of blood vessels and polymorphonuclear cell proliferation within the capillaries, in the perivascular tissue of the epithelium or in the lamina propria and to epithelial disruption. Nasal airway inflammation scores (2.86 ± 1.81) were significantly higher than lower airway scores (1.36 ± 0.77), (P < 0.01). We obtained a generalized mucosal inflammatory response against localized bacterial inflammation in a rabbit model of acute rhinosinusitis, confirming the suggestion of 'one airway--one disease' from a bacterial infection point of view.

Rhinobronchial syndrome: pathogenesis and correlation with allergic rhinitis in children

AIM

In the rhinobronchial syndrome a direct causal relationship exists between local nasal irritation and bronchopulmonary disease. Although allergic rhinitis has often been associated with lower airway hyperresponsiveness, no direct relationship between the two has been shown to date. The aim of this study was to determine the role of allergic rhinitis in the pathogenesis of the rhinobronchial syndrome in children by evaluating the effect of topical nasal treatment on lower airway hyperresponsiveness.

MATERIALS AND METHODS

A total of 168 children presenting with aeroallergy and nasal disease associated with bronchopulmonary disease (asthma, chronic cough, bronchopulmonary infection) were evaluated at baseline and at 1 year of follow-up. Nearly half (83) were noted to have signs of allergic rhinitis and were treated with topical nasal medications (cortisones and antihistamines). Changes in upper and lower airway diseases were evaluated and potential causal relationships established.

RESULTS

Allergic rhinitis treatment improved nasal disease symptoms in 67 (80.7%) patients; partial remission or lower healing rates were found in those with asthma (16.4%) and chronic cough (11.1%).

CONCLUSIONS

Although often associated with lower airway hyperresponsiveness, allergic rhinitis in children does not appear to be a pathogenetic factor, as confirmed by the scarce effect the nasal treatment had on the bronchopulmonary disease. Instead, the frequent co-existence of nasal and bronchial symptoms may come under the concept of global allergy of the airways.