Do chronic changes in nasal airflow have any physiological or pathological effect on the nose and paranasal sinuses? A systematic review

Impact of long-term nasal airflow deprivation on sinonasal structures and chronic rhinosinusitis in total laryngectomy patients

Objective

Total laryngectomy (TL) patients are good models in which to evaluate the effects of nasal airflow cessation on the sinonasal tract. Here, we evaluated changes in sinonasal structures and association with sinus opacification in the computed tomography (CT) images 3 years post-TL.

Methods

Patients who underwent TL from 2005 to 2017 in a teaching academic center were reviewed retrospectively. Patients with a final follow-up CT taken less than 3 years after TL, tracheoesophageal puncture, inadequate CT image, or history of sinonasal surgery were excluded. The control group included patients who underwent a partial laryngectomy or hypopharyngectomy without requiring a tracheotomy for more than a month. Altogether, 45 TL patients and 38 controls were selected. The volume of all four paranasal sinuses, inferior turbinate soft tissue volume (ITSTV), maxillary sinus natural ostium (MSNO) mucosal width, and Lund-Mackay scores (LMS) were measured on preoperative and postoperative CT scans.

Results

The mean duration between surgery and the final CT scan was 6.3 ± 2.4 and 5.5 ± 2.3 years for the TL and control groups, respectively. Neither group showed significant changes in the four paranasal sinuses' volume or MSNO mucosa width. The ITSTV decreased significantly, from 4.6 ± 1.3 to 2.8 ± 1.1 mL (p < .001), in the TL group, regardless of the presence of nasal septal deviation, showing ITSTV reduction on both concave and convex sides. By contrast, the control group showed no significant changes in ITSTV. Postoperative LMS changes in both groups were insignificant. The number of patients with LMS aggravation or alleviation was the same in both groups, regardless of preoperative sinus opacification.

Conclusions

Paranasal sinus structures and sinus opacification are not affected significantly by nasal airflow cessation; however, the inferior turbinate mucosa is affected by long-term discontinuation of nasal airflow.

Level of Evidence

4 (case-control study).

Nasal Cytology Changes in Head and Neck Cancer Treatment: A Systemic Review

Nasal cytology is a non-invasive, low-cost exam that can help physicians in the diagnosis of allergic and nonallergic rhinitis, discriminating between different nasal disorders. The aim of this review is to summarize and analyze the current knowledge about nasal cytological examination in head and neck cancer, with a specific focus on the effects of different treatments. Indeed, nasal cytology is important to choose the best treatment for nasal complaints in each patient. A review of the English literature (PubMed, Scopus, Cochrane) was performed (5404 records screened). The inclusion criteria were clinical trials, cohort studies, case-control studies, case series, and case reports regarding nasal cytology in head and neck cancer treatment. Exclusion criteria were as follows: non-human studies, non-English literature, non-cytological evaluations. Two independent reviewers, working separately, extracted the data from all the eligible studies, which were subsequently cross-checked. Five studies were included in qualitative synthesis: three assessed mucosal disorders after radiation therapy and two after total laryngectomy. Radiotherapy can determine mucous or squamous cell metaplasia and neutrophil inflammation. Laryngectomees show hyperplasia of the basal zone cells and mucous cell metaplasia, and they do not develop inflammatory changes. The main limitation of this review is the low number and heterogeneity of studies present in the literature. In conclusion, nasal cytology is useful and allows for identifying mucosal disorders of the nasal cavities after surgery and/or radiotherapy for head and neck cancer. This can help physicians to better treat the nasal complaints of such patients.

Numerical comparison of inspiratory airflow patterns in human nasal cavities with distinct age differences

As a primary determinant of nasal physiological functions, the nasal morphology and its effects on the airflow dynamics have been extensively studied in literature. However, gross flow features reported in literature are mostly obtained from subjects at similar ages, while studies focusing on nasal subjects with distinct age differences are significantly less. To advance current understandings of nasal airflow dynamics in the context of age diversity, this study employed three anatomically accurate nasal cavity models with distinct age features (5-, 24- and 77-year-old models) and numerically compared the physiological nasal airflow fields within these nasal cavity models. To demonstrate the validity of the present numerical models, in vivo rhinomanometry measurement was conducted on the 24-year-old female nasal model, and key anatomical features and pressure-flow curves of all three models were compared with models with similar age features in literature work. Apart from results comparison based on conventional velocity flow fields and wall shear stress distributions, a method for quantifying flow partitions in confined airway spaces was developed to reveal the proportions of fractional flow that enters the olfactory region. Our results revealed dramatic intersubject discrepancies between considered nasal cavity models, especially for the fractional flow that enters the olfactory region. Specifically, the 5-year-old girl nasal model received the highest proportion of fractional flow, which accounts for 13.3% ~ 15% of overall inhalation flow rates under different activity levels. For the 24-year-old female model, on the contrary, the olfactory fractional flow was dramatically reduced (with a local to overall percentage around 4.3%-7.7%). Finally, for the elderly subject-77-year-old male model, minimum level of olfactory flux was observed with a local to overall percentage ranging between 3.1% and 4.9% for considered wide range of inhalation flow rates. Therefore, the local flow intersubject variation can reach nearly fourfold. The vast local flow difference is mainly due to the inherent anatomical features (e.g., immature nasal turbinate structure in the child model, the partial narrowing superior nasal valve in the elder model). The results may further lead to discrepant health effects associated with inhalation exposure to airborne particles.

The potential role of peak nasal inspiratory flow to evaluate active sinonasal inflammation and disease severity

Although the pathophysiology of nasal polyposis is incompletely understood, rhinologists have seldom studied it with rhinomanometry or peak nasal inspiratory flow (PNIF) due to technical limitations and the perception that polyp size might impair reproducibility and the usefulness of recordings. The objective of this study is to assess how measures of rhinomanometry and PNIF relate to disease activity. Nineteen patients with polyps, 15 patients with chronic sinusitis without polyps and 11 negative controls were evaluated with active anterior rhinomanometry and PNIF. Sinusitis and polyp patients were re-evaluated after medical treatment. Polyp patients had the highest median Lund-Mackay score (14) and a median Johansen score of 1. PNIF and its variation after treatment were also lowest in this group (median 90 L/min before and after treatment; median variation of 0 L/min). Nasal resistance was similar between groups, and only correlated with Johansen score (Spearman = 0.517, p = 0.048) after treatment. Our study suggests that evaluating polyp patients using rhinomanometry and PNIF may provide useful and reproducible data. Several findings considered together suggest that polyp size is not the main determinant of nasal functional changes in these patients, warranting further studies to verify whether PNIF changes reflect sinus inflammation or merely airway obstruction.

Nasal Symptoms Following Laryngectomy: A Cross-sectional Analysis

Background

After total laryngectomy, the severe reduction in nasal airflow alters the function and physiology of the nasal cavity. These anatomic and physiologic changes may in turn impact sinonasal quality of life.

Objective

This study sought to characterize the degree of postoperative sinonasal symptoms experienced by laryngectomees.

Methods

Two groups of subjects were recruited in this cross-sectional analysis: patients who previously underwent laryngectomy with or without chemoradiation for laryngeal or hypopharyngeal cancer and a comparison group treated with radiation but not laryngectomy. Patients underwent assessment of sinonasal symptoms using the Reflective Total Nasal Symptom Score (rTNSS), 22-item Sinonasal Outcome Test (SNOT-22), and visual analog scales (VASs). Patients also underwent nasal endoscopy recorded and graded by blinded reviewers using the Modified Lund–Kennedy (MLK) scale.

Results

Thirty-six laryngectomees and 12 controls were enrolled. The total SNOT-22 was similar between the 2 groups (27.3 vs 20.3, P = .16), but the laryngectomy cohort had higher rhinologic ( P < .01), extranasal ( P = .01), and ear/face ( P = .01) subdomain scores. VAS scores were worse in the laryngectomy group for nasal congestion ( P < .01), rhinorrhea ( P < .01), postnasal drip ( P < .01), and smell ( P < .01) but not for nasal fullness ( P = .11). rTNSS (4.7 vs 2.8, P = .04) and MLK scores (2.8 vs 0.8, P < .01) were higher in the laryngectomy group. In addition, 44% and 83% of patients in the laryngectomy and nonlaryngectomy groups, respectively, subjectively reported well-controlled nasal symptoms.

Conclusion

Laryngectomees are likely to experience a higher degree of subjective and objective nasal disease than nonlaryngectomized patients. Postlaryngectomy nasal dysfunction may be an important aspect of quality of life impairment in the laryngectomee population.

Does Septoplasty Affect Hemoglobin and Erythropoietin Levels in Patients With Nasal Septal Deviation?

AIM

To investigate the effect of septoplasty in patients with nasal septum deviation (NSD) on erythropoietin (EPO) and hemoglobin (Hgb) levels.

METHODS

Between 2017 December and 2018 May, 47 patients with NSD who underwent septoplasty in Adiyaman University Medical Faculty Department of Otorhinolaryngology included in this prospective study. The changes in EPO and Hgb levels were studied before and 3 months after the surgery.

RESULTS

The mean age of the patients studied was 30.7 ± 9.9. 31 of the patients were male and 16 were female. Pre- and post-operative 3rd month mean EPO levels of the patients were 11.45 ± 4.9 Mu/mL and 11.39 ± 6.02 Mu/mL, respectively. When these values were analyzed, no statistically significant difference was found (P = .93). Pre- and post-operative 3rd month mean Hgb levels were 14.6 g/dL, and 14.6 g/dL, in turn. When these values were analyzed, no statistically significant difference was found (P = .68).

CONCLUSION

According to these results, the author can say there is no statistically significant relationship between NSD and EPO or Hgb. Therefore, this issue will be enlightened with future studies including more patients and objective tests evaluating nasal patency.

Lin E, Poetker DM, Garcia GJM. Clinical Importance of Nasal Air Conditioning: A Review of the Literature

Background

Nasal air conditioning (ie, heating and humidification of inspired air) is an important function of the nasal cavity. This function may be reduced in cases of aggressive nasal surgery. Future virtual surgery planning tools may be used to design surgical approaches that preserve the nasal air conditioning capacity while decreasing airflow resistance. However, it is unclear whether there is a threshold below which impaired nasal air conditioning is associated with negative health consequences.

Objective

This study aims to review the literature on the clinical impact of reduced nasal air conditioning and its implications for nasal surgery outcomes.

Methods

A literature search was performed on PubMed and Scopus databases for articles that investigated the effect of air temperature and humidity on mucociliary clearance, respiratory epithelial structure, and the prevalence and severity of respiratory diseases.

Results

Inspiration of cold, dry air has direct effects on the respiratory epithelium, such as reduced mucociliary clearance and loss of cilia. Nasal surgeries do inflict some changes to the nasal mucosa and geometry that may result in decreased heating and humidification, but it is unclear how long these effects last. Laryngectomy patients serve as a human model for the absence of nasal air conditioning. The heat and moisture exchangers that many laryngectomy patients wear have been shown to improve lung function and reduce pulmonary symptoms associated with breathing unconditioned air, such as increased coughing and thickened mucus.

Conclusion

Nasal air conditioning is an important mechanism to maintain mucociliary clearance and prevent infection by inhaled pathogens. Preservation of nasal air conditioning capacity should be considered in the implementation of future virtual surgery planning tools. However, a threshold for the onset of negative health consequences due to impaired nasal air conditioning is not yet available.

The impact of nasal airflow on sinus mucosa: A radiographic review

BACKGROUND

Chronic rhinosinusitis (CRS) is a disease of widespread prevalence and high morbidity. Many suggest that the introduction of toxins and allergens via nasal airflow plays a significant role in the development of CRS. In patients who have undergone total laryngectomy, nasal airflow is disrupted, providing an opportunity to examine the role of nasal airflow in sinonasal pathology.

METHODS

All patients who received a total laryngectomy between 2002 and 2012 with preoperative and postoperative computed tomography (CT) scans were retrospectively reviewed. The Lund-Mackay (LM) score for each sinus was recorded for both scans. The assessment of differences in pre-operative and post-operative LM scores was analyzed utilizing paired t-tests.

RESULTS

56 patients underwent total laryngectomy and had both preoperative and postoperative CT scans. There were no significant differences in the LM scores between pre-operative and post-operative scans within each sinus (frontal sinus, p = 1.0; anterior ethmoid sinus, p = 0.77; posterior ethmoid sinus, p = 0.45; maxillary sinus, p = 0.90; sphenoid sinus, p = 0.63; ostiomeatal complex, p = 0.78) or in the total LM scores (p = 0.97). Furthermore, patients with pre-operative sinonasal mucosal thickening (total LM score > 0) showed no significant change in their total LM score post-operatively (p = 0.13).

CONCLUSION

In total laryngectomy patients, studies demonstrate that a disruption in nasal airflow is correlated to altered sinonasal physiology and decreased subjective symptoms. However, our study shows that the disruption of nasal airflow results in no significant change in radiographic evidence of sinonasal mucosal thickening.

Nasal and Tracheal Cytological Changes After Total Laryngectomy in Long-Term Survivors

OBJECTIVE

Complete separation of upper and lower respiratory tract after total laryngectomy results in permanent effects on nasal cavities and tracheo-bronchial airways. Aim of this study is evaluating nasal and tracheal cytological alterations of mucosa in laryngectomy long-term survivors, analyzing the feasibility of scraping for cytological examination of tracheal mucosa.

METHODS

Twenty-five laryngectomy patients underwent symptoms' evaluation, endoscopic fiber optic examination, prick tests, and nasal and tracheal scraping for cytological exam. Twenty-five healthy subjects underwent the same assessment, except for tracheal scraping. Eleven laryngectomy patients accepted inferior turbinate biopsy for histological examination.

RESULTS

Nasal cytological analysis demonstrated mucous cell metaplasia in 20% of laryngectomized patients, but it was absent in all healthy subjects; no squamous cell metaplasia was found in both groups. In 15 patients (60%), bacteria were present, without inflammatory infiltrate. Tracheal cytological analysis demonstrated a quite high rate of squamous cell metaplasia (24%), neutrophilic infiltrate (32%), and presence of bacteria (40%). Histological examination of inferior turbinate showed submucosal stromal fibrosis in all patients and submucosal inflammatory infiltrate in 1 case (9%).

CONCLUSION

Nasal cavities and trachea of laryngectomy patients undergo long-term cytological and histological changes of mucosa and submucosa, probably due to airflow modifications.

The Effect of Nasal Septal Deviation on Frontal and Maxillary Sinus Volumes and Development of Sinusitis

The purpose of this study was to determine the possible role of nasal septal deviation on volume of maxillary and frontal sinuses. Between February 2011 and October 2013, paranasal sinus computed tomography (CT) findings of 732 patients (410 males, 322 females) who were admitted to Ear Nose and Throat Department of Kayseri Research and Training Hospital were retrospectively analyzed. By excluding the other coexistent sinonasal pathologies, 83 consecutive patients with nasal septal deviations were included in the study. The volume of each maxillary and frontal sinus (ipsi- and contralateral to the deviation side) was also calculated using the computer program. There was no statistically significant difference between ipsilateral and contralateral maxillary sinus volumes in group 1 and group 3 (P > 0.05). There was a statistically significant difference between ipsilateral and contralateral maxillary sinus volumes in group 2 (P < 0.05). There was no statistically significant difference between ipsilateral and contralateral frontal sinus volumes in group 1, group 2, and group 3 (P > 0.05). Moderate septal deviation significantly affects the volume of maxillary sinus. Mild and severe septal deviation does not significantly affect the volume of maxillary sinus. Effect of septal deviation on frontal sinus volume was not detected. The probability to encounter maxillary and frontal sinusitis ipsilateral to the all septum deviation groups was significantly increased in both right- and left-sided subjects.

Nasal and Tracheal Microbial Colonization in Laryngectomized Patients

OBJECTIVE

Complete separation of upper and lower respiratory tract after total laryngectomy results in loss of physiological nasal functions and presence of "unconditioned" inspired air in lower airways. Aim of this study is evaluating the presence of a microbial colonization of nasal cavities and trachea in laryngectomized long-term survivors.

METHODS

Twenty-five laryngectomized patients underwent symptoms' anamnestic evaluation, endoscopic fiber optic nasal and tracheal examination, specimen collection for microbiological exam, and culture. Enrolled patients had at least a 2-year follow-up period in order to evaluate long-term microflora.

RESULTS

Gram positive polimicrobic flora represented the main finding in nasal cavities and trachea (92% and 48% of patients, respectively). Other bacteria were non-fermenters Gram negative bacteria, Enterobacteriaceae and Staphylococcus aureus. The same microflora was demonstrated in nasal cavity and trachea in 5 patients (20%), while sterile nasal cavity and trachea were seen in 3 (12%) and 4 (16%) cases, respectively. No fungi were observed in nasal cavity and trachea.

CONCLUSION

Nasal cavities and trachea of laryngectomized patients are colonized by nonpathogenic and/or potentially pathogenic bacteria, in absence of signs and symptoms of infection. Colonizer microflora should be kept in mind when a culture from nasal or tracheal swabs is needed in daily practice.

The association between septal deviation and the presence of a maxillary accessory ostium

BACKGROUND

The etiology and the effects of the maxillary accessory ostium (MAO) are not well understood. The aim of this study is to investigate the association between septal deviation (SD) and the presence of an MAO.

METHODS

Paranasal computed tomography (CT) scans of 1104 adult patients were studied retrospectively. Patients with chronic sinusitis, acute sinusitis, nasal polyposis, allergic rhinitis, paranasal sinus tumors, septal perforation, and unilateral or bilateral maxillary sinus hypoplasia/aplasia, as well as patients who had previously had nasal surgery or a history of nasal trauma, were not included in the study. Eight-hundred and seven patients were found to meet the criteria and were included in the study. CT scans were examined to note the presence of SD and MAO and the side of both diseases.

RESULTS

A total of 807 patients were evaluated. SD and MAO were detected in 572 (70.9%) and 299 (37.1%) patients, respectively. A statistically significant relationship was found between the presence of SD and MAO, regardless of side of the disease (p = 0.002). The side of MAO showed a significant correlation with the direction of SD (p < 0.001).

CONCLUSION

Our results revealed a link between SD and MAO. This relationship was correlated with the side of occurrence of the disease.

Nasal region dimensions in children: a CT study and clinical implications

Atresias of nasal cavity, especially in young children, pose an essential problem in children's otolaryngology. Only a few morphometric studies of nasal cavity concerning healthy neonates and young infants without nasal stenosis are available. Multislice computed tomography is a perfect tool enabling a precise evaluation of anatomic structures. The aim of this study was a complex morphometric evaluation of clinically important bone and mucosal structures of nasal cavity and examination of their dependence on age and sex in children up to 3 years of age. 180 children, age range 0–3 years, were divided into 5 age groups, and measurements of 18 distances between skeletal structures and between mucosal structures of nasal cavity were performed on their CT scans. A correlation between the widths of selected bone structures was examined. There were no statistically significant differences in analyzed morphometric parameters between adjacent age groups. The differences were statistically significant only between extreme age groups. There was a correlation between evaluated structures and age. Our results are a valuable supplement of nasal cavity morphometric data of young children. They may be useful in setting reference values of evaluated parameters in children and in diagnosis and planning of surgical treatment in children's otolaryngology.

What is the Relationship between the Localization of Maxillary Fungal Balls and Intranasal Anatomic Variations?

Objectives

Although the mechanisms underlying the initiation and maintenance of inflammation in unilateral maxillary fungal balls (FBs) are poorly understood, the relationship between intranasal anatomy and maxillary FB is thought to play an important role. The aim of this study was to investigate the relationship between anatomic variations and FB.

Methods

We enrolled 140 patients who were composed of 56 patients with FB, 56 patients with unilateral chronic rhinosinusitis (CRS), and 28 patients with no sinus disease. Computed tomography scans were retrospectively analyzed to identify and compare the associated nasal anatomic abnormalities. To measure the volume of the nasal cavity and middle meatus, computed tomography scans were reconstructed into three-dimensional images.

Results

The relatively larger volume of the middle meatus was associated with the localization of the FB in contrast with the CRS. However, the nasal-cavity volume, nasal valve area, and nasal septal deviation were not significantly associated with localization of FB. The mean volumetric and areal measurements such as nasal cavity, middle meatus, and nasal valve in FB-ipsilateral sides were not significantly different from those in contralateral sides as well as other groups.

Conclusion

The middle meatus bears the major part of the inspiratory nasal airflow, and its volume may influence the occurrence of FB.

Amount of airflow required for olfactory perception in laryngectomees: a prospective interventional study

OBJECTIVES

To determine minimum airflow rate required for olfactory stimulation in successfully rehabilitated laryngectomised patients after learning the polite yawning technique (PYT) and to confirm the hypothesis that sense of smell is rehabilitated once the nasal airflow is re-established.

DESIGN

Prospective open interventional trial.

SETTING

Tertiary academic hospital.

PARTICIPANTS

The study population comprised 100 laryngectomised patients. The control group consisted of 100 non-laryngectomised patients of similar age and sex. Rhinomanometry was used to measure air flow in the right and left nostrils, respectively, while the Smell Diskettes Olfaction test (SDOT) was used to test each individual's sense of smell.

MAIN OUTCOME MEASURES

The primary endpoint was increasing the airflow, while the secondary endpoint was improvement in the Smell Diskettes Olfaction test score after learning the polite yawning technique.

RESULTS

The difference in the Smell Diskettes Olfaction test results before and after introducing the polite yawning technique was statistically significant (F = 53.077; P < 0.001). The number of accurately identified odours increased with each measurement. There was a significant difference among rhinomanometric measurements of airflow through the right (F = 65.002; P < 0.001) and left nostrils (F = 75.465; P < 0.001). Nasal airflow improved with each measurement. The minimum airflow required for olfactory stimulation in successfully rehabilitated patients was approximately 60 cm(3) /s. The control group had considerably better airflow in both nostrils than the laryngectomised group. The difference between the total number of rehabilitated (normosmic) patients (48%) in the laringectomised group and normosmic participants (56%) in the control group (z = 1.132; P = 0.129) was not statistically significant.

CONCLUSION

The number of odours identified by laryngectomised patients increased with the volume of nasal airflow. The number of patients with rehabilitated olfactory function approximated the percentage of normosmic individuals in the non-laryngectomised population. These findings confirm the hypothesis that sense of smell is rehabilitated once the nasal airflow is re-established.

Aerodynamic investigation of the correlation between nasal septal deviation and chronic rhinosinusitis

OBJECTIVES/HYPOTHESIS

To compare the aerodynamic differences around ostiomeatal complex between the convex side and concave side in patients with concurrent nasal septal deviation and chronic rhinosinusitis, and to explore the potential correlation between nasal septal deviation and chronic rhinosinusitis occurrence from the perspective aerodynamics.

STUDY DESIGN

Retrospective case series.

METHODS

Fifty-six patients with concurrent nasal septal deviation and chronic rhinosinusitis were recruited. Nasal septal deviation was divided into mild, moderate, and severe deviations according to deviation angle. Using computational fluid dynamics, indices such as maximal velocity, maximal turbulence kinetic energy, maximal wall shear stress, and minimal temperature around the ostiomeatal complex were calculated and compared between the convex side and concave side, and among patients with varying severities of deflection.

RESULTS

The proportion for mild, moderate, and severe deviations was 12.5%, 32.1%, and 55.4%, respectively. Significant differences for maximal velocity, maximal wall shear stress, maximal turbulence kinetic energy, and minimal temperature around the ostiomeatal complex between the convex side and concave side could be detected. No significant difference of aerodynamic characteristics around the osteomeatal complex could be detected with the increasing of deviation angles. The incidence for chronic rhinosinusitis in convex, concave, and bilateral sides was 16.1%, 25%, and 58.9%, respectively.

CONCLUSIONS

From the aerodynamics perspective, both sides of nasal cavity have the potential to predispose the occurrence of chronic rhinosinusitis in patients with nasal septal deviation. The increased deviation angle did not aggravate aerodynamic disturbance around the osteomeatal complex. The contributing role of nasal septal deviation in the pathogenesis of chronic rhinosinusitis should not be emphasized in excess.

Microscopic study of certain age-related structural changes of maxillary sinus lining epithelium in albino rats

Mucociliary clearance is essential to maintain the defense function of the maxillary sinus; however, no literatures described the age changes in its lining epithelium. Therefore, the current work sought to describe the morphological postnatal age-related changes of maxillary sinus lining epithelium in rats using light, transmission, and scanning electron microscopes. Eighteen albino rats were divided into six groups according to their ages: 2-week-old, 1-month-old, 2-month-old, 3-month-old, adults, and senile rats. One-month-old-rats' group was the first to have recognizable maxillary sinus cavities that were lined by either single flat cellular layer or two distinct epithelial layers. These cells were devoid of microvilli and cilia, none of them showed evidence of differentiation into identifiable cell types. In 2- and 3-month-old rats, the mucosa of maxillary sinus started to be lined with pseudostratified epithelium with apparent increase in both microvilli and cilia. The first indication of goblet cell differentiation was observed in 3-month-old-rats. In the adult rats, the sinuses became completely lined by mature respiratory epithelium. However, in senile rats the epithelium exhibited polyps with clumped cilia and some areas of stratification and desquamation. Goblet cells were scanty and degenerating. The impaired mucociliary components (epithelium, cilia, and goblet cells' mucus) found in young and old ages of the current work might be correlated to human to explain predisposition of rhino-sinusitis in these age groups.

Chemosensory function assessed with psychophysical testing and event-related potentials in patients with atrophic rhinitis

Atrophic rhinitis (AR) is a chronic inflammation of the nose characterized by an atrophy of the nasal mucosa. This is typically associated with an impaired sense of smell and a subjective sensation of poor nasal breathing. The aim of this study is to assess chemosensory function in patients suffering from AR using psychophysical testings and event-related potentials (ERP) responses. A cohort of nine patients was extensively studied. Eight out of nine had secondary AR sequela of a bilateral total inferior turbinectomy whereas one patient had a primary AR. All the patients had a clinical evaluation using Sniffin' Sticks test and a retro-olfaction test and an electrophysiological evaluation based upon ERPs obtained after both olfactory and trigeminal stimuli. All the patients complained of a poor nasal breathing and presented a distortion of the chemosensory function. Actually, the orthonasal psychophysical testing showed that four patients out of nine had anosmia, three out of nine had hyposmia and two out of nine were normosmic. All the patients demonstrated retro-olfaction scores inferior to the normal values. The chemosensory ERP showed that seven patients had no olfactory response whereas six had no trigeminal response. Four patients had neither olfactory nor trigeminal ERP response. In conclusion, this study demonstrates that most patients with AR secondary to a total bilateral inferior turbinectomy have a reduction of the chemosensory function measured objectively by psychophysical testings and ERP [corrected].

Physiology and pathophysiology of respiratory mucosa of the nose and the paranasal sinuses

In this review, anatomy and physiology of the respiratory mucosa of nose and paranasal sinuses are summarized under the aspect of its clinical significance. Basics of endonasal cleaning including mucociliary clearance and nasal reflexes, as well as defence mechanisms are explained. Physiological wound healing, aspects of endonasal topical medical therapy and typical diagnostic procedures to evaluate the respiratory functions are presented. Finally, the pathophysiologies of different subtypes of non-allergic rhinitis are outlined together with treatment recommendations.

The impact of tracheostomy on the nose

To establish the effect of tracheostomy on nasal function and quality of life. Teaching Hospital, Scotland, UK. Cross-sectional case-control study. Two groups of patients were selected; a group of ten patients who underwent surgical tracheostomy and a control group of ten patients with confirmed or suspected head and neck malignancy that did not require tracheostomy. Two questionnaires, the SNOT-22 quality of life instrument, and the Rhinogram nasal symptoms score were used to evaluate each group. For the Rhinogram questionnaire the median total score was 13.5 for the tracheostomy group and 2 for the control group (P = 0.02) whilst for the SNOT-22, the mean total scores were 39 and 29, respectively (P = 0.205). The tracheostomy group scored worse for all Rhinogram questions, and for the anosmia score this was independently statistically significant (5 vs. 0 units, P = 0.001). The tracheostomy group most commonly identified "loss of smell & taste" as their most important symptom, compared with only 2 subjects in the control group. Tracheostomy can give rise to nasal symptoms. This needs to be addressed in the routine follow up of these patients.

A systematic analysis of septal deviation associated with rhinosinusitis

OBJECTIVES/HYPOTHESIS

Rhinosinusitis might have many etiologies that lead to a common presentation of inflammation and impaired mucociliary clearance. Anatomic factors were once thought to play a large role in the pathogenesis of rhinosinusitis, and septal deviation was examined in multiple studies with conflicting results. With the more recent appreciation that the development of rhinosinusitis is likely multifactorial, it is appropriate to re-examine possible anatomic etiologies. A systematic analysis of septal deviation and rhinosinusitis was therefore performed to better define this association and describe possible etiologic mechanisms. Examination of a large sample, accomplished through systematically identifying and combining previous studies, may compensate for the several shortcomings of these separate analyses. A systematic analysis was therefore performed to answer the question, is septal deviation associated with rhinosinusitis?

STUDY DESIGN

Systematic analysis of previously published studies.

METHODS

Following a structured literature search, articles examining the association of septal deviation and rhinosinusitis were analyzed quantitatively and qualitatively. Based on the quantitative results, a septal deviation angle (SDA) cutoff of 10 degrees was chosen for distinguishing positive from negative for septal deviation in the qualitative analysis.

RESULTS

Of over 300 references initially identified, 13 articles comprised the basis of this review. Increasing angles of septal deviation were associated with increasing prevalence of rhinosinusitis in multiple studies. Combining the results of five previous studies on this subject demonstrated significant association of septal deviation and rhinosinusitis (P = .0004, chi(2) analysis). The clinical effect was found, however, to be modest with an odds ratio of 1.47. Interestingly, in all studies that examined the laterality of rhinosinusitis associated with septal deviation, inflammation was found bilaterally. Based on the data from this analysis, it appears that many of the previous analyses were insufficiently powered to detect an association between rhinosinusitis and septal deviation. Others failed to find an association by examining subjects with small SDAs.

CONCLUSIONS

Septal deviation is associated with an increased prevalence of rhinosinusitis, although the impact of this anatomic anomaly is limited. It appears to be one of many possible factors that might lead to the development of rhinosinusitis.

The maxillary sinus after total laryngectomy: an electron microscopic study

Nasal breathing is completely ceased after total laryngectomy. This results in some structural changes in the nasal mucosa, which has been described in numerous studies. This study investigates the changes that appear in the paranasal sinus mucosa. Eight patients who had undergone total laryngectomy at least 1-year ago were enrolled. Under general anesthesia, maxillary sinuses were examined with an endoscope inserted through canine fossa. 1-2 mm mucosal tissues for biopsy were taken from posterior wall of the maxillary sinus. Specimens were evaluated under an electron microscope. Control tissues for biopsy were obtained from two patients who had been operated for other reasons and analyzed under transmission electron microscopy. Results showed that in the control specimens, the epithelial cells appeared normal under transmission electron microscopy. Samples taken from two larygectomees in their first postoperative year were also completely normal. Samples from other larygectomees demonstrated ciliary loss, abundant degenerative vacuoles in ciliated epithelial cells and detachments in the interepithelial junctional complexes. The intracellular respiratory mechanisms such as the mitochondria, golgi complex and endoplasmic reticulum cisternae, and the integrity of the cellular or the nuclear membrane were spared. We conclude that the cessation of nasal breathing resulted in degenerative changes that could be reversible in the transmission electron microscopic examination of maxillary sinus mucosa. These changes emerged after 2 years following total laryngectomy. Nevertheless, these changes did not have any negative influence on the clinical outcome in this group of patients.

Evaluation of the nasal mucociliary transport rate by rhinoscintigraphy before and after surgery in patients with deviated nasal septum

In this study, we have investigated the effect of nasal septal deviation (NSD) on nasal mucociliary activity and how does a septoplasty operation affecs the nasal mucociliary transport rate in the first and third months during the post-operative period. Twenty-two patients who were diagnosed with NSD and 22 healthy controls were studied using rhinoscintigraphy with Tc-99m-macroaggregated albumin (Tc-99m-MAA). On each case, the nasal mucociliary transport rate (NMTR) was measured pre-operatively only on five cases, on the first and third months of post-operative period. The NMTRs of patients with a deviated septum were significantly lower than the NMTRs of the healthy controls on both the convex and concave sides. Significant improvement was observed in the first post-operative month. On the concave and convex sides, the average postop third month post-operative NMTR value was higher than the first month post-operative NMTR values. It was concluded that the septoplasty operation improves reduced NMTRs after surgery. The effect of nasal surgery on nasal mucociliary activity may be more accurately evaluated in the third month than the first month of post-operative period.

Atrophic rhinitis: a CFD study of air conditioning in the nasal cavity

Atrophic rhinitis is a chronic disease of the nasal mucosa. The disease is characterized by abnormally wide nasal cavities, and its main symptoms are dryness, crusting, atrophy, fetor, and a paradoxical sensation of nasal congestion. The etiology of the disease remains unknown. Here, we propose that excessive evaporation of the mucous layer is the basis for the relentless nature of this disease. Airflow and water and heat transport were simulated using computational fluid dynamics (CFD) techniques. The nasal geometry of an atrophic rhinitis patient was acquired from computed tomography scans before and after a procedure to narrow the nasal cavity. Simulations of air conditioning in the atrophic nose were compared with similar computations performed within the nasal geometries of four healthy humans. The excessively wide cavity of the patient generated abnormal flow patterns, which led to abnormal patterns of water fluxes across the wall. Geometrically, the atrophic nose had a much lower surface area than the healthy nasal passages, which increased water fluxes per unit area. Nevertheless, the simulations indicated that the atrophic nose did not condition inspired air as effectively as the healthy geometries. These simulations of water transport in the nasal cavity are consistent with the hypothesis that excessive evaporation of mucus plays a key role in the pathophysiology of atrophic rhinitis. We conclude that the main goals of a surgery to treat atrophic rhinitis should be 1) to restore the original surface area of the nose, 2) to restore the physiological airflow distribution, and 3) to create symmetric cavities.

Maxillary sinus pneumatization of an adult skull with an untreated bilateral cleft palate

INTRODUCTION

Patients with clefts of lip, alveolus and palate show a high incidence of maxillary sinusitis. In order to evaluate sinus size as a factor in sinusitis, this study investigates maxillary sinus morphology in an adult skull with an untreated bilateral cleft.

MATERIAL AND METHODS

The maxillary sinus volume (MSV) of a mixed-sex sample of 140 adult skulls from three different populations was assessed and compared with the MSV of a skull of a 25 year old man showing an untreated complete bilateral cleft. A least squares regression analysis was used to investigate the relationship between MSV and different external cranial dimensions.

RESULTS

The cleft skull shows a well-developed set of paranasal sinuses. There are close, significant relationships between MSV and the cranial measurements. The cleft skull had a MSV that does not deviate substantially from that predicted from the size of its facial skeleton.

CONCLUSION

This study indicates a close link between the size of the facial skeleton and the MSV in humans, even in case of an untreated bilateral cleft. This, in conjunction with the existing literature, makes it extremely unlikely that the sizes of the paranasal sinuses are a factor for sinusitis in patients with cleft lip, alveolus and palate.