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Kirtsreesakul V, Leelapong J, Ruttanaphol S. Can a Pretreatment Visual Analog Scale Predict Treatment Outcome in Allergic Rhinitis? Int Arch Allergy Immunol 2020; 181:285-291. [PMID: 32018258 DOI: 10.1159/000505745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The visual analogue scale (VAS) is a simple and useful tool to assess the severity of allergic rhinitis. Whether a pretreatment VAS score can guide appropriate medication is unclear. OBJECTIVE The aim of this study was to evaluate whether a pretreatment VAS score could be used to predict therapeutic response. METHODS A prospective 4-week cohort study involving 101 allergic rhinitis patients was carried out. All patients were treated with triamcinolone acetonide aqueous nasal spray 220 μg once daily for 28 days. The treatment outcomes were evaluated using VAS scores (0-10 cm), total nasal symptoms scores (TNSSs), nasal mucociliary clearance times (NMCCTs), and global symptom controls (GSCs). The minimal clinically important differences (MCIDs) method was used to separate the patients into with and without improvement groups. Receiver operating characteristic curve analysis was performed to evaluate the predictive value of pretreatment VAS scores in relation to MCIDs after treatment. RESULTS Pretreatment VAS scores showed a positive correlation with pretreatment TNSSs and NMCCTs (ρ = 0.66, p < 0.001 and r = 0.44, p < 0.001, respectively), and a negative correlation with GSCs after treatment (r = -0.53, p < 0.001). The MCID values of TNSSs and NMCCTs were 3.19 and 2.78, respectively. The cutoff value of pretreatment VAS ranged between 6.5 and 7.7 points, with an average value of 7.1. CONCLUSION A pretreatment VAS score of 7 or higher was associated with an unfavorable treatment outcome, which suggests the potential therapeutic predictive value of VAS scoring.
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Affiliation(s)
- Virat Kirtsreesakul
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand,
| | - Jitanong Leelapong
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Suwalee Ruttanaphol
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Kirtsreesakul V, Leelapong J, Ruttanaphol S. Correlation Between Peak Nasal Flow Reversibility and Mucociliary Clearance in Allergic Rhinitis. Laryngoscope 2019; 130:1372-1376. [PMID: 31385622 DOI: 10.1002/lary.28226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/22/2019] [Accepted: 07/18/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Reversibility of nasal airflow after decongestion measured by rhinomanometry is associated with the severity of allergic inflammation. Peak nasal flow is a simpler alternative method for assessing nasal patency. The aim of this study was to evaluate the correlation between changes in peak nasal expiratory and inspiratory flows (PNEFs and PNIFs) after decongestion and nasal mucociliary clearance times (NMCCTs). STUDY DESIGN Single-center, prospective cross-sectional study. METHODS One hundred one allergic rhinitis patients were enrolled. Nasal symptoms and NMCCTs were assessed. PNEF and PNIF were performed before and after decongestion. Correlations between changes in PNEF and PNIF after decongestion and NMCCTs were analyzed. One-half the standard deviation of baseline peak nasal flows was used to estimate the minimal clinically important differences (MCIDs) and discriminate between patients with reversible mucosa and with irreversible mucosa. RESULTS PNEF showed more peak flow improvements after decongestion compared to PNIF. Changes in PNEF had better negative correlations with NMCCTs than PNIF (ρ = -0.49, P < .001 and ρ = -0.34, P < .001, respectively). The MCID values of the PNEF and PNIF were 27.93 and 19.74, respectively. In comparisons of NMCCTs between patients with or without MCID of peak nasal flow after decongestion, PNEF had better discrimination ability compared to PNIF (P = .003 and P = .026, respectively). CONCLUSIONS The limitation of reversibility as measured by peak nasal flows could indirectly point to the affection of mucosal inflammation as indicated by NMCCTs. PNEF is more sensitive to assess peak flow changes after decongestion than PNIF. LEVEL OF EVIDENCE 2 Laryngoscope, 130:1372-1376, 2020.
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Affiliation(s)
- Virat Kirtsreesakul
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Jitanong Leelapong
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Suwalee Ruttanaphol
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Peng Y, Guan WJ, Tan KS, Zhu Z, Chen Z, Hong H, Wang Z, Tian T, Zi X, Ong YK, Thong M, Shi L, Yang Q, Qiu Q, Wang DY. Aberrant localization of FOXJ1 correlates with the disease severity and comorbidities in patients with nasal polyps. Allergy Asthma Clin Immunol 2018; 14:71. [PMID: 30459817 PMCID: PMC6234688 DOI: 10.1186/s13223-018-0296-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022] Open
Abstract
Background Upper airway inflammatory diseases are associated with abnormal expression of nasal epithelial forkhead-box J1 (FOXJ1) which regulates motile cilia formation. We sought to investigate whether aberrant FOXJ1 localizations correlate with the disease severity and the co-existence of allergic rhinitis (AR) or asthma in patients with nasal polyps (NPs). Methods We elucidated localization patterns of FOXJ1 by performing immunofluorescence assays in nasal specimens and cytospin samples from controls and patients with NPs. We also assayed mRNA expression levels of FOXJ1 by using quantitative real-time polymerase chain reaction. Four localization patterns [normal (N), intermediate (I), mislocalization (M), and absence (A)] were defined. A semi-quantitative scoring system was applied for demonstrating FOXJ1 localization in five areas per paraffin section, with individual sections being scored between 0 and 2. Results FOXJ1 localization score was significantly higher in samples from NPs than in controls (P < 0.001). Elevated FOXJ1 localization scores and down-regulation of FOXJ1 mRNA levels were observed in NPs with co-existing AR or asthma (all P < 0.05). Moreover, FOXJ1 localization scores positively correlated with Lund–Mackay score (r = 0.362, P = 0.007). Of primary cytospin samples, the mean percentage of patients with FOXJ1 localization patterns N, I, M and A was 15.0%, 3.3%, 53.3% and 28.3% in NPs, and 82.5%, 5.0%, 5.0% and 7.5% in controls, respectively (P < 0.001). Conclusions Aberrant localization of FOXJ1 correlates with the severity and co-existence of AR or asthma in patients with NPs, and might be a novel target for assessment and intervention in NPs. Electronic supplementary material The online version of this article (10.1186/s13223-018-0296-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yang Peng
- 1Department of Otolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong China.,2Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore.,3State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Wei-Jie Guan
- 2Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore.,3State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Kai Sen Tan
- 2Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore
| | - Zhenchao Zhu
- 1Department of Otolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong China.,4Department of Otolaryngology Head & Neck Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong China
| | - Zhuo Chen
- 5Department of Otolaryngology Head & Neck Surgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan China
| | - Haiyu Hong
- 6Department of Otolaryngology-Head and Neck Surgery, The 5th Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong China
| | - Zhaoni Wang
- 2Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore.,7Department of Pediatrics, The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong China
| | - Tengfei Tian
- 2Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore.,8Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi China
| | - Xiaoxue Zi
- 2Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore.,9Department of Otolaryngology, The Second Hospital, Shandong University, Jinan, China
| | - Yew Kwang Ong
- 2Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore
| | - Mark Thong
- 2Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore
| | - Li Shi
- 9Department of Otolaryngology, The Second Hospital, Shandong University, Jinan, China
| | - Qintai Yang
- 10Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong China
| | - Qianhui Qiu
- 1Department of Otolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong China.,4Department of Otolaryngology Head & Neck Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong China.,12Department of Otolaryngology Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282 Guangdong China
| | - De-Yun Wang
- 2Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore.,3State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.,11Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228 Singapore
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Bonnomet A, Luczka E, Coraux C, de Gabory L. Non-diluted seawater enhances nasal ciliary beat frequency and wound repair speed compared to diluted seawater and normal saline. Int Forum Allergy Rhinol 2016; 6:1062-1068. [PMID: 27101776 PMCID: PMC5074274 DOI: 10.1002/alr.21782] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/17/2016] [Accepted: 03/08/2016] [Indexed: 01/05/2023]
Abstract
Background The regulation of mucociliary clearance is a key part of the defense mechanisms developed by the airway epithelium. If a high aggregate quality of evidence shows the clinical effectiveness of nasal irrigation, there is a lack of studies showing the intrinsic role of the different irrigation solutions allowing such results. This study investigated the impact of solutions with different pH and ionic compositions, eg, normal saline, non‐diluted seawater and diluted seawater, on nasal mucosa functional parameters. Methods For this randomized, controlled, blinded, in vitro study, we used airway epithelial cells obtained from 13 nasal polyps explants to measure ciliary beat frequency (CBF) and epithelial wound repair speed (WRS) in response to 3 isotonic nasal irrigation solutions: (1) normal saline 0.9%; (2) non‐diluted seawater (Physiomer®); and (3) 30% diluted seawater (Stérimar). The results were compared to control (cell culture medium). Results Non‐diluted seawater enhanced the CBF and the WRS when compared to diluted seawater and to normal saline. When compared to the control, it significantly enhanced CBF and slightly, though nonsignificantly, improved the WRS. Interestingly, normal saline markedly reduced the number of epithelial cells and ciliated cells when compared to the control condition. Conclusion Our results suggest that the physicochemical features of the nasal wash solution is important because it determines the optimal conditions to enhance CBF and epithelial WRS thus preserving the respiratory mucosa in pathological conditions. Non‐diluted seawater obtains the best results on CBF and WRS vs normal saline showing a deleterious effect on epithelial cell function.
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Affiliation(s)
- Arnaud Bonnomet
- National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [INSERM]) Scientific Mixed Research unit UMRS-S 903, Federative Structure Health Research Champagne-Ardennes-Picardie (SFR CAP-Santé): FED 4231, University of Reims-Champagne-Ardenne, Reims, France.,Cellular and Tissular Imaging Platform (PICT), University of Reims-Champagne-Ardenne, Reims, France
| | - Emilie Luczka
- National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [INSERM]) Scientific Mixed Research unit UMRS-S 903, Federative Structure Health Research Champagne-Ardennes-Picardie (SFR CAP-Santé): FED 4231, University of Reims-Champagne-Ardenne, Reims, France
| | - Christelle Coraux
- National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [INSERM]) Scientific Mixed Research unit UMRS-S 903, Federative Structure Health Research Champagne-Ardennes-Picardie (SFR CAP-Santé): FED 4231, University of Reims-Champagne-Ardenne, Reims, France
| | - Ludovic de Gabory
- Ear Nose and Throat (ENT) Department, University Hospital of Bordeaux, Hôpital Pellegrin, Bordeaux, France.
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Kirtsreesakul V, Somjareonwattana P, Ruttanaphol S. The correlation between nasal symptom and mucociliary clearance in allergic rhinitis. Laryngoscope 2009; 119:1458-62. [PMID: 19507239 DOI: 10.1002/lary.20146] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE/HYPOTHESIS The Allergic Rhinitis and Its Impact on Asthma (ARIA) classification of allergic rhinitis (AR) is based on the severity and duration of nasal symptoms. Whether the nasal symptoms actually represent underlying nasal inflammation is unclear. The aim of this study was to evaluate the correlation between nasal symptoms and nasal inflammation using mucociliary clearance time (MCCT) in AR. STUDY DESIGN A prospective cross-sectional study. METHODS 73 AR patients were classified according to ARIA class: mild or moderate-severe intermittent AR (MIAR or MSIAR) and mild or moderate-severe persistent AR (MPAR or MSPAR). Each nasal symptom was scored as 1 to 3 on a severity scale (mild-moderate-severe). The sum of the individual nasal symptom scores gave the total symptoms score (TSS). MCCT was determined with the charcoal-saccharin method. MCCTs between ARIA classes were compared and correlations between TSS or days with symptoms per week (DSW) and MCCT were analyzed. RESULTS Of the patients, 67.1% were moderate-severe degree. MSPAR had the worst MCCT, followed by MSIAR, MPAR, and MIAR (mean MCCTs of 14.32, 13.87, 11.94, and 10.28 minutes, respectively). TSS was well correlated with MCCT (P = .538, P < .001). DSW was also correlated with MCCT, but did not reach statistical significance (r = 0.217, P = .065). The mean MCCT of overall nasal symptoms increased along with each score step and a significant difference was noted between scores 2 and 3 (P < .001). CONCLUSIONS A high percentage of moderate-severe disease and a significant correlation of the severity and MCCTs suggest an important heterogeneity in this disease severity group. Discriminating between moderate and severe rhinitis should help to obtain homogeneous populations and develop improved disease management strategies.
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Affiliation(s)
- Virat Kirtsreesakul
- Department of Otolaryngology, Prince of Songkla University, Hat Yai, Thailand.
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Wabnitz DAM, Wormald PJ. A blinded, randomized, controlled study on the effect of buffered 0.9% and 3% sodium chloride intranasal sprays on ciliary beat frequency. Laryngoscope 2005; 115:803-5. [PMID: 15867643 DOI: 10.1097/01.mlg.0000157284.93280.f5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are conflicting reports regarding the effect of intranasal saline sprays on the various components of the mucociliary clearance system. This study evaluates the effect of normal saline and hypertonic saline on the ciliary beat frequency (CBF). METHODS Eight healthy volunteers were randomized to receive 0.9% saline spray to one nostril and 3.0% saline spray to the other. Ciliated cells were collected, and the CBF was calculated using computerized microphotometry. RESULTS Although neither solution significantly altered the CBF from baseline measurements, there was a significant difference between the CBFs of the two solutions at 5 minutes postadministration (9.1 Hz with 0.9% saline, 10.1 Hz with 3.0% saline, P < .05). This was a transient effect and was not seen when cells were examined at 60 minutes postadministration. CONCLUSION The administration of hypertonic saline results in a significantly faster CBF 5 minutes after administration. This effect is not seen 60 minutes after administration.
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Affiliation(s)
- David A M Wabnitz
- Department of Surgery, Otolaryngology-Head and Neck Surgery, Adelaide and Flinders Universities, Adelaide, South Australia
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Naclerio RM, Baroody FM, Bidani N, De Tineo M, Penney BC. A comparison of nasal clearance after treatment of perennial allergic rhinitis with budesonide and mometasone. Otolaryngol Head Neck Surg 2003; 128:220-7. [PMID: 12601318 DOI: 10.1067/mhn.2003.70] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Evidence in vitro suggests that benzalkonium chloride, a preservative in many intranasal preparations, interferes with ciliary function and thus could potentially interfere with mucociliary transport, the mechanism for clearing secretions from the nasal cavity. STUDY DESIGN We performed a parallel randomized study with 10 subjects in each arm comparing Rhinocort AQUA (an intranasal steroid [budesonide] spray without benzalkonium chloride) and Nasonex (an intranasal steroid [mometasone furoate] spray with benzalkonium chloride). Before and after 2 weeks of treatment, subjects completed a Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and underwent a measurement of nasal clearance of a radioactive colloidal spray into the nose. RESULTS The groups were matched at entry for nasal clearance, even though there was variability among subjects. The amount of change after 2 weeks of treatment (Delta before versus after treatment) showed a significant difference in nasal clearance favoring budesonide. After 2 weeks of treatment, both budesonide and mometasone demonstrated overall improvement in quality of life as assessed by the RQLQ. Both treatments were well tolerated. CONCLUSION Our study extends the observation in vitro that demonstrates the adverse effect of benzalkonium chloride on cilia to a measurement in vivo of clearance. The effects after 2 weeks might not reflect changes after longer periods of treatment. SIGNIFICANCE To determine the clinical significance of the small improvement in mucociliary transport will require large clinical trials.
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Affiliation(s)
- Robert M Naclerio
- Sections of Otolaryngology-Head and Neck Surgery and Nuclear Medicine, The Pritzker School of Medicine, The University of Chicago, Chicago, IL 60637, USA.
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Alles R, Parikh A, Hawk L, Darby Y, Romero JN, Scadding G. The prevalence of atopic disorders in children with chronic otitis media with effusion. Pediatr Allergy Immunol 2001; 12:102-6. [PMID: 11338283 DOI: 10.1046/j.0905-6157.2000.00008.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We studied 209 children, referred to a multi-disciplinary 'Glue ear/Allergy' clinic at our hospital with a history of chronic or recurrent otitis media with effusion (OME), in order to determine the prevalence of atopic disease in this population. Referrals were made either from within the hospital by Ear, Nose and Throat (ENT) Surgeons and Audiological Physicians (internal), or by General Practitioners (external). Assessment of atopic status was based on medical history, physical examination, nasal smears and skin-prick testing (SPT) in all children; and on blood eosinophil counts and total immunoglobulin E (IgE) levels in a randomly selected subset. The main outcome measures were number of children with rhinitis, asthma, eczema, positive SPT, raised IgE level (> 100 IU/l), and nasal and blood eosinophilia. We found allergic rhinitis in 89%, asthma in 36%, and eczema in 24%. SPTs were positive to one or more of eight common inhalant aeroallergens in 57% of children. Blood tests in the selected subset revealed eosinophilia in 40% and a raised serum IgE in 28%. The worldwide prevalence of allergic rhinitis in children has been estimated to be 20%. The 89% prevalence found in this study is very high and there are a number of reasons which suggest that there may be a causal relationship. Whole-population studies will be required to confirm these findings, which could have important therapeutic implications for OME.
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MESH Headings
- Allergens/immunology
- Asthma/epidemiology
- Asthma/immunology
- Child
- Child, Preschool
- Chronic Disease
- Eczema/epidemiology
- Eczema/immunology
- Female
- Humans
- Hypersensitivity, Immediate/complications
- Hypersensitivity, Immediate/epidemiology
- Hypersensitivity, Immediate/immunology
- Male
- Otitis Media with Effusion/complications
- Prevalence
- Random Allocation
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/immunology
- Skin Tests
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Affiliation(s)
- R Alles
- Glue Ear Clinic, Royal National Throat, Nose and Ear Hospital, Gray's Inn Road, London, UK
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Affiliation(s)
- G Scadding
- Royal National Throat Nose & Ear Hospital, London, UK
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10
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Abstract
The symptoms of rhinosinusitis occur in a variety of sinonasal conditions, which may be broadly classified as allergic (seasonal, perennial or occupational rhinitis/rhinosinusitis) or non-allergic (caused by infection, or non-infectious, e.g. drug-induced or idiopathic). Correct diagnosis is important for optimal management. A thorough history should be taken, followed by general and endoscopic examinations and confirmatory investigations. Careful examination should reveal obvious alternative causes of symptoms, such as polyps or tumours. If allergy is suspected, this can be confirmed by further tests, particularly the skin-prick test or measurements of serum specific IgE. Imaging techniques, usually X-rays or CT scanning, are of use if a systemic condition or major sinonasal disorder needs to be excluded. Other useful diagnostic aids are measurements of nasal peak flow, rhinomanometry, acoustic rhinometry, olfactory threshold, and measures of mucociliary function (which may include biopsy for electron microscopy).
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MESH Headings
- Diagnosis, Differential
- Humans
- Rhinitis, Allergic, Perennial/classification
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/etiology
- Rhinitis, Allergic, Seasonal/classification
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/etiology
- Sinusitis/classification
- Sinusitis/diagnosis
- Sinusitis/etiology
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Affiliation(s)
- V Lund
- Royal National Throat, Nose and Ear Hospital, London, UK
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Incaudo GA, Wooding LG. Diagnosis and treatment of acute and subacute sinusitis in children and adults. Clin Rev Allergy Immunol 1998; 16:157-204. [PMID: 9561338 DOI: 10.1007/bf02739329] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Affiliation(s)
- Z Pelikan
- Department of Allergology and Immunology, Institute Medical Science, Ae Breda, The Netherlands
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Bonifazi F, Bilò MB, Antonicelli L, Bonetti MG. Rhinopharyngoscopy, computed tomography and magnetic resonance imaging. Allergy 1997; 52:28-31. [PMID: 9188945 DOI: 10.1111/j.1398-9995.1997.tb04802.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Rhinitis is defined as nasal congestion, sneezing, itching and rhinorrhoea, recently classified as allergic, infective, structural or "other". The increasing employment of flexible rhynolaringoscopy may represent one of the most useful diagnostic tools in the complex differential diagnosis between allergic and nonallergic rhinitis. Furthermore, chronic allergic rhinitis, with secondary impairment of mucociliary clearance and the plethora of frequent anatomical variations, especially in the ostiomeatal complex, appear to predispose the patient to recurrent rhinosinusitis. In the last two decades, a better understanding of mucociliary clearance of nasal cavity and paranasal sinuses has shifted the attention from the maxillary sinuses to the area of the antherior ethmoid sinuses. Plain film radiographic examination, the historical standard, due to its inability to individualize ethmoid and sphenoid disease, is being rapidly supplanted by computed tomography and magnetic resonance imaging in the diagnosis of rhinosinusitis. In allergic and non-allergic rhinitis the diagnostic role of magnetic resonance imaging and computed tomography is still under debate. Computed tomography and magnetic resonance imaging are more efficient in demonstrating the bone wall, mucosal layer and sinus content than classical and computerized radiology; they have a higher diagnostic performance index in spite of a higher cost and, for computed tomography, a higher radiation dose.
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Affiliation(s)
- F Bonifazi
- Allergy Respiratory Unit, Regional Hospital, Ancona, Italy
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Scadding GK, Hassab M, Darby YC, Lund VJ, Freedman A. Intranasal lysine aspirin in recurrent nasal polyposis. Clin Otolaryngol 1995; 20:561-3. [PMID: 8665721 DOI: 10.1111/j.1365-2273.1995.tb01603.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Twenty patients with recurrent nasal polyposis but without any history of aspirin sensitivity were given 2000 micrograms of intranasal lysine aspirin to one nostril and saline to the other once a week for periods of up to 15 months. Two patients had increased nasal obstruction following the initial test doses of lysine aspirin and were excluded from the trial proper. In the remainder symptomatic polyp recurrence was delayed compared with the previous experience while on intranasal steroids, with eight patients remaining symptom free at 15 months compared with an expected number of three (P = < 0.05, chi 2 test). Polyp recurrence was bilateral but there was a tendency for the lysine aspirin treated side to have less polyp tissue as assessed by nasendoscopy and by acoustic rhinometry.
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Affiliation(s)
- G K Scadding
- Royal National Throat, Nose and Ear Hospital NHS Trust, London, UK
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16
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Affiliation(s)
- D Passàli
- Department of Otorhinolaryngology, University Hospital, Siena, Italy
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Schuil PJ, Ten Berge M, Van Gelder JM, Graamans K, Huizing EH. Effects of prostaglandins D2 and E2 on ciliary beat frequency of human upper respiratory cilia in vitro. Acta Otolaryngol 1995; 115:438-42. [PMID: 7653268 DOI: 10.3109/00016489509139344] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Diminished mucociliary transport can occur in a type-I (Ig-E mediated) allergic reaction. We determined the effects of the allergy mediators prostaglandin D2 (PGD2) and prostaglandin E2 (PGE2) on the ciliary beat frequency (CBF) of human upper respiratory cilia in vitro. Human adenoid tissue was used as the source for ciliated epithelium. CBF was measured by a computerized photo-electric method. PGD2 (10(-8)-10(-5) M, n = 7) showed no statistically significant effect on CBF. PGE2 (10(-9)-10(-6) M, n = 10) caused a significant dose-dependent stimulation, with a maximum of 37% (ANOVA, p < 0.001). Thus prostaglandins D2 and E2 do not exert a direct negative influence on ciliary activity, which could account for a decrease in mucociliary transport. The stimulating effect of PGE2 may be relevant in promoting mucociliary clearance in vivo.
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Affiliation(s)
- P J Schuil
- Department of Otorhinolaryngology, University Hospital Utrecht, The Netherlands
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Scadding GK, Lund VJ, Darby YC. The effect of long-term antibiotic therapy upon ciliary beat frequency in chronic rhinosinusitis. J Laryngol Otol 1995; 109:24-6. [PMID: 7876731 DOI: 10.1017/s0022215100129159] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The mucociliary escalator is the first line of defence of the upper and lower respiratory tracts (Greenstone and Cole, 1985; Sleigh et al., 1988). Failure of mucociliary clearance is associated with chronic or recurrent respiratory tract infection. Ten patients with chronic rhinosinusitis underwent nasal brushings for the assessment of ciliary beat frequency. In two no beating cilia were seen; in the remainder the mean value was 9.3 Hz +/- 2.3; range 6.1-12.8 Hz (n = 8). Following three months continuous oral antibiotic therapy repeat nasal brushings demonstrated increased ciliary beat frequencies in all patients, mean value 13.7 Hz +/- 1.6; range 11.5-16.3 Hz (n = 10); (p < 0.01; paired t-test). Depression of mucociliary clearance can occur secondarily to chronic infection and is improved by prolonged antibiotics.
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Affiliation(s)
- G K Scadding
- Royal National Throat, Nose and Ear Hospital Trust, London
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Zinreich J. IMAGING OF INFLAMMATORY SINUS DISEASE. Immunol Allergy Clin North Am 1994. [DOI: 10.1016/s0889-8561(22)00675-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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