Levels of Immunoglobulin E Sensitization Drive Symptom Thresholds in Allergic Rhinitis

BACKGROUND

Allergic rhinitis (AR) is a common respiratory disease encompassing a variety of phenotypes. Patients can be sensitized to one or more allergens. There are indications that polysensitization is associated with more severe disease. However, the extent to which the level of sensitization is associated to clinical disease variability, underlying the distinct nature of AR from AR+ conjunctivitis or AR+ asthma, is not known.

OBJECTIVE

The aim of this study was to evaluate phenotypical differences between mono- and poly-sensitized patients with AR and to quantify their symptomatic variability.

METHODS

565 patients with a confirmed diagnosis of AR were included in this cross-sectional study. 155 were mono-sensitized and 410 poly-sensitized. Interactions between sensitization levels and reporting of different symptoms of AR and co-morbidities, disease duration and impact, were assessed. Furthermore, patients were stratified into mono- oligo- and poly-sensitized to assess whether the effect of sensitization on phenotype was ranked.

RESULTS

Poly-sensitized patients reported significantly more often itchy eyes (p=0.001) and had higher number of ocular (p=0.005), itch-related (p=0.036) and total symptoms (p=0.007) than mono-sensitized patients. In addition, polysensitized adults and children more often reported wheeze (p=0.015) and throat-clearing (p=0.04), respectively. Polysensitization was associated with more burdensome AR according to VAS (p=0.005). Increasing sensitization level was reflected in more itchy eyes, number of ocular, itch-related and total number of symptoms, as well as disease burden.

CONCLUSION

With increasing number of sensitizations, AR patients experience an increased diversity of symptoms. Multimorbidity-related symptoms increase with sensitization rank, suggesting organ-specific thresholds.

The effect of MemoVigor 2 on recent-onset idiopathic tinnitus: a randomized double-blind placebo-controlled clinical trial

Background: Tinnitus is a common symptom associated with the conscious perception of sound in the absence of a corresponding external or internal sound source, which can severely impact quality of life. Because of the current limited understanding of the precise pathophysiological mechanism of idiopathic tinnitus, no curable treatment has been attained yet. A food supplement trading as MemoVigor 2, which contains a combination of therapeutic ingredients with mainly antioxidant activity, has been used in the treatment of tinnitus. The objective of our study was to evaluate the effectiveness of MemoVigor 2 in the treatment of recent-onset idiopathic tinnitus. Methods: In a prospective single-centre randomized, double-blind, placebo-controlled clinical trial we studied 204 patients with idiopathic tinnitus divided into two groups: 104 patients who received MemoVigor 2 and 100 patients treated with placebo. To evaluate changes in tinnitus we used (1) audiometry/tympanometry; (2) specific measures of tinnitus perception, including tinnitus pitch, loudness at tinnitus pitch, loudness at 1 kHz, minimum masking level, and residual inhibition; (3) questionnaires of tinnitus handicap inventory, mini tinnitus questionnaire and patients' global impression of change. All patients underwent this test battery at the beginning of the study and in a repeat post-3-month session. Results: All tinnitus measures, including pitch, loudness, minimum masking level and residual inhibition improved significantly in the intervention group. Most of these measures improved in the placebo group too, but in a lesser degree. All questionnaire scores diminished significantly in both groups, but the degree of decrease was greater in the intervention group. The participants' tinnitus outcome reported after treatment using the patients' global impression of change score differed significantly between the two groups, with greater improvement observed in the intervention group. Conclusion: We found that the use of MemoVigor 2 improved recent-onset tinnitus, as proved by a set of tests performed for its evaluation, including audiometric measures, specific measures of tinnitus perception and tinnitus questionnaires. Tinnitus in the placebo group improved too, but to a lesser degree. Clinical Trial Registration: isrctn.com, Identifier ISRCTN16025480.

Chronic rhinosinusitis with nasal polyps (CRSwNP) treated with omalizumab, dupilumab, or mepolizumab: A systematic review of the current knowledge towards an attempt to compare agents' efficacy

BACKGROUND

The heterogeneity of existing studies, along with the fact that there are no published head-to-head trials, are the main reasons for the lack of guidelines regarding the selection of the proper biologic in treatment of chronic rhinosinusitis (CRS) with nasal polyps. The aim of this study is to summarize the current knowledge regarding the efficacy of omalizumab, dupilumab, and mepolizumab in CRS treatment. We also attempt to proceed to an indirect comparison of the agents and try to answer the tricky question: which agent to select and why?

METHODS

An extensive search in English literature was conducted in PubMed/Medline, Embase, Google Scholar, and Cochrane Database/Library. Eligibility criteria included papers with full text published in English, adult population studies, clearly described intervention protocol, and documented primary and secondary outcomes.

RESULTS

The studies included numbered 37. All agents provided significant improvement in polyp size, sinuses opacification, severity of symptoms, need for surgery and systemic corticosteroids use. Analysis of available systematic reviews, meta-analyses and indirect treatment comparison studies showed that dupilumab appeared to be the most beneficial agent, in terms of primary and secondary outcomes. However, these results are of relatively low level of evidence due to several methodological limitations.

CONCLUSIONS

Although the present analysis showed a moderate supremacy of dupilumab, there is still no evidence-based answer to the question "which biologic agent is the most effective in CRS treatment?" Improved statistical methodology, head-to-head trials, and real-life studies could lead to more robust conclusions, establishing the real role of the specific biologic agents.

The Clinical Significance of Pollen and Fungi Concentrations for Allergic Rhinitis: A Three-Year Study

INTRODUCTION

The relationship between disease severity and exposure to allergens in allergic rhinitis (AR) patients is not fully clarified presently. We aimed to detect the correlation between airborne pollen and fungi concentrations in a Mediterranean region with symptom scores.

METHODS

A total of 98 patients suffering from AR rated their symptoms at the time of exacerbation using the Total 5 Symptoms Score (T5SS) and the Visual Analogue Scale (VAS). Patients' quality of life (QoL) was estimated by using either disease-specific (Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and mini-RQLQ) or generic (Short-Form 36 (SF-36) and Beck Depression Inventory (BDI)) questionnaires. All patients' responses were correlated with aerobiological data. Skin prick tests (SPTs) were used to detect sensitivities to the most common registered pollen and fungi species.

RESULTS

A significant positive correlation between total pollen and fungi counts and disease-specific questionnaires was found only for the RQLQ. Accordingly, a significant positive correlation was found between total pollen and fungi counts and T5SS (r = 0.655, p = 0.021), with breathing (r = 0.620, p = 0.032) and sneezing (r = 0.660, p = 0.020) being strongly affected. Moreover, a tendency toward a higher VAS score was found as total pollen and fungi counts increased (r = 0.523, p = 0.081).

CONCLUSION

We found a significant correlation between patients' symptoms and pollen and fungal air concentrations. Our results emphasize the clinical significance of pollen and fungi maps in everyday clinical practice.

A Rare Case of a Giant Sialolith Within Wharton’s Duct

Sialolithiasis is a common disease characterized by the formation of calculi within the salivary glands or their ducts. Although many cases of large stones located within the submandibular gland have previously been reported, the presence of a giant stone within Wharton's duct is extremely rare. We report the case of a patient who presented with an unusually large stone measuring about 6 cm in the greatest dimension located within Wharton's duct and causing local swelling and pain. The sialolith was successfully removed intraorally indicating that a minor procedure under local anesthesia can be a successful treatment modality even in the case of a giant sialolith.

Cancer Microenvironment Defines Tumor-Infiltrating Lymphocyte Density and Tertiary Lymphoid Structure Formation in Laryngeal Cancer

BACKGROUND

The presence and activity of tumor-infiltrating lymphocytes (TILs) is a key parameter related to the antitumor immune response. A large number of studies reveal TIL density as a prognostic marker and predictor of response to radiotherapy, chemotherapy, and immunotherapy.

METHODS

We examined the TIL and tertiary lymphoid structure TLS density in the invading front and inner tumor stroma, in a 33 squamous cell laryngeal carcinomas (LSCC) treated with laryngectomy. TIL and TLS densities were in parallel examined with markers of anaerobic metabolism, vascular density (VD), vascular survival ability (VSA), and histopathological parameters.

RESULTS

TIL and TLS densities significantly decreased in inner tumor areas (p < 0.0001). TIL density in the invading tumor front was inversely related with lymph node involvement (p = 0.03), HIF1α expression (p = 0.008), vessel density (p = 0.02), and MIB1 (p = 0.006). TIL density in inner stroma was inversely linked to local invasion (marginal p = 0.05), tumor budding (TB) (p = 0.005), MIB1 (p = 0.02), and HIF1α expression (p = 0.02). Low-TLS density in the invading front and in inner tumor areas was related to high TB (p = 0.02 and 0.002, respectively), HIF1α (p = 0.003 and 0.01, respectively), and LDH5 expression (p = 0.003 and 0.007, respectively). CD4⁺, FOXP3⁺ TIL density, and FOXP3⁺/CD8⁺ ratio were directly associated with VSA (p = 0.008, 0.02, and 0.05, respectively).

CONCLUSION

Poor immune response is related to hypoxic background and anaerobic metabolism, as well as increased invasive and metastatic ability. Regulatory TIL markers are linked with increased angiogenic potential. The prognostic, predictive, and therapy-guiding value of TILs in clinical practice demands thorough investigation.

A Case of Neglected Frontal Sinusitis Led to Frontal Sinus Empyema with Ocular Complications

No abstract available.

New concepts in pediatric rhinitis

Rhinitis-and especially allergic rhinitis (AR)-remains the most frequent hypersensitivity condition, affecting up to a quarter of the population and impacting the quality of life of individual patients and the health economy. Data, especially with respect to underlying pathophysiologic mechanisms, mainly derive from studies on adults and are subsequently extrapolated to the pediatric population. Therapeutic algorithms for children with rhinitis are long based on the same principles as in adults. We explore and describe novel aspects of rhinitis, ranging from mechanisms to disease classification, phenotypes, diagnostic and monitoring tools, and the use of treatments, with a focus on the traits of pediatric age groups.

Cabbage and fermented vegetables: From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID‐19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS‐CoV‐2 binds to its receptor, the angiotensin‐converting enzyme 2 (ACE2). As a result of SARS‐CoV‐2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT₁R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID‐19. The nuclear factor (erythroid‐derived 2)‐like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT₁R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof‐of‐concept of dietary manipulations that may enhance Nrf2‐associated antioxidant effects, helpful in mitigating COVID‐19 severity.

The clinical course of smell and taste loss in COVID-19 hospitalized patients

BACKGROUND

Recent studies have demonstrated an association between a new onset of smell or taste loss and COVID-19. We investigated the prevalence of smell and/or taste loss and the clinical characteristics and recovery in a comprehensive cohort of consecutive patients treated by two COVID-19 reference hospitals and evaluated late persistence of hyposmia.

METHODS

A retrospective observational questionnaire study was conducted. All consecutive RT-PCR diagnosed patients who had been hospitalized in March-April 2020 in the COVID-19 care wards were contacted, excluding patients with cognitive disorders and severe deconditioning. The patients responded to a survey about the loss of smell and taste, nasal blockage, and rhinorrhea, rated the symptoms' severity from 0 to 4, and reported the recovery of smell and taste with time. Demographic and clinical characteristics were recorded.

RESULTS

We contacted 117 patients. Ninety responded to the questionnaire; 38.9 % of them reported olfactory and 36.66 % gustatory disorders during their disease. Smell loss prior to other symptoms was reported by 42.86 %, and severe hyposmia/anosmia by 74.28 % of the hyposmic. Among the non-ICU treated patients, 43.75 % reported hyposmia. Only 8.89 % had nasal blockage, and 6.66 % rhinorrhea. Most of the patients (85.71 %) recovered their sense of smell in 3-61 days (median: 17; IQR: 24), but 8.57 % had persistent hyposmia. For one out of four, the olfactory loss lasted longer than a month.

CONCLUSION

Smell and taste loss are highly prevalent and early symptoms in hospitalized COVID-19 patients. The great majority recover their smell, but nearly one out of ten have not recovered in two months.  HIPPOKRATIA 2020, 24(2): 66-71.

Immunologic mechanisms of a short-course of Lolium perenne peptide immunotherapy: A randomized, double-blind, placebo-controlled trial

BACKGROUND

A 3-week short-course of adjuvant-free hydrolysates of Lolium perenne peptide (LPP) immunotherapy for rhinoconjunctivitis with or without asthma over 4 physician visits is safe, well tolerated, and effective.

OBJECTIVE

We sought to investigate immunologic mechanisms of LPP immunotherapy in a subset of patients who participated in a phase III, multicenter, randomized, double-blind, placebo-controlled trial (clinical.govNCT02560948).

METHODS

Participants were randomized to receive LPP (n = 21) or placebo (n = 11) for 3 weeks over 4 visits. Grass pollen-induced basophil, T-cell, and B-cell responses were evaluated before treatment (visit [V] 2), at the end of treatment (V6), and after the pollen season (V8).

RESULTS

Combined symptom and rescue medication scores (CSMS) were lower during the peak pollen season (-35.1%, P = .03) and throughout the pollen season (-53.7%, P = .03) in the LPP-treated group compared with those in the placebo-treated group. Proportions of CD63⁺ and CD203c^brightCRTH2⁺ basophils were decreased following LPP treatment at V6 (10 ng/mL, P < .0001) and V8 (10 ng/mL, P < .001) compared to V2. No change in the placebo-treated group was observed. Blunting of seasonal increases in levels of grass pollen-specific IgE was observed in LPP-treated but not placebo-treated group. LPP immunotherapy, but not placebo, was associated with a reduction in proportions of IL-4⁺ T_H2 (V6, P = .02), IL-4⁺ (V6, P = .003; V8, P = .004), and IL-21⁺ (V6, P = .003; V8, P = .002) follicular helper T cells. Induction of FoxP3⁺, follicular regulatory T, and IL-10⁺ regulatory B cells were observed at V6 (all P < .05) and V8 (all P < .05) in LPP-treated group. Induction of regulatory B cells was associated with allergen-neutralizing IgG₄-blocking antibodies.

CONCLUSION

For the first time, we demonstrate that the immunologic mechanisms of LPP immunotherapy are underscored by immune modulation in the T- and B-cell compartments, which is necessary for its effect.

Symptomatology Patterns in Children with Allergic Rhinitis

Background

Although allergic rhinitis (AR) is recognized as a growing global health disease with considerable importance for patients’ lives, especially among children and adolescents, there is a lack of population studies concerning symptomatology patterns of the disease. The present study aimed to explore symptoms prevalence among school-aged children, to detect any correlation between allergen sensitivities with symptomatology patterns, and, finally, to evaluate the association of the sensitivity grade score with symptoms severity or seasonality.

Material/Methods

This was a cross-sectional, observational study in a childhood population. The first stage included recruitment of children and parental-completed questionnaires. The second stage included skin-prick tests for the most common allergens. Severity of symptoms was self-evaluated using a scale that ranged from “0” (no symptoms), “1” (mild), and “2” (moderate-to-severe). AR was classified as seasonal (SAR) or perennial (PAR).

Results

The most frequent symptoms were reported for nasal obstruction, sneezing, and rhinorrhea. All nasal symptoms were significantly more profound among children with HDM sensitivity. However, more symptoms, not only nasal, but also ocular and general ones, were detected among patients with grass pollen sensitivity. Patients with PAR reported more severe symptoms. SAR was associated with mild disease. Finally, the sensitivity grade score was significantly correlated with symptom severity.

Conclusions

Our results suggest that allergen sensitivity may be correlated with symptomatology patterns among children who have allergic rhinitis.

The effects of smoking on quality of life recovery after surgery for chronic rhinosinusitis

BACKGROUND

The effects of smoking on quality of life (QoL) results in chronic rhinosinusitis (CRS) patients still remain a matter of debate.

OBJECTIVE

To explore the impact of smoking on QoL and determine how quantity of daily smoking and duration affect QoL results after endoscopic sinus surgery (ESS).

METHODOLOGY

Patients with CRS were prospectively asked to evaluate their QoL pre- and after ESS. All subjects' QoL was evaluated by means of validated questionnaires either specific (Questionnaire of Olfactory Deficits), for assessing psychology (Zung Anxiety Scale, State -Trait Anxiety Inventory, Zung Depression Scale and Beck Depression Inventory) or generic (Short-Form-36). Smoking habits were expressed in pack-years.

RESULTS

No statistically significant differences were found in the pre-treatment scores in any of the questionnaires between smokers and non smokers. Post-operatively, all QoL questionnaires' results were significantly improved among both groups, although non smokers exhibited significantly greater improvement compared to smokers. There was a negative impact of the number of pack-years on the changes of QoL results; less improvement was observed as the number of pack-years was increasing.

CONCLUSION

Although smoking did not improve preoperative QoL results and proved not to be a contra-indication factor for ESS regarding QoL, smokers presented worse treatment outcomes. Quantity and duration of smoking were significantly associated with worse postoperative results in all QoL questionnaires.

Benign Paroxysmal Positional Vertigo Secondary to Mild Head Trauma

Objectives:

We studied the clinical characteristics, nystagmographic findings, and treatment outcome of a group of patients with benign paroxysmal positional vertigo (BPPV) secondary to mild head trauma and compared them with a group of patients with idiopathic BPPV.

Methods:

The medical records of 33 patients with BPPV associated with mild head trauma were reviewed. Data of a complete otolaryngological, audiological, neurotologic, and imaging evaluation were available for all patients. Three hundred and twenty patients with idiopathic BPPV were used as a control group.

Results:

The patients with BPPV secondary to mild head trauma presented the following features, in which they differed from the patients with idiopathic BPPV: (1) lower mean age, with more intense symptoms; (2) increased rate of horizontal and anterior semicircular canal involvement and frequent multiple canal and bilateral involvement; (3) greater incidence of canal paresis and presence of spontaneous nystagmus; (4) poorer treatment results, attributed mainly to coexisting canal paresis in many patients, and higher rate of recurrence.

Conclusions:

Benign paroxysmal positional vertigo associated with mild head trauma differs from idiopathic BPPV in terms of several epidemiological and clinical features; it responds less effectively to treatment and is prone to recurrence.

Allergic sensitization prevalence in a children and adolescent population of northeastern Greece region

OBJECTIVES

To evaluate the prevalence of allergic sensitization in a childhood and adolescent population, to explore age- and gender-specific variations and finally to discover co-sensitivities among allergens.

METHODS

A two-stage cross-sectional survey among school-aged children. The two stages of the study involved enrollment of schools and then skin prick testing (SPT) within schools. A total of 675 school children were included in the study. Of those, 231 were diagnosed with allergic rhinitis (AR), according to the medical history as provided by parental-completed questionnaires and positive SPT results. The antigen panel consisted of common allergens and more specifically house dust mites-HDM (Dermatophagoides farinae and Dermatophagoides pteronyssinus), grass mix, trees (olive, cypress and pine), weeds (Parietaria spp.), cat and dog epithelium and moulds (Alternaria spp., Cladosporium spp.). The SPT sensitivity was graded according to SPT-USA Standards.

RESULTS

The overall prevalence rate of AR was 34.22%. In total, 93 school children (40.3%) were mono- and 138 (59.7%) were poly-sensitized. Overall, the most prevalent sensitizations in decreasing order were to HDM (59.74%), to grasses (48.9%), to Alternaria (34.6%) and to olive (14.71%). There were no age- and sex-specific differences, except for Alternaria mould that showed a significant prevalence among primary school-aged children and predominance in the female gender, by contrast to grass pollen allergy that was predominant to males. A 32% of SPT-positive individuals were not aware of their allergy, with no statistically significant differences between ages. Co-sensitivities were detected for grass pollens and pine and olive trees, for Alternaria and Cladosporium moulds, for cypress and pine trees, and finally for dog and cat danders.

CONCLUSIONS

Given data among school-aged children should be a baseline from which to monitor disease trends and is considered important for the optimal management of AR patients.

Smoking effects on quality of life of allergic rhinitis patients after sublingual immunotherapy

BACKGROUND

Although tobacco smoking is of great concern, there is no evidence for the effects of smoking on quality of life (QoL) results after sublingual immunotherapy (SLIT).

OBJECTIVE

This study aims tο explore any association between smoking habits (duration and quantity) and QoL results after SLIT in allergic rhinitis (AR).

METHODOLOGY

One hundred and sixty three patients following SLIT for AR were participated. SLIT efficacy related to smoking was prospectively evaluated by means of validated widely used QoL questionnaires, either for assessing psychology (Zung Anxiety Scale, State-Trait Anxiety Inventory, Zung Depression Scale and Beck Depression Inventory) or generic (Short Form-36) ones, pre- and immediately upon cessation of SLIT. Smoking habits were expressed in pack-years.

RESULTS

Significant improvement of total symptoms score (T5SS) and of all QoL questionnaires' results were observed in our patients' group, both for smokers and non smokers. The comparison of changes between smokers and non smokers, controlling for the effect of all patients' characteristics, showed that there was no significant differences on improvement values. Additionally multivariate linear regression analysis revealed that the effect of pack-years on the QoL scales was not significant.

CONCLUSIONS

Our results suggest that smoking habits (quantity of daily smoking and duration) do not influence the success of SLIT with regards to QoL outcomes.

Demographic correlates of anxiety and depression symptoms in chronic sinonasal diseases

OBJECTIVES

To explore mental health of patients with olfactory loss due to chronic sinonasal diseases and investigate the effects of age-, gender-, and socio-economic variables on anxiety and depression symptoms.

METHODOLOGY

One hundred and eight patients (62 males; mean age: 39.78 ± 16.11 years), suffering from olfactory impairment due to chronic rhinosinusitis and allergic rhinitis and 30 healthy subjects (16 males; mean age, 37.03 ± 13.09 years) were studied. Olfactory function was evaluated using "Sniffin' Sticks" test. All patients completed four validated questionnaires specific for assessing anxiety and depression (Zung Anxiety Scale, State-Trait Anxiety Inventory-STAI, Zung Depression Scale, and Beck Depression Inventory-BDI).

RESULTS

We found significantly more severe anxiety and depression symptoms in anosmic (all p < 0.001) and hyposmic patients compared to healthy controls. No significant differences were observed between normosmic patients and controls. Scores in all psychological measures were significantly higher in elderly and female patients as well as in low, compared to high, socio-economic status patients. No significant differences were found between low and medium socio-economic level.

CONCLUSIONS

Olfactory loss in chronic sinonasal diseases was found to be associated with anxiety and depression symptoms. Moreover, anxiety was correlated with depression. With regard to patients' demographics, female gender and low socioeconomic status proved to be independently correlated with anxiety and depression levels.

Duration of benign paroxysmal positional vertigo as a predictor for therapy

OBJECTIVE

To evaluate the prognostic significance of the duration of disease in patients with benign paroxysmal positional vertigo (BPPV).

METHODS

We studied all patients with idiopathic BPPV of the posterior semicircular canal who were treated during 3 consecutive years, divided into 2 groups: those with recent disease onset (within 4 weeks) and those with more remote disease onset. Outcome of treatment by repositioning maneuver and rate of recurrence were compared.

RESULTS

110 patients had BPPV of recent onset and 121 of more remote onset (mean ages 51.3 and 58.2, respectively). Treatment outcomes were similar in both groups, but the rate of recurrence was higher in patients with BPPV of longer duration (21.5% versus 10%).

CONCLUSION

Long duration of the disease does not affect the treatment outcome in patients with idiopathic BPPV, but is correlated with increased rate of recurrence. Older age of these patients is probably a contributing factor for recurrence.

Seasonal variations of allergenic pollen in a Mediterranean region - Alexandroupolis, north-east Greece

OBJECTIVES

The aim of this study was to describe the aerobiological characteristics of NE Greece, identify the most prevalent taxa, define the duration of the main pollen season and correlate allergen records with meteorological parameters.

MATERIALS AND METHOD

A 7-day volumetric trap, running continuously throughout the year, was used to collect circulating pollen. Pollen taxa were characterized by standard protocols and counted as grains/m(3) . The main pollen season was deduced from these data and running means (10-day averages) were plotted against time. Correlations with climatic factors (temperature, rain, humidity, wind velocity) were assessed by single linear regression analysis.

RESULTS

In total, 11 pollen families were identified, including 6 arboreal and 5 non-arboreal taxa. The 5 most prevalent taxa were Oleaceae, Fagaceae, Poaceae, Cupressaceae and Pinaceae. Peak pollen concentrations were detected in April and May, with daily averages exceeding 410 grains/m(3) . Compositeae had the longest pollen season of 135 days and Oleaceae the shortest, extending to only 27 days. Correlations with meteorological parameters showed variable associations among different taxa, with mean temperature (p<0.001), relative humidity (p=0.015), and wind speed (p=0.042) emerging as the most significant determinants as regards total pollen counts.

CONCLUSIONS

Describing the aerobiological characteristics of NE Greece enabled the identification of allergenic risks that are specific for this region. Records generated in this study can be used to alert sensitized individuals of prevailing seasonal patterns, in order to take necessary precautions against imminent exposures. The monitoring system established here can serve as a reference guide for future epidemiological research focusing on allergic asthma and rhinitis.

Impact of chorioamnionitis on the development of human fetal lung: an immunohistochemical study

PURPOSE

Current studies suggest that changes of chorioamnionitis are associated with the appearance of bronchial-associated lymphoid tissue (BALT), during fetal development. The aim of this study was to examine and analyse apart from the appearance of BALT, the expression of structural proteins in the lung parenchyma during gestation.

MATERIALS AND METHODS

A series of 149 paraffin-embedded human fetal lung specimens at the second trimester of development were examined by immuunohistochemistry using the monoclonal antibodies CD20, CD3, Tenascin-C, Vimentin, and Fibronectin.

RESULTS

The results of this study showed that (1) BALT does not develop in fetal period and (2) BALT which develops during fetal period is probably in response to antigenic stimulation where in the present cases occurs to be changes of chorioamnionitis which decreased the expression of filaments proteins in the intermediate cells of lung parenchyma in comparison with the normal ones.

CONCLUSION

The expressions' pattern of intermediate filaments proteins in the lung parenchyma can be modified by the presence of chorioamnionitis in the fetal membranes.

Predictors of quality of life improvement in allergic rhinitis patients after sublingual immunotherapy

OBJECTIVES

Sublingual immunotherapy (SLIT) has been described as a significant intervention in the treatment of allergic rhinitis (AR). However, factors that may predict treatment outcomes with respect to quality of life (QoL) results and mainly the role of olfactory function are still being underestimated. In this study, we investigated determinants that best predict treatment outcomes for QoL, exploring mainly the role of olfaction.

METHODS

One hundred forty-five patients following SLIT, 45 placebo-controls, and 48 healthy subjects were studied. Olfactory function was objectively evaluated using "Sniffin' Sticks" test pre- and post-cessation of SLIT. Three categories of validated QoL questionnaires were filled out by all subjects: questionnaire specific for olfaction (Questionnaire of Olfactory Deficits), questionnaires for assessing psychology (Beck Depression Inventory, Zung Depression Scale, State & Trait Anxiety Inventory), general Short Form-36 health survey.

RESULTS

Statistically significant improvement of olfactory function by 11.1% and of all QoL questionnaires results (all P<.001) was observed on final evaluation. Anosmia, asthma history, and the severity of symptoms-expressed by the Total Symptoms Score-were proven independent determinants of clinically significant improvement in patients' QoL.

CONCLUSIONS

Several factors were found that may predict QoL outcomes in AR patients following SLIT.

Overall survival and clinicopathological characteristics of patients with breast cancer in relation to the expression pattern of HER-2, IL-6, TNF-α and TGF-β1

The present study was conducted to investigate the prognostic significance of co-expression patterna of HER-2, IL-6, TNF-a and TGF-β1 in breast cancer, by correlating the number of markers with positive expression with clinicopathological characteristics indicative of tumor progression and overall survival. One hundred thirty consecutive patients with primary breast cancer were prospectively included and evaluated. Serum concentrations of the above markers were measured by ELISA. Median split was used to subdivide patients with marker positive or negative expression. The presence of ≥ 3 positive markers was independently associated with extended lymph node (>3) involvement (aOR, 11.94, p=0.001) and lymphovascular invasion (aOR, 12.04, p=0.018), increasing the prognostic significance of each marker considered separately. Additional prognostic information regarding survival was also provided; as the number of positive markers increased, a gradually reduction of survival time was observed. In addition, patients with 4 positive markers had significantly shorter survival (25 vs 39 months, p=0.006) and a more than 4 fold increased risk of death (aHR, 4.35, p=0.003) compared to patients with 3 positive markers. Our findings suggest that the coexpression pattern of these four markers could be used clinically as a useful marker for tumor extension and outcome of breast cancer.

Olfactory dysfunction in type 2 diabetes mellitus: an additional manifestation of microvascular disease?

We evaluated olfactory dysfunction in 154 adults (74 men, mean age 60.9±11.9 years), of whom 119 had type 2 diabetes mellitus (T2DM). Olfactory function was assessed with "Sniffin' Sticks." A total Threshold-Discrimination-Identification (TDI) score was calculated. Type 2 diabetes mellitus, hypertension, and hyperlipidemia were associated with lower olfactory scores (all TDI scores<0.001). Age was negatively associated with odor threshold, odor identification, and TDI score (P=.009, <.001, and <.001, respectively). After adjusting for age, gender, body mass index, smoking, alcohol, diabetes, hypertension, hyperlipidemia, and cardiovascular disease, only T2DM and hypertension were associated with TDI score (R square=0.281). Diabetic complications were associated with olfactory dysfunction (P=.006): TDI scores were lower in the presence of diabetic peripheral neuropathy (P=.017) and retinopathy (P=.047). In conclusion, T2DM and hypertension are independently associated with olfactory dysfunction while diabetic peripheral neuropathy and retinopathy are significantly associated with lower olfactory scores. The clinical relevance of these findings needs to be further examined.

Olfactory dysfunction and asthma as risk factors for poor quality of life in upper airway diseases

BACKGROUND

The study of olfaction/quality of life (QoL) interaction has not been adequately discussed and remains to be further explored. Determination of clinical predictors for poor QoL may support consultation of respective patients. This study explores QoL of patients with olfactory dysfunction and evaluates associated clinical risk factors for QoL prediction.

METHODS

One hundred eight patients suffering from chronic rhinosinusitis (CRS) and allergic rhinitis (AR) and 30 healthy subjects were studied. Olfactory function was evaluated using objective olfactory test. All patients completed six validated questionnaires either specific for olfaction (Questionnaire of Olfactory Deficits [QOD]) and for assessing psychological state (Zung Anxiety Scale [ZAS], State-Trait Anxiety Inventory, Zung Depression Scale, and Beck Depression Inventory [BDI]) or a generic one (Short Form 36).

RESULTS

Significantly poorer QoL and more severe anxiety and depression symptoms were observed in anosmic (all p < 0.001) and hyposmic patients compared with controls. Anosmic patients presented significantly worse results compared with hyposmic and normosmic patients. However, higher scores were observed in hyposmic compared with normosmic patients only in the QOD, ZAS, and BDI scale. Patients with CRS presented significantly poorer QoL than patients with AR only. The presence of nasal polyps or concomitant AR in patients with CRS did not show any differentiation in the results. Asthma was associated with significantly worse scores in all the psychometric questionnaires.

CONCLUSION

Olfactory dysfunction was found to decrease QoL among patients. Anosmia, CRS disease, and asthma as clinical predictors were proved to be independently correlated with QoL, anxiety, and depression levels.

Immunohistochemical studies of wound healing after monopolar electrocautery and ultrasound submucosal inferior nasal turbinate reduction in sheep

BACKGROUND

Extracellular matrix (ECM) proteins such as fibronectin and collagen III, enzymes such as matrix metalloproteinases and macrophages have been demonstrated to intervene in nasal and paranasal sinuses wound healing.

AIM OF THE STUDY

To compare concentration of ECM proteins, enzymes and the recruitment of macrophages during wound repair after monopolar electrocautery in contrast with ultrasound submucosal surgical tissue reduction of inferior nasal turbinate (INT) tested in sheep.

MATERIALS AND METHODS

Prospective controlled study in sheep. Immunostaining for collagen III, fibronectin, CD68 and matrix metalloproteinase-9 (MMP9) was applied in tissue specimens of INT mucosa after monopolar electrocoagulation (MEC) and ultrasound tissue reduction (UTR). Twelve INTs were studied 1, 3 and 8 weeks post-operatively in each interventional group (MEC and UTR) and 5 INTs were studied in animals of the control group (without surgery). The immunoreactivity was quantitatively graded between 0% to 100% immunoreactivity by a blinded senior pathologist.

RESULTS

At the end of the study period collagen III, fibronectin and MMP9 were increased in both groups compared to the levels of the control group. When compared to control group, CD68 immunoreactivity was found higher in MEC group but not in UTR group. Fibronectin subepithelial immunoreactivity exhibited a substantial negative correlation with mucosal epithelial cell necrosis, a substantial positive correlation with fibrosis in MEC-treated specimens and a significant positive correlation with sinusoid engorgement in UTR-treated specimens. Collagen III tissue immunoreactivity showed a particularly significant negative correlation with sinusoid engorgement in MEC-treated specimens.

CONCLUSION

Correlation of fibronectin and collagen III immunoreactivity to histopathologic findings suggests different ECM repair processes between MEC and UTR turbinate tissue reduction. The use of CD68 and MMP9 provides additional clues to the mode of actions of these techniques and to the molecular and cellular events of the nasal mucosa wound healing process.

Improvement of olfactory function for quality of life recovery

OBJECTIVES/HYPOTHESIS

To explore quality of life (QoL) improvement after treatment of patients with chronic olfactory disorders; and to correlate QoL with olfactory rehabilitation and evaluate olfactory improvement values over which QoL outcomes are significantly recovered.

STUDY DESIGN

Prospective clinical study.

METHODS

Eighty-nine patients following endoscopic sinus surgery for chronic rhinosinusitis (CRS) and immunotherapy for allergic rhinitis (AR) were studied. Olfactory function was evaluated using Sniffin' Sticks test pre-and 12 months after treatment. All patients completed six validated QoL questionnaires either specific for olfaction (Questionnaire of Olfactory Deficits-QOD) and for assessing mental health (Zung Anxiety Scale, State-Trait Anxiety Inventory, Zung Depression Scale, Beck Depression Inventory), or generic one (Short Form-36).

RESULTS

Significant improvement (all P < 0.001) of olfactory function by 27.4% in total cohort (AR: 10.4%, P = 0.004; CRS: 39.9%, P < 0.001), expressed by the combined Threshold-Discrimination-Identification (TDI) score-and of all QoL questionnaires scores (all P < 0.01) as well, was observed after treatment. There was a positive correlation between olfactory recovery and improvement of patients' QoL. ROC analysis revealed that an increase in the TDI score by 3.50 points in AR and 4.75 points in CRS was necessary for a clinically significant improvement in all QoL questionnaires results.

CONCLUSIONS

QoL and mental health of patients suffering from chronic sinonasal diseases are totally recovered after treatment, presenting a direct positive relationship with smell improvement. An increase of olfactory function by 3.50 points for AR and 4.75 points for CRS might be considered the cutoff point for patients' QoL significant recovery.

Inflammatory patterns in upper airway disease in the same geographical area may change over time

BACKGROUND

Inflammatory patterns of nasal polyps (NPs) may vary. Changes over time have not been investigated so far. This study was designed to evaluate the inflammatory patterns of NPs in Thailand at two time points 12 years apart, explore differences in Staphylococcus aureus (SA) mucosal carriage rates over time, and the latter's relationship with the inflammatory patterns.

METHODS

Formalin-fixed nasal tissue was obtained from 89 (47 in 1999 and 42 in 2011) patients suffering from chronic rhinosinusitis with NPs (CRSwNPs). Tissues were evaluated for eosinophils, neutrophils, IgE(+) cells, IgE and macrophage mannose receptors, interleukin (IL)-5 and IL-17 cytokine profile, and the presence of SA, using automated immunohistochemistry and peptide nucleic acid-fluorescence in situ hybridization.

RESULTS

We found a significant increase in the absolute values of eosinophils and IgE(+) cells in the 2011 CRSwNP tissue series compared with 1999 and a significant but smaller increase in neutrophils. Semiquantitative evaluation revealed significantly higher mean values of positive cells for all studied inflammatory markers in the 2011 group of patients, except for the high-affinity IgE receptor. This "eosinophilic shift" of inflammation was accompanied by higher SA carriage, as well as higher frequencies of SA invasion (54.8% versus 10.6%; p < 0.001) in the 2011 compared with 1999 subjects. Patients with asthma were more likely to have higher SA carriage rates compared with nonasthmatic patients.

CONCLUSION

There was a shift from predominantly neutrophilic to eosinophilic CRSwNPs in Thai patients within 12 years, with an increase in various inflammatory markers including IgE, which is associated with an increase in intramucosal presence of SA.

Benign paroxysmal positional vertigo secondary to vestibular neuritis

The aim of this study was to present the demographic, pathogenetic and clinical features of benign paroxysmal positional vertigo (BPPV) secondary to vestibular neuritis (VN). The medical records of 22 patients, who presented with BPPV within 12 weeks after the onset of VN, were reviewed. Data of a complete otolaryngological, audiological, neurotologic and imaging evaluation were available for all patients. Two hundred and eighty-four patients with idiopathic BPPV were used as a control group. The patients with BPPV secondary to VN presented the following features, in which they differed from the patients with idiopathic BPPV: (1) a lower mean age; (2) involvement of the posterior semicircular canal; (3) presence of canal weakness; (4) more therapeutic sessions needed for cure and a higher rate of recurrence. It may be, thus, concluded that BPPV associated with VN differs from idiopathic BPPV in regard to several epidemiological and clinical features, it responds less effectively to treatment and may follow a protracted course, having a tendency for recurrence.

Congenital disorder of true cyclopia with polydactylia: case report and review of the literature

Cyclopia is a rare type of holoprosencephaly and a congenital disorder characterized by the failure of the embryonic forebrain to properly divide the orbits of the eye into two cavities (the embryonic forebrain is normally responsible for inducing the development of the orbits). As a result a birth defect in which there is only one eye is developed. This eye is centrally placed in the area normally occupied by the root of the nose. As a rule, there is a missing nose or a non-functioning nose in the form of a proboscis (a tubular appendage) located above the central eye. In this report the macroscopic, radiographic, and immunohistochemical findings of a case of true cyclopia in a female fetus are described. Cyclopia is a lethal condition that is associated with dramatic symmetric deformities of the nose, skull, orbits, and brain.

Olfaction-associated quality of life in chronic rhinosinusitis: adaptation and validation of an olfaction-specific questionnaire

OBJECTIVES/HYPOTHESIS

To detect validity and reliability of the Questionnaire of Olfactory Disorders (QOD) compared to other quality-of-life (QoL) questionnaires, to explore its ability to reflect olfaction-related QoL changes, and to investigate age- and gender-related effects of olfactory changes on QOD results.

STUDY DESIGN

Prospective clinical study.

METHODS

One hundred two patients (56 males, 46 females; mean age, 41.15 ± 16.31 years), suffering from chronic rhinosinusitis, whose olfactory function was measured using Sniffin' Sticks test were studied. All patients completed three validated general health-related QoL questionnaires (Short Form-36 Health Survey [SF-36], Beck Depression Inventory [BDI], and Zung anxiety scale), and the olfaction-related QOD.

RESULTS

Internal consistency and test-retest reliability for the QOD was high. Convergent validity assessment showed statistically significant negative correlations of the QOD and the QOD-negative statements (NS) with overall SF-36 score (P < .05 for all groups) and positive correlations of the same scores with BDI and Zung (P < .001). The QOD-positive statements (PS) was positively correlated to SF-36. Discriminative validity demonstrated statistically significant differences of the QOD and QOD-NS scores between all groups of patients (normosmics, hyposmics, anosmics; all pairwise comparisons, P < .001). The QOD-PS score was significantly higher in normosmics and hyposmics compared to anosmics. Patients' age was negatively correlated with the QOD-PS, whereas it was positively correlated with BDI (P < .001) and Zung (P = .007). Females presented significantly higher scores in the QOD, QOD-NS, BDI, and Zung (all P < .001) compared to males.

CONCLUSIONS

The QOD proved to be a valid, reliable, and easy-to-use method of assessment of olfaction-related QoL with high specificity and sensitivity.

Clinical significance of Alternaria alternata sensitization in patients with allergic rhinitis

PURPOSE

The aim of the study was to determine the epidemiologic profile of Alternaria alternata (AA)-sensitized patients with allergic rhinitis including coexistence of other atopic diseases, seasonal distribution of AA aeroallergens, age of onset of AA sensitization, and prevalence of sensitization to other allergens.

MATERIALS AND METHODS

History, clinical examination, and skin prick tests were performed in 623 patients with allergic rhinitis from central Greece. Patients' age, cosensitization, place of living, seasonal distribution, and concomitant symptoms were the variables used to discriminate between AA-sensitized and non-AA-sensitized patients. Significant predictor variables for AA sensitization were determined.

RESULTS

A alternata sensitization was associated with male sex, age younger than 18 years, living in new-built apartments in urban and semiurban areas by the sea, perennial distribution, and nonsmoking. A alternata-sensitized patients were affected more frequently by asthma than non-AA-sensitized patients. No significant differences were found in frequency of bronchitis, cough, conjunctivitis, urticaria, or eczema between patients sensitized or not to AA. Most (66.7%) of AA-sensitized patients were oligosensitized, 18.5% of patients were polysensitized, and 14.8% were monosensitized. Patients' age, cosensitization, place of living, and seasonal distribution were the significant predictor variables discriminating AA-sensitized from non-AA-sensitized patients. These variables correctly classified 79.7% of the patients. A alternata-sensitized patients were more frequently sensitized to grasses, cat epithelia, and flours-rye and less frequently sensitized to artemisia, Dermatophagoides pteronyssinus, D farinae, and chenopodium.

CONCLUSIONS

Patients meeting the aforementioned epidemiologic criteria should be preferentially offered skin prick tests for AA sensitization.

Chronic pharyngitis is associated with severe acidic laryngopharyngeal reflux in patients with Reinke's edema

OBJECTIVES

We evaluated the association between pathological acidic laryngopharyngeal reflux (LPR) events and chronic pharyngitis in patients with Reinke's edema.

METHODS

We performed a prospective controlled study in 20 consecutive patients with Reinke's edema without pathological acidic LPR events (group A) and 40 consecutive patients with Reinke's edema with both clinical symptoms and 24-hour pH-metry suggesting acidic LPR (group B). The severity of acidic LPR was assessed by use of the Reflux Finding Score (RFS), the Reflux Symptom Index (RSI), and dual antimony probe 24-hour pH-metry. The patients were evaluated for the presence of chronic pharyngitis by clinical examination and biopsy specimens taken from the posterior pharyngeal wall. The Chi2 test was used to compare the groups for the presence of pharyngitis. In group B, the RSI, the RFS, and the total duration and number of acidic LPR events on 24-hour pH-metry were compared between patients with and without concomitant pharyngitis by use of the Mann-Whitney test.

RESULTS

Five patients of group A and 20 patients of group B had chronic pharyngitis. Therefore, more patients with Reinke's edema and clinical signs of LPR tended to have chronic pharyngitis than did those with Reinke's edema and no clinical signs of LPR, but the difference was not statistically significant (p = 0.064; odds ratio, 3.0; 95% confidence interval, 0.9 to 9.8). Among group B patients, those with pharyngitis had significantly more acidic LPR events (p < 0.001) and a greater exposure time to gastric fluid (p = 0.008) than did those without pharyngitis. Their RFS and RSI did not differ significantly (p = 0.692 and p = 0.914, respectively).

CONCLUSIONS

Only in the subgroup of patients with Reinke's edema and LPR was there a statistically significant correlation between the pH probe results and the incidence of clinical pharyngitis. Awareness should increase among physicians about addressing chronic pharyngitis in therapy for acidic LPR and/or Reinke's edema.

Immunohistological study of wound healing after submucosal radiofrequency tissue ablation of inferior nasal turbinate in a sheep model

BACKGROUND

Data on the molecular processes involved in nasal mucosa wound healing after radiofrequency tissue ablation (RTA) of the inferior nasal turbinate (INT) are missing. This study was designed to examine tissue expression of fibronectin, collagen III, CD68, and matrix metalloproteinase (MMP) 9 in the INT (ventral) after RTA in sheep.

METHODS

An experimental randomized controlled study was performed. Seventeen INTs (ventral) of nine sheep were used. RTA was applied in 12 INTs. Turbinate samples were studied 1, 3, and 8 weeks postoperatively (4 samples/time point) and in five control INTs (without surgery). Besides hematoxylin and eosin staining, immunostaining was done for MMP-9, collagen III, fibronectin, and CD68. A quantitative grading ranging between 0 (no immunoreactivity at all) and 100% (profuse immunoreactivity) was performed by a blinded senior pathologist. Comparisons between groups were performed using Mann-Whitney U test and Kruskal-Wallis one-way ANOVA. Spearman's rho correlation coefficients were calculated between histological and/or immunohistological variables.

RESULTS

At week 8, fibronectin (p = 0.025), collagen III (p = 0.004), and MMP-9 (p < 0.001) immunoreactivity was significantly higher than controls, while immunoreactivity for CD68 was higher, although not significantly (p = 0.114) compared with controls. Strong correlations have been found between mucosal vascularization and interstitial space volume (r = 0.776), interstitial space volume and epithelial cell necrosis (r = 0.730), and CD68 immunostaining and epithelial cell necrosis (r = 0.784).

CONCLUSION

Given their high tissue concentrations after RTA application, fibronectin, collagen III, CD68, and MMP-9 deserve further study as candidate modulators of the INT wound-healing process.

Biometric predictive models for the evaluation of olfactory recovery after endoscopic sinus surgery in patients with nasal polyposis

BACKGROUND

Determination of predictive factors and specific values of olfactory function after endoscopic sinus surgery (ESS) using objective diagnostic methods may support consultation of respective patients. This study was designed to assess the longitudinal olfactory functional outcome after ESS in patients with severe chronic rhinosinusitis (CRS) with nasal polyposis, to evaluate associated clinical factors and to provide statistical models for prediction of olfactory recovery.

METHODS

One hundred sixteen patients with nasal polyposis refractory to medical treatment underwent ESS. Olfactory testing was performed preoperatively and 1, 3, and 6 months after surgery using "Sniffin' Sticks" (Burghardt, Wedel, Germany). Using multivariate linear and logistic regression analysis, statistical models were generated to predict (i) the 6th-month composite threshold-discrimination-identification (TDI) score and (ii) the probability of attaining normal olfaction at 6 months.

RESULTS

A significant stepwise increment of all olfactory function indices was found over time. Factors influencing final olfactory recovery were patients' age, duration of olfactory deficit, previous paranasal sinus surgery, and aspirin-exacerbated respiratory disease. The first model explained 70% of the observed variation in postoperative TDI scores. The second model correctly classified 76% of the patients.

CONCLUSION

A significant progressive improvement of olfaction for at least 6 months was observed after ESS. The statistical models developed may be useful for consultation of ESS candidates in clinical practice.

Increased seroprevalence of Toxoplasma gondii in a population of patients with Bell's palsy: a sceptical interpretation of the results regarding the pathogenesis of facial nerve palsy

Facial nerve oedema and anatomical predisposition to compression within the fallopian tube seem to be the only generally accepted facts in the pathophysiology of Bell's palsy. Several infectious causes have been suggested as possible triggers of this oedema. Most of the suggested pathogens have been associated with facial nerve lesions during latent infections, reinfections or endogenous reactivations. The aim of this study was to investigate the seroprevalence of three such pathogens Toxoplasma gondii, Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in a population of patients with facial nerve palsy. Fifty-six patients with Bell's palsy were included in the study. A group of 25 individuals with similar age and gender distribution was used as control. Seropositivity for T. gondii, EBV viral capsid antigen (VCA) and CMV-specific IgM and IgG antibodies was investigated 2-5 days after the onset of the palsy. Comparisons for both IgM and IgG antibodies against T. gondii attributed significantly higher seroprevalence in the patients' group than in the control group (p = 0.024 and 0.013, respectively). The respective examinations for EBV and CMV attributed no significant results. The roles of EBV and CMV in the pathogenesis of Bell's palsy were not confirmed by this study. However, a significantly higher seroprevalence of IgM- and IgG-specific T. gondii antibodies was detected in patients with Bell's palsy when compared to healthy controls. The possibility that facial nerve palsy might be a late complication of acquired toxoplasmosis may need to be addressed in further studies.

Ultrasound submucosal inferior nasal turbinate reduction technique: histological study of wound healing in a sheep model

AIM OF THE STUDY

To describe histological changes after application of an ultrasound tissue reduction (UTR) technique in a newly introduced sheep model to study inferior nasal turbinate mucosal wound healing.

MATERIALS AND METHODS

An experimental study in a sheep model. Stromal fibrosis, submucosal interstitial space volume (ISV), mucosal epithelial cell necrosis, mucosal inflammation and blood vessels' engorgement in inferior turbinate samples were assessed after application of UTR using hematoxylin/eosin staining in 12 turbinate samples after different time points. Histological grading was performed using a 4-point scale

RESULTS

After one week, extensive development of fibrosis (p = 0.006) and significant reduced stromal ISV (p < 0.001) compared to controls were observed. The degree of fibrosis and the stromal ISV remained constant during the 8-week period. The extensive epithelial cell necrosis observed at week 1, diminished later, so that at 8 weeks no significant difference with controls in the necrosis extent was noted. Significant reduction of engorgement of blood vessels in the submucosal layer was noted after 8 weeks (p = 0.008, compared with baseline). Mucosal inflammation, while pronounced at week 1 (p = 0.005, compared with baseline), was normalized at week 8.

CONCLUSION

Due to the rapid induction of extensive fibrosis, to the limited inflammation reaction, to the moderate degree of epithelial necrosis, to the reduction of subepithelial ISV and the persistence of these features till week 8 at least, UTR emerges as an effective minimally invasive technique for inferior nasal turbinate volume reduction.

Inferior nasal turbinate wound healing after submucosal radiofrequency tissue ablation and monopolar electrocautery: histologic study in a sheep model

OBJECTIVES/HYPOTHESIS

To study differences in inferior nasal turbinate (INT) mucosal and submucosal wound-healing histology after radiofrequency tissue ablation (RTA) and monopolar electrocautery (MEC).

STUDY DESIGN

Randomized controlled trial.

METHODS

Experimental study in sheep. Using hematoxylin- and eosin-stained sections, stromal fibrosis, submucosal interstitial space volume (ISV), mucosal epithelial cell necrosis, submucosal inflammation, and vascularization in inferior turbinate samples were compared after RTA and MEC. Twelve turbinate samples were studied for each technique after 1, 3, and 8 weeks postoperatively (four samples at each time point) and there were five samples of controls. A 4-point semiquantitative histologic grading scale (0 = absence, 1 = mild, 2 = medium, 3 = pronounced) was used to assess changes. Comparisons were performed using the Mann-Whitney test and the Kruskal-Wallis one-way analysis of variance (ANOVA).

RESULTS

At postoperative week 8, the RTA group had more extensive fibrosis (P = .061) and ISV reduction (P = .127), less epithelial cell necrosis (P = .131), and significantly less submucosal inflammation (P = .036) and vascularization (P = .011) compared with the MEC group. Epithelial cell necrosis and submucosal inflammation at week 8 did not differ significantly between RTA and control group (P = 1.000 and P = .356, respectively). A significant decrease in submucosal layer vascularization in RTA-treated INTs has been observed (P = .003 compared with controls).

CONCLUSIONS

RTA is more effective (although not significantly) and less invasive than MEC for INT volume reduction. Tissue damage and wound healing were dominated by inflammation and associated epithelial cell necrosis in MEC and by a disturbance in the INT submucosal microcirculation in RTA in the studied sheep model.

Is the width of the labyrinthine portion of the fallopian tube implicated in the pathophysiology of Bell's palsy?: a prospective clinical study using computed tomography

OBJECTIVES/HYPOTHESIS

The pathogenetic mechanisms underlying Bell's palsy remain obscure, despite the extensive relevant research. Magnetic resonance imaging (MRI) studies have strongly indicated that facial nerve edema cannot be regarded as the sole etiologic factor, because it might persist long after full clinical recovery, or might be demonstrated in the clinically unaffected side or healthy controls. The aim of this study was to investigate the hypothesis that a narrow facial canal might be implicated in the pathophysiology of Bell's palsy.

STUDY DESIGN

Prospective clinical study.

METHODS

A high-resolution computerized tomography of the temporal bone with 1-mm thick contiguous axial sections was performed in 25 patients with unilateral Bell's palsy. The width of the fallopian tube was measured at the meatal foramen and the middle part of its labyrinthine segment.

RESULTS

When using paired Student t tests, the measured width of the affected ear was found significantly smaller than that of the unaffected side, both at the meatal foramen (P = .007) and at the middle part of the labyrinthine segment (P = .03).

CONCLUSIONS

Bell's palsy seems to usually coincide with the narrower fallopian tube of the patient. This anatomical detail, supported by previous MRI studies, seems to indicate that an asymmetry between the right and left fallopian tube might be a necessary pathogenetic mechanism for the development of a facial nerve edema into Bell's palsy in the narrower fallopian canal. More studies on large healthy populations are needed before a notable facial canal asymmetry is linked to a higher risk for developing Bell's palsy.

Allergic rhinitis and aspirin-exacerbated respiratory disease as predictors of the olfactory outcome after endoscopic sinus surgery

BACKGROUND

Unlike the functional outcomes of endoscopic sinus surgery, which have been thoroughly studied, the effect of the surgery on olfactory performance and the relative predictive factors have not been adequately assessed by literature. Allergic rhinitis and aspirin-exacerbated respiratory disease (AERD) are examined as potential confounding factors of the olfactory outcome in patients with extensive nasal polyposis and rhinosinusitis treated with functional endoscopic sinus surgery (FESS).

METHODS

A population of 116 adults with severe nasal polyposis was subjected to FESS after failure of the appropriate medical treatment. The olfactory outcome was quantified by Sniffin' Sticks at the 1st, 3rd, and 6th postoperative month in relation to the concomitant presence of allergic rhinitis (n = 62) or AERD (n = 18).

RESULTS

Allergic patients seemed to perform worse than nonallergic patients at all time frames. However, when patients with similar olfactory acuity, age, and medical history are compared, allergic rhinitis does not seem to affect the postoperative improvement of the composite threshold-discrimination-identification scores. The same seems to apply for the likelihood of acquiring normosmia after surgery. On the contrary, AERD significantly limits the recovery of olfactory function at all follow-up examinations and patients with AERD are unlikely to become normosmic.

CONCLUSION

The olfactory recovery after FESS for nasal polyposis is significantly affected by the concomitant presence of AERD. Although allergy seems to have a general negative effect on olfactory acuity, it was not found to affect the extent of the olfactory improvement, when patients with comparable preoperative characteristics are addressed.

Evaluation of prognostic factors for olfaction in nasal polyposis treated by endoscopic sinus surgery

AIM

This prospective study aimed to assess treatment outcome on olfaction in patients undergoing Endoscopic Sinus Surgery (ESS) for nasal polyposis, and to evaluate the role of previous sinus surgery and the duration of olfactory deficit as prognostic factors for olfaction improvement.

METHODS

In total, 116 patients with nasal polyposis who underwent ESS were studied. Olfactory testing was performed using the Sniffin' Sticks test, preoperatively and 1-, 3- and 6-month postoperatively.

RESULTS

The values of the composite threshold discrimination identification score were significantly lower in patients with long duration of olfactory deficit and history of previous sinus surgery in all testing sessions. Adjustment for preoperative olfactory measures and all potential confounders revealed that both parameters remained strong independent predictors of normal olfactory function; a successful outcome was more frequent in patients with short duration of olfactory deficit and in patients who had not undergone previous sinus surgeries. However all patients achieved a significant stepwise increment of all indices of olfactory function over time, after ESS.

CONCLUSIONS

Duration of olfactory deficit and previous sinus surgery presented highly significant predictive value for the short-term outcome of the olfactory function after ESS. However all patients suffering from nasal polyposis will probably improve olfaction significantly in a period up to six months after surgery.