Vergleichende pH-Messungen an Schleimhäuten der Nase und des Mundrachens bei Gesunden und Laryngektomierten

Zusammenfassung Es wird erstmalig über vergleichende in vivo-pH-Messungen an Schleimhäuten des oberen Respirationstraktes bei Gesunden und Laryngektomierten berichtet, die nach einem in der Klinik standardisierten Meßverfahren (Flachmembran-Glaselektrodenmeßkette) einmal zum Zwecke der Orientierung über die Schleimhaut-pH-Werte beim Kehlkopflosen (Nase, Mundhöhle, Tracheostoma) und andererseits zur indirekten Objektivierung des Ansäuerungseffektes am Nasenschleim durch die kohlendioxidhaltigere Ausatemluft durchgeführt wurden. Hiernach liegen die Schleimhautoberflächen-pH-Werte bei Kehlkopflosen in allen Meßbereichen — besonders auch an der Oberfläche der Nasenschleimhaut — signifikant niedriger, also saurer als bei gesunden Vergleichspersonen; der Ausfall des Ansäuerungseffektos beim Kehlkopflosen mit Zeichen einer pH-Verschiebung zum Neutralpunkt odor Alkalischen war somit nicht reproduzierbar. Es ist beachtenswert, daß der Organismus trotz Wegfall des Säuerungseffektes der Ausatmungsluft den sauren Charakter des Sekretes der oberen Luftwege aufrechterhält.

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Comparative pH-measurements of the mucosa of nose and mouth in healthy and laryngectomized persons

Summary This paper reports for the first time on in-vivo measurements of the pH in mucosal secretions of the upper respiratory tract. Measurements were taken in normal subjects and in laryngectomees, employing a standardized method developed by this department: an array of glass electrodes for measurement on flat membranes. The objective of these measurements was (a) to ascertain pH values of the mucosal secretions in the nose, pharynx, and around the tracheostoma in laryngectomees, and (b) to demonstrate the acidifying effect of CO₂ in the respiratory air upon the nasal mucus. Results indicated that, in laryngectomees, the pH values of the mucosal secretions in all areas, especially of the nasal mucus, were significantly lower, i.e., more acid, than those found in normal controls. Thus, the lack of acidification of the nasal mucus could not be demonstrated in laryngectomees.

     

Quantitative Cytology of Nasal Secretions With Perennial Allergic Rhinitis in Children: Comparison of Noninfected and Infected Conditions

This study was performed to quantify the number of inflammatory cells in nasal secretions from pediatric patients with perennial allergic rhinitis under noninfected and infected conditions. Nasal secretions were obtained from seven children under both noninfected and infected conditions with perennial allergic rhinitis to house dust mites, and secondary quantitative cytology was performed on the secretions. The number of neutrophils under infected condition was significantly higher than that under noninfected condition (P < .05), whereas the number of eosinophils in infected condition was significantly lower than that in noninfected condition (P < .05). The ratio of eosinophil count to neutrophil count was more than 0.1 in noninfected condition. The ratio was significantly decreased in infected condition (P < .02). These results suggest that the distribution of inflammatory cells in the nasal mucus of children with allergic rhinitis would be modified under infected condition.     

The mycotic flora of adenoids and antibodies to Candica albicans in children

Summary We cultured the adenoid tissues of 72 children with recurrent respiratory infections for fungal organisms. We also took fungal cultures of nasopharyngeal secretions from 20 healthy children and 13 healthy adults as controls. Culture for fungi were positive in 15% of the patients, in 15% of the healthy adults and in 25% of the healthy children. Candica albicans, C.parapsilosis, C. tropicalis and Aspergillus sp. were the most common organisms found. In studying the children with recurrent respiratrory infections, we were unable to find any significant correlation between the positive cultures and the age, type of day-care and previous antibiotic therapy given. We then studied the hemagglutination titers against C. albicans in 44 patients. This titer was 1—160 or lower in all but three patients, and was 1—320 in these latter three patients. However, fungal cultures were negative in all patients having hemagglutination titers of 1—80 or more.     

Eosinophil cationic protein in the nasal secretions of patients with mite allergic rhinitis

In 25 patients with mite nasal allergy and 13 healthy control subjects, levels of eosinophil cationic protein (ECP) and histamine in nasal secretions were examined before and after challenge with mite extract. The ECP level was found to be significantly higher in the washings taken 30 minutes after challenge compared with the washings taken before challenge (P<.05). ECP levels measured both before and after mite extract challenge were found to be significantly higher in the patients than in the controls (P <.01). These facts suggest that the ECP affects the nasal mucosa by causing injury to ciliated cells and by acceleration of the processes of modification and inhibition of the allergic reaction.     

Clinical significance of eosinophilic cationic protein levels in nasal secretions of patients with nasal polyposis

Nasal polyps are characterized by eosinophilic infiltration, and frequently coexist with asthma, aspirin intolerance and allergy. Eosinophilic cationic protein (ECP) is a specific eosinophil granule protein released upon activation of eosinophils. We investigated the ECP levels in nasal secretions of patients with nasal polyposis (NP) in order to correlate them with disease severity and associated diseases and to compare ECP levels between patients with and without recurrence of NP after surgical treatment. A total of 78 patients who had surgery for NP were followed up for a minimum of 18 months. The presence of asthma, allergies or aspirin intolerance was noted. Nasal secretions were obtained 1 day before the surgery and during the follow-up period after surgery. Immunoassays were used to quantify ECP in nasal secretions and serum and interleukin (IL)-5 in nasal secretions. ECP levels in nasal secretions were higher in patients with asthma or aspirin intolerance than in patients without asthma or aspirin intolerance, while no significant differences were found between allergic and non-allergic patients. ECP levels in nasal secretions correlated significantly with IL-5 levels in nasal secretions, the degree of tissue eosinophilia and computed tomographic (CT) scores. In total, 30 patients (38%) developed recurrent NP during the follow-up period. Preoperative ECP and IL-5 levels in nasal secretions were significantly higher in patients with recurrence compared to patients without recurrence. During the follow-up period, patients without recurrence demonstrated a significant reduction in the ECP levels in nasal secretions, whereas there was no significant reduction in the ECP levels of patients with recurrence. The results of this study provide evidence that ECP levels in nasal secretions of patients with NP correlate with the presence of asthma or aspirin intolerance and severity of NP determined by CT scores.     

Quantitative cytology of nasal secretions under various conditions

Quantitative cytology was performed in nasal secretions of normal control (NC), seasonal allergic rhinitis in season (SAR), perennial allergic rhinitis (PAR), chronic sinusitis with mucoid secretion (MS), and chronic sinusitis with mucopurulent secretion (MPS). The majority of inflammatory cells were neutrophils in NC, MS, and MPS; the majority were eosinophils in SAR and PAR. The concomitant appearance of inflammatory cells in nasal secretions was found, i.e., there were significant correlations between neutrophil and eosinophil counts in MPS, and between eosionophil and basophil counts in SAR. The eosinophil/neutrophil ratio was more than 0.1 in SAR and PAR, but the ratio was less than 0.1 in all NC, all MPS, and in 93% of MS; this indicates that 0.1 in eosinophil/neutrophil ratio is the critical value between allergic and nonallergic nasal diseases.     

Effects of macrolides on interleukin-8 secretion from human nasal epithelial cells

Low-dose, long-term macrolide treatment has recently been reported to be very effective in patients with chronic airway diseases. We examined the in vivo and in vitro effects of 14-membered macrolide antibiotics erythromycin (EM) and clarithromycin (CAM) on interleukin (IL)-8 secretion from human nasal epithelial cells. Fifteen patients with chronic sinusitis received macrolide treatment (CAM 400 mg/day) for 1 to 3 months. The number of infiltrated neutrophils and IL-8 concentrations in the nasal discharges of these patients decreased significantly at 1 to 2 months after the treatment. In vitro effects of EM and CAM on IL-8 secretion were examined in nasal epithelial cells cultured at the air-liquid interface. After 14-day culture in the air-liquid interface, macrolide antibiotics were added in medium for 24 h. EM and CAM at concentrations of 10^–4 M did not affect spontaneous secretions or IL-1β-induced secretions of IL-8 either apically or basolaterally. When cells were preincubated with 10^–4 M CAM for 7 days, the IL-1β-induced secretion of IL-8 decreased significantly. However, no difference was observed between the effects of 10^–4 M CAM and 10^–4 M josamycin, a 16-membered macrolide. These results suggest that macrolide treatment inhibits neutrophil infiltration and IL-8 secretion in nasal epithelium in vivo and that these clinical effects depend on a mechanism other than the direct action of macrolide on nasal epithelial cells. Received: 30 December 1998 / Accepted: 8 July 1999     

A study on collagenase production of nasal polyp-derived fibroblasts stimulated by nasal secretions of chronic sinusitis

The collagenase produced by mesenchymal cells has been thought to have a great importance in the pathophysiology of connective tissue metabolism and prolongation of chronic inflammation. The factors, such as IL-1 and PMN factor, released by inflammatory cells have been known to induce mesenchymal cells to produce collagenase. In the present study, the collagenase activity of the nasal secretions were estimated using FITC-labelled collagens as substrates. The factor, enhancing the fibroblasts to produce collagenase, was also isolated from nasal secretions and partially characterized. The fibroblasts used in the present study were cultured with explant of the sections of nasal polyp obtained from a patient with chronic sinusitis. The collagenase activity in nasal secretions from patients with chronic sinusitis was high, whereas that of allergic nasal secretions was extremely low. Furthermore, the collagenase productions of nasal polyp-derived fibroblasts were enhanced by the extracts of nasal secretions from patients with chronic sinusitis. Crude extracts of nasal secretions were fractionated by ammonium sulfate precipitation. The active materials precipitated by 50% to 80% ammonium sulfate were further purified by Sephadex G-75 gel chromatography. The molecular weight determination of the active fraction checked by HPLC utilizing for TSK 2,000 SW gel column indicates 20,000 daltons for the active materials. However, the collagenase production of human microvascular endothelial cells derived from nasal mucosa was not enhanced by this factor. Although either the origin or the nature was not confirmed, the factor was considered to relate to the prolongation of chronic inflammation in the nasal and paranasal sinus pathology. Analysis of these factors will expected to establish methods for new therapeutics in chronic inflammation.     

Immunohistochemical detection of serous cells in nasal mucosa with monoclonal antibody against a component in human nasal secretion.

Secreting mechanisms of secretory cells in nasal mucosa and the changes of nasal secretions in chronic inflammatory sinusitis have been studied by the biochemical and histochemical methods. These methods could not clarify the changes of quality and quantity of nasal secretions and secretory cells. In order to obtain the specific marker for the secretions in different cells, we have produced monoclonal antibodies against a component in human nasal discharge. One antibody was selected for further characterization, because it stained submucosal serous cells specifically. This antibody stained the components of serous cells with molecular weight of 14 kD specifically, and was sensitive to periodate oxidation treatment. This antibody will be useful for detecting the subpopulation in secretory cells of human nasal mucosa, and may be serve as a biochemical probe for secretory activity of particular secretory cell types.     

The preservation and regeneration of cilia on human nasal epithelial cells cultured in vitro

Summary Dissociated human nasal epithelial cells from nasal polyps were cultured in Ham's F12-DME 1/1 supplemented with NU-serum 10%, choleratoxin (10 ng/ml), retinoic acid (10^–7 M) and antibiotics. In monolayer cultures, the epithelial cells grew to confluency on collagen gels, became squamous, and lost their cilia within 2–6 weeks. In suspension cultures, epithelial cell sheaths formed stable vesicles and aggregates. These maintained a respiratory-type morphology and normal ciliary activity for over 6 months. When deciliated, squamous cells from monolayer cultures were brought in suspension, a respiratory-type morphology with cilia reappeared. This in vitro ciliogenesis resulted in normal and coordinated ciliary activity observed for more than 5 months.Presented at the First European Congress of Oto-Rhino-Laryngology and Cervico-Facial-Surgery, Paris, 26–29 September 1988     

变应性鼻炎鼻分泌物中上皮细胞集落和嗜酸粒细胞的检测

为了观察变应性鼻炎（allesgicrhinitis，AR）患者鼻分泌物中的上皮细胞集落和嗜酸粒细胞，对20例AR患者（AR组）和15例鼻窦炎患者（感染组）鼻分泌物中细胞成分进行了电镜观察，发现AR组鼻分泌物中有大量上皮细胞集落，其特征是数个至数十个上皮细胞成片状脱落，上皮细胞集落的数量和嗜酸粒细胞的数量、嗜酸粒细胞阳离子蛋白（eosinophiliccationicprotein，ECP）的含量呈正相关。感染组中上皮细胞集落和嗜酸粒细胞极少，ECP含量甚微。结果提示嗜酸粒细胞的ECP可能导致AR患者的鼻粘膜上皮呈片状脱落，对上皮结构造成损害。     

Quantitative Cytology of Nasal Secretions and Scrapings in Japanese Cedar Pollinosis Patients

To explore the dynamics of the cellular response to natural allergen exposure, the authors of this study performed quantitative cytology in both the nasal secretions and nasal scrapings of 16 normal control subjects and 23 Japanese cedar pollinosis patients before and during the pollen season. In nasal scrapings, the number of metachromatic cells increased significantly during the pollen season, although there was no significant difference between the normal subjects and the preseason pollinosis patients. The cell differential count in the patients with pollinosis showed that lymphocytes were predominant in scrapings; however, the majority of inflammatory cells in the nasal secretions were neutrophils before the season and eosinophils during the season. The study findings suggest that the appearance of metachromatic cells in nasal scrapings is specific to the pollen exposure and that the cytology in nasal secretions is significantly different from that in nasal scrapings.     

An endoscopic study of tubal function and the diseased ethmoid sinus

Summary Diseases of the paranasal sinuses — especially of the anterior ethmoid sinus — may affect tubal function. Acute and chronic sinus inflammations cause alterations in the normal pathways for secretions out of the sinus system. The normal secretion pathways usually bypass the orifice of the eustachian tube in the nasopharynx. Excessive or infected mucus can then be transported directly over the tubal orifice to cause its obstruction and promote ascending infections into the middle ear. We have found that nasal endoscopy proves to be very helpful in detecting even hidden pathologies due to sinus disease in key areas in the middle meatus, and furthermore allows a direct visualization of the tubal orifice. Functional endoscopic surgery has also enabled us to clear diseased and stenotic areas involving the sinus ostia with minimal procedures. Normal drainage and ventilation are reestablished via the physiologic sinus ostia and thus help to normalize tubal function.A shorter version of this paper was presented at the Adam Politzer Memorial Conference, 12 September 1985, Vienna, Austria     

Elevated levels of interleukins IL-1 β , IL-6 and IL-8 in naturally acquired viral rhinitis

We studied the cytokines IL(interleukin)-1β, IL-4, IL-6 and IL-8 in nasal lavage samples from 20 patients with naturally acquired viral rhinitis and 5 healthy controls without nasal complaints. IL-1β, IL-6 and IL-8 levels in lavage fluid from the viral rhinitis patients were significantly elevated when compared to control subjects. IL-4 was not measurable in any of the samples. The cytokine levels in secretions from the healthy controls remained stable intraindividually on 5 consecutive sampling days. We suggest that cytokines such as IL-1β, IL-6 and IL-8, but not IL-4, are involved in the pathophysiology of the common cold.     

Prevalence of upper and lower airway symptoms: the Skövde population-based study

Conclusion. This study was able to present representative data from Sweden as a whole and illuminates the epidemiological background of symptoms of the upper and lower airways. Current regular smokers, compared with non-smokers, had more problems with nasal blockage, cough and asthma. The relationship between the upper and lower airways was confirmed as regards airway symptoms. Background. Epidemiology of common respiratory symptoms is basic information in health care. This study has focused on the prevalence of upper and lower airway symptoms. Patients and methods. A random sample of 1900 age- and gender-stratified adults was recruited from a general population for this study, which included a structured interview about symptoms of nasal secretions and blockage, cough and asthma, and a clinical examination with nasal endoscopy, and peak nasal-inspiratory flow (PNIF). Smoking habits were evaluated by a questionnaire for current and previous smoking. Results. A response rate of 73% was achieved. The prevalence of various symptoms varied between age strata and gender. There was a statistically significant relationship between subjectively experienced nasal blockage and objectively observed nasal congestion. PNIF was negatively related to age and height and was increased in male gender. Smoking was most common among females and related to nasal blockage, cough and asthma, but not to nasal secretions. Significant relationships between the upper and lower airways were found.     

Virtual endoscopy of the nasal cavity in comparison with fiberoptic endoscopy

Purpose: To apply virtual-endoscopic mode to display the nasal cavity and to evaluate clinical application of virtual endoscopy in comparison with nasal fiberoptic endoscopy. Materials and methods: Eleven patients were examined by virtual endoscopy after axial spiral computed tomography (CT) scanning was performed. In addition, 9 out of these 11 patients underwent fiberoptic endoscopy. Spiral CT scanning was performed with 1-mm collimation, 0.5- to 1-mm increment, 25–250 mA s, and pitch 1–2. Virtual endoscopy was performed by Explorer software package. Results: Virtual endoscopy could clearly demonstrate anatomic structures in the nasal cavity, septal deviation, stenosis and obstruction of the middle meatus, turbinate hyperplasia, and pathological masses larger than 3 mm in diameter. However, “false adhesions” may appear in virtual endoscopy. The main limitation of virtual endoscopy was the inability to evaluate mucosa and its surface. Conclusion: Virtual endoscopy of the nasal cavity is a new and noninvasive method. It can demonstrate normal and pathological structures in the nasal cavity. Its ability to visualize is comparable with fiberoptic endoscopy except for evaluating mucosal surface and secretions. In the future, this method will probably be a basic instrument of computer-assisted surgery in the midfacial region. Received: 9 December 1999 / Accepted: 7 September 2000     

The effect of the H2 antagonist cimetidine on the numbers of CD4+ and CD8+ cells in the nasal mucosa of patients with allergic rhinitis

This paper reports the effects of the H₂ antagonist cimetidine on the number of CD4⁺ and CD8⁺ cells in nasal mucosa and the IgE level of nasal secretions in patients with allergic rhinitis. The results showed the numbers of CD4⁺ cells were greater than the numbers of CD8⁺ cells in nasal mucosa, both in the patients with allergic rhinitis and normal subjects, but the ratio of CD4⁺ : CD8⁺ cells was much higher in the patients with allergic rhinitis. After treatment with cimetidine locally for 4 weeks, the numbers of CD4⁺ cells fell and the numbers of CD8⁺ cells increased in the patients with allergic rhinitis. The high IgE level of nasal secretion of the patients with allergic rhinitis was much reduced after treatment with cimetidine. The results suggest that there are high numbers of CD4⁺ cells and lower numbers of CD8⁺ cells in the nasal mucosa and a high level of IgE in the nasal secretions of the patients with allergic rhinitis. Treatment with cimetidine locally may be of some value to relieve the clinical symptoms of allergic rhinitis.