Argon plasma coagulation in the treatment of nonallergic hypertrophic inferior nasal turbinates

PURPOSE: Various surgical procedures have been recently proposed for the treatment of hypertrophic inferior nasal turbinates as a result of the advances made in medical technology and growing public demand for minimally invasive therapies. The aim of this study was to evaluate the safety and efficacy of the argon plasma coagulation technique for inferior turbinate reduction in a homogeneous series of patients with nonallergic inferior turbinate hypertrophy.Material and methods: Twenty symptomatic patients underwent argon plasma coagulation surgical treatment under local anesthesia and were clinically followed up after 1 month and then every 3 months (anterior rhinoscopy and nasal endoscopy). Diagnostic evaluations using active anterior rhinomanometry were made after 3 and 12 months. RESULTS: All of the patients reported a postoperative improvement in nasal swelling and patency. No postoperative complications were observed. Rhinomanometry after 12 months showed a reduction in mean total resistance from the pretreatment level of 1.06 Pa s/cm(3) to 0.49 Pa s/cm(3). There was also a statistically significant reduction in nasal resistance for each of the investigated conditions (inspiration and expiration in orthostatism and clinostatism). CONCLUSIONS: Argon plasma coagulation is a safe and efficacious procedure for the minimally invasive treatment of inferior turbinate hypertrophy, which can be performed under local anesthesia in an outpatient setting with little discomfort for the patient.     

Submucous diathermy of the inferior turbinates in chronic hypertrophic rhinitis

Twenty patients, 10 allergic and 10 non-allergic, with chronic hypertrophic rhinitis and presenting mainly with bilateral nasal obstruction were subjected to submucosal diathermy of their inferior turbinates. There was significant post-operative improvement clinically, histopathologically and histochemically in the non-allergic group, while the improvement was less obvious in the allergic cases. The post-operative clinical improvement as regards rhinorrhea and sneezing was not as marked as that for nasal obstruction. Evaluation of the results showed that submucous diathermy of inferior turbinates is a good line of treatment for cases of chronic hypertrophic rhinitis, with better results in the non-allergic group of patients.     

Expression patterns of galectin-1 and galectin-3 in nasal polyps and middle and inferior turbinates in relation to growth regulation and immunosuppression

BACKGROUND: The term nasal polyposis describes benign growth processes in the nasal and sinus mucosa, which are mainly located in the middle meatus and never in the inferior meatus. As a step to define the biochemical determinants relevant for growth regulation, we focused on endogenous lectins known for anti-apoptotic (galectin-3) and immunomodulatory (galectin-1) activities. DESIGN: Using computer-assisted microscopy, we performed an immunohistochemical investigation defining the quantitative parameters of expression of galectin-1 and galectin-3 in 10 nasal polyps, 10 middle turbinates, and 10 inferior turbinates, all of which were obtained from surgical resection. RESULTS: Our data show that galectin-3 expression is markedly (P<.001) higher in nasal polyps than in turbinates. No relation to the allergic status was discovered. Galectin-1 expression is higher in nasal polyps than in middle turbinates (P<.001) in nonallergic patients compared with allergic ones (in glandular epithelium, P =.009; in connective tissue, P =.006). The lowest galectin-1 expression was observed in the middle turbinate. CONCLUSIONS: These data are in line with a positive influence of galectin-3 on growth and an immunoregulatory role of galectin-1, mimicking an increased expression dependent on glucocorticoid.     

Fas及Bcl-2在鼻息肉组织中的表达及意义

目的：探讨Fas和Bcl 2在鼻息肉组织中的表达及与鼻息肉发病的关系。方法：应用S P免疫组化法检测36例鼻息肉组织及19例下鼻甲组织中Fas和Bcl 2的表达情况。结果： （1）Fas在鼻息肉上皮及腺上皮的表达弱于对照组（P＜0.05）;（2）Bcl 2在鼻息肉上皮及腺上皮的表达强于对照组（P＜0.05）;（3）鼻息肉上皮细胞中Fas、Bcl 2蛋白的表达无相关性（P＞0.05）。结论：（1）Fas和 Bcl 2在鼻息肉发生发展中起重要作用;（2）在NP上皮细胞中, Fas和Bcl 2无相关性,因此这两种凋亡基因在NP的形成过程中各起独立作用,协调抑制NP上皮细胞的凋亡。     

86例慢性肥厚性鼻炎手术治疗的临床疗效分析

目的:比较手术和微波热凝术治疗慢性肥厚性鼻炎的疗效。方法:86例患者,其中男性51例(59.3％),女性35例(40.7％),随机分为两组,一组(43例)采用下鼻甲部分切除术(PIT),另一组(43例)用微波热凝术(MTC)进行治疗。结果:PIT组1年后鼻通气改善38例(88.37％);MTC组1年后鼻通气改善27例(62.79％),经检验X~2=7.62,P=0.006,差异有显著性。2～5年后鼻通气改善PIT组35例(81.40％);MTC组2～5年后鼻通气改善11例(25.58％)。经检验X~2=7.62,P=0.000。结论:对慢性肥厚性鼻炎伴骨质增生的病人运用PIT具有良好的近期效果和远期效果,优于MTC。     

Comparison of microdebrider-assisted inferior turbinoplasty and submucosal resection for children with hypertrophic inferior turbinates

OBJECTIVES: The aim of this study was to compare the effectiveness and safety of microdebrider-assisted inferior turbinoplasty (MAIT) with submucosal resection (SR) for children with hypertrophic inferior turbinates. MATERIALS AND METHODS: One hundred and twenty children with chronic nasal obstruction due to hypertrophic inferior turbinates were enrolled. These children were randomly assigned to receive SR of the inferior turbinate (n=60) or MAIT (n=60). Ten children who did not appear to display any nasal discomfort served as normal controls. Surgical-outcome was evaluated with respect to four distinct parameters: nasal endoscopy, subjective assessment of nasal symptoms by the patient using a visual analogue scale, anterior rhinomanometry, and saccharin test. These evaluations were conducted before surgery and at 1 week, 1 and 3 months after surgery. RESULTS: In the SR group, turbinate edema was decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal secretions and crusting were increased significantly (p<0.05) in the SR group at 1 week after surgery and then decreased significantly at 1 and 3 months after surgery. In the MAIT group, turbinate edema and nasal secretions were decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal crusting was not observed after surgery. Subjective complaints including nasal obstruction, sneezing, rhinorrhea and hyposmia were significantly improved in both groups from 1 month after surgery (p<0.05). Rhinomanometric assessment did not reveal significant improvement until 3 months after surgery in both groups. Saccharin transit time was significantly increased (p<0.05) compared to baseline at 1 week after surgery in the SR group but was not significantly different in the MAIT group. CONCLUSION: MAIT and SR are both effective at relieving nasal obstruction due to the presence of hypertrophic inferior turbinates. MAIT is superior to SR with regard to preserving the nasal mucosa.     

Ho:YAG and diode laser treatment of hyperplastic inferior nasal turbinates

BACKGROUND: Since the early 80's, chronic nasal obstruction due to hyperplastic turbinates is treated by laser light. Comparative clinical studies were performed to assess the clinical outcome of laser assisted endonasal turbinate surgery in longterm. METHODS: By means of a pulsed Ho:YAG laser emitting light at lambda = 2100 nm (0.8 - 1.2 J/pulse, 4 - 8 Hz), 69 patients suffering from nasal obstruction due to allergic rhinitis (46 %) and vasomotor rhinitis (54 %) were treated under local anesthesia. Furthermore, 50 patients (52 % with allergic rhinitis and 48 % with vasomotor rhinitis) were treated by means of a GaAlAs-diode laser (c. w., lambda = 940 nm, 8 - 10 W). The treatment time took 3 - 10 min/turbinate and nasal packing was not necessary after the laser procedure. The study was conducted by a standardized questionnaire, photo documentation, allergy test, mucociliar function test, rhinomanometry, and acoustic rhinometry. RESULTS: Within 4 weeks after laser treatment, an improvement of nasal airflow correlating to the extent of the ablated turbinate tissue could be determined in more than 80 % of the patients. Rhinomanometry revealed a significant improvement of the nasal airflow 6 months and 1 year after the laser treatment compared to the preoperative data. Side effects like nasal dryness and pain were rare (< 5 %). Diode laser treatment revealed more effective results than Ho:YAG laser treatment, however there was no significant difference between the two investigated groups. Patients suffering from vasomotor rhinitis showed far better results in long term in comparison to allergic rhinitis patients. CONCLUSIONS: Ho:YAG and diode laser treatment can be performed as an outpatient procedure under local anesthesia in a short treatment time with promising results. It could become a time and cost effective treatment modality in endonasal laser surgery.     

ERK1/2磷酸化在鼻息肉组织中的表达及其意义

目的:研究磷酸化的细胞外信号调节激酶1/2(ERK1/2)在鼻息肉组织中的表达及其意义.方法:应用免疫组织化学研究磷酸化的ERK1/2在鼻息肉组织和正常中鼻甲黏膜的表达及定位.进一步用免疫印迹对磷酸化ERK1/2在鼻息肉组织的表达进行半定量分析.结果:免疫组织化学发现,磷酸化ERK1/2在鼻息肉表达显著高于正常对照组,主要定位于增生的上皮细胞、炎症细胞、腺上皮细胞和内皮细胞,且以胞核阳性为主.免疫印迹结果显示鼻息肉中磷酸化ERK1/2的表达显著高于正常中鼻甲黏膜,为其4.2倍.结论:研究提示磷酸化ERK1/2可能在鼻息肉的发生发展过程中起重要作用.     

Long-term efficacy of microdebrider-assisted inferior turbinoplasty with lateralization for hypertrophic inferior turbinates in patients with perennial allergic rhinitis

Objectives: The aim of the study was to evaluate the long‐term efficacy of microdebrider‐assisted inferior turbinoplasty with lateralization (MAITL) compared to submucosal resection for hypertrophic inferior turbinates. Study Design: Surgical outcomes were evaluated with respect to visual analogue scale, anterior rhinomanometry, and saccharin test results. Methods: From January 2002 to December 2006 inclusively, 160 patients with perennial allergic rhinitis and hypertrophic inferior turbinates were enrolled into this study. The patients, all suffering from chronic nasal obstruction, were randomly classified into two groups, MAITL group or SR group, each comprised of 80 patients. Ten patients who did not display any nasal discomfort served as normal controls. For the submucosal resection group, patients underwent submucosal resection of the inferior turbinate, whereas patients in the MAITL group underwent microdebrider‐assisted inferior turbinoplasty with lateralization. Assessments (visual analogue scale, anterior rhinomanometry, and saccharin test) were conducted prior to the surgery and 1, 2, and 3 years after completion of surgery. Results: Compared to preoperative values, subjective complaints including nasal obstruction, sneezing, rhinorrhea, and snoring improved significantly in both groups at 1, 2, and 3 years after surgery in both groups (P < .05 for all). Rhinomanometric assessment also showed significant improvement at 1, 2, and 3 years postoperatively in both groups (P < .05 for all). Saccharin transit time was significantly decreased (P < .05 for all) compared to preoperative values 1, 2, and 3 years after surgery in both groups. Conclusion: Microdebrider‐assisted inferior turbinoplasty with lateralization appears to be as effective as submucosal resection at relieving nasal symptoms and decreasing total nasal resistance and saccharin transit times for more than 3 years in patients with perennial allergic rhinitis who have had substantial nasal obstruction.     

糖皮质激素对鼻息肉缺氧诱导因子-1α及血管内皮生长因子表达的影响

目的 探讨组织缺氧诱导因子-1α(HIF-1α）及血管内皮生长因子（VEGF）在鼻息肉组织中的表达及相关性, 探讨局部应用糖皮质激素类药物对鼻息肉的作用机制。方法 采用免疫组化SP法检测鼻息肉组织在应用丙酸氟替卡松鼻喷剂治疗前、后及下鼻甲HIF-1α及VEGF的表达变化。结果 鼻息肉组织中HIF-1α和VEGF的表达水平明显高于下鼻甲组织（P均＜0.01）;激素治疗后HIF-1α、VEGF表达下降(P＜0.05)。鼻息肉的发病与组织中HIF-1α、VEGF的表达呈明显正相关（r=0.627, P＜0.05）。结论 局部应用糖皮质激素可降低HIF 1α、VEGF的表达,有效治疗鼻息肉。     

Diode laser treatment of hypertrophic inferior turbinates and evaluation of the results with acoustic rhinometry

Inferior turbinate hypertrophy is the most common cause of chronic nasal obstruction. When conservative medical treatment options fail in patients with inferior turbinate hypertrophy, reduction of the inferior turbinate can be performed using surgical techniques. Laser-assisted turbinate surgery has the advantages of limited tissue trauma and reduced bleeding. We evaluated the effectiveness and outcomes of using a diode laser (λ?=?980?nm) in turbinate reduction. Our study included 62 patients with symptoms of nasal obstruction due to hypertrophic inferior turbinates, who did not respond to medical treatment (≥1?year). Patients were treated with diode laser between January 2009 and December 2010 in our ENT (ear, nose, and throat) department. Subjective outcome of severity of nasal obstruction was assessed on a standard 10-cm visual analog scale (VAS). Acoustic rhinometry was used to measure nasal patency. The cross-sectional areas 1, 2, and 3 and the volumes between 2.5 and 5.5?cm were measured. VAS scores and acoustic rhinometry measurements were performed preoperatively and 1, 6, and 12?months after surgery. The mean follow-up was 13.1?±?1?months. The mean operation time was 3?min per turbinate; no nasal packing was necessary. We did not observe any major complications. Both subjective and objective evaluations showed significant improvement. VAS scores improved, the mean MCA2, MCA3, and V2–5 measurements increased significantly 1?year after surgery. In the first year after surgery, 53 of 62 (85.4%) patients reported marked improvements in nasal breathing. Our results showed that, objectively and subjectively, the success rates in diode laser-assisted turbinate reduction were satisfactory. The diode laser, being one of the most portable and least expensive of the lasers available for turbinate surgery, makes it possible for turbinate reduction to be performed under topical anesthesia within a short period of time with excellent patient acceptance.     

IL-12和IL-4在鼻息肉表达的意义

目的探讨鼻息肉组织中T辅助细胞1（Th1）和Th2细胞及细胞因子IL 12和IL 4的含量及意义。方法标本取自30例鼻息肉患者的息肉组织和20例行鼻中隔手术患者的正常中鼻甲黏膜（对照组）。新鲜鼻息肉手术标本和正常中鼻甲黏膜制备单细胞悬液,流式细胞术测定Th1和Th2细胞的百分率。用酶联免疫吸附测定（ELISA）法检测IL 12和IL 4在冰冻鼻息肉标本和正常中鼻甲黏膜的含量。结果鼻息肉组织以Th1细胞亚群为主,且其中Th1和Th2细胞亚群显著高于对照组（P<0.05）;鼻息肉组织IL 12、IL 4的水平高于对照组（P<0.05）;Th1细胞百分率与IL 12的水平正相关（P<0.05）,Th2细胞百分率与IL 4的水平正相关（P<0.05）,IL 12的水平与IL 4负相关（P<0.05）。结论鼻息肉中Th细胞在IL 12和IL 4作用下分化为Th1和Th2,二者共同参与鼻息肉的发生发展和免疫应答。     

Effects of surgical treatment of hypertrophic turbinates on the nasal obstruction and the quality of life

Purpose

Chronic hyperplasia of the inferior nasal concha is accompanied by a nasal obstruction; however, there is no standardised surgical treatment for this condition. Here, we compared the outcome of three surgical techniques frequently used to treat the hyperplasia of inferior turbinates: turbinectomy with lateralization, submucosal electrocautery and laser cautery additional to septoplasty.

A comparison of anterior and radical trimming of the inferior nasal turbinates and the effects on nasal resistance to airflow

A study of 18 patients with chronic rhinitis who underwent anterior or radical trimming of the inferior turbinates is presented. Radical trimming produced a significant decrease in both total nasal resistance to airflow and subjective nasal obstruction (P less than 0.005). Anterior trimming produced a significant decrease in total nasal resistance to airflow (P less than 0.05), but had no significant effect on subjective nasal obstruction. These results suggest that the main site of nasal resistance in patients with chronic rhinitis is the same as in the normal nose. On the basis of this study, adoption of anterior trimming in place of radical trimming of the inferior turbinates cannot be recommended.     

p-ERK2及ERK2在鼻息肉组织的表达及其意义

目的 检测磷酸化细胞外信号调节激酶2(p-ERK2)及细胞外信号调节激酶2(ERK2)在鼻息肉(NP)组织的定位及表达情况;初步探讨p-ERK2/ERK2在NP发病中的临床意义。 方法 应用间接免疫荧光技术(IIF)及蛋白免疫印记技术(WB)检测p-ERK2/ERK2在NP及正常鼻黏膜组织的定位及表达水平,并探讨其临床意义。 结果 NP:p-ERK2主要表达在增生的上皮细胞、炎症细胞以及腺上皮细胞,主要位于胞核;ERK2主要表达在腺上皮细胞、炎症细胞,主要位于胞质。正常鼻黏膜组织:p-ERK2主要表达在炎症细胞、腺上皮细胞,主要位于胞核;ERK2主要位于炎症细胞,主要位于胞质。荧光强度值:p-ERK2在NP和正常鼻黏膜组织的表达有统计学差异(P<0.05);ERK2在NP和正常鼻黏膜组织的表达无统计学差异(P>0.05)。WB灰度值:p-ERK2在NP和正常鼻黏膜组织的表达有统计学差异(P<0.05);ERK2在NP和正常鼻黏膜组织的表达无统计学差异(P>0.05)。 结论 p-ERK2在NP的发病机制中可能具有重要作用,而ERK2与NP的发生可能无关。ERK2在NP组及正常鼻黏膜组织均表达,提示ERK2可能参与鼻黏膜正常生理功能的维持。     

Alterations of nasal mucociliary transport in patients with hypertrophy of the inferior turbinates, deviations of the nasal septum and chronic sinusitis

Mucociliary transport (MCT) represents the first barrier of the nasal fossae and paranasal sinuses against various biological and physical insults. We studied the nasal MCT time using a mixture of vegetable charcoal powder and 3% saccharin in three groups of patients suffering from hypertrophy of the inferior turbinates, deviations of the nasal septum or chronic sinusitis. The mean values of the nasal MCT in the first two groups were practically identical to the normal ones. In contrast, significantly delayed times were found in patients with chronic sinusitis (P < 0.01). Findings indicate that this delay is determined by an increase in viscoelasticity of the mucus following the acute release of mediators of inflammation, together with a reduction in the periciliary stratum, which slows down the metachronous wave of the MCT. Received: 28 August 1998 / Accepted: 6 January 1999     

克拉霉素对离体鼻息肉组织中环氧合酶-2及核因子κB表达的影响

目的：检测用不同浓度梯度的克拉霉素干预后,离体鼻息肉组织中环氧合酶-2（COX-2）及核因子κB（NF-κB）的表达状况,探讨其在鼻黏膜炎症机制中的作用。方法：将鼻息肉组织块分别与克拉霉素（0、10^-6、10^-5及10^-4mol／L）于体外共同培养1d,应用Western blot和荧光实时定量PCR技术检测COX-2和NF-κB亚基的表达水平,观察克拉霉素干预后COX-2和NF-κB表达的变化规律。结果：对照组（0mol／L克拉霉素组）鼻息肉组织中COX-2、NF-κBp50和NF-κcBp65的蛋白质和核酸表达水平最高;随着克拉霉素干预剂量的增加,COX-2、NF-κBp50和NF—κBp65的表达水平呈剂量依赖性下降。相关分析表明,同一组鼻息肉组织中,COX-2核酸表达量分别与NF-κBp50、NF-κBp65呈直线正相关。结论：COX-2异常表达参与了鼻-鼻窦黏膜慢性炎症反应,克拉霉素可能通过阻断NF-κB通路来下调COX-2的合成,发挥其抗炎作用。