Is the nasal cycle ablated in patients with high spinal cord trauma?

We have observed at our centre that patients with high spinal cord injury frequently complain of nasal obstruction requiring decongestants. This may be due to damage to the cervical sympathetic nerves supplying the nasal mucosa, which ablates the nasal cycle. In this study we assessed the nasal cycle in 10 patients with high spinal cord trauma (above T1 segment) using acoustic rhinometry. We found that all patients assessed within 1 year of injury had nasal obstruction and no nasal cycle. Patients with injuries between 1 and 4 years who complained of a nasal obstruction showed an irregular cycle. Patients with injuries older than 4 years showed a normal alternating reciprocal nasal cycle and an improvement of nasal symptoms. The exact reason for this recovery is presently not clear from this pilot study. Further research will be undertaken to assess reasons for the recovery and possible treatment regimens for this distressing condition.     

Is the nasal cycle ablated in patients with high spinal cord trauma?

Is the nasal cycle ablated in patients with high spinal cord trauma? We have observed at our centre that patients with high spinal cord injury frequently complain of nasal obstruction requiring decongestants. This may be due to damage to the cervical sympathetic nerves supplying the nasal mucosa, which ablates the nasal cycle. In this study we assessed the nasal cycle in 10 patients with high spinal cord trauma (above T1 segment) using acoustic rhinometry. We found that all patients assessed within 1 year of injury had nasal obstruction and no nasal cycle. Patients with injuries between 1 and 4 years who complained of a nasal obstruction showed an irregular cycle. Patients with injuries older than 4 years showed a normal alternating reciprocal nasal cycle and an improvement of nasal symptoms. The exact reason for this recovery is presently not clear from this pilot study. Further research will be undertaken to assess reasons for the recovery and possible treatment regimens for this distressing condition.     

Congenital midnasal stenosis in an infant

Neonates and infants are obligate nasal breathers and nasal obstruction in this age group can be a life threatening emergency. Even though the commonest cause for nasal obstruction is nasal oedema, bony stenosis of the posterior choanae or pyriform aperture is quite common and may be seen on CT scans. We describe a case of mid-nasal stenosis in a neonate and discuss the aetiology and management of nasal obstruction in this age group.     

Basaloid Squamous Cell Carcinoma in Nasal Cavity

Basaloid squamous cell carcinoma (BSCC) is often founded in the head and neck region. However, BSCC in the sinonasal tract is rare. We report here on the case of a 58-yr-old woman who presented with nasal obstruction and epistaxis. Computed tomography and examination of the nasal cavity revealed a tumor mass that originated from the right inferior turbinate with erosion of the nasal floor. The tumor that was attached to the inferior turbinate, the lateral nasal wall and the eroded right side hard palate, and so all this was resected. Histopathologic examination of the excised tumor confirmed BSCC in the nasal cavity. We report here on a nasal cavity BSCC that was treated with partial maxillectomy only.     

External lateral osteotomy in rhinoplasty for the correction of nasal dorsal deviations

We present a revision of 45 patients with nasal deviation operated on between 1993 and 2001. Septorhinoplasties were done in all cases using the external lateral nasal osteotomies technique. 67% of our patients were male and 33% were female with a mean age of 25. In all cases a septoplasty was performed. To correct nasal deviation, medial osteotomies through an intercartilaginous approach and external lateral nasal osteotomies were done. We did a postoperative follow-up of 35 patients. In terms of patient satisfaction, 78% of them felt that their nasal appearance had improved after surgery, and 22% felt that they had a great improvement. One case had to be reoperated on because of a traumatic nasal fracture after surgery. We believe this technique offers important advantages, such as: an excellent control of the fracture line, fewer incidences of open roof and lateral step, without causing visible scars.     

Nasal septal clip (Ciğdem clip)

We report the use of a nasal septal clip. We believe that this instrument is more easily inserted and removed when compared with the classical nasal packs.     

Prolonged allergen challenge in murine nasal allergic rhinitis: nasal airway remodeling and adaptation of nasal airway responsiveness

BACKGROUND: Nasal airway remodeling exists in allergic rhinitis, but it appears to be far less extensive than in asthma. However, there has been little study about nasal airway remodeling and no study using mice models. It has been reported that airway hyperresponsiveness decreased after prolonged allergen challenge in a chronic murine asthma model together with the progression of remodeling. However, there has been no study of the relation of remodeling and airway responsiveness in nasal allergy. Therefore, we have undertaken this investigation to characterize nasal airway structural changes after prolonged allergen challenge and to examine the relationship between nasal airway hyperresponsivity and remodeling. METHODS: We prepared murine allergic rhinitis for ovalbumin. Mice were subsequently challenged three times a week with ovalbumin from day 19 to days 53, 88, and 130. We examined allergen-induced nasal symptoms and objective nasal hyperresponsiveness using the enhanced pause system. Moreover, the pathologic changes were investigated after allergen challenge. RESULTS: The extended allergen challenge protocol caused significant nasal airway remodeling. Specifically, remodeling was characterized by goblet cell hyperplasia and deposition of collagen in the submucosal area. Allergen-induced nasal hyperresponsiveness was first increased but gradually decreased in nasal symptoms and Penh after prolonged allergen challenge. CONCLUSIONS: We have demonstrated that a remodeling of nasal mucosa in a murine allergic rhinitis model prolonged allergen exposure. Moreover, prolonged allergen exposure induced a reduction of nasal hyperresponsiveness together with a progression of nasal remodeling.     

Office treatment by cryotherapy for severe posterior nasal epistaxis--update

We have used cryotherapy as an office treatment for severe posterior nasal epistaxis for 15 years. In 1971 we reported a retrospective study on 42 consecutive patients with severe posterior nasal bleeding; 26 had cryotherapy and 16 had anterior and posterior nasal packing. Our data showed that cryotherapy controlled epistaxis with less morbidity. We have now used cryotherapy for posterior epistaxis in over 450 patients. In this presentation we review the history of cryotherapy, rationale for treatment with cryotherapy, experimental tissue changes in cryotherapy, and the method for freezing in cryotherapy. We then discuss 50 recent patients with severe posterior nasal bleeding whom we have treated with cryotherapy. We have found that cryotherapy is a successful way to manage patients with severe posterior nasal bleeding.     

Posttraumatisches Aneurysma der A. dorsalis nasi

We report the case of a 69-year-old male patient who appeared in our clinic with persistent swelling on the right middle nasal bridge of 3 months' standing following blunt trauma. On physical examination the swelling was pulsatile and a flow was identified on color Doppler sonography. MRT of the head demonstrated an aneurysm of the dorsal nasal artery. We treated the aneurysm in an open surgical procedure under local anaesthesia. Due to the superficial position of this artery, open injuries are common after blunt nasal trauma. Some cases of aneurysm of the temporal artery have been described. Aneurysm of the dorsal nasal artery is a rare result of nasal trauma.     

Deviated nasal septum in case of Klippel-Trenaunay-Weber Syndrome

Klippel-Trenaunay-Weber Syndrome (KTWS) is a rare entity. It includes cutaneous hemangioma (Port-wine stains) of the face and extremities with associated varicosities and hypertrophy of underlying soft tissue and bone. Craniofacial involvement is rare in this syndrome. We report a case of Klippel-Trenaunay-Weber Syndrome who presented with craniofacial deformity leading to deviated nasal septum, nasal obstruction and intermittent nasal bleed. These patients can have involvement of oral cavity and nasal mucosa with angiomatous malformation, which can give rise to epistaxis and excessive bleeding during oral and nasal surgeries. We discuss the review and management of such cases from Otolaryngologists point of view.     

Supernumerary nostril with congenital cataract

Supernumerary nostril is a very rare congenital anomaly. It can be unilateral or bilateral, and it sometimes occurs in the presence of other congenital deformities. Behind the external opening of a supernumerary nostril is a small accessory nasal cavity, which may or may not communicate with the normal nasal cavity on the same side. We describe a new case in which the supernumerary nostril with a small accessory nasal cavity, which did not communicate with the normal nasal cavity on the same side, appeared in a young girl who also had microcornea and congenital cataract. The accessory nasal cavity was successfully removed surgically. We believe that this case may represent the first reported case of a supernumerary nostril with a congenital cataract on the same side. We also discuss the hypotheses that have been proposed to explain supernumerary nostrils.     

The endoscopic approach for congenital nasolacrimal duct obstruction

Probing of the nasolacrimal duct is a common procedure in children with congenital stenosis. Although simple probing of the nasolacrimal duct is successful in a majority of patients, a number of failures occur. In those temporary intubation of the nasolacrimal duct with a silicone drain may solve the problem. We performed silicone intubation in 11 infants under nasal endoscopic control. By this improved visualization of the inferior meatus, the procedure was facilitated. In four children the probe was unable to pierce the nasal mucosa and stayed in the submucosal space. An incision of the nasal mucosa was needed before the probe could be passed into the nasal lumen. We believe that this situation, inability to pierce the nasal mucosa, may explain a number of failures of simple probing. It is therefore advisable, especially if initial probing has failed, to repeat the procedure under endoscopic control.     

Role of the nose in inspiration in mouth breathing: quantitative determination by analysis of expiratory gases

It is widely accepted that increased nasal resistance plays a major role in habitual mouth breathing. We investigated oronasal air flow distribution during voluntary mouth breathing in subjects without nasal obstruction. To determine whether nasal air flow contributes to total inspiratory flow, we administered 100% O2 by a nasal mask while the lips were kept apart by a mouth piece. Expired O2 concentrations measured at the mouth were a sensitive indicator of nasal admixture during inspiration. Theoretical considerations predict that mixed expired pO2 from two consecutive steady state periods should allow calculation of nasal admixture. Measurements made on 22 healthy volunteers revealed a very variable degree of nasal contribution to inspiratory air flow (mean +/- SD, 25 +/- 15%, range 3-70%). There was no correlation between this proportion and anthropometric data, smoking habits, nasal resistance, or presence of rhinitis. We suggest that changes in the position of the soft palate, tongue, and/or pharyngeal wall associated with respiration are mainly responsible for the within and between subject variation observed in this study. This explanation is consistent with recent experimental findings on the pharyngeal dilating muscles.     

Management of severe bilateral nasal wall collapse

OBJECTIVE: The aim of this study was to examine and analyze the pathology contributing to severe bilateral nasal wall collapse seen in certain revision rhinoplasty patients and identify those surgical maneuvers in the previous nasal surgery, which may have contributed to this complication; suggest alternatives or modifying steps in nasal surgery to prevent lateral wall collapse; analyze consecutive revision rhinoplasties and identify those patients who have complete bilateral nasal collapse at the internal nasal valve; and analyze the results achieved after surgical reconstruction of complete bilateral nasal collapse. PATIENTS: We identified 49 patients, who presented from 1990 to 2000 for revision surgery, who had bilateral collapse of the upper lateral cartilage. All patients had at least one previous rhinoplasty and all but 14 patients had undergone two or more procedures. The patients were reconstructed with a conchal cartilage graft placed through an external rhinoplasty approach. RESULTS: All patients complained of nasal obstruction with forced nasal inspiration. The collapse was visualized on inspiration and when prevented with intranasal positioning of a bayonet, all patients experienced an immediate improvement in nasal breathing. Postoperatively, all patients experienced this same improvement in their nasal airway. Collapse was not identified in any of the patients after surgery. Two patients underwent revision because of cosmetic asymmetries. CONCLUSION: We strongly recommend a cartilage overlay to reconstitute the rigid midline continuity of the upper lateral cartilages. Unfortunately, with any significant hump removal, this structural interruption is, to varying degrees, inevitable in most rhinoplasty techniques. The upper lateral cartilages can be sutured to circumvent some of the inferior drift, but this will not reconstitute the rigid lateral cantilever effect of the intact cartilage.     

Traumatic nasal arterio-venous malformation: a case report

Traumatic arterio-venous malformations of the nasal bones represent a rare but well defined clinical entity. We have described a case of a traumatic soft-tissue nasal arterio-venous malformation and commented on its investigation, pathophysiology and subsequent management. As far as we are aware this represents a hitherto unrecognised complication of nasal trauma.     

Use of nasal flowmeter to measure nasal patency

We determined nasal peak flow using a peak flowmeter with a face mask (PALROD peak expiratory flowmeter) and nasal airway patency with an anterior rhinomanometer (Nihon Koden MPR-1100) at a minimum time interval in the same individual. We compared the values obtained by two kinds of measurements to evaluate the usefulness of the peak flowmeter for nasal airway patency. In this study, the nasal patencies were experimentally changed and measured in 30 patients using alpha-1 stimulant spray and in 25 patients with nasal allergy using nasal provocation of antigens. We also measured the natural circadian changes of nasal patency in 21 patients with nasal allergy and in 18 normal persons every two hours from 8:00 A.M. to 8:00 P.M. and from 9:00 A.M. to 9:00 P.M., respectively. As a result, we found close correlations between percent change of the peak flow and the nasal airway patency measured after spraying alpha-1 stimulant (r = 0.699, p less than 0.01), after antigen provocation (r = 0.585, p less than 0.01), and during circadian change (r = 0.464, p less than 0.01 in normal persons and r = 0.251, p less than 0.05 in allergy patients). In conclusion, peak flowmeter is handier and cheaper than rhinomanometer and is useful in evaluating the effect of vasoconstrictors and nasal provocation on nasal patency and in measuring the circadian changes of nasal patency. Since nasal secretion in the nose affects the measurement of peak flow, it should be removed as much as possible immediately before the flowmeter is used.     

Frequency spectra of normal expiratory nasal sound

BACKGROUND: The computerized analysis of the nasal sound reflects the nasal airflow. We have developed a new software program that analyzes the nasal sound to use in the research area and clinical applications. We aimed to analyze automatically the spectral parameters of nasal sound in healthy people by our new versatile PC-based nasal sound analyzer software. METHODS: In this study, we analyzed and recorded the expiratory nasal sound in 30 healthy people. This analysis includes the time-expanded waveform, the spectral analysis with time-averaged fast Fourier transform, the automatic detection, and the waveform analysis of nasal sound. RESULTS: We calculated the mean frequency of low-intensity sound (LIS) and high-intensity sound (HIS). The mean frequency of LIS was found as 1254 +/- 10.23 Hz at the right nose and 1375 +/- 18.45 Hz at the left nose. The mean frequency of HIS was found as 2453 +/- 22.23 Hz at the right nose and as 2234 +/- 21.12 Hz at the left nose. These results showed that the values between LIS and HIS are statistically significant (p < 0.005) and different from each other. We found that the nasal sound of the similar nasal airflow was the same type and amplitude in the analysis of the nasal sound recordings. CONCLUSION: The frequency of the nasal sound is an indicator of the intensity of the nasal airflow. The method that provides the analysis of the nasal sound may lead to a new diagnostic method. The method, which is noninvasive, rapid, of low cost, and even applicable for small children, requires little cooperation of the subjects. In addition, it will be possible to record and save the analysis of the nasal airflow as digital data.     

A new in vitro method of decongestant assay of nasal mucosa: a preliminary report

BACKGROUND: The calculation of cell planar surface area, successfully used for glomerular mesangial cell-altered contractility, also is a reasonable methodology to assess nasal mucosal contractility. A simple technique that works particularly well with vasoconstriction-inducing agents has been introduced to test the effects of several drugs on patient turbinate nasal mucosa in vitro. This report will introduce this technique and present some of the initial findings. METHODS: We tested epinephrine, norepinephrine, pseudoephedrine HCl, and methoxamine, respectively, for effectiveness as a vasoconstricting drug. We also tested the effectiveness of verapamil as a vasodilating drug. A piece of nasal mucosa approximately 3 x 4 mm in size was mounted with a 27-gauge needle and submersed in a 4-mL muscle bath in a Petri dish at room temperature. The bath consisted of 4 mL of Kreb's solution. We recorded the decrease of nasal mucosa planar surface area in response to the application of vasoconstricting agents, as measured using a digital microscope connected to a Pentium III with morphometric software, as the estimated degree of contraction. A photograph of the same mucosa was taken every 3 minutes for a total period of 18 minutes. RESULTS: Nasal mucosa that was mounted in a muscle bath in a Petri dish and treated with a small dose of a nasal decongestant was l observed to contract. Drug dosage determined the degree of nasal mucosa contraction. Nasal mucosa similarly prepared but treated with a vasodilating agent, such as verapamil, exhibited a relaxation response only when pretreated with a vasoconstricting agent, such as methoxamine. Both vasoconstricting and vasodilating drugs induce dose-related responses in planar surface calculation. CONCLUSION: In this study, drug dosage determined the degree of nasal mucosa contraction. We also found that the rate of contraction and percent of contraction were dose dependent. We believe this new method will prove useful in studying the effects of drugs on nasal blood vessels.     

鼻息肉中血管内皮生长因子mRNA的检测与意义

目的 :检测鼻息肉组织和鼾症下鼻甲粘膜组织中的血管内皮生长因子 (VEGF) m RN A水平的表达 ,了解其在慢性炎症过程中的作用。方法 :取 6例行下鼻甲切除术的下鼻甲粘膜和 7例鼻息肉切除术的鼻息肉标本 ,用半定量的反转录 -聚合酶链反应 (RT- PCR)方法检测 VEGF的 m RNA表达。结果 :RT- PCR结果显示在鼻息肉组织中 V EGF的表达较鼾症患者下鼻甲粘膜组织明显升高。结论 :鼻息肉组织中 VEGF的表达显著升高 ,推测 VEGF在鼻息肉的形成、生长及复发过程中具有极其重要的作用。     

Inferior turbinate schwannoma: report of a case

Schwannomas of the nasal cavity are extremely rare. We evaluated a 42-year-old woman who presented with a 4-year history of slowly progressive nasal obstruction. The cause of the obstruction was identified as a schwannoma in the left inferior turbinate. The tumor was completely excised, and no sign of recurrence was evident at the 1-year follow-up. To the best of our knowledge, this is only the third case of a schwannoma originating in the inferior nasal turbinate that has been reported in the English-language literature. We review the clinical and pathologic features of this case.