Nasal polyps: pathogenesis and treatment implications

Nasal polyps (NPs) represent a common clinical end point for a myriad of inflammatory disease processes involving the paranasal sinuses. Chronic rhinosinusitis is the most common cause for NPs, but not all NPs are created equally. This article outlines the current understanding of pathogenesis in nasal polyposis and discusses the implications on therapy.     

北京城区春季花粉与过敏性疾病就诊比例分析

目的 监测北京城区春季优势花粉,初步推测其与过敏性疾病关系.方法 应用重力法监测2019年春季每日花粉种类及浓度,计算每月优势花粉.通过杜恩综合医生工作站系统统计同期本院变态反应科诊断为过敏性鼻炎(AR)、过敏性结膜炎(allergic conjunctivits,AC)和过敏性哮喘(allergic asthma,A...     

Rhinobronchial syndrome: pathogenesis and correlation with allergic rhinitis in children

AIM: In the rhinobronchial syndrome a direct causal relationship exists between local nasal irritation and bronchopulmonary disease. Although allergic rhinitis has often been associated with lower airway hyperresponsiveness, no direct relationship between the two has been shown to date. The aim of this study was to determine the role of allergic rhinitis in the pathogenesis of the rhinobronchial syndrome in children by evaluating the effect of topical nasal treatment on lower airway hyperresponsiveness. MATERIALS AND METHODS: A total of 168 children presenting with aeroallergy and nasal disease associated with bronchopulmonary disease (asthma, chronic cough, bronchopulmonary infection) were evaluated at baseline and at 1 year of follow-up. Nearly half (83) were noted to have signs of allergic rhinitis and were treated with topical nasal medications (cortisones and antihistamines). Changes in upper and lower airway diseases were evaluated and potential causal relationships established. RESULTS: Allergic rhinitis treatment improved nasal disease symptoms in 67 (80.7%) patients; partial remission or lower healing rates were found in those with asthma (16.4%) and chronic cough (11.1%). CONCLUSIONS: Although often associated with lower airway hyperresponsiveness, allergic rhinitis in children does not appear to be a pathogenetic factor, as confirmed by the scarce effect the nasal treatment had on the bronchopulmonary disease. Instead, the frequent co-existence of nasal and bronchial symptoms may come under the concept of global allergy of the airways.     

特异性免疫治疗对过敏性鼻炎和哮喘的同步控制和远期疗效

近年来，过敏性鼻炎(AR)和哮喘的患病率呈明显增加的趋势。随着对特异性免疫治疗(SIT)的不断了解与深入，目前认为该方法可能是惟一通过调节免疫机制从而改变变应性疾病的自然进程，并且可以在治疗停止之后获得长期疗效。综述了SIT对AR和哮喘的同步控制和远期疗效，通过国内外文献回顾及分析对比，认为SIT在治疗AR和哮喘的过程中起着十分重要且积极的作用，并且能够预防AR向哮喘进展。但是，SIT也存在一些问题,值得进一步研究及探讨。     

浅谈伴有变应性鼻炎的慢性鼻窦炎的治疗

慢性鼻窦炎和变应性鼻炎是两种常见的慢性上呼吸道疾病,存在着某些内在联系以及类似炎症机制。有必要完善慢性鼻窦炎、鼻息肉患者的术前变态反应检查以及治疗:包括避免过敏原(环境和食物)、免疫治疗、鼻腔冲洗、鼻用糖皮质激素、针对鼻窦病原体的抗菌药物、抗变态反应(抗组胺药、白三烯受体拮抗剂等)和抗胃食管反流。此外,维生素D诱导细胞分化、参加免疫调节和调节内分泌系统也在慢性鼻窦炎和变应性鼻炎的炎症过程中发挥重要作用。     

儿童腺样体肥大与耳鼻咽喉科常见疾病关系的研究进展

腺样体肥大(AH)是小儿耳鼻咽喉科的常见病、多发病。国内外学者关于AH的病因、临床症状及治疗方式均有深入研究并达成共识,但其与耳鼻咽喉科相关疾病的关系仍未得到广泛关注和重视。研究发现,AH与小儿耳鼻咽喉科的过敏性鼻炎(AR)、急慢性鼻-鼻窦炎(ARS/CRS)、急性中耳炎、分泌性中耳炎、中耳胆脂瘤、急慢性扁桃体炎、扁桃体肥大、儿童阻塞性睡眠呼吸暂停综合征(OSAS)及其他咽喉部疾病等均有密切联系。     

脂肪来源的间充质干细胞治疗变应性鼻炎的研究进展

变应性鼻炎(AR)是机体经变应原诱发产生的常见良性变态反应性疾病。除了与过敏相关的鼻部和眼部症状外,还会导致睡眠质量下降,白天生活质量降低等问题,影响患者的工作和生活。目前AR的治疗方法是以远离变应原及药物控制为主,且在疗效上有其局限性和弊端。干细胞疗法的应用在各疾病的治疗中正在得到极大地发展。脂肪来源的间充质干细胞(MSCs)因其独特的免疫调节及抗炎等作用以及获取方便等优势,在AR的治疗上具有相当的潜力。本文就脂肪来源MSCs治疗AR的实验研究进展作一综述。     

Clinical Characteristics of Allergic Rhinitis According to Allergic Rhinitis and Its Impact on Asthma Guidelines

Objectives

The Allergic rhinitis and its impact on asthma (ARIA) guidelines were suggested for use to classify allergic rhinitis (AR). However, few studies have been performed in Asians. The objective of this study is to identify the clinical characteristics of AR in Korean patients according to the ARIA guidelines.

Methods

For the study, 610 patients who had been diagnosed with allergic rhinitis at Seoul National University Bundang Hospital and 545 patients who had been diagnosed with allergic rhinitis at 3 local clinics were included. All the patients were categorized into 4 groups, such as the mild intermittent, mild persistent, moderate-severe intermittent and moderate-severe persistent groups. The patients were given a questionnaire on allergic rhinitis-related symptoms and they underwent blood tests, including the blood eosinophil count and the serum total IgE level.

Results

The most prevalent type was the moderate-severe persistent group (34.7%), and the moderate-severe intermittent group (17.1%) was the rarest. There were significant differences among the 4 groups for olfaction (P<0.001), self-awareness of rhinitis (P=0.013), a previous history of AR (P<0.001), self-awareness of asthma (P=0.001) and allergic conjunctivitis (P<0.001). On the allergy laboratory tests, there was a significant difference between the groups for the eosinophi count (P=0.004). The number of blood eosinophil was more in the persistent groups than in the intermittent groups.

Conclusion

According to the ARIA guidelines, the moderate-severe persistent group was the most prevalent for Korean patients. Blood eosinophilia and olfactory dysfunction were the most severe in the moderate-severe persistent group.     

Inhalant allergen sensitization is an independent risk factor for the development of angioedema

Background/objective

The etiology and risk factors for angioedema remain poorly understood with causative triggers often going undiagnosed despite repeated reactions. The purpose of this study was to determine the relationship between inhalant allergen sensitization and angioedema.

儿童鼻窦炎与哮喘:统一气道疾病

鼻窦炎和哮喘是儿童常见的异质性疾病,发病因素多样。慢性鼻窦炎可能是哮喘的危险因素,二者之间存在强关联性。上下气道炎症常伴发,具有共同的病理机制。对此,“统一气道疾病”的理论得到广泛认可。对于哮喘患者,特别是严重哮喘,常伴有鼻窦炎,是影响儿童哮喘严重程度和临床控制的主要合并症之一。对一种疾病的治疗可能会影响另一种疾病的控制,而深入理解病理生理学机制将有助于更好地进行疾病管理。本文从儿童鼻窦炎和哮喘的疾病特征、发病机制、药物治疗以及生物制剂治疗等方面进行讨论。     

A new audio processor for combined electric and acoustic stimulation for the treatment of partial deafness

Abstract

Conclusions. Modified vidian neurectomy combined with inferior turbinoplasty provided an optimal surgical outcome as a treatment for intractable chronic rhinitis as evidenced by a relatively long-term follow-up. Objective. The study was designed to determine the efficacy of submucosal reduction of the inferior turbinate and resection of the posterior nasal nerve for the treatment of resistant chronic rhinitis. Patients and methods. Fifty-six consecutive patients (37 males and 19 females; mean ± SD age, 26 ± 11 years) with resistant allergic rhinitis or nonallergic rhinitis with eosinophilia syndrome despite medical treatment. Symptomatic improvement including nasal obstruction, nasal discharge, sneezing, smell perception, and quality of life and objective evaluation of nasal airway resistance and nasal provocation test before and after surgery were investigated. Results. The patients showed a remarkable improvement of ≥80%, with the exception of two patients who had an approximately 50% reduction of the total symptomatic scores. Four of eight patients with anosmia subjectively improved whereas the other four patients felt unchanged. All patients who underwent rhinomanometry (n = 15) and nasal provocation testing (n = 15) both before and after surgery showed a significant improvement. There were no intraoperative complications. Postoperative epistaxis occurred in one patient. One patient complained of a transient hypesthesia of the soft palate and dry eye. Nasal mucosal tears were observed in approximately 30% of the patients who otherwise showed no severe synechia or persistent crusting.     

Prevalence of and associations with allergic rhinitis in children with chronic rhinosinusitis

Objectives

Chronic rhinosinusitis (CRS) in children has been associated with a variety of disorders including atopic disease, cystic fibrosis, immunologic disorders and ciliary dyskinesia. Although a strong association, or even cause and effect relationship, between allergic rhinitis (AR) and CRS is commonly assumed, the epidemiologic relationship between these disorders has not yet been defined in children.

Methods

A retrospective review of all children diagnosed with CRS on otolaryngology or allergy office evaluation at a large tertiary-care pediatric hospital over a ten-year period was performed. Demographic data and concomitant diagnoses of AR, cystic fibrosis, immunologic disorders and primary ciliary dyskinesia were analyzed for relationships with CRS.

Results

A total of 4044 children with an average age of 8.9 years and a slight male predominance (53.8%) with CRS were identified. Of these children, 0.2% had primary ciliary dyskinesia, 4.1% had cystic fibrosis, 12.3% had an immunologic disorder, and 26.9% had AR. A concomitant asthma diagnosis was positively associated with a diagnosis of AR (OR = 6.24, 95% CI: 5.27–7.39, P < 0.001), whereas a concomitant cystic fibrosis diagnosis was negatively associated (OR = 0.12, 95% CI: 0.06–0.26, P < 0.001).

Conclusions

AR is more prevalent than the other comorbidities combined in children with CRS, and is independently associated with the presence of asthma. Formal allergy testing, guided by clinical history and regional allergen sensitivity prevalence, should be strongly considered in all children with CRS, in particular those with reactive airway disease.     

尘螨疫苗皮下注射治疗变应性鼻炎的疗效和安全性评估

目的 本研究旨在通过使用标准化尘螨疫苗对变应性鼻炎伴或不伴支气管哮喘的患者进行2年皮下免疫治疗,探讨尘螨皮下免疫治疗的疗效和安全性。 方法 纳入58例对尘螨过敏(单一过敏35例,多重过敏23例)的变应性鼻炎患者,伴或不伴支气管哮喘。在治疗前与治疗后的第6、12、24个月,分析症状评分、视觉模拟量表评分和生活质量评分的变化,观察记录发生的局部及全身不良反应。 结果 与治疗前相比,鼻部症状和哮喘症状评分在治疗6个月后均显著降低(P<0.05),并在2年治疗期内呈持续性下降。治疗2年后,单一过敏患者和多重过敏患者的症状评分差异无统计学意义(P>0.05)。皮下免疫治疗6、12、24个月后,鼻炎和哮喘的相关生活质量也得到了显著改善(P<0.05)。发生的不良反应以局部反应为主,未出现严重不良反应。 结论 皮下免疫治疗是针对尘螨引起的变应性鼻炎的一种安全、有效的治疗方法,对于变应性鼻炎合并支气管哮喘的患者,也能取得显著的疗效。