The prognostic significance of β-catenin,cyclin D1 and PIN1 in minor salivary gland carcinoma: β-catenin predicts overall survival

Minor salivary gland carcinoma is a rare and heterogeneous type of cancer. Molecular prognostic and predictive markers are sparse. The aim of this study was to identify new prognostic and predictive markers in minor salivary gland carcinoma. 50 tissue samples of carcinomas of the minor salivary glands (adenoid cystic carcinoma n = 23, mucoepidermoid carcinoma n = 12, adenocarcinoma n = 10, carcinoma ex pleomorphic adenoma n = 2, salivary duct carcinoma n = 1, clear cell carcinoma n = 1, basal cell carcinoma n = 1) were immunohistochemically stained for β-catenin, cyclin D1 and PIN1. Expression patterns were analyzed and correlated to clinical outcome of 37 patients with complete clinical data. High expression of membranous β-catenin was linked to significantly better overall survival in patients with adenoid cystic carcinoma (log rank test, χ² = 13.3, p = .00397, Bonferroni corrected p = .024). PIN1 and cyclin D1 did not show any significant correlation to patients’ clinical outcome. Expression of β-catenin in adenoid cystic carcinoma of the minor salivary glands significantly correlates with better overall survival. Hence, evaluation of β-catenin might serve as a clinical prognostic marker.     

A prospective investigation of predictive parameters for post-surgical recurrences in sinonasal polyposis

Even after appropriate surgical therapy, a significant number of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) experience recurrences. The end-point of this prospective study was to apply univariate and multivariate statistical models to identify clinical, pathological, and laboratory variables that could predict CRSwNP recurrence after endoscopic sinus surgery. The study enrolled 143 patients between 2010 and 2013, who were all treated by the same surgeon for CRSwNP. Twenty-one patients developed recurrent polyposis. The recurrence rate was significantly higher for the eosinophilic than for the non-eosinophilic type (p = 0.020). Among the patients who developed a recurrence, the disease-free interval was significantly shorter for those with eosinophilic-type polyposis (p = 0.003). Univariate statistical analysis disclosed significant associations between CRSwNP recurrence and age (p = 0.035), allergy (p = 0.014), and eosinophilic granulomatosis with polyangiitis (p = 0.01). The multivariate model showed that only histological evidence of the eosinophilic type of CRSwNP retained an independent prognostic significance in relation to recurrent polyposis (p = 0.033). Judging from our results, it is reasonable to consider both stricter follow-up protocols and postoperative adjuvant medical treatments for patients with a histological diagnosis of eosinophilic-type CRSwNP.     

A 16-year experience in treating thyroglossal duct cysts with a “conservative” Sistrunk approach

Although Sistrunk operation is the standard method to treat thyroglossal duct cyst, the reported recurrence rates after a “classic” or “modified” Sistrunk procedure still varied from 0 to 15.8 %, indicating the existence of some technical uncertainties. While simple cystectomy has been recognized as the most important prognostic factor predicting thyroglossal duct cyst recurrence, whether other clinico-pathological parameters also affect disease recurrence has not been well studied. We retrospectively reviewed the medical records of all patients who underwent thyroglossal duct cyst surgery between June 1998 and June 2014 at our institution. Among the 180 primary patients, 160 patients received a “conservative” Sistrunk operation, while the remaining 20 patients received simple cystectomy only. Five patients (2.8 %, 5/180) had recurrence. Four of them received simple cystectomy while 1 had “conservative” Sistrunk operation. In univariable analysis, age (p = 0.02), history of previous infection (p = 0.004) and the type of resection (p = 0.001) were significantly correlated with disease recurrence. In multivariable analysis, the type of resection turned out to be the most important factor (p = 0.03) related to recurrence. In the most parsimonious model selected by backward elimination, both history of infection (p = 0.048) and the type of resection (p = 0.02) were important predictors of postoperative recurrence. Our results demonstrated that a “conservative” Sistrunk approach could provide a comparably low recurrence rate (0.6 %, 1/160) in dealing with primary thyroglossal dust cysts. Routine dissection of suprahyoid tissue may not be imperative. Overall, the type of resection and history of infection are the most important predictors of recurrence for thyroglossal duct cyst.     

The incidence of thyroid cartilage invasion through the anterior commissure in clinically early-staged laryngeal cancer

In this study, the incidence of thyroid cartilage invasion in early-stage laryngeal tumors involving anterior commissure was assessed. Medical charts and pathology reports of 62 patients who underwent supracricoid partial laryngectomy as the primary treatment of early-staged laryngeal squamous cell carcinoma were retrospectively reviewed. Patients were divided into two groups according to the macroscopic examination of the surgical specimen: tumors limited to the glottis with the involvement of anterior commissure (TLG); tumors invading both supraglottis and glottis with the involvement of anterior commissure (TISG). Thirty-seven of the cases were classified as TLG group (59.7 %) and the remaining 25 of them were classified as TISG group (40.3 %). Thyroid cartilage invasion was observed totally in ten patients (16.1 %), as macroscopic invasion in two cases and microinvasion in eight patients. Only two were in the TLG group (cartilage invasion rate of 5.4 %), the remaining eight were in the TISG group (cartilage invasion rate of 32 %). Thyroid cartilage invasion rate of TISG group was significantly higher than that of TLG group (p = 0.011, p < 0.05). Tumors limited to the glottis with AC involvement may be more suitable for endoscopic resection; on the contrary, tumors with vertical extension invading both AC and supraglottis should be evaluated more suspiciously due to high rate of thyroid cartilage invasion, which may still necessitate external laryngectomy techniques.     

(Chemo)radiotherapy after laser microsurgery and selective neck dissection for pN2 head and neck cancer

This study analyzed the efficacy of transoral laser microsurgery and postoperative (chemo) radiotherapy (CRT) for head and neck squamous cell carcinoma. Between 1987 and 2007, 318 patients with pN2 neck disease were included. Seventy-three patients received laser resection and neck dissection alone, 154 postoperative radiotherapy, and 91 postoperative (C)RT. Mean follow-up was 58.2 ± 51.2 months, and locoregional control was significantly better after postoperative (C)RT (surgery alone: 42 %, radiotherapy: 57 %, CRT: 59 %; p < 0.01). Postoperative (C)RT did not have a significant impact on disease-specific survival (DSS) (surgery alone: 55 %, radiotherapy alone: 60 %, CRT: 64 %; p = 0.36). Fifty-seven patients (17.92 %) developed distant metastases, and 39 patients (12.26 %) presented with secondary malignancies, with no significant differences found between the treatment groups. Postoperative (C)RT significantly improved locoregional control, but had no significant effect on DSS because of high rates of secondary malignancies and distant metastases. Reduced radicality in combination with an effective screening might improve prognosis and quality of life of these patients.     

Prognostic factors for local control in patients receiving radiation therapy for early glottic cancer: anterior commissure involvement and effect of chemoradiotherapy

To assess the prognostic factors for local control in patients with early glottic cancer, we retrospectively analyzed the data of 130 consecutive patients who were treated by definitive radiation therapy (RT) or concurrent chemoradiotherapy (CRT) for early glottic squamous cell carcinoma (UICC sixth edition T1N0M0 and T2N0M0) at Kanagawa cancer center between 1999 and 2011. There were 63 patients with T1 cancer and 67 patients with T2 cancer. Twenty-one patients with T2 tumors were treated by chemoradiotherapy (CRT). The median follow-up period was 73 months (range, 22–165 months). The 5-year local control (LC) rate in all patients was 81 %. The 5-year LC rates in the patients with T1 and T2 cancer were 89 and 74 %, respectively. Univariate analysis showed that a higher T stage (T2) (p = 0.0301), anterior commissure involvement (p < 0.000001), and habitual drinking (p = 0.054) were correlated with decreased local control rate. Multivariate analysis identified only anterior commissure involvement as a significant prognostic factor for local control (LC rate 91 vs. 51 %, risk ratio 5.3, 95 % CI 2.3–12, p < 0.001). In the patients with T2 cancer, there was no statistically significant difference in the LC rate between patients who received RT alone and those who received CRT (RT alone 76 % vs. CRT 67 %; p = 0.832). The findings of this study suggest that anterior commissure involvement is a significant factor influencing the prospect of local control. CRT was not found to be effective for T2 patients in this study.     

Profiles of resting potentials across the stria vascularis in kanamycin-deafened guinea pigs

The resting potentials of the marginal cells in the stria vascularis of the guinea pig were determined from changes in the combined electrode-tissue resistance of the electrode. The resistance of the electrode was 45.5±16.0 MΩ (n=20) before penetration of the stria vascularis and 46.7±17.3 MΩ (n=20) after penetration. The resistance drops across the luminal membrane of the marginal cells were 46.0±22.6 MΩ (n=12) in kanamycin-deafened guineal pigs and 54.5±33.1 MΩ (n=9) in normal guinea pigs. The endocochlear potential (EP) and resting potentials in the marginal cells were 90.1±6.0 mV (n=14) and 70.4±11.3 mV (n=14) in kanamycin-deafened guinea pigs and 84.8±5.1 mV (n=29) and 74.7±11.7 mV (n=29) in normal guinea pigs. The resting potentials in the marginal cells decreased gradually and were approximately 0 mV around 20 min after anoxia in both kanamycin-deafened and normal guinea pigs. These changes were comparable to those of EP in kanamycin-deafened guinea pigs during anoxia. The mechanism of the EP in kanamycin-deafened guinea pigs is discussed.     

The effect of partial superficial parotidectomy on amplitude,latency and threshold of facial nerve stimulation

The aim of this study is to assess the effect of partial superficial parotidectomy and facial nerve dissection to electrophysiologic parameters of intraoperative facial nerve monitoring such as nerve stimulation threshold, stimulus amplitude and latency. Twenty-five patients who underwent partial superficial parotidectomy for benign parotid gland mass were included in the study. After the identification of the facial nerve main trunk, minimum stimulation threshold, latencies and amplitudes of the orbicularis oculi (electrode 1) and orbicularis oris (electrode 2) electrodes at 0.50 milliamperes (mA) were recorded. All of the recordings were repeated after the completion of parotidectomy. Median nerve dissection duration was calculated and size of the tumors was measured during macroscopic pathology. The median minimum nerve stimulation threshold was 0.15 mA [interquartile range (IQR) = 0.05] before and 0.15 mA (IQR = 0.08) after the parotidectomy (p = 0.02). Median nerve dissection duration was 49 min (IQR = 38). Median amplitude and latency in electrode 1 before and after the facial nerve dissection were 322 millivolts (mV) (IQR = 330), 370 mV (IQR = 370) (p = 0.02), 3 milliseconds (ms) (IQR = 1) and 4 ms (IQR = 2) (p = 0.05), respectively. Median amplitude and latency in electrode 2 before and after the facial nerve dissection were 396 mV (IQR = 275), 365 mV (IQR = 836) (p = 0.86), 3 ms (IQR = 1.5) and 4 ms (IQR = 1.5) (p = 0.17), respectively. Minimal nerve stimulation threshold and amplitude of electrode 1 were affected by facial nerve dissection among the electrophysiologic parameters (p = 0.02 and p = 0.02). Of the electrophysiological parameters only the latency of electrode 2 was significantly correlated with tumor size (p = 0.03). Besides, none of the parameters were predictive for a possible postoperative facial nerve dysfunction regarding superficial partial parotidectomy.     

Long-term outcomes of central neck dissection for cN0 papillary thyroid carcinoma

Objective.The risk-benefit ratio of central neck dissection (CND) in patients affected by papillary thyroid carcinoma (PTC) without clinical or ultrasonographic (US) evidence of neck lymph node metastasis (cN0) is currently debated. The aim of this study was to evaluate long-term outcome of CND on locoregional recurrence, distant metastasis, survival, and postoperative complications in a large series of patients with cN0-PTC.Study Design.Observational retrospective controlled study.

Effects of endocrine therapy on the prognosis of elderly patients after surgery for papillary thyroid carcinoma

Papillary thyroid carcinoma (PTC) is a common thyroid malignancy. Elderly patients have more severe disease and more complications following postoperative endocrine therapy to control thyroid-stimulating hormone (TSH) levels. We aimed to identify optimal postoperative serum TSH levels in elderly patients to prevent recurrence and metastasis and minimize complications. This retrospective cohort study collected data of 87 consecutive elderly patients (age >75) who underwent surgery for PTC with postoperative levothyroxine therapy (50–150 μg/d) between January 2006 and June 2008 and were followed until 2013. After 24 patients with TSH fluctuations and incomplete data were excluded, 73 patients were grouped based on postoperative TSH levels: Group A, 0.3–0.5 mIU/mL; Group B, 0.1–0.3 mIU/mL; and Group C <0.1 mIU/mL (n = 24, 25, 24, respectively). Subjects’ baseline, preoperative data, postoperative complications and 1-, 3- and 5-year follow-up data were compared between groups. No significant differences in gender, age (median age of 80 years old), surgery type or clinical characteristics were found between groups (all p value >0.05). Postoperatively, all subjects had normal ECG and neck ultrasound, no osteoporosis, and no differences in survival rate or metastasis. Five-year follow-up revealed significant differences in development of arrhythmias, osteoporosis, insomnia and anxiety between Groups B (0.1–0.3 mIU/mL) and C (<0.1 mIU/mL) compared to Group A (0.3–0.5 mIU/mL). Postoperative incidence of PTC recurrence and metastasis remained stable in elderly patients undergoing thyroid surgery and endocrine therapy but complications increased significantly with increasing TSH levels. Controlling TSH to lower limits of normal may help prevent PTC recurrence and metastasis and reduce complications in this high-risk population.     

Rapid-maxillary-expansion induced rhinological effects: a retrospective multicenter study

Conventional dental-borne rapid maxillary expansion (RME) leads to a widening of the airways, followed by improved nasal breathing. Although combined skeletal–dental appliances are nowadays being inserted increasingly often and provide a force at the center of resistance in the nasomaxillary complex, no study exists so far that shows whether this treatment may improve the expansionary effect on the airways. In this study, low-dose computed tomography (CT) images from 31 patients (average age 14.63 ± 0.38 years) were examined retrospectively. Both records (T0 = before expansion and T1 = immediately after maximum expansion) were taken in a time interval of 25 days to avoid growth influence. Five patients were treated with Hyrax RME, 6 patients with Hybrid RME, and 20 patients with acrylic cap RME. The total airway volume increased highly significantly (mean +7272.6 mm³; P < 0.001, power = 0.998), representing an average airway expansion of +11.54 % (2.35 %/mm activation). While the nasopharynx and oropharynx showed highly significant expansion (P < 0.000, power = 0.999), the airway at the laryngopharynx did not change significantly (P > 0.779, power = 0.05). Although the patients were significantly older in the Hybrid RME group (P = 0.006), the positive rhinological effects were comparable within all groups of different appliances (P > 0.316). Hybrid RME may, therefore, be an advisable procedure in patients with nasomaxillary impairment and pronounced patient’s age.     

Glutaminolysis and carcinogenesis of oral squamous cell carcinoma

Glutaminolysis is a crucial factor for tumor metabolism in the carcinogenesis of several tumors but has not been clarified for oral squamous cell carcinoma (OSCC) yet. Expression of glutaminolysis-related solute carrier family 1, member 5 (SLC1A5)/neutral amino acid transporter (ASCT2), glutaminase (GLS), and glutamate dehydrogenase (GLDH) was analyzed in normal oral mucosa (n = 5), oral precursor lesions (simple hyperplasia, n = 11; squamous intraepithelial neoplasia, SIN I–III, n = 35), and OSCC specimen (n = 42) by immunohistochemistry. SLC1A5/ASCT2 and GLS were significantly overexpressed in the carcinogenesis of OSCC compared with normal tissue, while GLDH was weakly detected. Compared with SIN I–III SLC1A5/ASCT2 and GLS expression were significantly increased in OSCC. GLDH expression did not significantly differ from SIN I–III compared with OSCC. This study shows the first evidence of glutaminolysis-related SLC1A5/ASCT2, GLS, and GLDH expression in OSCC. The very weak GLDH expression indicates that glutamine metabolism is rather related to nucleotide or protein/hexosamine biosynthesis or to the function as an antioxidant (glutathione) than to energy production or generation of lactate through entering the tricarboxylic acid cycle. Overcoming glutaminolysis by targeting c-Myc oncogene (e.g. by natural compounds) and thereby cross-activation of mammalian target of rapamycin complex 1 or SLC1A5/ASCT2, GLS inhibitors may be a useful strategy to sensitize cancer cells to common OSCC cancer therapies.     

A novel muscle for electroneurography in peripheral facial palsy: occipitalis

Electroneurography (ENoG) is one of the most objective tests in grading the damage and prediction of prognosis in peripheral facial palsy (PFP). We aimed to determine temporal changes of ENoG recorded over occipitalis muscle in acute idiopathic PFP. Consecutive 21 patients with unilateral acute idiopathic PFP and age- and sex-matched 15 healthy volunteers were included in the study. Nasal and occipital ENoG values were recorded once in the control group and the same procedure was repeated daily between the second and eight days of the disorder in the PFP group. Occipital ENoG value began to increase on the third day while nasal ENoG value was still within the normal range (27.04 vs 7.69 %, p = 0.0001). In the fourth, fifth and sixth days, occipital ENoG value was significantly high compared to nasal ENoG value (p = 0.0001 for each day) whereas nasal and occipital ENoG values were very similar in the seventh and eighth days (p = 0.181 and p = 0.584, respectively). Our study presents further support for technical possibility of occipital ENoG which may reflect the degree of fiber degeneration earlier than the nasalis muscle in PFP.     

Long-term vestibulocochlear functional outcome following retro-sigmoid approach to resection of vestibular schwannoma

The objective of this study was to evaluate long-term vestibulocochlear functional outcomes of patients operated for unilateral vestibular schwannoma via the retro-sigmoid approach. Patients who underwent vestibular schwannoma resection via retro-sigmoid approach between 2004 and 2008 at our institution, without prior surgical or radio-surgical therapy were considered to be eligible for this study. Preoperative auditory and vestibular symptoms were assessed retrospectively. Postoperative symptoms were prospectively assessed using a standardised questionnaire, pure tone audiometry, video-oculography, and rotary chair testing. Out of a total of 203 patients, 120 were eligible for this study, of whom 64 responded to follow-up requests and could be enrolled. Serviceable hearing was reported in 42 patients (66 %) preoperatively and was maintained in 18 (43 %) postoperatively. While no significant change in rate of tinnitus and balance impairment between pre- and postoperative periods was detected, vertigo decreased significantly (40 to 28 %, p < 0.001). Postoperative video-oculography demonstrated vestibular paresis in 80 %. Rotary chair testing demonstrated normal or central compensation in 84 %. Absence of central compensation was associated with postoperative balance disturbance (p = 0.035). Increasing tumour size and patient age, also decreasing quality of preoperative hearing were independent factors predictive of a postoperative non-serviceable hearing (p = 0.020, p = 0.039 and p = 0.002, respectively). Resection of vestibular schwannoma via the retro-sigmoid approach is associated with improvement in postoperative vertiginous symptoms. Absence of central compensation leads to increased postoperative balance disturbances. Preservation of serviceable postoperative hearing is associated with good preoperative hearing status, younger age, and smaller tumours.     

Cochlear implantation through the round window with a straight slotted electrode array: optimizing the surgical procedure

The question addressed here is how optimizing the quality of insertion through the round window with the lower morbidity, when using a straight and slotted electrode array of regular length. This retrospective analysis includes all cases implanted with a cochlear implant Digisonic SP (Neurelec-Oticon Medical) since 2004. We checked the operative charts, the depth of insertion, and the follow-up. For comparisons, contingency tables were used and a Chi-square test was performed. A p value <0.05 was considered significant. 126 cases of patients with non-malformed cochleas were implanted through the round window. The mean age was 53.8 ± 16.2 for adults and 3.6 ± 2.6 for children (24 cases). The mean follow-up was 33 ± 22 months. The straight electrode array had either a square or a soft pointed tip (n = 84). Full insertion was achieved in 79 out of 84 cases with a soft tip vs. 18 out of 42 square tips (χ² = 41.41, DOF = 1, p < 0.0001). Two cases were stuck at the round window niche by a prominent crista fenestrae. In all cases but one, the chorda tympany was preserved. In one case, a misrouting to the vestibule required a revision surgery. Implantation through the round window with a straight and slotted electrode array with a soft tip (Digisonic SP, Neurelec-Oticon Medical) can lead to a full insertion in 94 % of cases. Drilling out a prominent crista fenestrae is recommended.     

Bioelectrical impedance phase angle and subjective global assessment in detecting malnutrition among newly diagnosed head and neck cancer patients

Malnutrition, which can be determined by subjective and objective methods, has a high prevalence in head and neck cancer patients. Subjective Global Assessment is a subjective method of nutritional status evaluation. Phase angle, determined by bioelectrical impedance analysis, is proposed as an objective nutritional marker in various disease conditions. The study was conducted to investigate the association between phase angle and Subjective Global Assessment to validate the determination of the nutrition status in adult patients with head and neck cancer. In a prospective cohort study, patients were classified as either well-nourished or malnourished using the Subjective Global Assessment. Phase angle measured by bioelectrical impedance analysis was planned in 75 naive patients with histologically confirmed head and neck cancer. Receiver operating characteristic curves were estimated using the non-parametric method to determine the optimal cut-off level of phase angle. The study was conducted on a cohort population of 75 patients. Well-nourished patients (n = 45) had a statistically significantly higher (p = 0.005) median phase angle score (5.25º) as compared to those who were malnourished (4.73º) (n = 30). A phase angle cut-off of 4.73 was 80 % sensitive and 56.7 % specific in detecting malnutrition diagnosed by SGA in these populations. Phase angle is considered to be a nutritional indicator in patients with head and neck cancer in detecting malnutrition. Further observations are needed to calculate survival, and validate the prognostic significance of phase angle. For future studies, it is important to indicate the specificity of the PA in comparison to SGA measurement.     

Ultrasonography in the diagnosis of nasal bone fractures: a comparison with conventional radiography and computed tomography

The purpose of this study was to evaluate and compare the diagnostic efficacy of ultrasonography (US) with radiography and multi-detector computed tomography (CT) for the detection of nasal bone fractures. Forty-one patients with a nasal bone fracture who underwent prospective US examinations were included. Plain radiographs and CT images were obtained on the day of trauma. For US examinations, radiologist used a linear array transducer (L17-5 MHz) in 24 patients and hockey-stick probe (L15-7 MHz) in 17. The bony component of the nose was divided into three parts (right and left lateral nasal walls, and midline of nasal bone). Fracture detection by three modalities was subjected to analysis. Furthermore, findings made by each modality were compared with intraoperative findings. Nasal bone fractures were located in the right lateral wall (n = 28), midline of nasal bone (n = 31), or left lateral wall (n = 31). For right and left lateral nasal walls, CT had greater sensitivity and specificity than US or radiography, and better agreed with intraoperative findings. However, for midline fractures of nasal bone, US had higher specificity, positive predictive value, and negative predictive value than CT. Although two US evaluations showed good agreements at all three sites, US findings obtained by the hockey-stick probe showed closer agreement with intraoperative findings for both lateral nasal wall and midline of nasal bone. Although CT showed higher sensitivity and specificity than US or radiography, US found to be helpful for evaluating the midline of nasal bone. Furthermore, for US examinations of the nasal bone, a smaller probe and higher frequency may be required.     

Nasal congestion after visual sexual stimulation with and without sildenafil (Viagra<Superscript>®</Superscript>): a randomized placebo-controlled study

Sildenafil (Viagra^®) is a selective phosphodiesterase type 5 inhibitor (PDE5-I) approved for treatment of erectile dysfunction. Although relatively well-tolerated, sildenafil is associated with undesired effects including headache, flushing, dyspepsia, nasal congestion, and visual disturbances. In the present study we explored the impact of sildenafil on nasal airway parameters in young potent men. Eleven men (age 26.0 ± 1.8 years) with normal BMI (25.7 ± 0.5) and without nasal respiratory disorders were enrolled in a double-blind, crossover study. All men underwent evaluation of systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), SpO₂%, acoustic rhinometry, and nasal endoscopy before and after placebo or sildenafil (50 mg) plus visual sexual stimulation (VSS). Nasal examination was performed using 0° rigid telescopes, 4 mm in diameter. A Student’s t test was used for direct comparisons, while the Kruskal–Wallis test (K–W) was utilized for multiple comparisons. After administration of sildenafil plus VSS, the minimum cross sectional area (MCA) was significantly lower that observed with either placebo (P = 0.03) or sildenafil alone (P = 0.003). However, the post-stimulation values did not demonstrate any significant differences among the different treatment arms (P = 0.48; DF = 2; K–W test). In contrast, endonasal volume (VOL) was significantly lower after sildenafil + VSS (P = 0.01), but not after placebo + VSS (P = 0.18). None of the other parameters monitored showed any significant variations. Rhinoscopy showed a characteristic increase of the volume of the inferior turbinates, with subjective differences between placebo and sildenafil. These preliminary results suggest that sildenafil reduces nasal volume, and that sexual stimulation may decrease nasal airflow by itself.