变应性鼻炎引起嗅觉障碍的临床分析

目的分析变应性鼻炎引起嗅觉障碍的发病机制。方法选取216例变应性鼻炎患者作为实验对象,同时选取99例健康志愿者作为对照组。采用嗅棒气味嗅觉测试方法测定两组患者的嗅觉功能;采用酶联免疫吸附法检测鼻腔分泌物中嗜酸性粒细胞阳离子蛋白（eosinophil ationicprotein,ECP）及类胰蛋白酶的含量;应用鼻压计测定鼻气道阻力。结果变应性鼻炎患者鼻气道阻力与对照组比较差异无统计学意义（P〉0．05）;变应性鼻炎组患者嗅觉功能,鼻腔分泌物ECP和鼻腔分泌物类胰蛋白酶与对照组比较,差异具有统计学意义（P〈0．05）。结论嗜酸性粒细胞和肥大细胞的活性增加可能导致了变应性鼻炎患者的嗅觉障碍,而鼻腔阻塞可能不是引起变应性鼻炎患者嗅觉障碍的主要原因。     

Up-date on neuro-immune mechanisms involved in allergic and non-allergic rhinitis

Non-allergic rhinitis (NAR) is a common disorder, which can be defined as chronic nasal inflammation, independent of systemic IgE-mediated mechanisms. Symptoms of NAR patients mimic those of allergic rhinitis (AR) patients. However, AR patients can easily be diagnosed with skin prick test or allergen-specific IgE measurements in the serum, whereas NAR patients form a heterogeneous group and are difficult to diagnose because of an extensive list of different phenotypes, all varying in severity, underlying etiology and type of inflammation. Characterization of those phenotypes, mechanisms and management of NAR represents one of the major unmet needs in the field of allergic and non-allergic diseases. This review aims at providing a comprehensive overview of the state of the art in classifying the NAR patients and focuses on the neuro-immune mechanisms involved in allergic and non-allergic rhinitis, including reflections on the pathophysiology and the currently available treatment options.     

IL-16和IL-17在变应性及非变应性鼻炎中的表达水平及意义

目的：检测变应性鼻炎（AR）、非变应性鼻炎（NAR）患者和健康对照者在外周血及鼻分泌物中IL-16和IL-17的表达水平,初步探讨IL—16和IL-17可能参与AR发病的免疫学机制。方法：选取AR患者（AR组）与NAR患者（NAR组）各45例,健康对照者45例（对照组）,所有入组患者均进行过敏原皮肤点刺试验和血清特异性IgE检测。对入组的所有患者进行鼻部症状的视觉模拟量表评分（VAS）。采集患者外周血及鼻腔分泌物,检测其中IL-16和IL-17的表达水平。结果：AR及NAR组患者VAS评分差异无统计学意义（P〉0．05）;在外周血中,AR组中IL-16和IL-17表达水平高于NAR组（P〈O．05）;NAR组中IL-16和IL-17表达水平高于对照组（P〈0．05）。鼻分泌物中,AR组和NAR组中IL-16和IL-17表达均高于对照组（P〈0．05）。结论：IL-16和IL-17可能参与AR的病理过程,具体机制有待进一步探讨。     

儿童非变应性鼻炎与变应性鼻炎患者生活质量的对比研究

目的：分析比较儿童非变应性鼻炎（NAR）患者与变应性鼻炎（AR）患者生活质量之间的差异,探讨NAR对患儿生活质量的影响。方法2011年6月～2012年6月在门诊首次确诊的52例NAR患儿和69例AR患儿（6～12岁）,指导患儿及家长采用视觉模拟量表（VAS）评价患儿的鼻、眼及胸部症状,并采用儿童鼻结膜炎生活质量调查表（RQLQ）评估并比较NAR与AR患儿的生活质量有无差异。统计结果采用SPSS13.0软件进行分析。结果 NAR组与AR相比,VAS评分无明显差异（P〉0.05）;RQLQ两组评分无明显差异（P〉0.05）。NAR组内,各项症状VAS评分比较差异有统计学意义（P〈0.01）,“鼻堵”为首要症状;RQLQ各项目以及各方面间比较差异均有统计学意义（P〈0.01）,各项鼻部症状相比差异有统计学意义（P〈0.05）,“鼻堵”和“流涕”为首要症状,各项非鼻眼部症状相比差异也有统计学意义（P〈0.01）,“注意力难以集中”为首要症状。结论 NAR对患儿的生活质量有着明显的影响,值得临床护理工作中重视。     

Impaired olfactory function in mice with allergic rhinitis

Objective

It has been reported that olfactory function is impaired in patients with allergic rhinitis. However, the mechanism of olfactory dysfunction in allergic rhinitis remains poorly understood. Because of difficulties in obtaining and analyzing human olfactory mucosa due to both technical and ethical issues, an animal model needs to be established to clarify the mechanism of olfactory dysfunction in allergic rhinitis. The purpose of this study was to study olfactory function and changes in olfactory mucosa using allergic rhinitis mice.

Methods

A model of allergic rhinitis mice with olfactory dysfunction was developed by sensitizing with ovalbumin (OVA), and intranasally challenging with the same allergen. Olfactory function of mice with or without allergic rhinitis was assessed by odor detection ability test with cycloheximide and local field potential (LFP) with 1-octanal. We also evaluated histological changes in the olfactory mucosa of allergic rhinitis mice by both light and electron microscopy.

Results

Both of odor detection ability test and LFP showed that olfactory function was impaired in mice with allergic rhinitis, but not in mice without allergic rhinitis. Histopathological findings showed prominent infiltration of eosinophils, plasma cells, neutrophils, mast cells, and macrophages in lamina propria of olfactory mucosa of mice with allergic rhinitis, although infiltration of these cells was not seen in control mice. Allergic rhinitis also increased the number and size of glands in olfactory mucosa, suggesting an elevated amount of mucin in olfactory mucosa.

Conclusion

This study showed for the first time that mice with allergic rhinitis have impaired olfactory function, increased size and number of olfactory glands, and infiltration of eosinophils, neutrophils, mast cells, plasma cells, and macrophages in the olfactory mucosa. This suggests that allergic reactions are seen in olfactory mucosa of mice with allergic rhinitis, and that greater olfactory gland activity is associated with olfactory dysfunction. Also, this mouse model could provide an expedient system for analyzing mechanisms of olfactory dysfunction.     

Comparison of pre- and post-operative stress levels in patients with allergic rhinitis and non-allergic rhinitis

The effects of stressful events, such as surgery, on patients with allergic diseases are unclear. The aim of this study was to evaluate whether patients with allergic rhinitis (AR) are more susceptible to stress and oxidative stress than non-allergic individuals. 20 AR patients and 20 non-allergic rhinitis (NAR) patients were recruited to this study and underwent nasal septoplasty. To evaluate the degrees of stress and oxidative stress, we collected urine and blood samples 1?day before and 1?day after surgery. Stress was assessed by measuring urine cortisol levels. Oxidative stress was assessed by calculating the balance of reactive oxygen metabolites (ROM) measured by the diacron reactive oxygen metabolites test, and antioxidant capacity (AC) was measured by the biological antioxidant potential test. In both groups, the level of post-operative urine cortisol was significantly higher than the pre-operative level, with no significant difference between the two groups. ROM levels were significantly higher in both groups after surgery than before surgery. The antioxidant capacity of the AR group was lower after surgery than before surgery, while it was greater in the NAR group after surgery. There were no significant differences in pre- or post-operative ROM or AC levels between the two groups. The ROM/AC ratio was significantly higher after surgery in the AR group than it was in the NAR group. The post-operative ROM/AC imbalance of AR patients suggests that these patients might be vulnerable to stress, especially oxidative stress.     

非变应性鼻炎与变应性鼻炎患者患病相关因素比较

目的 调查和比较非变应性鼻炎(non-allergic rhinitis,NAR)与变应性鼻炎(allergic rhinitis,AR)患者的年龄、性别、发病季节以及相关环境因素的差异.方法 收集2010年1-8月在门诊首次确诊的NAR患者111例与AR患者112例,通过调查问卷详细记录患者的一般资料、病史经过及患病相关因素.采用SPSS 13.0软件进行统计学分析.结果 相对于AR而言,NAR随着年龄增加患病人数有增加的趋势.NAR的好发年龄为21～30岁,而AR的好发年龄处于11～20岁.在18岁以上成年人中,NAR和AR患者的平均年龄((-x)±s)分别为(38.6±14.5)岁和(32.8±13.0)岁,差异有统计学意义(t=2.58,P=0.024).NAR在30岁前以男性居多,30岁后则女性病例数上升;而AR患者在20岁前以男性居多,20岁后则以女性多见.NAR在冬季高发(χ2=27.57,P=0.000),AR则高发于春季(χ2=13.75,P=0.003);冬季NAR的发病例数明显多于AR(χ2=12.34,P=0.000).在相关环境因素中,居住地或工作场所靠近交通干道者NAR的发病风险是AR的1.94倍,而居住地或工作场所位于建筑物底层或每天日照<2 h者AR的发病风险分别是NAR的1. 77倍和1.91倍.当患者有过敏性疾病个人史或家族史时,可使AR的发病风险升高至NAR的2.14～4.06倍.NAR患者自报的发病诱因主要为温度变化(56.3%)、经常上呼吸道感染(52.8%)、气候改变(32.4%)和刺激气味(31.1%)等,但与AR患者比较,这些非特异性诱发因素差异均无统计学意义(P值均>0.05).结论 NAR与AR患者在年龄、性别和发病季节分布,个人和家族过敏史,以及某些与发病相关的环境因素等方面存在明显差异.     

变应性鼻炎与食物因素相关性的初步研究

目的 :探讨变应性鼻炎 (AR)的发病与食物因素的相关性。方法 :对AR组 10 1例 (其中并发支气管哮喘 10例 )与非变应性鼻炎 (NAR)组 112例作食物频率问卷调查。主要询问含脂肪、盐、糖类较多的食物进食情况 ,得出饮食总分。并将组胺配制成不同的浓度 ,滴入下鼻甲 ,检测鼻高反应性。结果 :AR组的饮食总分与NAR组差异有显著性意义 (P <0 .0 5 ) ;AR组的鼻高反应性强度与NAR组差异有极显著性意义 (P <0 .0 1) ;饮食总分与组胺剂量间①单纯AR组和②AR、NAR两组合并均存在负相关关系 (P <0 .0 5 )。结论 :AR发病与饮食因素存在相关性。鼻高反应性随食物中脂肪、盐、糖类增加而增强     

Serum 25-hydroxyvitamin D3 levels in children with allergic or nonallergic rhinitis

ObjectivesThe relationship between vitamin D and allergic diseases such as asthma and atopic dermatitis is shown in several studies. But there is a lack of knowledge about vitamin D status in children with allergic rhinitis (AR). We aimed to investigate serum vitamin D levels of children with AR or nonallergic rhinitis (NAR), to compare with normal subjects and to evaluate the relationship between vitamin D and the severity of AR.MethodsThe study included a total of 141 children (76 patients with rhinitis and 65 control subjects), who applied to the Pediatric allergy immunology outpatient. Skin prick tests were performed using the same antigens for all patients. Serum 25-hydroxyvitamin D3 (25OHD3) levels were measured. AR was classified according to the ARIA guidelines.ResultsMean 25OHD3 levels were 18.07 ± 6.1 ng/mL in the AR group, 14.81 ± 4.86 in the NAR, and 24.03 ± 9.43 ng/mL in the control group. These differences among groups were statistically significant (p = 0.001). Vitamin D status was determined as deficient in 32 (66.7%) patients, insufficient in 14 (29.2%) and normal in 2 (4.2%) of the AR group. These frequencies for NAR and control groups are 25 (89.3%), 3 (10.7%), 0, and 25 (38.5%), 32 (49.2%), 8 (12.3%), respectively. Vitamin D status was found to be different among groups (p = 0.001). There were not any association between 25OHD3 levels and allergen sensitivity (p > 0.05). The comparison of the mean 25OHD3 levels according to the severity and duration of AR did not detect statistically significant difference among groups (respectively, p = 0.384, p = 0.23 Denburg J, Fokkens WJ, Togias A5).ConclusionsThe mean serum 25OHD3 levels of the children both with AR and NAR were lower than control group. No association between 25OHD3 levels and allergen sensitivities was found in our study. We did not find any relationship between 25OHD3 levels and the severity and duration of allergic rhinitis     

A study of the role of different forms of chronic rhinitis in the development of otitis media with effusion in children affected by adenoid hypertrophy

Objective

The aim of the present study was to evaluate the role of the different forms of chronic rhinitis in the pathogenesis of otitis media with effusion in children affected by obstructive adenoid hypertrophy.

Methods

81 patients, aged between 4 and 15 years (mean age of 6.9 years), affected by obstructive adenoid hypertrophy were evaluated. All patients underwent accurate history taking, physical examination with endoscopy of the nasopharynx, skin prick test, nasal cytology and hearing evaluation.

Results

Nasal citology showed that 21% of patients had a non-allergic rhinitis (NAR) subtype, 17.4% NAR overlapping with infectious rhinitis (IR), 29.6% IR, 4.9% allergic rhinitis (AR), 2.5% AR overlapping with IR and the remaining 24.6% a negative cytology. The presence of OME was positively correlated with neutrophils (p = 0.01) and mast cells (p = 0.022), while it was negatively correlated with the presence of eosinophils (p = 0.02) and bacteria (p = 0.02).

Conclusions

A chronic rhinitis was present in more than 70% of children with AH and 60% of them showed OME. Nasal cytology together with SPT showed that AR was rarely present in this group of children, while the mast-cells and neutrophils positively correlated with OME.     

Prevalence of Self-reported Allergic and Non-allergic Rhinitis Symptoms in Stockholm: Relation to Age,Gender, Olfactory Sense and Smoking

Objective--To estimate the prevalence of isolated self-reported allergic and non-allergic rhinitis symptoms in an adult population and to explore the relations to age, gender, olfaction and smoking habits. Material and methods--Self-judged health and environmental exposures were investigated by means of a questionnaire survey administered to a stratified random sample of 15,000 adults in Stockholm County. Results--A total of 10,670 individuals were included in the analysis, corresponding to a response rate of 73%. The results revealed a high prevalence of self-reported non-allergic rhinitis, 19%, almost as high as the prevalence of self-reported allergic rhinoconjunctivitis, 24%. In contrast to current clinical opinion, we did not find a significant increase in the prevalence of non-allergic symptoms with increased age. There were no statistically significant gender differences in the prevalence of either allergic or non-allergic symptoms. A reduced sense of smell was twice as common in the non-allergic group, 23%, as in the healthy population. The prevalence of rhinitis symptoms differed according to smoking habits. Conclusion--Both self-reported allergic rhinitis symptoms and non-allergic nasal symptoms are frequent in the population sample. Self-reported non-allergic nasal symptoms seem to occur independent of age and reduced olfactory sense is a common complaint among these subjects. The prevalence of self-reported allergic and non-allergic nasal symptoms did not differ much between men and women or between individuals with different smoking habits.     

广州地区变应性鼻炎与非变应性鼻炎临床特征的研究

目的　了解广州地区变应性鼻炎和非变应性鼻炎患者在年龄、性别和发病季节的特征和差异,并且探讨近10年两者比例的变化趋势。方法　5486例鼻高反应症状患者分为变应性鼻炎组和非变应性鼻炎组,对两组患者的临床特征资料进行分析。结果　广州地区近10年变应性鼻炎与非变应性鼻炎的比例无明显变化趋势。变应性鼻炎与非变应性鼻炎均以男性患者为主,性别差异有统计学意义。变应性鼻炎患者年龄小于非变应性鼻炎患者年龄,变应鼻炎男性患者发病年龄低于女性患者,而非变应性鼻炎发病年龄在性别分布上无明显差异。随年龄增加变应性鼻炎患者比例逐渐下降而非变应性鼻炎比例逐渐增加。本地区变应性鼻炎在夏季高发,而非变应性鼻炎则高发于冬季。结论　广州地区变应性鼻炎与非变应性鼻炎患者在年龄、性别和发病季节等临床特征方面存在明显差异,但近10年两者比例无明显变化趋势。     

Chronic rhinitis in HTLV-1 carriers: a histopathologic study

The nasal histopathology of HTLV-1 carriers with chronic rhinitis is unknown.ObjectiveTo describe the histopathological features of HTLV-1 carriers with chronic rhinitis.Materials and MethodsBiopsies of nasal mucosa of ten HTLV-1 carriers with chronic rhinitis (eight patients with allergic rhinitis and two patients with non-allergic rhinitis) were studied using a light microscope. Samples from ten patients with allergic rhinitis not infected with HTLV-1 were used as controls.ResultsSubepithelial fibrosis was more pronounced in patients with allergic rhinitis infected with HTLV-1 (p=0.01), while the basement membrane thickness was greater in controls (p=0.03). There was a trend towards less eosinophilia and edema among those infected with HTLV-1, without statistical significance (p=0.2). For the lymphocytic infiltrate, there was no difference between infected and not infected patients with allergic rhinitis (p=1.0). Subepithelial fibrosis associated to moderate or small number of lymphocytes were found in the two HTLV-1 carriers with non-allergic rhinitis.ConclusionsThis study suggests HTLV-1 may modify the histopathology of allergic rhinitis, especially by promoting subepithelial fibrosis, and may be related to chronic non-allergic rhinitis with lymphocytic infiltrate.     

Nasal lavage cytology and mucosal histopathological alterations in patients with rhinitis

IntroductionThe extent of epithelial lesion in allergic and non-allergic rhinitis and its association with inflammatory changes in nasal lavage has not been clarified.ObjectiveTo verify the association between the inflammatory cells in the nasal lavage, epithelial lesion extent and basement membrane thickness, in the nasal mucosa of patients with rhinitis; to determine the cutoff point of the percentage of eosinophils in the nasal lavage associated with the atopic patients.MethodsPatients with rhinitis and indication for septoplasty and (or) turbinectomy for turbinate hypertrophy were selected, and were submitted to allergy skin tests, nasal lavage with measurement of albumin and interleukin-8 levels, total and differential counting of cells, and mucosal histopathological analysis to determine the extent of epithelial lesion, and degree of basement membrane thickening.ResultsFifty-six patients with a median age of 24.5 years and a diagnosis of allergic rhinitis (n = 36) and non-allergic rhinitis (n = 20) were studied. In atopic subjects, allergy skin tests were positive for Dermatophagoides pteronyssinus in 35 (97.0%) and Lolium perenne in 18 (50.0%). Atopic subjects showed a higher clinical score index of rhinitis compared to non-atopic ones. The total count of cells, neutrophils, and levels of albumin and IL-8 were not different in the nasal lavage of atopic and non-atopic subjects. The cutoff point for eosinophil count in nasal fluid for the distinction between allergic rhinitis and non-allergic rhinitis was 4%. Some degree of epithelial lesion was more frequent in allergic rhinitis (94%) than in non-allergic rhinitis (65%) patients. In the presence of basement membrane thickness, as a marker of remodeling, there was no difference in the nasal lavage of patients with allergic rhinitis and non-allergic rhinitis.ConclusionIn this series, 4% was the cutoff point for the number of eosinophils in the nasal lavage, for atopy differentiation. Upper airway remodeling accessed by basement membrane thickness showed similar inflammatory cell infiltrate in the nasal lavage, regardless of the presence of atopy.     

变应性鼻炎对儿童阻塞性睡眠呼吸暂停低通气综合征的影响

目的 探讨变应性鼻炎(AR)对儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的影响。方法 经多导睡眠监测(PSG)明确诊断的OSAHS患儿91例, 对其进行血清学过敏原检测。依据病史、查体及过敏原检测结果将其分成非AR组及AR组, 比较两组的呼吸暂停低通气指数(AHI)及最低血氧饱和度(LSaO₂)。统计学方法为两独立样本t检验, P<0.05为差异有统计学意义。结果 AHI结果AR组高于非AR组, LSaO₂结果AR组低于非AR组。结论 变应性鼻炎可能是加重OSAHS严重程度的因素之一。     

腺样体肥大儿童伴变应性鼻炎与分泌性中耳炎的相关性分析

目的 分析腺样体肥大儿童伴分泌性中耳炎(ＯＭＥ)与变应性鼻炎(ＡＲ)发病的相关性。方法 回顾性分析12岁以下870例腺样体肥大患儿的病史,分析AR、咽鼓管功能不良及OME的相关性。结果 本组腺样体肥大患儿中AR发病率为30.11%,AR在不同年龄组中的发病率差异有统计学意义,随着年龄增加,发病率逐渐升高(P<0.01)。6岁以内发生咽鼓管功能障碍及OME的概率高,其中1~3岁组发生分泌性中耳炎的概率最大(P<0.01)。春季OME发病率高(P<0.001)。与不伴AR患者相比,伴有AR患儿患咽鼓管功能不良的概率增加了0.4倍(P=0.042);但患有OME的检出率减少了32%(P=0.0472)。结论 在腺样体肥大患儿中,多种因素使咽鼓管功能不良乃至OME高发。其中咽鼓管及其周围结构生理、病理、发育特点是最主要的因素,变态反应是次要影响因素。随着年龄增长,前者因逐渐发育完善,致病性降低,后者致病性增高,但总的发病率是逐渐降低的。     

变应性鼻炎伴嗅觉障碍小鼠嗅黏膜的观察

目的观察变应性鼻炎伴嗅觉障碍小鼠嗅黏膜形态结构的改变及相关免疫组织化学变化,探讨变应性鼻炎对嗅觉功能的影响。方法将40只BALB/C小鼠随机分为实验组(30只)和对照组(10只)。实验组应用卵清蛋白致敏后,利用埋藏食物小球实验(buried food pellet test,BFT)评估小鼠嗅觉功能,ELISA法测定并比较血清中IgE水平。建立变应性鼻炎伴嗅觉障碍小鼠动物模型。取小鼠鼻腔嗅黏膜,观察形态结构的改变,检测各组嗅黏膜中嗅觉标记蛋白(olfactory marker protein,OMP)和神经元特异性烯醇化酶(neuron- specific enolase,NSE)的表达。结果变应性鼻炎伴嗅觉障碍组嗅黏膜OMP阳性的成熟嗅感觉神经元(olfctory receptor neurons,ORNs)减少,与变应性鼻炎不伴嗅觉障碍组及对照组相比差异存在统计学意义(P=0.046<0.05,P=0.039<0.05)。变应性鼻炎伴嗅觉障碍组嗅黏膜NSE阳性的成熟ORNs减少,与变应性鼻炎不伴嗅觉障碍组及对照组相比差异存在统计学意义(P=0.041<0.05,P=0.033<0.05)。结论通过卵清蛋白致敏激发可以成功建立变应性鼻炎伴嗅觉障碍小鼠的动物模型。变应性鼻炎的炎症反应导致嗅黏膜的改变,可能是变应性鼻炎嗅觉障碍的发病机制之一。     

变应性鼻炎和非变应性鼻炎临床特征比较

目的探讨变应性鼻炎（allergic rhinitis,AR）和非变应性鼻炎（non-allergic rhinitis,NAR）临床特征的差异。方法选取2010年1月～2010年12月在我院门诊就诊的AR和NAR患者1647例,通过病史采集、皮肤点刺实验（skin fastinsertion test,SPT）、鼻分泌物涂片嗜酸性粒细胞计数和血清总IgE检查等评价分析两者的差异。结果鼻炎患者中AR占72.4%,NAR占2 7.6%;AR患者发病年龄（25.8±1 3.5）岁,显著低于NAR患者发病年龄（31.4±16.0）岁,两者比较差异有统计学意义（P〈0.001）;AR发病有明显的季节性,NAR发病受季节性影响不大。鼻部症状中,AR易出现打喷嚏（AR,88.4%;NAR,47.9%）,两组比较差异有统计学意义（P〈0.001）;鼻痒症状AR占8 4.4%,NAR占4 3.6%,两组比较有统计学意义（P〈0.001）;而NAR易出现鼻塞（NAR,9 6.3%,AR,9 1.2%）,两组比较差异有统计学意义（P〈0.001）和流涕（NAR,9 3.5%,AR,91.8%）,两组比较差异有统计学意义（P〈0.05）。AR患者鼻分泌物涂片嗜酸性粒细胞比例占50.1%±33.1%,血总IgE（359.7±323.4）IU/ml,且显著高于NAR患者20.1%±30.5%,123.0IU/ml±205.6 IU/ml,两组比较差异有统计学意义（P均〈0.001）。结论 AR与NAR在发病年龄、发病季节、临床症状、鼻分泌物涂片嗜酸性粒细胞比例和血总IgE上有明显差异。     

Partial laser turbinectomy: two year outcomes in patients with allergic and non-allergic rhinitis

OBJECTIVE: The aim was to compare two year outcomes of partial laser turbinectomy in patients with allergic and non-allergic rhinitis with respect to nasal obstruction symptom scores and nasal peak inspiratory flow rates (nPIFR). This has not been reported previously. METHOD: Fifty-four patients underwent partial laser turbinectomy (28 with allergic rhinitis, 26 with non-allergic rhinitis). NPIFR was measured preoperatively, at 3 months and two years postoperatively. A symptom score questionnaire was also completed. RESULTS: Both allergic and non-allergic patients showed a significant improvement in symptom scores and nPIER at three months (n = 54). The improvement in allergic patients was greater. In the 31 patients seen at two years, there was still a significant improvement in median symptom scores but no such improvement in median nPIFR. In allergic patients (n = 18) at two years, there was no significant improvement in symptom and nPIFR scores. Non-allergic patients (n = 13), however, did show sustained significant improvement in these scores (p < 0.05). Eighty-seven percent (26/31) considered the operation successful and would recommend it to others. CONCLUSIONS: Non-allergic patients derive a more sustained improvement in the medium term compared to allergic individuals when undergoing partial laser turbinectomy. The improvement in symptom scores in the group as a whole was still significant.     

Nasal airway response to infused phenylephrine in normals and in patients with allergic and non-allergic rhinitis

To find whether patients with chronic rhinitis might be congested because of hyporesponsiveness to adrenergic vasoconstrictive influences, we measured nasal airway resistance (NAR) in normals and allergic and non-allergic rhinitics during intravenous infusion of graded doses of phenylephrine. All responded with decreases in NAR and first evidences of NAR fall appeared no later in those with rhinitis than in normals. Nasal congestion and response were asymmetrical; absolute NAR in the low resistance side was similar in all groups and there was little response to phenylephrine. In the high resistance side, NAR reached its minimum by the time the total infused dose was 1400 mcg, indicating maximum response to drug was achieved within the dose range studied. Minimum NAR achieved on the high resistance side was higher in rhinitics suggesting residual vascular engorgement resistant to phenylephrine or non-vascular mucosal swelling. Resistance to adrenergic vasoconstriction does not appear to be the primary contributor to mucosal swelling in chronic rhinitis.