Patients with positive allergen test have less favorable outcome after endoscopic microdebrider-assisted inferior turbinoplasty

BACKGROUND: Endoscopic microdebrider-assisted inferior turbinoplasty is a newly developed surgical technique to treat patients with nasal obstruction. Although the procedure has been reported to be safe and effective, we tested the hypothesis that the prognosis might deteriorate with time in allergic rhinitis patients as identified by a positive allergen test in patients who have a persistent regional inflammation of the nose. We assessed the degree of nasal obstruction in a prospective cohort to investigate whether positive allergen test predicts outcome. METHODS: In 70 consecutive patients, the symptom of nasal obstruction was evaluated subjectively by a visual analog scale (VAS) and objectively by acoustic rhinometry using cross-sectional area of the second notch (CSA-2) and nasal cavity volume before operation, and 3 months, 12 months after operation, respectively. Then, patients were classified and compared according to the multiple-antigen simultaneous test (MAST). RESULTS: Both MAST(+) and MAST(-) groups showed statistically significant improvement in VAS score, CSA-2, and nasal cavity volume at 12 months after operation (p < 0.01). Of note, MAST(+) patients showed less favorable results than MAST(-) patients at 12 months after operation (p < 0.05). CONCLUSION: Microdebrider-assisted inferior turbinoplasty provides effective relief for patients with nasal obstruction. However, such turbinate surgery may be successful only for a short period of time in patients with allergic rhinitis. Our finding suggests that, in selecting appropriate candidates, surgeons should consider criteria other than symptomatology, especially in patients with allergic rhinitis who may have manifestations other than at the level of the inferior turbinate contributing to nasal blockage.     

Passive smoking, allergic rhinitis and nasal obstruction in children

Allergic rhinitis is a common cause of nasal obstruction in childhood. This prospective study looked at the effect of passive smoking on nasal obstruction in children with and without allergic rhinitis. Eighty-one children took part. Each child was asked to score his or her degree of nasal obstruction on a visual analogue scale. Exposure to passive smoking was determined subjectively using a parental questionnaire, and objectively by measuring the urinary cotinine/creatinine ratio. Results were tabulated using Microsoft Excel and analysed with SPSS statistical software. Nasal obstruction was significantly worse in children with a positive history of allergic rhinitis (p < 0.05). There was also a trend towards a higher nasal obstruction score in children without allergic rhinitis exposed to passive smoking compared to those who were not so exposed. As would be expected, nasal obstruction is worse in children with allergic rhinitis than in those without. Passive smoking tends to increase the symptom of nasal obstruction in children without allergic rhinitis.     

等离子射频消融术在鼻腔手术中的联合应用

目的:探讨在鼻腔手术中联合应用等离子射频消融术治疗下鼻甲肥大及变应性鼻炎的疗效。方法:91例伴下鼻甲肥大及变应性鼻炎的鼻中隔偏曲或鼻息肉患者,行鼻中隔成形术或鼻内镜下鼻息肉摘除加筛窦开放术后,其中62例行等离子射频消融术(消融组),29例未行等离子射频消融术(对照组)。术前及术后3个月应用视觉模拟评分表(VAS)评价鼻塞的主观感觉。根据1997年海口会议疗效评定标准判断变应性鼻炎的疗效。结果:消融组术前鼻塞VAS评分左、右侧分别为(89.5±8.7)%和(90.3±10.5)%,术后3个月分别为(26.2±8.7)%和(32.1±10.3)%,左、右侧分别与术前比较,差异有统计学意义(均P<0.01);32例变应性鼻炎患者,显效31例(96.9%),有效1例(3.1%)。对照组术前鼻塞VAS评分左、右侧分别为(90.5±8.0)%和(89.9±11.5)%,术后3个月分别为(39.2±8.9)和(48.1±8.1)%,左、右侧分别与术前比较,差异均有统计学意义(均P<0.01);16例变应性鼻炎患者,显效4例(25.0%),有效10例(62.5%),无效2例(12.5%)。两组术后VAS评分差异有统计学意义(P<0.01)。结论:在鼻腔手术中联合应用等离子射频消融术治疗下鼻甲肥大及变应性鼻炎安全、有效。     

Posture-induced nasal obstruction in patients with allergic rhinitis

Nasal resistance is affected by posture. In this study, the effects of supine and lateral recumbent positions were investigated in eight normal subjects and 31 patients with allergic rhinitis. Of the 31 patients with allergic rhinitis, five showed unilateral complete nasal obstruction and one patient showed bilateral complete obstruction during the change of posture. Total nasal resistance had a tendency to increase with repeating the change of posture (a paired t-test, P < 0.05). The supine and lateral recumbent positions did not induce variable changes in total nasal resistance in normal subjects. Posture induces complete nasal obstruction in the supine or lateral recumbent positions in some patients with allergic rhinitis.     

Prospective evaluation of the method of measurement of the peak nasal inspiratory flow (PNIF) in allergic rhinitis. Observational study "Pratic in ORL"

OBJECTIVES: To establish the ENT specialists's interest for the nasal obstruction measurement by the Peak Nasal Inspiratory Flow (PNIF) for the primary care medical management of patients with allergic rhinitis. MATERIAL AND METHODS: A nation wide mail survey was conducted on the whole set of 2,800 French ENT specialists. Physicians had to use the PNIF in 4-consecutive patients with allergic rhinitis and assess through a questionnaire their interest for this tool. RESULTS: About 8% of all ENTs (n = 228) responded. 65.3% of them had used the PNIF with their 4 patients, 29.7% used it in only 1 to 3 of their patients, and 5% did not use it at all. The PNIF was mainly used in moderate to severe rhinitis (94%) in contrast with mild rhinitis (32%) and in persistent rhinitis (94.2%) compared to intermittent rhinitis (54.8%). The primary motivation to use the PNIF on a systematic basis was to quantitatively assess nasal obstruction and to obtain an objective measurement of nasal obstruction. Conversely, the reasons for not using the PNIF were the needless of an objective measurement of nasal obstruction, the drawback of the PNIF in the patient physician relationship and lack of patient's acceptance of the device. Most physicians considered training for a correct usage of the PNIF was easy. Finally, about 2 thirds of the sample gave a positive rating on the usefulness of the PNIF for their patients. CONCLUSION: This study demonstrates the interest of the practitioners to dispose of a simple and reliable tool for the follow up of nasal obstruction in allergic rhinitis.     

Neuronal nitric oxide synthase immunoreactivity in the nasal mucosa of patients with idiopathic and allergic rhinitis

The localization of neuronal nitric oxide synthase (nNOS) in the mucosa of the inferior and middle turbinates of 30 patients with and without allergic rhinitis was examined by immunohistochemical methods. Staining of paraffin sections from allergic and nonallergic patients revealed nNOS immunoreactivity (nNOS-IR) in the muscular layer of vessels, in the basal portion of submucosal glands and in the periost and the osteocytes of the turbinate bones. In contrast to earlier investigations, nNOS-IR was also seen in the nasal respiratory epithelium of allergic and nonallergic patients. The immunostaining of sections of submucosal glands from allergic patients was stronger than that of sections from patients with idiopathic rhinitis or patients with no nasal obstruction. The present result - nNOS-IR around glands is elevated in patients with allergic rhinitis - could indicate that this enzyme is involved in the pathogenesis and symptomatology of allergic rhinitis.     

Nasal hyperreactivity to methacholine measured by acoustic rhinometry in asymptomatic allergic and perennial nonallergic rhinitis

This study was carried out to assess nasal response to different doses of methacholine and to evaluate the diagnostic possibilities of this test. Thirty-seven patients with allergic rhinitis induced by pollen (out of season), 16 with nonallergic rhinitis, and 25 normal subjects were evaluated. After provocation with saline, increasing doses of methacholine, ranging from 0.5 to 16 mg/mL, were applied. Nasal obstruction was assessed by acoustic rhinometry 10 minutes after each dose, the minimum cross-sectional area and the nasal volume in both fossae were obtained. Ipratropium bromide was applied after the last dose of methacholine to evaluate reversibility. After methacholine challenge with 0.5, 1, 2, and 4 mg/mL there was a statistically significant decrease (p < 0.05) in nasal area and volume in a dose-dependent manner in patients with allergic and nonallergic rhinitis in comparison with controls. A ROC (receiver-operating characteristic) analysis showed that a decrease in nasal volume > or = 20% at methacholine concentration of 2 mg/mL is able to predict the presence of rhinitis (positive predicted value 93%, negative predicted value 79%) in 75% of subjects. The clinical relevance of this finding suggests that patients with symptomatic nonallergic rhinitis or even asymptomatic patients with allergic rhinitis out of pollen season present a nasal hyperreactivity to methacholine, and that a decrease of nasal volume > 20% by acoustic rhinometry after challenge with methacholine at 2 mg/mL is able to discriminate these patients from normal subjects. This method seems to be a suitable tool in the diagnosis of rhinitis.     

Relationship between rhinitis duration and response to nasal decongestion test

Objectives/Hypothesis: Nasal obstruction depends on allergic inflammation. Decongestion tests evaluate the reversibility of nasal airflow limitation. It has been previously reported that duration of persistent allergic rhinitis (PER) may involve important functional consequences. The purpose of the study was to evaluate the impact of the duration of rhinitis on the response to nasal decongestion test in a cohort of patients with PER. Methods: A total of 312 patients with moderate‐severe PER were prospectively and consecutively evaluated: 234 males and 78 females, mean age 23.6 years. A detailed clinical history was taken and complete physical examination, nasal endoscopy, skin prick test, rhinomanometry, and nasal decongestion test were performed for all patients. Results: A strong inverse correlation was observed (Pearson's r = −0.81) between rhinitis duration (years) and posttest percentage change of nasal airflow values. Conclusions: The duration of PER may induce a progressive impairment of the response to nasal decongestion test.     

Allergic rhinitis does not constitute a risk factor for obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is a condition characterized by recurrent episodes of obstruction of the upper airway. The aim of this study was to evaluate whether nasal obstruction due to allergic rhinitis constitutes a risk factor for OSAS. Patients (n = 119) presenting typical symptoms of sleep apnea were tested for OSAS using polysomnography. Additionally all patients were tested in vivo and in vitro (including nasal eosinophilic cationic protein) for allergic rhinitis. Examination for allergic rhinitis revealed that 88.3% of all patients had no allergic rhinitis, whereas only 11.7% were diagnosed as allergic. No significant differences in sleeping parameters were observed between allergic and non-allergic patients. Comparison of parameters indicative of relevant OSAS (apnea-hypopnea index [AHI] > 10) revealed that 60% of non-allergic patients had relevant OSAS, compared to only 50% of allergic patients. Investigation of allergic subgroups revealed similar results: no significant differences in sleeping parameters or elevated rates of relevant OSAS parameters were observed, especially in perennial allergic rhinitis due to house dust mites. No elevated rates of allergic rhinitis were observed in the studied cohort of patients suffering from sleep apnea or OSAS. Furthermore, no significant differences in sleeping behavior or polysomnography parameters were found on comparing allergic and non-allergic patients. In summary, our data rule out allergic rhinitis as a major risk factor for OSAS.     

Impaired norepinephrine-mediated contraction of isolated nasal mucosa in guinea pigs with allergic rhinitis

BACKGROUND: One of the causes of nasal obstruction associated with allergic rhinitis probably is caused by the dilatation of plexus cavernosum in nasal mucosa. In this study, the change in vascular responsiveness of nasal mucosa was investigated in the septal mucosae isolated from guinea pigs with allergic rhinitis. METHODS: An allergic rhinitis model was prepared in guinea pigs by repeated challenge with aerosolized dinitrophenylated-ovalbumin antigen. Twenty-four hours after the last antigen challenge, the changes in the isometrical tension of isolated nasal septal mucosa were measured. RESULTS: In isolated nasal mucosal tissues, both norepinephrine (NE) and leukotriene D4 caused concentration-dependent contractile and relaxant responses, respectively. The NE-induced contractile response was significantly attenuated in nasal mucosae of the repeatedly antigen challenged guinea pigs. The mucosal relaxation induced by leukotriene D4 was slightly attenuated in this animal model of allergic rhinitis. CONCLUSION: This study shows an attenuation of NE-induced contraction of isolated nasal mucosa in the antigen-exposed guinea pigs. The impaired contractile response mediated by sympathetic alpha-adrenoceptors of nasal blood vessels might be involved in the development of nasal obstruction in allergic rhinitis.     

地氯雷他定治疗季节性变应性鼻炎疗效及安全性观察

目的:评价地氯雷他定治疗季节性变应性鼻炎(SAR)的疗效及安全性.方法:采用随机、对照方法,治疗组40例,口服地氯雷他定5 mg/d;对照组35例,口服氯雷他定10 mg/d,疗程12 d;分别分析、评估其疗效及安全性.结果:治疗组总有效率为92.50%,对照组总有效率为85.71%,两组总有效率比较差异有统计学意义(P＜0.05);与治疗前比较,治疗组SAR患者服用地氯雷他定后鼻塞程度减轻,差异有统计学意义(P＜0.05);治疗组不良反应发生率为2.50%.结论:地氯雷他定能有效缓解SAR患者包括鼻塞在内的鼻部和非鼻部症状,安全性好.     

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.     

变应性鼻炎中嗅觉障碍的研究进展

单纯变应性鼻炎导致的嗅觉障碍不仅是机械阻塞的结果，鼻粘膜嗜酸粒细胞炎症可能是更主要的原因。变应性鼻炎合并鼻窦炎和鼻息肉者，其嗅觉障碍的原因可能为机械阻塞加炎症。通过综述国内外相关文献，以期对炎症因素在变应性鼻炎嗅觉障碍发病机制中的作用以及变应性鼻炎的诊断和治疗原则作一阐述和初步探讨。     

Allergic Rhinitis does not Constitute a Risk Factor for Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is a condition characterized by recurrent episodes of obstruction of the upper airway. The aim of this study was to evaluate whether nasal obstruction due to allergic rhinitis constitutes a risk factor for OSAS. Patients (n = 119) presenting typical symptoms of sleep apnea were tested for OSAS using polysomnography. Additionally all patients were tested in vivo and in vitro (including nasal eosinophilic cationic protein) for allergic rhinitis. Examination for allergic rhinitis revealed that 88.3% of all patients had no allergic rhinitis, whereas only 11.7% were diagnosed as allergic. No significant differences in sleeping parameters were observed between allergic and non-allergic patients. Comparison of parameters indicative of relevant OSAS (apnea-hypopnea index [AHI] &gt; 10) revealed that 60% of non-allergic patients had relevant OSAS, compared to only 50% of allergic patients. Investigation of allergic subgroups revealed similar results: no significant differences in sleeping parameters or elevated rates of relevant OSAS parameters were observed, especially in perennial allergic rhinitis due to house dust mites. No elevated rates of allergic rhinitis were observed in the studied cohort of patients suffering from sleep apnea or OSAS. Furthermore, no significant differences in sleeping behavior or polysomnography parameters were found on comparing allergic and non-allergic patients. In summary, our data rule out allergic rhinitis as a major risk factor for OSAS.     

春季花粉浓度对过敏性鼻炎患者的影响

目的 探讨春季花粉浓度及其对过敏性鼻炎(AR)患者的发病时间及临床症状的影响.方法 使用Durhum花粉采集仪监测北京城区2011年3～6月花粉的浓度和种属;过敏原皮肤点刺试验筛选春季花粉过敏的AR患者,分为单纯花粉过敏患者组(单纯组)及花粉并常年性过敏原过敏患者组(混合组),两组患者均予症状评估,并分析其发病时间与花...     

变应性因素及变应性鼻炎与慢性鼻-鼻窦炎鼻息肉的相关性探讨

目的：探讨变应性因素及变应性鼻炎（AR）与慢性鼻-鼻窦炎鼻息肉的临床相关性。方法：将200例研究对象分为A、B组,A组诊断为AR（110例）,B组诊断为慢性鼻-鼻窦炎鼻息肉（90例）,通过欧蒙印迹法定量检测血清sIgE浓度并观察慢性鼻-鼻窦炎鼻息肉手术治疗后的复发率、AR并发慢性鼻-鼻窦炎鼻息肉的发生率。结果：A组sIgE总阳性率为89.09%,B组sIgE总阳性率为74.44%。B组中sIgE阳性者术后复发率为58.21%,sIgE阴性者术后复发率为8.70%。A组41例（37.27%）并发慢性鼻-鼻窦炎鼻息肉,血清sIgE阳性率为97.56%;69例（62.73%）未并发慢性鼻-鼻窦炎鼻息肉,血清sIgE阳性率为79.71%;组内slgE阳性率比较差异有统计学意义（χ2=6.96,P〈0.01）。结论：变应性因素及AR与慢性鼻-鼻窦炎鼻息肉的发生有一定的相关性,提示避免接触变应原、合理治疗AR能够有效控制慢性鼻-鼻窦炎鼻息肉的复发率。     

Radiofrequency for the treatment of allergic rhinitis refractory to medical therapy

OBJECTIVES/HYPOTHESIS: The ideal treatment for allergic rhinitis refractory to medical therapy is still lacking. The aim of the study is to evaluate the efficacy of turbinate surgery with radiofrequency for the treatment of allergic rhinitis that is unresponsive to medical therapy. STUDY DESIGN: A prospective, nonrandomized clinical study. METHODS: From February 2000 to April 2002, 108 consecutive patients (45 men and 63 women [mean age, 29.5 y]) with allergic rhinitis refractory to medical therapy who underwent radiofrequency turbinate surgery were enrolled in the study. Postoperative follow-up ranged from 12 to 26 months. A standard 0-to-10 visual analogue scale with an anchor was used to assess the pain and the allergic symptoms, including nasal obstruction, rhinorrhea, sneezing, itchy nose, and itchy eyes, preoperatively and postoperatively at the end of weeks 1 and 2 and months 1, 3, 6, and 12 after surgery. Statistical analysis was determined by repeated measures of ANOVA. RESULTS: None of the 108 patients had obvious discomfort other than mild numbness over the premaxillary area (24 of 108 [22.2%]) during operation. Also, no adverse reactions including bleeding, infection, adhesion, or a worsening of allergic symptoms were encountered. One hundred one patients were included in the final statistical analysis. Only nine patients reported no improvement at all after treatment. The response rate of radiofrequency turbinate surgery for allergic rhinitis refractory to medical therapy was 91.1% (92 of 101). At 1 year after the treatment, the degree of nasal obstruction had changed on the visual analogue scale (mean +/- SD) from 6.84 +/- 2.09 to 2.47 +/- 1.60, an improvement of 63.9%. The degree of rhinorrhea had changed from 5.74 +/- 2.75 to 2.57 +/- 2.31, an improvement of 55.2%. The degree of sneezing had changed from 5.30 +/- 2.80 to 2.59 +/- 2.13, an improvement of 51.1%. The degree of itchy nose had changed from 3.74 +/- 3.16 to 1.82 +/- 2.27, an improvement of 51.3%. The degree of itchy eyes had changed from 3.17 +/- 3.09 to 1.68 +/- 2.38, an improvement of 47.0%. The visual analogue scale scores for nasal obstruction, rhinorrhea, sneezing, itchy nose, and itchy eyes decreased significantly with time, from preoperative scores to scores at 1 year after surgery. Other additional effects and improvements, including headache, lumpy throat, night cough, and tinnitus, were also reported by the patients. Most of the patients stated that they would consider repeating this procedure if necessary and would recommend the new method to their friends with the same problems. CONCLUSIONS: The study demonstrates that radiofrequency appears to be an effective and safe tool for treating allergic rhinitis with poor response to medical therapy. In the future, radiofrequency has the potential to be one of the most popular surgical modalities for the treatment of allergic rhinitis refractory to medical therapy.     

Nasal responsiveness to methacholine stimulation in allergic rhinitis patients

Summary We examined the nasal responsiveness to topical methacholine application in allergic rhinitis and non-allergic chronic rhinitis patients, and in control subjects. Methacholine responsiveness was significantly higher in allergic rhinitis patients than in non-allergic patients and control subjects. In perennial rhinitis, methacholine responsiveness correlated with the severity of daily nasal symptoms and those provoked by specific allergen challenge tests. Among nasal symptoms, hyper-rhinorrhoea was found to be closely related to methacholine responsiveness. As a result of these findings, the possibility of cholinergic hyper-reactivity in allergic rhinitis patients is discussed.     

Evaluation of nasal symptoms and mucociliary function in patients with allergic rhinitis treated with chemosurgery using trichloroacetic acid

PURPOSE: We treated allergic rhinitis with trichloroacetic acid (TCA) applied to the inferior turbinates. Further clinical evaluations were made to determine the effect of TCA application on symptoms of allergic rhinitis. We also report the results of measurement of the mucociliary transit time (saccharin time) and nasal airway resistance. MATERIALS AND METHODS: A group of 54 patients with perennial allergic rhinitis was treated with 80% TCA applied to the inferior turbinate. Further clinical evaluations were made to determine the effect of TCA application on symptom scores of allergic rhinitis. We also report the results of measurement of the mucociliary transit time (saccharin time) and nasal airway resistance in those cases. RESULTS: The most common complaint, nasal obstruction, improved effectively in 82% of cases, watery rhinorrhea in 86%, and sneezing in 86%, 1 year after treatment. A significant decrease in scoring was noted for subjective nasal obstruction, watery rhinorrhea, and sneezing. Nasal airway resistance was effectively reduced 1 year after treatment, and the difference was statically significant. In our study, saccharin time appeared to be shortened in the early and late periods after the TCA application. There was a statistical difference between the before- and after-treatment groups. CONCLUSIONS: We concluded that TCA treatment was quite effective for controlling nasal allergic symptoms and that it does not damage the mucociliary function.     

Nd:YAG laser treatment of the lower turbinates with contact in hyperreflexic and allergic rhinopathy]

BACKGROUND: Nasal obstruction caused by mucosal swelling due to hyperreflectory or allergic rhinitis is a very frequent disorder. We would like to report about our first results (ENT department, University of G?ttingen) in the reduction of hyperplastic inferior turbinates by Nd:YAG Laser treatment. PATIENTS AND METHOD: One hundred seventeen patients with nasal obstruction were treated by Nd:YAG laser between October 1993 and February 1997. We used the laser in "contact mode" and all outpatients were under local anaesthesia. Follow-up was possible in 83 cases. A subjective scale was used to evaluate our results. One quarter of the patients suffered from an allergic rhinitis. RESULTS: For 80% the nasal airflow was increased. Sixty percent had excellent or good results without any nasal obstruction after therapy. The patients with allergic rhinitis performed as well as the patients with hyperreflectory rhinopathy. This improvement appeared as early as four weeks after treatment and was permanent in 37 of 40 cases with long-term observation of at least one year. Side effects: 14% reported a dry nasal mucosa for two weeks; 31% had a bloody nasal secretion for two days after treatment, but did not bleed. Fifteen percent complained of pain during the procedure. CONCLUSION: The reduction of the inferior turbinates by Nd:YAG laser is an effective treatment of equal value in symptomatic therapy of the hyperplastic turbinates due to hyperreflectory and allergic rhinopathy. Seventy-three percent of these patients would like to be treated in this way again if necessary.