Evaluation of the effectiveness of the external nasal dilator strip in adolescent athletes: A randomized trial

Objectives

Evaluate the cardio-respiratory capacity (VO₂max.) and peak nasal inspiratory flow (PNIF) of healthy adolescent athletes with experimental and placebo external nasal dilator strips (ENDS).

Methods

48 healthy adolescent athletes between the ages of 11 and 15 were evaluated and submitted to a cardio-respiratory 1000 m race in randomized order. The participants had peak nasal inspiratory flow (PNIF) values measured using the In-check-inspiratory flow meter. Dyspnea intensity was evaluated after a 1000 m test race using a labeled visual analog scale for dyspnea.

Results

In relation to VO₂max., when the participants used the experimental ENDS, significantly higher means were noted than when the placebo was used (53.0 ± 4.2 mL/kg min⁻¹ and 51.2 ± 5.5 mL/kg min⁻¹, respectively) (p < 0.05). In relation to PNIF, there was a statistically significant difference between the experimental and placebo ENDS result, that being, 123 ± 38 L/min and 116 ± 38 L/min, respectively (p < 0.05). The dyspnea perceived by the participants was representatively lesser in the experimental ENDS condition compared to the placebo after the cardio-respiratory test (p < 0.05).

Conclusions

The results suggest that the ENDS improve maximal oxygen uptake, nasal patency and respiratory effort in healthy adolescent athletes after submaximal exercise.     

The effects of physical exercise and smoking habits on the expression of SPLUNC1 in nasal lavage fluids from allergic rhinitis subjects

Objective

Palate lung nasal epithelial clone (PLUNC) is a family of proteins, which are proposed to participate in the innate immune defense against infections in the upper aero-digestive tract. The aim of this study was to investigate the expression of SPLUNC1 in allergic rhinitis subjects with considerations taken to the mucosal function and smoking habits.

Methods

The participants, recruited from a cohort followed from infancy, were re-examined at the age of 18 years regarding allergy development. Based on medical histories and skin prick tests the participants were classified into groups with persistent allergic rhinitis (n = 18), intermittent allergic rhinitis (n = 8) and healthy controls (n = 13). Seven subjects (3, 2 and 2 in each group, respectively) reported smoking habits. The SPLUNC1 levels in nasal lavage fluids were analyzed by Western blot. Changes in the volume of the proper nasal cavity before and after physical exercise (Vol2^increase) were analyzed by acoustic rhinometry.

Results

Compared to the control group the SPLUNC1 level was significantly lower in the persistent allergy group (3.8 ± 3.4 OD vs. 1.3 ± 1.5 OD; p = 0.02), but not in the intermittent allergy group without current exposure to allergens (3.6 ± 4.7 OD). No differences were found in Vol2^increase between any of the allergy groups and controls. In smokers Vol2^increase was significantly reduced (p < 0.01) and the SPLUNC1 levels were lower compared to non-smokers. A significant correlation was found between SPLUNC1 and Vol2^increase (p < 0.01; r = 0.53) in non-smokers.

Conclusions

Current allergen exposure has an impact on SPLUNC1 expression in nasal lavage fluid, why allergy ought to be considered in study populations where analyses of SPLUNC1 levels are included in the reports. The normal nasal decongestion after exercise was not affected by allergy in contrast to smoking habits. The correlation between SPLUNC1 levels and Vol2^increase in non-smokers may indicate involvement of SPLUNC1in the regulation of the normal function of the nasal mucosa. Complementary studies are needed to confirm the smoke-related reduction of SPLUNC1 expression and to analyze the possible participation of SPLUNC1 in the nasal mucosa regulation.     

Pediatric nasal valve surgery: Short-term outcomes and complications

Objectives

To examine the short-term outcomes and complications of open nasal valve surgery in children under 16 years of age. Study design: case series and chart review study setting: an urban, tertiary, pediatric otolaryngology practice.

Methods

Children under 16 years of age who had undergone nasal valve surgery with cartilage grafting for functional indications were identified. Patients with cleft-related nasal deformities were excluded. Charts were reviewed for indications and short-term outcomes (patient satisfaction and postoperative complications within the first 90 days). A literature review assessed prior outcomes in adult nasal valve patients.

Results

Fifteen pediatric patients, 15 years old or younger, were identified as having undergone open nasal valve repair utilizing septal or auricular cartilage grafts. Patient age ranged from 6 to 15 years. Surgical indications were nasal obstruction with nasal valve stenosis related to either previous trauma (n = 10), congenital deformity (n = 3), iatrogenic injury (n = 1) or hemangioma of infancy (n = 1). All patients noted improvement of symptoms at the 90 day interval or later. There was one episode of self-limited epistaxis, which occurred on postoperative day 7 following splint removal.

Conclusions

In children, an obstructive nasal breathing pattern may be caused by nasal valve collapse, which can be addressed with nasal valve surgery. This small series suggests that short-term results in children may be similar to those observed in the adult population. Pediatric nasal valve surgery outcomes have not been described previously; studies focused on long-term outcomes following pediatric nasal valve surgery are needed.

Level of evidence

4.     

Efficiency of external nasal dilators in pediatric nasal septal deviation

Inroduction

Nasal septal deviation results from irregular development of the nasomaxillary complex and trauma. Treatment of nasal septal deviation in pediatric patients is one of the biggest challenges in rhinology. Surgery may alter craniofacial growth patterns, and so it may be indicated only in the selected cases. The use of external nasal dilators is a relatively new treatment modality in nasal obstruction.

Objective

This study was performed to assess the efficacy of external nasal dilator in pediatric nasal septal deviation patients.

Methods

Seventy-six children who were diagnosed with nasal septal deviation at our outpatient clinic were included in the study. The patients were divided into 2 groups: the external nasal dilator group was composed of 48 children that had used an external nasal dilator for at least 1 month and still been using, while the control group was comprised of 28 children that had not received any treatment and had not used an external nasal dilator. The parents of the children were asked to complete the obstructive sleep apnea 18 questionnaire. In addition, the external nasal dilator group was asked to complete the questionnaire after stopping external nasal dilator use for 2 weeks and the control group also repeated the obstructive sleep apnea 18 questionnaire.

Results

The obstructive sleep apnea 18 questionnaire results were significantly different between the external nasal dilator group and the control group at the beginning of the study (i.e., when patients in the external nasal dilator group were still using their dilators, P = 0.000). On the other hand, there was no difference between the 2 groups after the patients in the external nasal dilator group had stopped using their external nasal dilator (P = 0.670).

Conclusion

External nasal dilator use relieved nasal septal deviation, which narrows the nasal valve. The results of this study suggest that external nasal dilator could be used in patients that are not candidates for septoplasty.     

Comparison of nasal packs with transseptal suturing after nasal septal surgery

Objectives

To investigate the effects of transseptal suturing against two different types of nasal packs with respect to pain, operative time and postoperative complications following nasal septal surgery.

Patients and methods

One hundred and fifty patients (aged 18–61 years) scheduled for nasal septal surgery were included. Following surgery, three types of nasal packing systems were utilized: (1) transseptal suturing (Group A: 50 patients); (2) internal nasal splint (Group B: 50 patients); (3) a Merocel standard 8-cm nasal dressing without airway (Group C: 50 patients) to the patients. Postoperative pain, operation time, septal perforation and synechiae formation were evaluated.

Results

The difference between mean operative time of groups B and C was not statistically significant (p > 0.05). The difference between operative time of the two groups against group A was statistically significant (p < 0.05). The mean postoperative pain scores were 2.8 ± 1.2 (median 2) in group A, 6.1 ± 1.3 (median 6) in group B, and 7.3 ± 1.2 (median 7) in group C 1 h to 48 h post-surgery. Merocel and internal nasal splint tampons were found to be significantly more painful than transseptal suturing during 48 h (p < 0.05). There was no statistically significant difference in terms of infection, hematoma, synechiae formation or perforation between the groups (p > 0.05).

Conclusion

The use of transseptal suturing technique is a useful alternative to packing, with only minor increase in operating time.     

Measurement of nasal resistance by rhinomanometry in 892 Japanese elementary school children

Objective

The normal value of nasal resistance in adults has been reported (0.25 Pa/cm³/s), but that in children has not. In this study, we measured nasal resistance in Japanese school children by employing rhinomanometry.

Methods

An otolaryngologist examined 939 Japanese school children with regard to the presence or absence of nasal diseases and tonsil size. Nasal resistance was measured by rhinomanometry employing the active anterior method in 892 children. A questionnaire concerning the condition during sleep, such as the presence or absence of snoring and sleep apnea syndrome, was performed.

Results

The mean nasal resistance was 0.43 ± 0.50 Pa/cm³/s: 0.46 ± 0.65 and 0.39 ± 0.22 Pa/cm³/s in boys and girls, respectively. Of the 892 children, Grade 3 and 4 tonsil hypertrophy was noted in 84 (9%), but the presence of tonsil hypertrophy did not influence nasal resistance. Nasal diseases were noted in 335 children (38%) and the nasal condition was normal (the normal group) in 557 (62%). Nasal resistance was 0.56 ± 0.75 Pa/cm³/s in the nasal disease group and 0.36 ± 0.21 Pa/cm³/s in the normal group, showing that the resistance was significantly higher in the nasal disease group. The resistance tended to decrease as the school grade increased. In the normal group, 290 children (33%) experienced no problem regarding the upper airway, such as snoring and sleep apnea syndrome, based on a questionnaire, and nasal resistance was 0.35 ± 0.17 Pa/cm³/s.

Conclusion

This normal nasal resistance value may be adopted for the objective evaluation of nasal obstruction and effects of treatment in pediatric nasal diseases.     

Objective measurements differ for perception of left and right nasal obstruction

Objective

Nasal obstruction is one of the most common sensation complaints of nasal disease in clinical practice. It is a subjective sensation of nasal airflow. Objective assessment of nasal patency and nasal physiology includes the use of rhinomanometry and acoustic rhinometry. The perception of nasal obstruction changes as the alternating of nasal airway resistance and nasal airflow. However, there were limited studies reported whether the perceptions of the left and right nostrils are similar. We examined the relationship between subjective and objective parameters of the nasal airway in the left and right nostrils.

Methods

A prospective study of 101 patients with a deviated nasal septum and chronic hypertrophic rhinitis was conducted for subjective and objective nasal airway evaluation. Patients were then divided into three groups based on the visual analog scale. Associations between measures were evaluated with analysis of variance, f tests and simple regression.

Results

Among three patient groups with different subjective sensations of nasal obstruction, there were significant differences among three patient groups according to the objective measurements of airflow resistance on the right side (p = 0.0002 for inspiration right mean resistance; p = 0.0049 for expiration right mean resistance), and for the minimal cross-sectional area (p = 0.030) and nasal cavity volume (p = 0.028 for 0–3.3 cm left nostril; p = 0.047 for 2–4 cm left nostril) on the left side. This indicates that nasal flow resistance is an important determinant for right side nasal obstruction. Nasal minimal cross-sectional area and nasal cavity volume are an important determinant for left side nasal obstruction.

Conclusion

Our study indicates the important role of rhinomanometry in objective measurement of right side nasal obstruction and acoustic rhinometry in objective measurement of left side nasal obstruction. Thus, human perception of right and left nostrils may be different and requires further study.     

Topical Nigella Sativa for nasal symptoms in elderly

Objective

To compare the effects of intranasal application of black seed (Nigella Sativa) oil (NSO) and isotonic sodium chloride solution (ISCS) on nasal symptoms of the elderly.

Methods

In this prospective, crossover randomized controlled trial, 42 geriatric patients with nasal dryness and related symptoms were randomized to receive either 2 weeks of isotonic sodium chloride solution (ISCS) followed by 2 weeks of N. sativa oil (NG oil) or the same treatment in the opposite order. There was a washout period of 3 weeks in between the treatment periods. Subjective symptoms including nasal dryness, burning, obstruction, itching and crusting were evaluated by a visual analog scale. Mucociliary function was evaluated with saccharin test.

Results

Nasal dryness, obstruction and crusting improved significantly with the use of NSO compared to ISCS without any evidence of relevant carryover effects (p < 0.05 for all for the difference in treatment). There was no significant difference between the effect of NSO and ISCS on nasal burning and itching (p > 0.05 for all). There was no change in mucociliary clearance during any of the treatment periods.

Conclusion

NSO is a better alternative to ISCS to treat nasal mucosa symptoms due to aging.     

Nasal cavity dimensions in congenital pyriform aperture stenosis

Objective

To determine the dimensions of the nasal cavity in infants with congenital pyriform aperture stenosis (CPAS).

Study design

The nasal cavities of seven children with CPAS were identified and were compared to the nasal cavities of 13 neonates (<30 days old) who had received CT scans for other indications.

Methods

The width of the nasal cavities was measured at the pyriform aperture, choana, and at two standardized points along the lateral nasal wall (LW-1 and LW-2) between the pyriform aperture and choana.

Results

Comparison between neonates with and without CPAS demonstrates significant narrowing of the nasal cavity (not just the pyriform aperture) in infants with CPAS. Significantly smaller nasal width was noted at pyriform aperture, LW-1, and LW-2 (p < 0.01, p < 0.01, p = 0.02). No significant narrowing was seen at the choana.

Conclusion

These findings suggest that CPAS is associated with narrowing of the anterior 75% of the nasal cavity. This has implications for surgical management because simple pyriform aperture ostectomy may not be sufficient to relieve symptoms of obstruction.     

A prospective CBCT study of upper airway changes after rapid maxillary expansion

Objective

The aim of this prospective study was to investigate the upper airway changes after rapid maxillary expansion utilizing CBCT.

Methods

16 children (10 male, 6 female) with a mean age of 12.73 ± 1.73 years underwent RME as part of their comprehensive orthodontic treatment with4,6-banded hyrax expanders. The screws were activated 2 turns a day. Depending on the expansion amount (2.7–6.3 mm), the activation period ranged from 2 to 3 weeks. CBCT images were taken immediately before (T1) and three months after expansion (T2) in upright position, with patients’ heads kept in consistent position. All CBCT data were processed with the software EZ3D2009. After orienting the CBCT images, a set of linear, area and volumetric parameters of the upper airway were measured and calculated. Student paired t test and one-way ANOVA were applied. The significance level of P < 0.0033 was used according to the Bonferroni correction.

Results

After expansion, with molar-to-molar width increasing 4.4 ± 1.3 mm and molars tipping 6.2 ± 6.2°, the nasal floor width and nasal lateral width increased 1.6, 1.5, and 1.6 mm and 1.3, 1.7, and 1.4 mm from the anterior to the posterior part, respectively. And there was no difference among the anterior, median and posterior part. The lower nasal volume increased 1348.5 mm³ with the percentage change being 8.1%. The pharyngeal airway showed no positive change.

Conclusion

RME can expand the nasal cavity and the expansion pattern may follow the parallel opening configuration. However, the influence on the pharyngeal airway is limited.     

Evaluation of ceruloplasmin levels in patients undergoing surgical interventions with nasal polyps

Objective

Oxidative stress is believed to have a role in the development of nasal polyps (NPs). It is also known that ceruloplasmin (CP), an acute phase protein, limits oxidative stress. The purpose of this study was to evaluate the ceruloplasmin levels in patients with NPs.

Methods

One hundred and twenty patients with NPs, septal deviations and concha hypertrophies were recruited to the study. Patients were divided in two groups; group 1 (n = 60) consisted of patients with NPs, and group 2 (n = 60) consisted of septal deviations and concha hypertrophies. Polyp specimens were taken from all patients who underwent endoscopic surgery due to NPs, as well as control specimens were acquired who underwent an operation due to septoplasty or concha hypertrophy. Blood and tissue samples were obtained to assess CP levels.

Results

There were no statistical differences in gender, age and biochemical values between two groups (p > 0.05 for all). Compared to group 2, group 1 had significantly higher CP levels both in serum and the tissue samples (both p < 0.001).

Conclusion

As a result of our study; CP levels both in serum and the tissue in patients with NPs were higher, may be consequence of the inflammation, than in patients without NPs.     

Effects of caffeic acid phenethyl ester on wound healing of nasal mucosa in the rat: an experimental study

Purpose

Wound healing of the nasal mucosa is a highly complex process that restores the anatomical and functional integrity of tissue that has been exposed to trauma. In this experimental study, our aim was to use histopathological examination to investigate the effects of caffeic acid phenethyl ester on the wound healing of rat nasal mucosa after mechanical trauma.

Materials and methods

The rats were randomly divided into 3 experimental groups: a non-treated group (n = 7), a control saline group (n = 7) and a caffeic acid phenethyl ester group (n = 7). The non-treated group received no treatment for 15 days. The second group was administered saline (2.5 mL/kg, intraperitoneal) once a day for 15 days. The third group received caffeic acid phenethyl ester intraperitoneally at a dose of 10 μmol/kg once a day for 15 days. At the beginning of the study, unilateral mechanical nasal trauma was induced on the right nasal mucosa of all rats in the three groups using a brushing technique. Samples were stained using hematoxylin and eosin solution and were examined by a pathologist using a light microscope.

Results

The severity of inflammation was milder in the caffeic acid phenethyl ester group compared with that in the non-treated and saline groups (P < 0.05). The subepithelial thickness index was lower in the experimental group (P < 0.05). Goblet cell and ciliated cell loss was substantially reduced in the experimental group compared with the non-treated and saline groups (P < 0.05).

Conclusions

Caffeic acid phenethyl ester decreases inflammation and the loss of goblet cells and ciliated cells. Therefore, caffeic acid phenethyl ester has potential beneficial effects on the wound healing of nasal mucosa in the rat.     

Comparison of nasal mucociliary clearance in adenoid hypertrophy with or without otitis media with effusion

Objective

To investigate pre- and postoperative mucociliary clearance in patients with adenoid hypertrophy or combined with otitis media with effusion.

Methods

Patients were divided into two groups: Group 1—patients with adenoid hypertrophy (AH), and Group 2—patients with AH and otitis media with effusion (AHOME). In all patients, AH size was recorded, and the Andersen saccharin and methylene blue tests were conducted before and 1 month after surgery to obtain mucociliary clearance time (MCT). Nasal cavity length was measured intraoperatively to establish mucociliary clearance velocity (MCV). Patients with allergic rhinitis, active infection, and history of nasal or ear surgery were excluded.

Results

This study included 64 patients with a mean age of 8.34 ± 2.98 years (range: 3–18 years). Pre- and postoperative MCT were 14.60 ± 4.83 and 9.48 ± 2.63 min in Group 1 and 16.03 ± 4.31 and 12.12 ± 3.78 min in Group 2, respectively. Pre- and postoperative MCV were 0.77 ± 0.30 and 1.16 ± 0.42 mm/min in Group 1 and 0.67 ± 0.16 and 0.89 ± 0.28 mm/min in Group 2, respectively. MCT and MCV were significantly improved postoperatively in both groups (p < 0.001). In addition, the postoperative MCT and MCV of Group 1 were significantly better than those of Group 2 (p < 0.001). Exposure to cigarette smoking and adenoid size had negative correlations with mucociliary clearance.

Conclusions

Otitis media was associated with impaired mucociliary clearance and further studies should be performed to demonstrate the causes of this deficiency.     

Compliance and efficacy of saline irrigation in pediatric chronic rhinosinusitis

Objective

The objective of this study was to evaluate compliance with and effectiveness of nasal irrigation in children with chronic rhinosinusitis (CRS) and to assess its clinical course.

Methods

Seventy-seven children with refractory CRS resistant to medical treatment including antibiotics and nasal corticosteroids were included. We evaluated patients’ nasal symptom and Lund Mackay CT scores at baseline. All patients were educated about nasal irrigation and encouraged to perform nasal irrigation 1–3 times a day. After 1 month, patients were reevaluated regarding compliance with the protocol and improvement of CRS by assessing symptom score and endoscopic evaluation. The patients were followed up for at least two months to assess need for further treatment including surgery.

Results

Mean age of patients was 8.3 years ranging from 4 to 13 years. Mean follow-up duration with nasal saline irrigation was 6.2 months (2–32 months). Forty nine patients (63.6%) successfully carried out nasal irrigation during follow-up (good compliance [GC] group) and 28 patients (36.4%) did not successfully carry out nasal irrigation (poor compliance [PC] group). There were no significant differences between GC and PC groups regarding clinical characteristics and baseline Lund–MacKay CT scores. Subjective and objective improvements were observed in 36 patients (73.5%) in the GC group and 14 patients (50.0%) in the PC group. Surgery including endoscopic sinus surgery and/or adenoidectomy was performed in 8 patients (16.3%) in the GC group and 12 patients (42.9%) in the PC group. The rate of surgical treatment was significantly different between the groups (p = 0.019).

Conclusion

Nasal irrigation in children with long standing CRS is relatively well tolerated (63.6%) and effective. Nasal saline irrigation should be considered as a primary treatment tool in CRS even in pediatric age group.     

Nasal pH in patients with chronic rhinosinusitis before and after endoscopic sinus surgery

Purpose

Physiologically acidic nasal pH depends on intact nasal mucosal function. The aim of this study was to determine nasal pH in patients with chronic rhinosinusitis and to investigate the changes in pH related to mucosal healing after endoscopic sinus surgery.

Materials and methods

Normal subjects and the patients with chronic rhinosinusitis who showed no recurrence after endoscopic sinus surgery were enrolled. Using a portable pH meter and a glass-tipped probe, nasal pH was measured in the inferior meatus in normal subjects and patients before and after surgery at 3 months.

Results

The mean (± SD) nasal pH was 6.5 ± 0.5 (5.9 to 7.3) in 19 normal subjects, and 6.7 ± 0.6 (5.3 to 7.6) in 19 CRS patients before surgery, which showed no significant difference between the groups. The nasal pH values were in the range of 3.8–7.7 (mean ± SD 5.7 ± 0.9) at 3 months after surgery, and significantly lower than the preoperative values in patients (P = .004). The patients showing pH lower than 6.0 accounted for 10.5% before surgery, but 68.4% after surgery.

Conclusions

Normal nasal pH was in the slightly acidic range, and the mean nasal pH of patients with chronic rhinosinusitis fell within normal limits as well, which indicates that chronic rhinosinusitis may not disturb the electrolyte milieu of the nasal mucosa. The average nasal pH measured at 3 months after endoscopic sinus surgery exhibited acidity of pH 5.7. The factors causing a fall in nasal pH during the healing period after the sinus surgery remain to be elucidated.     

The use of large volume low pressure nasal saline with fluticasone propionate for the treatment of pediatric acute rhinosinusitis

Objectives

Fluticasone propionate and nasal saline irrigation have been used in the treatment of sinonasal diseases for a long time. Our study investigates the effect of the combination of large volume low pressure nasal saline irrigation and fluticasone propionate for the treatment of pediatric acute rhinosinusitis.

Methods

Ninety-one pediatric patients with acute rhinosinusitis were included in our study. The patients were randomized into two groups. The first group (n = 45) was treated with standard therapy (antibiotherapy + nasal decongestant) for 2 weeks, the second group was treated with the large volume low pressure nasal saline + fluticasone propionate combination for 3 weeks. The clinical scores, radiologic evaluations (X-ray Waters view), peak nasal inspiratory flow (PNIF) measurements, total symptom scores and hematologic parameters (WBC, CRP, ESR) of the patients were evaluated and compared.

Results

There were no significant differences in between the two groups regarding age, gender, height and weight. Even though the clinical scores of Group 2 improved more rapidly, there were no significant differences in between groups regarding clinical scores by the 21st day. There were no significant differences in post treatment radiologic evaluations (Waters graphy). Both groups had significant improvement of their post treatment PNIF values, yet the improvement was more marked in Group 2 than in Group 1. The rhinorrhea, nasal congestion, throat itching and cough symptoms improved more rapidly in Group 2 than in Group 1. Post-treatment nose itching and sneezing symptoms were significantly less in Group 2. The values of hematologic parameters were significantly reduced at the end of the 3rd week in both groups.

Conclusions

Our study is a first in investigating the combined use of large volume low pressure nasal saline and fluticasone propionate in acute pediatric rhinosinusitis, and the results reveal that the combination therapy was effective. Low pressure large volume nasal saline + fluticasone propionate combination can be employed as a new line of therapy for the treatment of pediatric acute rhinosinusitis, either by itself or combined with standard therapy.     

Melatonin and cortisol rhythm in patients with extensive nasal polyposis

Purpose

Extensive nasal polyposis is an inflammatory disease which effects 1%–4% of normal population. The mechanism of its formation and the circadian rhythm of cortisol and melatonin in ENP have not investigated.

Materials and methods

Salivary levels of melatonin and cortisol were measured by radioimmunoassay in 31 patients with extensive nasal polyposis and in 27 control subjects matched for age and gender. In both groups none of the subjects did not have obstructive sleep apnea.

Results

The baseline and the peak levels of salivary melatonin in the extensive nasal polyposis group were significantly lower than in the control group (p < 0.001). However, no differences were found in the acrophase and the peak duration of salivary melatonin between the study and control groups (p > 0.05). The highest values of melatonin were recorded at 04:00 h in both the study and control groups.The amplitude and the 24 h mean levels of salivary cortisol in the extensive nasal polyposis group were significantly lower than in the control group (p < 0.001). The acrophase was delayed by about 8 h in extensive nasal polyposis patients (p < 0.001).

Conclusion

The circadian rhythms of salivary melatonin and cortisol were found to be disrupted in patients with extensive nasal polyposis. These results may be applicable as therapeutic tools in the future and melatonin drugs might be useful in the therapy of nasal polyposis like cortisol drugs.     

Cytological alterations of nasal mucosa after nasal packing

Purpose

To assess the efficacy, tolerability and cytological alterations of nasal mucosa with various materials for nasal packing.

Materials and methods

One hundred and five patients, submitted to a nasal surgery and post-operative packing with four different materials (Clauden®, Merocel®, two-fingered glove pack with gauzes inside and Lyofoam™) were prospectively enrolled in the study. All patients were submitted to a questionnaire of 12 questions which required the patients to refer to the tolerability of packing. Finally a nasal cytological test was performed after removal of packing and 10 days after, to evidence the alterations of ciliated cells and reduction of supranuclear stria.

Results

The questionnaire of tolerability of packing revealed a severe discomfort (grade III) in 13 patients (38.2%) with Clauden, 1 (2.4%) with Merocel, 7 (41.1%) with two-fingered glove packing and 6 (46.1%) with Lyofon.As regards cellular alterations, the two-fingered glove and the Merocel groups had the lowest percentage of cellular alterations which was particularly different from the Clauden group (p = .0014) The supranuclear stria was reduced in the Clauden group and the two-fingered glove packing group both after packing removal and after ten days with a statistical difference when compared to the other two groups (p < .001).

Conclusions

Merocel packing appears to be well tolerated by the patients with the lowest percentage of cytological alteration, of ciliated cells. Also finger glove packing shows scarce damage of nasal mucosa with a lower percentage of nasal bleeding but its tolerability is not so good.     

The effectiveness of nasal saline irrigation (seawater) in treatment of allergic rhinitis in children

Objective

To evaluate the effect of nasal saline irrigation in the treatment of allergic rhinitis (AR) in children and to assess whether nasal saline irrigation could be used as a complementary therapy for AR in children in combination with the intranasal corticosteroids (INS).

Method

In total, 61 children with AR were divided into three groups: the nasal irrigation, intranasal corticosteroid, and combined treatment groups. Symptoms and signs of AR and eosinophils (EOS) in the nasal secretions were evaluated after 4 weeks, 8 weeks, and 12 weeks of treatment.

Results

In AR children treated with nasal irrigation and a decreased the INS dose, a significant improvement in symptoms and signs and a significant decrease in the mean EOS count in nasal secretions were observed at week 12.

Conclusion

Nasal saline irrigation with physiological seawater is well tolerated and benefits the patients with AR, and can thus be considered a good adjunctive treatment option to maintain the effectiveness of the INS at a lower dose, thus resulting in reduced side effects and a decreased economic burden.     

Risk of respiratory distress in the patients who were applied nasal packing at the end of nasal surgery

Objective

This prospective study investigated the risk of respiratory distress in the patients who were applied nasal packing at the end of nasal surgery; and effects of nasal packing on consciousness level while the patients were awake or asleep, measured by Bispectral Index (BIS).

Methods

The study group consisted of 15 adult patients (10 male, 5 female), who were applied nasal packing at the end of nasal surgery. The control group consisted of 15 adult patients (10 male, 5 female), who received general anesthesia for various reasons. In the study and control groups, BIS index, respiratory rate, peripheral oxygen saturation, pulse per minute and blood pressure were measured at seven different times.

Results

There was no statistically significant difference between BIS indexes of the study and control groups. In the fourth hour after sleep (AS-4 h), respiratory rate of the study group was significantly lower than that of the control group. In the fourth hour after the anesthesia (AA-4 h), oxygen saturation value of the study group was lower than that of the control group.

Conclusion

We conclude that in patients who are applied nasal packing at the end of nasal surgery; at AA-4 h and AS-4 h times, there may be risk of decrease in the oxygen saturation and respiratory rate parameters, respectively. Therefore, it is necessary to monitor non-invasive respiratory parameters and to give enriched oxygen by an oral catheter.