Endoscopy in nasal myiasis

Nasal myiasis is a common disease in tropical and developing countries.The maggots cause extensive necrosis, sloughing and destruction of intranasal tissue and reach to deep and inaccessible areas of the nose and paranasal sinuses. In such a situation removal of maggots is difficult by manual extraction and several sittings are required. To overcome this problem nasal endoscope is being used for removal of maggots under direct vision. In comparing both methods nasal endoscopic procedure is found to be superior to the manual extraction method for removal of maggots.The maggots located in deep and inaccessible area can be approached more easily by endoscopic procedure.The disease is being controlled in shorter time and in few sittings.Thus quick and complete eradication of myiasis is possible before the maggots cause irreparable damage to the intranasal tissues.     

Mediators in nasal polyposis

Nasal polyposis (NP) is a chronic inflammatory disease of the sinuses often associated with asthma. Although we have not yet achieved a full understanding of the precise mechanisms underlying the pathogenesis of NP, recent insights have been acquired into the regulation of eosinophil chemotaxis, activation, and survival, in addition to their possible link to gross histopathologic changes such as pseudocyst formation. Interleukin (IL)-5, transforming growth factor-β1, and eotaxin seem to be crucial players in the regulation of eosinophilic inflammation and extracellular matrix breakdown. The cytokine pattern in NP assumes neither a T helper 1 (Th1) nor Th2 type predominance, because IL-4, IL-5, IL-12, and interferon-γ have all been shown to be upregulated in NP tissue, without influence of the atopic status. However, recent studies have demonstrated a strong local upregulation of the immunoglobulin E (IgE) synthesis with the formation of specific IgE to Staphylococcus aureus enterotoxins, suggesting a possible role of superantigens in these pathologic processes.     

Combined effects of a nasal dilator and nasal prongs on nasal airflow resistance

STUDY OBJECTIVES: Nasal prongs (NPs), when used to assess nasal flow, can result in dramatic increases in nasal airflow resistance (NR). The aim of this study was to investigate whether the NP-induced increases in NR could be corrected by the simultaneous use of an internal nasal dilator (ND). DESIGN: NR was estimated by posterior rhinomanometry, in the basal state (NRb), and while breathing with NP (NRp), with ND (NRd), and with both ND and NP (NRd + p). PARTICIPANTS: The study was performed in 15 healthy subjects. Measurements and results: NR (mean NRb [+/- SEM], 2.5 +/- 0.4 cm H(2)O/L/s) significantly decreased with ND (NRd = 1.4 +/- 0.2 cm H(2)O/L/s; p < 0.001) and significantly increased with NP (NRp = 3.8 +/- 0.8 cm H(2)O/L/s; p < 0.001). A significant logarithmic relationship was found between NRd and NRb (r(2) = 0.95; p < 0.0001), and a significant exponential relationship was found between NRp and NRb (r(2) = 0.99; p < 0.0001). While breathing with both ND and NP, NRd + p was significantly lower than NRb (1.9 +/- 1.4 cm H(2)O/L/s; p < 0.02). CONCLUSIONS: Our results demonstrate that the ND tends to slightly overcorrect the NP-induced increase in NR and suggest that, in view of the possible effects of NPs on upper airway resistance, the combination of both devices might be used for nasal airflow monitoring during nocturnal polysomnography in patients presenting with highly resistive nares.     

Effects of nasal prongs on nasal airflow resistance

STUDY OBJECTIVES: The aim of this study was to investigate whether nasal prongs, which have been proposed to assess nasal flow during sleep, affect nasal airflow resistance (NR). DESIGN: NR was estimated by posterior rhinomanometry at a 0.5 L/s flow, under eight conditions: in the basal state, and with seven different nasal prongs. PARTICIPANTS: The study was performed in 17 healthy supine subjects, 8 of whom had basal NR values within the normal range (< or = 2 cm H(2)O.L(-1).s, group 1), and 9 had increased basal NR values (> 2.5 cm H(2)O.L(-1).s, group 2), because of nare narrowness and/or deviated nasal septum. Measurements and results: NR increased significantly while breathing with nasal prongs (p < 0.0001 in both groups). The changes in NR (DeltaNR) induced by the different nasal prongs were characterized by large intersubject and intrasubject variability, with a maximum DeltaNR of 24.2 cm H(2)O.L(-1).s. Significant differences were found between the DeltaNR induced by the different nasal prongs (p < 0.001 in group 1, and p < 0.0003 in group 2), and for six of them, DeltaNR was significantly higher in group 1 than in group 2 (p < 0.02). CONCLUSIONS: This study demonstrates that nasal prongs can markedly increase NR in subjects presenting with nare narrowness and/or deviated nasal septum. Further investigations that would include nocturnal polysomnography are still required to evaluate the possible influence of nasal prongs on the diagnosis of obstructive sleep apnea syndrome and its severity.     

Snoring is not relieved by nasal surgery despite improvement in nasal resistance

OBJECTIVES: In the present study, we evaluated the effect of nasal surgery on snoring time, snoring intensity, and sleep-disordered breathing. The role of abnormal cephalometry in treatment outcome was assessed. DESIGN: A cross-sectional prospective study. SETTING: University teaching hospital. PATIENTS: Forty consecutive snoring men who were referred to ENT Hospital because of a snoring problem or suspicion of sleep apnea. INTERVENTIONS: The patients underwent anterior rhinomanometry and polysomnography (PSG) with recording of snoring before and after operative treatment of nasal obstruction. Cephalometric radiographs were obtained before surgery. RESULTS: Nasal resistance decreased significantly in the overall patient group. Snoring time, snoring intensity, nocturnal breathing, and sleep architecture did not change after nasal surgery. Cephalometry did not predict operative outcome in these patients. Snoring intensity was found to be significantly higher during non-rapid eye movement (NREM) sleep than during rapid eye movement sleep. CONCLUSIONS: Operative treatment of mainly structural nasal obstruction did not seem to decrease snoring intensity, snoring time, or sleep-disordered breathing in an objective assessment by PSG performed after surgery. The effect of treating inflammatory nasal changes during nocturnal breathing, as well as the role of cephalometry in the prediction of treatment outcome will need further evaluation. Higher snoring intensity related to NREM sleep may add to the sleep disturbance of a bed partner in the evening.     

Involvement of vascular endothelial growth factor in nasal obstruction in patients with nasal allergy

It has recently been shown that vascular endothelial growth factor (VEGF) enhances vascular permeability and that mast cells produce VEGF, suggesting the involvement of VEGF in allergic diseases. In the present study we quantitatively analyzed VEGF in the nasal lavage fluid of patients with nasal allergy. We performed nasal antigen challenge with Japanese cedar pollen antigen in 10 healthy adult volunteers and in 10 cedar pollen IgE-positive patients with nasal allergy. In all patients with nasal allergy, VEGF and histamine levels in the nasal lavage fluid reached a peak 30 min after antigen challenge, then returned to prechallenge values 2 h after antigen challenge. In these patients, the histamine level increased three-fold, while the VEGF level increased 10-fold. However, in all healthy adult volunteers, VEGF and histamine levels did not increase. A stronger correlation was noted between the ratio of decreased nasal cavity volume and the ratio of increased VEGF levels (R = 0.823; P < 0.001) than between the ratio of nasal cavity volume and the ratio of increased histamine levels (R = 0.660; P < 0.01). These results suggest that VEGF may contribute to the pathogenesis of nasal obstruction in the early phase of nasal allergy as a new factor involved in increasing vascular permeability.     

经鼻高流量氧疗

经鼻高流量氧疗(high-flow nasal oxygen,HFNO)是一种新型的氧疗技术,近年来开始逐步在临床普及应用。经过临床研究的不断探索,发现HFNO相较于传统氧疗具有诸多优势,并且在部分呼吸衰竭患者中的应用效果与无创通气相似,这为呼吸衰竭患者的呼吸支持提供了新的选择和思路。但其临床具体适应证仍不明确,因此现阶段应重视HFNO的临床使用规范,而其适用范围仍需临床研究的进一步探索。该文就其研究概况进行综述。     

The effect of nasal decongestant on nasal mucous velocity.

Nasal mucous velocity was measured in 13 healthy nonsmokers before and 10 min after topical application of 2 alpha adrenergic nasal decongestant sprays, phenylephrine and tetrahydrozoline. Phenylephrine increased nasal mucous velocity from 8.4 +/- 2.7 mm per min (mean +/- SD) to 13.7 +/- 4.8 mm per min and tetrahydrozoline from 8.1 +/- 3.8 mm per min (mean +/- SD) to 13.8 +/- 5.1 mm per min. These increases were significant (P less than 0.01) when compared to topical application of phenylephrine and tetrahydrozoline vehicles, normal saline, and sham (empty aerosol container).     

鼻腔鼻窦真菌感染的基础诊断

在近20多年来,尤其是抗生素与皮质类固醇激素广泛应用后真菌感染所造成的真蓖病的发病率大为升高,这需要广大医务工作者给予重视,要认识到真菌病,尤其是深部真菌病的防治不可忽视.为此我们对60例鼻腔鼻窦真菌病的基础综合诊断方法的诊断意义进行分析总结.     

Oxytocin nasal spray in fibromyalgic patients

Fibromyalgia is a pain disorder associated with frequent comorbid mood, anxiety, and sleep disorders. Despite the frequent use of a complex, poly-drug pharmacotherapy, treatment for fibromyalgia is of limited efficacy. Oxytocin has been reported to reduce the severity of pain, anxiety, and depression, and improve the quality of sleep, suggesting that it may be useful to treat fibromyalgia. To evaluate this hypothesis, 14 women affected by fibromyalgia and comorbid disorders, assuming a complex pharmacotherapy, were enrolled in a double-blind, crossover, randomized trial to receive oxytocin and placebo nasal spray daily for 3 weeks for each treatment. Order of treatment (placebo–oxytocin or oxytocin–placebo) was randomly assigned. Patients were visited once a week. At each visit, the following instruments were administered: an adverse drug reaction record card, Visual Analog Scale of Pain Intensity, Spielberger State Anxiety Inventory, Zung Self-rating Depression Scale, and SF-12. Women self-registered painkiller assumption, pain severity, and quality of sleep in a diary. Unlikely, oxytocin nasal spray (80 IU a day) did not induce positive therapeutic effects but resulted to be safe, devoid of toxicity, and easy to handle.     

Biological markers in nasal secretions.

Biological markers in nasal secretions provide valuable information on nasal pathophysiology. However, published data on biomarker concentrations in nasal fluids are remarkably inconsistent, and the bias due to different sampling techniques, has not yet been systematically evaluated. Concentrations of various protein were repeatedly determined in nasal secretions of 16 healthy volunteers. The proteins were detected by using: 1) alpha2-macroglobulin as a marker for plasma contamination; 2) lactoferrin as a marker for glandular secretion; 3) lactate dehydrogenase as a marker for tissue injury; and 4) interleukin (IL)-1beta, IL-8, tumour necrosis factor-alpha, and eosinophil cationic protein and tryptase as indicators for tissue inflammation. A total of four different sampling methods, including nasal lavage (NL) and a new polyurethane foam sampler technique (PFST) were employed. Analyte concentrations in NL were approximately 10-times lower than in specimens obtained by PFST. Due to the unpredictable dilution during NL, various analytes were below the detection limit of the high sensitivity assays employed. With PFST, concentrations below the detection limit rarely occurred. The specimens did not significantly differ regarding plasma contamination, glandular secretion or tissue injury. The considerable variability of reported analyte concentrations in nasal secretions mainly results from different sampling techniques. To collect nasal secretions, samplers are considered superior to nasal lavage techniques.     

Barrier dysfunction in the nasal allergy

Epithelial cells form the first physiological barrier against invasion by pathogens and the infiltration of allergens. Tight junctions (TJ), a cell–cell junctional complex located on the apical side of epithelial cells, have a critical role in the maintenance of epithelial barrier function. Impaired TJ structures are observed in patients with asthma, atopic dermatitis and nasal allergy; therefore, the dysfunction of epithelial barriers might be involved in the initiation or progression of allergic diseases. Protease-containing allergens and environmental pollutants enhance paracellular transport in epithelial cells through disruption of epithelial barrier function. This suggests that the disruption of TJ leads to the promotion of allergen delivery into the subepithelia, resulting in the progression of allergic diseases. Thus, protection of the epithelial barrier function might prevent or inhibit the development or exacerbation of allergic diseases. Recently, we reported that diesel exhaust particles (DEP), the main component of particulate patter 2.5, exacerbated allergic rhinitis (AR) in a mouse model through TJ disruption. In addition, we revealed that the oxidative stress-mediated pathway is involved in the effects caused by DEP and that nasal treatment with a reactive oxygen species (ROS) scavenger suppressed DEP-induced TJ disruption and exacerbation of AR. In this review, we focus on the relationship between TJ disruption and allergic disease. Furthermore, we discuss our recent findings regarding TJ disruption and the exacerbation of AR.