Histopathologic characteristics of chronic sinusitis with bronchial asthma

CONCLUSION: These findings suggest that patients with both sinusitis and asthma present the histopathologic characteristic of a marked chronic inflammatory reaction, and that eosinophil infiltration may play a significant role in this marked inflammation of the sinus mucosa. OBJECTIVE: Chronic sinusitis and bronchial asthma are known to be closely related. However, the appearance of the mucosa in chronic sinusitis patients with asthma is somewhat different from that in patients without asthma. MATERIAL AND METHODS. We compared the sinus mucosal histopathologies of asthmatic patients with those of non-asthmatic patients. Fifty-three sinusitis patients with a diagnosis of asthma and 54 sinusitis patients without asthma, who served as controls, were enrolled in the study. All of these patients underwent endoscopic sinus surgery. The following seven light microscopic findings were compared in the asthmatic and non-asthmatic groups: the thickness of the basement membrane, goblet cell hyperplasia, subepithelial edema, submucous gland formation, eosinophil infiltration, lymphocyte infiltration and polymorphonuclear leukocyte infiltration. In addition, we explored a possible link between asthma and sinusitis by comparing the following factors in asthmatic and non-asthmatic patients: the presence of allergy, the degree of preoperative polyposis and the extent of preoperative disease as scored by means of ostiomeatal unit CT findings. RESULTS: No statistically significant differences were found between the two groups in terms of the presence of allergy, the degree of preoperative polyposis or the extent of preoperative disease. Basement membrane thickening, goblet cell hyperplasia and eosinophil infiltration were more prominent in the asthmatic compared to the non-asthmatic group (p <0.05).     

Anthropometric study of alar cartilage in Asians

Measurements of 52 alar cartilages in 26 Koreans were obtained for an anthropometric study during primary open-approach rhinoplasties. The lateral crura were found most commonly to be concave, exhibited in 40% of the male patients and in 50% of the female patients. The medial crura were most often straight, found in 56% of the male patients and in 46% of the female patients. The average length, width, and thickness of the lateral crura were 19.7 mm, 10.5 mm, and 0.55 mm, respectively, in men; and 16.8 mm, 9.8 mm, and 0.54 mm, respectively, in women. The lengths of the columellar and footplate segments of the medial crura were 10.0 mm and 7.8 mm in men, and were 8.0 mm and 6.3 mm in women. These data suggest that the alar cartilage in Asians, contrary to popular myth, is not markedly smaller than that of whites. However, differences were found in the configuration of the cartilage and the length of the footplate of the medial crus.     

Mucus circulation between accessory ostium and natural ostium of maxillary sinus

We report a case of one asymptomatic 28-year-old male with mucus circulation between the natural ostium and the accessory ostium of the maxillary sinus. Computerized tomography (CT) revealed a recirculating mucus ring between the two ostia of the maxillary sinus.     

Estrogen protects against 3-methylindole-induced olfactory loss

Olfactory dysfunction is among the first signs of Alzheimer's disease (AD). Since estrogen therapy may mitigate the cognitive symptoms of AD, we determined whether 17beta-estradiol (E2) alters the olfactory discrimination performance of female rats exposed to the olfactotoxicant 3-methylindole (3-MI). Twelve ovariectomized rats received daily injections of E2 (1 mg/kg i.p.) in corn oil and 10 received daily injections of corn oil alone. Sensory testing occurred on a near-daily basis throughout a 10-week test period, midway in which a single injection of 3-MI was administered (300 mg/kg i.p.). On each pre- and post-3-MI test day, the rats were required to perform a series of successively more difficult odor discrimination tasks until one was reached where <80% performance was attained. The tasks were between the odor of a 10-4 v/v concentration of ethyl acetate (EA) and the odor of each of six different concentrations of butanol added to the EA (10-4, 10-4.5, 10-5.0, 10-5.5, 10-6.0, 10-6.5 v/v). Following 3-MI treatment, the performance of the E2-treated rats was found to be superior to that of the oil-treated rats and to return more quickly to the pre-3 MI baseline, suggesting that high doses of E2 mitigate 3-MI-induced smell loss in rats. Additional work is needed to determine the physiologic basis of this phenomenon.     

A Relationship between the Obstructive Sleep Apnea Syndrome and the Erythrocyte Sedimentation Rate

Objectives

The erythrocyte sedimentation rate (ESR) is a marker for inflammation, and it has been identified as a risk factor for atherothrombotic cardiovascular disease. The aim of this study was to determine the relationship between the plasma ESR level and nocturnal oxygen desaturation or other polysomnographic variables and to examine the role of obesity in patients with obstructive sleep apnea syndrome (OSAS).

Methods

This retrospective study included 72 patients with a diagnosis of OSAS who underwent overnight polysomnography and routine blood tests between July and December of 2005. We compared the plasma ESR level with the sum of all the polysomnographic variables and divided the patient group into obese and non-obese patients.

Results

The mean ESR level was 8.45 mm/hr. There was a significant difference in the ESR level between genders (P<0.001). A significant correlation was found between the percentage of time spent at a SpO₂ below 90% and the ESR level in the obese group (BMI ≥25, N=43, P=0.012). In addition, the ESR levels had a positive correlation with age in the obese group (P=0.002). However, there was no significant correlation with the percentage of time spent at a SpO₂ below 90% in the whole group of patients and in the non-obese group (BMI <25, N=29). The ESR level showed no correlation with the other polysomnographic variables.

Conclusion

The duration of deoxygenation in obese patients with OSAS may be associated with the ESR level which is an independent predictor of cardiovascular disease.     

Risk factors for intraoperative saddle nose deformity in septoplasty patients

European Archives of Oto-Rhino-Laryngology - Septoplasty is one of the most common otolaryngologic procedures. Previous studies have reported that the overall rate of significant change in cosmetic...     

Endodontic treatment: a significant risk factor for the development of maxillary fungal ball

Objectives

The risk factors for maxillary fungal ball are largely unknown. The aim of this study was to determine whether endodontic treatment of maxillary teeth is a risk factor for fungal ball development in the maxillary sinus, and to identify other possible risk factors.

Methods

One hundred and twelve case patients diagnosed with maxillary fungal ball (FB group) and age and gender matched control patients diagnosed with chronic paranasal rhinosinusitis (PNS group) were included to determine associations between previous endodontic treatment and maxillary fungal ball. In addition, we reviewed the dental extraction status of maxillary teeth and the underlying disease in both groups to analyze the other risk factors for maxillary fungal ball.

Results

There were 36.3% of patients in the FB group and 16.1% in the PNS group showed evidence of endodontic treatment on the maxillary teeth (P<0.001). Even after correction for possible confounding factor - the frequency of dental extractions - the rate of endodontic treatment remained higher in the FB group. The mean number of endodontically treated maxillary teeth in the FB group and PNS group were 0.63 and 0.27, respectively (P=0.001). In addition, 20.5% of the patients in the FB group and 13.4% in the PNS group has diabetes mellitus (P=0.154).

Conclusion

Endodontic treatment on maxillary teeth was a significant risk factor for the development of fungal balls in the maxillary sinus.     

Computed tomographic assessment of chronic rhinosinusitis with asthma

BACKGROUND: The purpose of this study was to investigate differences in the extent of disease in patients with chronic rhinosinusitis (CRS) both with and without asthma. METHODS: Medical records and computed tomographic (CT) scans of 48 consecutive asthmatic patients and 523 nonasthmatic patients with CRS between April 1995 and December 2001 were reviewed, retrospectively. Each sinus in the ostiomeatal complex CT scans was assigned a score of 0-2 according to the extent of disease using the Lund-Mackay scoring system, and the ratios of the score of each sinus to the total score were analyzed for the difference between the asthmatic and nonasthmatic groups. A Mann-Whitney test was used for statistical evaluation, with p < 0.05 accepted as statistically significant. RESULTS: The ratios of ethmoid sinus score to total score were higher in asthmatic patients than in nonasthmatic patients (p < 0.001), and the ratios of the score of maxillary sinus to total score were lower in asthmatic patients than in nonasthmatic patients (p < 0.001). CONCLUSION: Our study shows that the ethmoid sinus is the preferred site of CRS in patients with coexisting asthma.     

Clinical characteristics of chronic rhinosinusitis with asthma

OBJECTIVE: This study was directed at identifying clinical features of chronic rhinosinusitis with asthma, and examining the differences of the postoperative outcomes in asthmatics and nonasthmatics. STUDY DESIGN AND SETTING: Twenty-one asthmatic and 77 nonasthmatic patients who underwent functional endoscopic sinus surgery (FESS) were entered into the study. The following six parameters were determined in asthmatic and nonasthmatic groups; the presence of allergy, previous sinus surgery, severity of preoperative rhinosinusitis symptoms, improvements in postoperative rhinosinusitis symptoms, preoperative disease extent, and postoperative endoscopic outcomes. RESULTS: Symptom scores improved significantly in both asthmatics and nonasthmatics postoperatively, and asthmatics exhibited significantly worse postoperative endoscopic outcomes compared with nonasthmatics. No difference was found in other parameters between two groups. Multivariate analysis revealed asthma continues to be an independent predictor of success. CONCLUSIONS: The present study found that chronic rhinosinusitis in asthmatics showed worse postoperative outcomes than in nonasthmatics, and every attempt should be made for the improvement of surgical results in these patients.     

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.