Showing papers in "Rhinology in 1993"

The role of acoustic rhinometry in studying the nasal cycle.

Abstract: The nasal cycle has been demonstrated in man using several techniques, including magnetic resonance imaging, anterior rhinoscopy, rhinomanometry, all of which have limitations due to expense, discomfort, limited scope or poor reproducibility. Acoustic rhinometry is a new technique which analyses nasal geometry throughout the nasal cavity, not just at the flow-limiting segment. Six adult volunteers were examined at 15-to 30-min intervals using acoustic rhinometry. The classical alternating cycle was seen in three subjects, a non-classical cycle was seen in two, and no cycle seen in one subject. Changes occurred throughout the nasal cavity and corresponded with fluctuations in subjective scores of obstruction and, in one case, with nasal resistance measurements. Acoustic rhinometry is a rapid, reproducible and non-invasive technique. This pilot study demonstrates that it has potential for studying in detail the physiology of the nasal cycle.

Nasal distribution of budesonide inhaled via a powder inhaler.

Abstract: The distribution pattern of budesonide in the nasal passages and lungs was investigated in 10 healthy subjects after nasal inhalation. The subjects inhaled drug powder, radiolabelled with 99mTc, at maximum flow rate (46.3 +/- 6.8 l/min) and at 29.9 +/- 2.5 l/min via Turbuhaler. At both flows, the majority of the dose was deposited in the anterior part of the nasal cavity on a single, rather localized area, but some particles also penetrated more posteriorly into the main nasal passages and to the lungs. At maximum flow rate the nasal deposition was 65.2% (range 39.5-84.1%) and the lung deposition 4.7% (range 1.4-9.3%) of the metered dose, and at 30 l/min, the nasal deposition was 67.6% (range 49.7-81.6%) and the lung deposition was 4.2% (range 1.7-7.9%). A large fraction of the metered dose was deposited in the nasal adaptor of the inhaler during the administration (mean values 29 and 28%, for the two inhalation flows). Of the dose actually reaching the subject, 91 and 93% (mean values) was deposited in the nose. There were no statistically significant differences in distribution pattern between the two inhalation flows.

Constraints on the moral agency of nurses.

Abstract: Awareness of nurses' ethical concerns has increased greatly over the last few years. In response to this awareness, the Canadian Nurses Association revised the Code of Ethics to provide direction for the implementation of ethical standards for nursing. Yet, a growing body of literature suggests that situational constraints make it difficult for nurses to uphold these standards. Overcoming these constraints will take concerted efforts in nursing education, administration, practice and research.

Olfactory neuroblastoma: clinical and pathological aspects.

Abstract: Twenty cases of olfactory neuroblastoma were available for clinical and histopathological evaluation The usefulness of immunohistochemistry in the diagnosis of this tumour was investigated and was best achieved using a panel of monoclonal and polyclonal antibodies, notably neuron-specific enolase, PGP 95, S-100 protein, synaptophysin and chromogranin A This study confirmed that immunohistochemistry is a useful adjunct in cases where conventional histology is equivocal

A test for objective diagnosis of nasal hyperreactivity.

Abstract: The aim of this study was to develop a method for the objective diagnosis of nasal hyperreactivity. The method should be standardized and simple enough to be used in clinical practice. In the study nasal challenge test with histamine was performed. Ten healthy volunteers and ten patients with a history of nasal hyperreactivity entered the trial. Recordings of nasal mucosa congestion were made with rhinostereometry. The results indicate that this method can indeed be used for the objective diagnosis of nasal hyperreactivity.

The effect of intranasal azelastine and beclomethasone on the symptoms and signs of nasal allergy in patients with perennial allergic rhinitis.

Abstract: A double-blind, randomized, parallel-group, placebo-controlled study involving 130 patients was conducted at 9 centres in the U.K. to assess the effect of 6 weeks of treatment with azelastine nasal spray (azelastine) and beclomethasone dipropionate nasal spray (BDP) on the symptoms of perennial rhinitis. Efficacy was assessed by patients recording daily the severity of the symptoms of rhinitis on 10-cm visual analogue scales. Analysis of this diary data showed significant reductions in sneezing, blocked nose, running nose, and itching nose during azelastine treatment. Patients on BDP recorded a consistent reduction in rhinitis symptoms, but these reductions were significant only for sneezing on treatment day 7. When rhinitis symptoms were assessed by clinical investigators on a 4-point scale, the scores obtained following treatment with the 2 study medications showed little change from baseline or "active" treatment scores. There was no evidence of a consistent change in nasal airway resistance, measured using anterior rhinomanometry, following treatment with either BDP or azelastine. Azelastine nasal spray and BDP nasal spray were well tolerated by the patients and the relative incidence of adverse events was similar in the azelastine and placebo/azelastine treatment groups, except that taste perversion occurred more frequently during azelastine treatment than during placebo/azelastine treatment. There was no evidence of an increased incidence of somnolence or fatigue in patients who received azelastine nasal spray. Overall, the results of this study indicate that azelastine administered twice daily as an intranasal spray is a safe and efficacious treatment for the symptoms of rhinitis in patients suffering from mild to moderate perennial rhinitis.

The effect of different preparations of nasal decongestants on ciliary beat frequency in vitro.

Abstract: Ciliated cells from the nasal mucosa of normal persons were collected in culture medium and exposed to either oxymetazoline without preservatives, oxymetazoline with preservatives, xylometazoline with preservatives, or sham (culture medium). There was a significant decrease in ciliary beat frequency only by the two drugs with preservatives after 20 min. After substitution of the test media with culture medium ciliary action did not recover in any group.

A multicentre study to assess long-term use of fluticasone propionate aqueous nasal spray in comparison with beclomethasone dipropionate aqueous nasal spray in the treatment of perennial rhinitis.

Abstract: Two hundred and fifty-one patients, aged 16 years and over, with perennial rhinitis were recruited to this multicentre, randomized, double-blind, parallel group study. One hundred and fifty-nine patients received fluticasone propionate (200 micrograms) aqueous nasal spray (FPANS) twice daily, and 83 patients received beclomethasone dipropionate (200 micrograms) aqueous nasal spray (BDPANS) twice daily; treatment randomization being 2:1, respectively, in order to increase the number of patients in the FPANS group as FPANS was the drug under study. After 1 year of treatment, nasal blockage (p = 0.002), nasal discharge (p = 0.002) and eye watering/irritation (p = 0.048) were significantly improved in patients treated with FPANS twice daily, compared to patients treated with BDPANS twice daily. The symptom grades for nasal itching (p = 0.052) were improved in the FPANS group, but just failed to attain statistical significance at the 5% level. The symptom grades for sneezing tended to be better for the FPANS group, but the difference was not statistically significant. Assessment of changes in the findings during nasal examination (rhinoscopy) and in haematological, biochemical and urinary parameters, and measurements of plasma cortisol levels during the one year of treatment with the study drugs, showed that there were no clinically significant differences between the two treatment groups and that the study drugs were equally well tolerated. This study indicates that long-term use of FPANS provides better relief than BDPANS for most of the symptoms of perennial rhinitis.

The role of CT in functional endoscopic sinus surgery

Abstract: The intricate anatomy of the paranasal sinus unit (sinus/nasal cavities and ostia) and its relations to the orbit and anterior cranial fossa make accurate pre-operative evaluation of disease in this region mandatory before undertaking functional endoscopic sinus surgery (FESS). Plain radiography often fails to provide vital information in cases of chronic rhinosinusitis, especially of the ethmoid labyrinth, which is a key area of the paranasal sinus unit. Computerized tomography has significantly enhanced the scope of endoscopic sinus surgery by offering the surgeon hitherto inaccessible information regarding the sinus status. In this article, we review the pros and cons of the two imaging modalities, and present our experience fo 70 CT scans in patients of FESS. We also propose a surgical classification of CT findings. All in all, plain radiographs prove to be of little value for pre-operative assessment in FESS, while CT scans are an essential tool.

Immunocompetent cells in human nasal polyps and normal mucosa.

Abstract: The distribution of T- and B-lymphocytes, HLA-DR-expressing cells, and macrophages was determined using monoclonal antibodies in frozen biopsy sections of nasal polyps from 12 patients, and of nasal mucosa from five disease-free controls. The relative proportion and spatial distribution of different lymphoid cells was similar with regards to both nasal polyps and normal mucosa. Numerous scattered T lymphocytes (Leu4-positive) and HLA-DR-expressing macrophage/dendritic-like cells were shown and tended to accumulate in the subepithelial areas. Aggregates of T lymphocytes and HLA-DR-positive cells were also found close to deeper glands. In the submucosal clusters, the Leu3a-positive ("helper/inducer") cells were more common than the Leu2a-positive ("suppressor/cytotoxic") cells. Furthermore, a number of epithelial, non-lymphoid cells were found to express the HLA-DR antigen, which suggests an active role for the epithelium in the immunological response of the normal mucosa as well as that of the nasal polyp.

Open septorhinoplasty. Experiences in 200 patients.

Abstract: There are two approaches for septorhinoplasty, the endonasal approach and the external approach. The external approach is much criticized for the risk of columellar skin flap necrosis and visible scar formation. This series of patients has shown that the risk can be minimized using a mid-columellar broken incision with a meticulous closure technique. The exposure of the surgical anatomy is much better than with the endonasal approach, leading to better insight in nasal deformities and more detailed reconstruction. There seems to be no reasonable objection which can be raised against the columellar incision to reject the open approach.

Continuous infrared thermometry of the nasal mucosa.

Abstract: This study aims to continuously measure nasal mucosal temperature without interruption of nasal breathing using infrared thermometry. An infrared thermometer (Medi-Therm 310; Everest Interscience, Inc.) was directed at the nasal septum from a distance of 15 cm. Infrared radiation was continuously collected, then converted to an electrical signal proportional to the mucosal temperature and output to a chart recorder. In 70 subjects the mean nasal mucosal temperature was 30.4 +/- 2.0 degrees C on inspiration and 32.0 +/- 1.8 degrees C on expiration. Using multiple regression, nasal mucosal temperature was significantly related to atmospheric temperature (p < 0.0001) and inversely related to the airway patency of the ipsilateral nasal passage (p < 0.05).

Demonstration of bilateral cholinergic secretory response after unilateral nasal cold, dry air challenge

Abstract: Cold, dry air (CDA) causes rhinorrhoea and nasal congestion in some individuals. This response can be mimicked in the laboratory by exposing susceptible individuals to cold, dry air nasal breathing. One of the characteristics of this response is that nasal secretions are produced by both nostrils after a unilateral challenge. This study evaluated the role of cholinergic innervation on the ipsi- and contralateral responses to unilateral CDA challenge. Twelve individuals participated in a randomized, double-blind, placebo-controlled, 3-way crossover study where local atropine and placebo were alternated ipsilateral and the contralateral to the CDA challenge. The reproducibility of the model, assessed by the response after pre-treating with placebo, was excellent; after placebo, the ipsilateral response was double the size of the contralateral. Regardless of the site of application, atropine significantly reduced the secretory response to CDA by 60-70%. However, significant secretions were still induced by CDA, even after atropine treatment. We conclude that cholinergically-mediated neuronal pathways play a major role in the nasal secretory response to CDA. Additional neuronal pathways may, however, be involved. This method is a tool to understand the different components of the mucosal response to a cold and dry environment.

Giant osteoma of the frontal sinus.

Abstract: Osteoma is the most common benign tumour of the nose and paranasal sinuses, and the frontal sinus is its most frequent location. This tumour may be discovered incidentally on radiographs, or may enlarge to produce symptoms and, rarely, complications referable to its location near the orbit and anterior cranial vault. A 61-year-old man presented with right proptosis was found to have a giant osteoma involving frontal sinus. The aetiology, presenting features, and treatment of this tumour are reviewed.

Comparison of carbon dioxide laser and electrosurgery in the treatment of rhinophyma.

Abstract: Cosmetic results of rhinophymas treated with carbon dioxide laser or electrosurgery were compared in six patients 2-5 years after surgery. Although the results were comparably good the use of the carbon dioxide laser proved to be more time-consuming and less convenient. Scar formation was observed in both patient groups equally and was related to the depth of tissue removal, independent of the instrument used.

Repair of saddle nose deformity in Wegener's granulomatosis and ectodermal dysplasia.

Abstract: Two cases are reported involving surgical treatment of a saddle nose deformity due to Wegener's granulomatosis and ectodermal dysplasia, respectively. The association of ozena with both diseases requires special consideration for any type of transplants because of a high risk of infectious complications. By extranasal incisions the nasal dorsum has been successfully reconstructed by transplanting autogenic conchal cartilage. There has been no resorption or displacement of the transplant after twelve months in the case of ectodermal dysplasia, and after 25 months in the patient with Wegener's granulomatosis despite a severe recurrence of this disease.

The effect of ostial opening on experimental maxillary sinusitis in rabbits

Abstract: Obstruction of the natural ostium is known to be one of the major factors in the pathogenesis of maxillary sinusitis. To explore the therapeutic effect of ostial patency, sinusitis was induced in 32 rabbits by obstruction of the natural ostium and inocculation of Streptococcus pneumoniae. They were divided into two groups: the first ("open") group included 16 rabbits with experimentally induced sinusitis, from which bone chips for obstruction of the natural ostium were removed after a period of 5 days, and the second ("closed") group included 16 rabbits with continuous obstruction of the natural ostium. The induction of sinusitis was found to be successful in all cases, when examined after five days. The amount of nasal and sinus secretion as well as histopathological findings of the sinus mucosa were investigated with light microscopy, scanning and transmission electron microscopy, two and four weeks after induction of sinusitis. The findings were significantly improved in the "open" group.

Evaluation of allergen-specific IgE antibodies by MAST for the diagnosis of nasal allergy.

Abstract: Multiple-antigen simultaneous test (MAST) is a new system for detecting allergen-specific IgE antibodies. Multiple antigens can be examined simultaneously in a short period of time by this method. The purpose of this study is to evaluate the usefulness of this method and to compare the results of MAST with those of RAST and intradermal skin test using 133 serum samples obtained from patients with nasal allergy. The positive rates of the main allergens detected by the MAST system are 56% for Japanese cedar, 31 for Dermatophagoides farinae (DF), 30% for Dermatophagoides pteronyssinus (DP), 27% for house dust (HD), and 27% for timothy grass. The positive rates of food allergens are very low. An average of 3.5 different allergens can be simultaneously detected in one serum. We have compared MAST and RAST with respect to nine allergens: HD, DF, cat, Japanese cedar, timothy, bahia, sweet vernal, velvet, and ragweed. There are statistically significant correlations between MAST and RAST for all allergens except ragweed, the correlation coefficients in the eight allergens are greater than r = 0.60, and total agreements exceed over 70%. Similarly, there also is a good correlation between MAST and skin test for the allergens: HD, cat, Japanese cedar, timothy grass, and ragweed. These results indicate the clinical usefulness of the MAST system for detecting specific IgE antibodies in patients with nasal allergy.

The prolongation of drug action in the treatment of diseases of the nose and paranasal sinuses.

Abstract: In order to prolong drug contact with the mucous membrane, and thus therapeutic action, cellulose polymers have been used. These polymers exert no toxic action on liver function. The release of the drug from the polymer depends on the degree of polymer viscosity. The use of drug-containing polymers in the treatment of nasal diseases and paranasal sinusitis is highly effective.

An unusual case of sphenoid sinus mucocele with severe intracranial extension.

Abstract: We present an unusual case of sphenoid sinus mucocele with severe intracranial extension, which was diagnosed and treated at the AHEPA General Hospital, University of Thessaloniki, Greece. The patient was a 54-year-old female who presented with endocrine, nasal and ophthalmological symptoms, and headache. She was successfully treated by surgery using an intranasal approach. While presenting this case, we briefly review the literature on the subject of sphenoid sinus mucoceles.

Nasal hyperreactivity. A histamine provocation model.

Abstract: The aim of the study was to see whether it is possible to select non-allergic persons with hyperreactivity, especially in the nose, from healthy individuals with a histamine standardization test. Another aim was to elucidate whether a so-called priming effect could be present in such a non-allergic disorder. Seven patients with a history of perennial rhinitis, expressed as either or both swelling or discharge from the nose and a negative allergic investigation, were examined on three up to seven consecutive occasions. Rhinostereometry was used to register the reaction in the mucous membrane to a solution of histamine in successively increased concentrations. The results showed a statistically significant difference between this group compared with a control group of healthy volunteers. We could not detect any increase in the sensitivity during repeated provocations.

Endonasal endoscopy and posterior epistaxis.

Abstract: The availability of a comprehensive range of endonasal telescopes facilitates systematic examination of the nasal cavity. Epistaxis is normally divided into anterior and posterior. Posterior epistaxis is diagnosed when anterior rhinoscopy fails to visualize anterior-located bleeding points. With the aid of endonasal endoscopy the exact location of bleeding points can be identified and diathermy applied under direct vision. Twenty-seven cases of the so-called posterior epistaxis were treated successfully by endonasal endoscopy. The technique is particularly useful during acute nose bleeds, it shortens hospital stay, and reduces the discomfort inflicted by the presence of nasal packing. The need for blood transfusion is reduced by using endonasal endoscopy in the acute stage of epistaxis.

Effect of surface-active substance on nasal mucociliary clearance time: a comparison of saccharin clearance time before and after the use of surface-active substance.

Abstract: Mucociliary clearance measured by saccharin clearance time is depending on ciliary function and on the physiological characteristics of mucus. The aim of this study was to determine whether the application of surface-active substances changed the mucociliary transport time. Twenty healthy persons were manually sprayed with surface-active substance in one of their nose cavities. The saccharin clearance time was measured before spraying and statistically compared with saccharin clearance time after spraying. Saccharin clearance time was significantly shortened immediately after spraying with surface-active substances. This difference was not found 2 h later. Our assay indicates that surfactant increases the rate of mucociliary transport in the upper respiratory tract.

Nasal dorsal cyst after rhinoplasty.

Abstract: Nasal dorsal cyst formation after rhinoplasty is considered a rare complication. These cysts are due to entrapment of mucosal remnants in the subcutaneous space. Meticulous surgical technique aimed at preserving the mucosal lining may prevent cyst formation. Surgical excision with the open approach is a reliable treatment. A case of nasal dorsal cyst after previous rhinoplasty is presented. After four years no sign of recurrence is noted.

Cholesterol granuloma of the frontal sinus. A case report.

Abstract: A rare case of cholesterol granuloma of the frontal sinus is reported. The pathogenetical mechanisms and the tumour's behaviour are discussed on the basis of the patient's, the radiologic examination and the pathologist's finding's. A follow-up of three years is given.

Adrenergic and non-adrenergic vasoconstrictor mechanisms in the human nasal mucosa.

Abstract: The possible occurrence of adrenergic and non-adrenergic vasoconstrictor mechanisms has been studied in human nasal mucosa biopsies. The tissue contractions (reflecting vascular tone variation) in response to exogenous noradrenaline (NA), neuropeptide Y (NPY) and somatostatin (SOM) were measured in vitro. Dose-dependent contraction of the nasal mucosa was observed for the three agents studied and the rank order of their vasoconstrictive potency was NA > SOM > NPY. On a molar basis NPY showed an 80% less potent vasoconstrictive activity than SOM. Pretreatment with the alpha-adrenoceptor antagonist phenoxybenzamine (10(-6) M) almost completely abolished the vasoconstrictive response to NA, whereas the effects of NPY and SOM remained intact. The responses to SOM were significantly reduced after pretreatment with high dose of the competitive SOM-antagonist analog cyclo(7-aminoheptanoyl-PHE-D-TRP-LYS-THR[BZL]). When SOM was administered simultaneously with NA, the contractile response was significantly reduced as compared to the effect of NA alone. In contrast, concomitant administration of NPY and NA potentiated the vasoconstrictive effect of NA. The present data suggest that both adrenergic and non-adrenergic vasoconstrictor mechanisms are present in the human nasal mucosa vascular bed. Furthermore, NPY and SOM may act as modulators of the NA-induced vasoconstrictive effects.

Effect of S-carboxymethylcysteine on ciliary activity in chronic sinusitis.

Abstract: This study was designed to investigate the possible pharmacological effect of S-carboxy-methylcysteine (S-CMC) on the ciliary activity, using an in vitro experimental system after removing mucus. Ciliary activity from healthy rabbit maxillary sinus and from healthy human nasal mucosa demonstrated no significant change in RPMI 1640 containing S-CMC. On the other hand, the effect of S-CMC on the reduced ciliary activity from patients with chronic sinusitis was quite varied among the cases examined. S-CMC demonstrated no stimulatory effect on the beating activity of cilia that have a baseline activity of less than 400 beats/min. However, S-CMC was able to enhance the beating activity of cilia that demonstrated a baseline activity of more than 400 beats/min. S-CMC at 0.5% induced a larger ciliostimulatory effect than 0.05% S-CMC. In conclusion, our study has clearly demonstrated that S-CMC could directly enhance ciliary activity of chronic sinusitis in the absence of significant organic change of ciliated cells.

A preliminary comparison of the effects of halothane and isoflurane on nasal mucosal blood flow.

Abstract: The differing effects of halothane and isoflurane on nasal mucosal blood-flow was investigated by means of laser-doppler flowmetry in a total of fourteen patients who received one of these inhalational agents during anaesthesia. A trend towards lower nasal flux was seen in the halothane group but, due to insufficient numbers, significance could not be demonstrated. These changes in flux appeared not to be related to the falls in perfusion pressure which were seen in both groups of patients and were thought to be due to locally vasoactive effects.

The influence of beta-adrenoceptors on nasal mucosal function.

Abstract: The aim of the study was to elucidate the role of beta-adrenoceptors in normal human nasal mucosa. In two studies, beta-receptor function was tested by the application of agonists and antagonists. Measurements of nasal secretion and nasal peak expiratory flow were performed at 4-min intervals, during 12 min of rest, pre- and post-treatment, 12 min of exercise and 20 min of recovery. In Study 1, placebo was compared with 100 micrograms salbutamol and 2 mg propranolol. Neither placebo nor 100 mg salbutamol affected nasal secretion production at rest, but propranolol caused a transient significant increase (p < 0.05). Exercise significantly increased secretion production in all three treatment groups (p < 0.05). Nasal peak expiratory flow was not altered at rest, but increased significantly (p < 0.05) during exercise in the three treatment groups. In Study 2 placebo was compared with 200 mg salbutamol, 80 micrograms isoprenaline and 2 mg atenolol. Secretion production was not altered at rest by any treatment and increased during exercise in all four (p < 0.05). There was no significant difference between weights of secretions produced between any of the treatment groups during exercise. Salbutamol significantly decreased nasal peak expiratory flow at rest compared with placebo (p < 0.05). During exercise nasal peak flow increased in all groups, but peak exercise values were significantly reduced by both salbutamol and isoprenaline (p < 0.05). Atenolol appeared to have no effect on nasal peak expiratory flow.(ABSTRACT TRUNCATED AT 250 WORDS)