Nasal hypersensitivity in purulent middle ear effusion

The existence of a physiopathologic connection between nose and middle ear is widely accepted so that chronic purulent middle ear effusion (CPMEE) could be expected to be usually associated with nasal chronic disease or impaired function. Nevertheless such association is less frequently observed in clinical practice than one could expect, possibly because of inadequate nasal function evaluation. Thirty-five patients affected by CPMEE were included in this study in order to assess the incidence of nasal disorders. E.N.T. clinical history was obtained and E.N.T. physical examination, nasal endoscopy by fiberoptics, anterior rhinorheomanometry, non-specific nasal provocation test with histamine, mucoliary transport test, and allergic skin tests were performed. In the clinical history assessment 26 patients were affected by chronic rhinopathies, 16 by chronic pharyngitis, and 20 by frequent headache. At rhinoscopy we registered nasal septum deviation in 24 cases and mean and inferior turbinates hypertrophy in 31 cases. CPMEE and nasal septum deviation or turbinates hypertrophy were more frequently omolateral (p < .001 and p < .05, respectively). Total nasal resistance was 0.99 ± 0.49; it was abnormally high in 11 subjects bilaterally and in 4 subjects monolaterally and increased significantly in 32 patients following nasal provocation test. Mucociliary transport time was longer in CPMEE subjects than in 10 healthy subjects (18 ± 5 vs 13 ± 4 min; p < .05). Finally 10 patients presented positive skin tests. On the whole, 96% of non allergic patients included in this study showed signs of non-specific nasal hypersensitivity which could theoretically cause purulent middle ear effusion to chronicize. Indeed recurrent histamine release in response to specific and/or aspecific stimuli could cause the obstruction of the Eustachian tube and consequently inadequate middle ear ventilation

Research of non-specific hyperreactivity of upper airways in subjects with gastro-esophageal reflux (G.E.R.): Preliminary reports

An association between asthma and gastro-esophageal reflux (GER) is well recognized but the underlying mechanism is still unclear. The authors suggest that could exist an association between GER and upper airways hyperreactivity and this association could represents the mechanism underlying the lower esophageal sphincter releasing, that determine the reflux. In fact they suppose that, the noxious injury of acid reflux follows a course that could be: pharynx → larynx → bronchi → 1/3 inferior of the esophagus → reflux. From these presuppositions the authors carried out a study on the possible relationship between GER and non-specific hyperreactivity of upper airways on 14 subjects, divided in 2 groups: 10 subjects with functional GER, 4 subjects suffering from GER caused by hiatus hernia as control group. All patients had a thorough medical history, ENT examination with rigid and flexible endoscope, anterior Rhinomanometry (RRM), skin-test for inhalant and alimentary allergens, RAST, audiometric exam, non-specific nasal provocation test (NSNPT) with histamine, using as control the number of sneezes. From a through analysis of objective examination and from the results of the NSNPT with histamine resulted that all subjects with functional GER were rhinopathics. In all tests both in vivo (Skin-test) and in vitro (RAST) for the most common allergens (pollens-inhalant-mycophites-alimentary) the results were negative. The authors also found an involvement of paranasal sinuses that raised: 91% in the patients with recurrents phlogosis due to non specific nasal hyperreactivity; 40.9% in the allergic subjects (20% in the Graminacee +; 32% in the Parietaria O. +; 76% in the Dermatophagoides Pt. +; others 4%); 100% in the ASA-intollerance subjects. The NSNSPT with histamine showed in the group with functional GER a hyperreactivity with sneezes in 6/10 subjects, and 1/4 subjects of the group with GER with hiatus hernia. The RRM variations showed an unilateral nasal hyperreactivity in 6/10, bilateral in 3/10 subjects of the group with functional GER. In the group with GER with hiatus hernia only 1/4 subject showed reliable unilateral RRM variation. From the analysis of data resulted that subjects with functional GER showed a completely involvement of the upper airways and not only of the pharynx and larynx, caused by non specific hyperreactivity at the NSNPT with histamine, associated with a chronic pathology

Surgical-pathological findings in type 1 and 2 endometrial cancer: An NRG Oncology/Gynecologic Oncology Group study on GOG-210 protocol

To report clinical and pathologic relationships with disease spread in endometrial cancer patients

Input effects across domains:The case of Greek subjects in child heritage language

A recurring question in the literature of heritage language acquisition, and more generally of bilingual acquisition, is whether all linguistic domains are sensitive to input reduction and to cross-linguistic influence and to what extent. According to the Interface Hypothesis, morphosyntactic phenomena regulated by discourse–pragmatic conditions are more likely to lead to non-native outcomes than strictly syntactic aspects of the language (Sorace, 2011). To test this hypothesis, we examined subject realization and placement in Greek–English bilingual children learning Greek as a heritage language in North America and investigated whether the amount of heritage language use can predict their performance in syntax–discourse and narrow syntactic contexts. Results indicated two deviations from the Interface Hypothesis: First, subject realization (a syntax–discourse phenomenon) was found to be largely unproblematic. Second, subject placement was affected not only in syntax–discourse structures but also in narrow syntactic structures, though to a lesser degree, suggesting that the association between the interface status of subject placement and its sensitivity to heritage language use among children heritage speakers is gradient rather than categorical

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS