Surfactant protein A and D in chronic rhinosinusitis with nasal polyposis and corticosteroid response

WOS: 000303148400005PubMed ID: 22487281Background: Corticosteroids are a mainstay of treatment for chronic rhinosinusitis with nasal polyposis (CRSwNP). Data related to the effect of systemic methylprednisolone on surfactant protein (SP) expression in CRSwNP is limited. This study aimed to reveal the consequences of systemic methylprednisolone treatment on levels of SP-A and SP-D, which play a role in innate immunity, in patients with CRSwNP. Methods: Twenty-one patients with CRSwNP were included in the study, along with 15 control patients scheduled for dacryocystorhinostomy. A polypoid tissue biopsy was taken under local anesthesia, and 15 CRSwNP patients were scheduled for endoscopic sinus surgery after 3 weeks of oral methylprednisolone. Posttreatment biopsies were performed perioperatively. Pre- and posttreatment endoscopic polyp grades were determined, as were symptom scores regarding nasal obstruction, headache, and nasal discharge using a visual analog scale (VAS). SP-A and SP-D levels were measured using enzyme-linked immunosorbent assay and the results were compared. Results: All patients reported relief from clinical symptoms through VAS after methylprednisolone treatment. The posttreatment polyp grade was reduced (p < 0.0001). SP-A and SP-D levels did not yield a significant difference between CRSwNP patients and controls (p = 0.25 and p = 0.13, respectively). Statistically significant up-regulation was detected in SP-A and SP-D levels after oral methylprednisolone (p = 0.0002 and p = 0.0004, respectively). Conclusion: In this study, significant up-regulation of SP-A and SP-D was revealed in patients with CRSwNP after systemic steroid treatment. The role of SP-A and SP-D up-regulation in CRSwNP pathogenesis and therapeutic outcomes of corticosteroids have potential importance for the introduction of new therapeutic modalities that are more effective and produce fewer adverse effects. (Am J Rhinol Allergy 26, e76-e80, 2012; doi: 10.2500/ajra.2012.26.3739

The Evaluation of Olfactory Function in Individuals With Chronic Halitosis

Halitosis and olfactory dysfunction may disrupt an individual's quality of life remarkably. One may ask whether halitosis has effects on olfactory functions or not? Thus, the aim of this study was to evaluate the olfactory abilities of subjects with chronic halitosis evaluated using the measurements of volatile sulfur compounds. This study was carried out in 77 subjects, with a mean age of 40.1 +/- 13.3 years, ranging from 18 to 65 years. Forty-three participants were diagnosed as halitosis according to the gas chromatography results and constituted the halitosis group. Also, a control group was created from individuals without a complaint of halitosis and also who had normal values for volatile sulfur compounds. Each subject's orthonasal olfactory and retronasal olfactory functions were assessed using "Sniffin' Sticks" and retronasal olfactory testing. The results showed that odor threshold scores were lower in participants with halitosis compared with controls. Also, hyposmia was seen more common in the halitosis group than in controls. Moreover, a significant negative correlation was found between odor threshold scores and volatile sulfur compounds levels, particularly with hydrogen sulfide and dimethyl sulfide levels. The results suggest that the chronic presence of volatile sulfur compounds may have a negative effect on olfactory function

Transcervical Tongue Base Reduction with Hyoepiglottoplasty: Long-Term Results

Aims To evaluate the long term results of tongue base reduction with hyoepiglottoplasty as a surgical option in the treatment of severe obstructive sleep apnea. Material and Method Severe obstructive sleep apnea patients diagnosed as upper airway narrowing at the tongue base level were treated with transcervical tongue base reduction with hyoepiglottoplasty. Seven years after single stage multilevel surgery, the patients were reevaluated clinically, radiologically and polysomnographic records were taken. Preoperative, early postoperative and long-term postoperative parameters were compared to determine the success rate of the surgical technique. Results In the postoperative long-term follow-up Epworth sleepiness scale (ESS) scores were reduced to 4 and 6 respectively 2 months after surgery despite the initial values of 17 and 15. BMI were decreased from 29.7 and 27.9 kg/m2 respectively to 26 and 24 kg/m2. The apnea/hypopnea index (AHI) were reduced to 14.1 and 16.2 respectively from 68.6 and 83.83. O2 nadir was 55 and 66% respectively and improved to 86 and 89%. Flexible nasopharyngoscopy revealed competent airway in both retropalatal and retroglossal level. Bed partners scored snoring as 2/10 and 4/10 corresponding to very mild and moderate. Daytime somnolence and witnessed apneic periods were completely disappeared in both patients. Conclusion Open tongue base resection with hyoepiglottoplasty is effective among all other surgical corrections of sleep apnea even after 7 years postoperatively