International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

Background: Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR).Methods: Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus.Results: The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR.Conclusion: This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding. </p

Localization of T cells and subtypes in the paranasal sinus and turbinate mucosa in patients with chronic sinusitis

WOS: 000226985200005PubMed: 15903204The aim of this study was to quantitate total T lymphocytes (total CD3+ cells) and T-lymphocyte subtypes (CD4+ [T helper] and CD8+ [T suppressor] cells) in patients with chronic sinusitis, who were treated with functional endoscopic sinus surgery (FESS) and to investigate the pathophysiology of persistent inflammation in chronic sinusitis. This prospective study was conducted in study and control groups. The study group consisted of 32 patients (20 male, 12 female) with chronic sinusitis who underwent FESS. The control group consisted of 8 nonsinusitis patients (5 male, 3 female) who underwent septoplasty. Specimens from the study group were excised from five regions: the uncinate process, maxillary and ethmoid sinuses, and middle and inferior turbinates. The specimens were examined with x10 magnification by light microscopy, and the slides with a severe inflammatory process were included. Punch biopsy of the control group was taken from the inferior turbinate with patients' written approval. The surgical specimens from the study and control groups were examined with an immunohistochemical staining technique with monoclonal antibodies against CD3, CD4, and CD8 surface antigens of T lymphocytes. In every specimen, the numbers of CD3+, CD4+, and CD8+ cells were-calculated in 3 to 4 high magnification field on light microscopy, and the mean number of these cells in the epithelium, subepithelial layer of the lamina propria, and deep paraglandular layer of the mucosa was determined. Statistical analysis by Kruskal-Wallis analysis of variance and the Mann-Whitney U test with Bonferroni correction revealed that the CD3 epithelial layer value of the inferior turbinate (p = .030) and the CD4 deep layer value of the middle turbinate (p = .048) were significantly higher than the corresponding values of the control group. In the epithelial (p = .018) and subepithelial (p = .012) layers of the uncinate process group, in the epithelial (p = .050) and subepithelial (p = .012) layers of the ethmoid sinus group, and in the subepithelial (p = .018) and deep paraglandular (p = .012) layers of the middle, turbinate group, the difference between the CD4+ and CD8+ cell counts was found to be statistically significant by the Wilcoxon signed rank test. The number of CD4+ cells was higher than the number of CD8+ cells. In conclusion, T cells play a role in the pathophysiology of chronic sinusitis. CD4+ T helper cells, in particular, are predominant at the initiation and regulation of inflammation. The uncinate process, ethmoid sinus, and middle and inferior turbinates have the main roles by T cells and subtypes in the defense system in chronic sinusitis

Relationship between tinnitus loudness level and internal jugular venous flow rate measured by coloured Doppler ultrasonography in patients with a high jugular bulb

WOS: 000229703700011PubMed: 16076414The aim of this study was to investigate the relationship between tinnitus loudness level (TLL) and internal jugular venous flow rate (IJVFR) in tinnitus patients with a unilateral high jugular bulb detected by temporal bone high-resolution computed tomography (HRCT). The study group consisted of 24 adult patients (13 male, 11 female) with a unilateral high jugular bulb. One ear suffered from tinnitus with a high jugular bulb was included into the study group. The ears without tinnitus and no high jugular bulb on temporal bone HRCT comprised the control group. All patients were evaluated with a history and physical and otolaryngologic examinations, and, using a questionnaire, TLLs were detected. The patency and flow rates in the internal jugular veins were measured by right and left internal jugular venous Doppler ultrasonography. The TLLs were "very quiet" in 1 (4.1%) patient, "intermediate loud" in 17 (70.9%) patients, and "very loud" in 6 (25.0%) patients. IJVFRs were not different in the study and control groups. In the study group, IJVFRs were not correlated with age. There was no relationship among TLLs and IJVFRs, dominance, dehiscence, and bony septum thickness between the high jugular bulb and the middle ear. TLLs were not affected by IJVFRs, dominance, dehiscence, and bony septum thickness in patients with a high jugular bulb. More detailed studies should be undertaken to determine the reason for the different TLLs in patients with a high jugular bulb

Emotional effects of nasal packing measured by the hospital anxiety and depression scale in patients following nasal surgery

WOS: 000231846100004PubMed: 16089220The aim of this study was to test the validity of the Hospital Anxiety and Depression (HAD) Scale in patients who underwent nasal surgery as a method of screening for emotional disorders during their hospital stay. The study group consisted of 50 adult patients (29 male, 21 female) who underwent nasal surgery for different reasons, such as chronic sinusitis, nasal polyposis, and nasal septal deviation. Functional endoscopic sinus surgery and/or septoplasty were managed in these patients, and all of the patients had nasal packing applied bilaterally for 2 days. The HAD Scale was given to all of the patients 1 day before surgery and 1 day after surgery, with anterior nasal packing bilaterally during the hospital stay. The anxiety and depression levels of the male group were under the cutoff points. For the female group, the depression levels were under the cutoff points, and the anxiety levels were high in the preoperative period and decreased after the operation. Anxiety and depression levels in the pre- and postoperative periods for the male and female groups were analyzed by Paired t-test. No statistically significant result was found (p >.05). It was concluded that, for patients well informed about nasal packing and hospital conditions, nasal packing may be used safely, without any psychological disturbance. The HAD Scale should be a more useful screening method to diagnose emotional disorders, especially in patients who are hospitalized for a long time

Role of mast and goblet cells in the pathogenesis of nasal polyps

WOS: 000236956400009PubMed: 16527032In this study, the role of mast and goblet cells and eosinophils in the pathogenesis of nasal polyposis was investigated. The study group consisted of 28 adult patients (15 males, 13 females) with nasal polyposis Who underwent functional endoscopic Sinus surgery (FESS). All patients in the study group were examined with a questionnaire, an otolaryngologic examination, an endoscopic examination with 0 degrees and 30 degrees endoscopes, Waters' graphy, and axial and coronal computed tomography of the paranasal sinuses. The control group consisted of 10 adult patients without nasal polyp (7 males and 3 females) Who Underwent septoplasty. They gave written approval to enter the study. The polyp specimens from the study group were excised from four regions: the maxillary sinus, ethmoid sinus, sphenoid sinus, and nasal cavity. The), were examined at x400 magnification by light microscopy, and only the slides with polypoid tissue were included in the study. Slides including a chronic inflammatory process without polypoid tissue were excluded from the study. The control group was composed of the slides of specimens from the inferior turbinate. Forty slides (10 in each group) in the study group and -10 slides in the control group were included in the study. The surgical specimens from the study and control groups were examined with a histochemical staining techique. In every surgical specimen, the type of epithelium and the numbers of goblet and mast cells and eosinophils were calculated in x400 high-magnification field in 10 areas oil light microscopy, as well as the mean number of these cells, and for mast cells separately, cell count in the epithelium and the stromal layer of polyp tissue and total mast cell count, including both epithelial and stromal mast cells, were identified. Goblet cells, mast cells, and inflammation with cosinophils were observed in all sinonasal mucosa. The common epithelial type in the polyp tissue Was pseudostratified ciliated cylindric epithelium, which contains goblet cells. Goblet cell numbers in the maxillary, ethmoid, and sphenoid sinuses and nasal cavity were found to be significantly higher than in the control group (p <.05). For total mast cell and cosinophil count, no statistically significant difference was found between all five groups. In each group, there was no statistically significant difference between goblet and mast cells. Increased goblet cells in sinonasal polyps indicated that systemic factors also affect nasal polyposis as much as local factors, Such is airflow and muscosal contact. Surgical treatment of sinonasal polyps by FESS Causes more Sufficient air ventilation in the nasal cavity and paranasal Sinuses. Therefore, the goblet cell density will decrease because of the exposure of the mucosal surfaces to the air. In particular, FESS and then the appropriate medical treatment may decrease the recurrence rates and increase the patient's comfort. The significantly increased goblet cell Count ill the sinonasal mucosa demonstrated the importance of these cells in the pathogenesis of nasal polyposis. Also, mast cells and eosinophils may have a role in the inflammatory processes, leading to nasal polyposis formation

Minnesota Multiphasic Personality Inventory Profile of patients with allergic rhinitis

WOS: 000184555000011PubMed: 12921140The aim of this study was to investigate the relationship between allergic rhinitis and personality traits in a nonpsychiatric population of proven allergic status. Subjects were assigned to the allergic group (n = 29) and the nonallergic group (n = 29) on the basis of the medical examination, allergic prick tests, and self-reported allergic status. Analysis of Minnesota Multiphasic Personality Inventory Profile (MMPI) profiles showed that male subjects with allergic rhinitis had significantly higher scores on depression, paranoia, and social introversion. Depression, hypochondriasis, and hysteria scores were significantly higher in female subjects. It may be concluded that patients with allergic rhinitis have poorer psychological function compared with the nonallergic subjects

CT assessment of the effect of fluticasone propionate aqueous nasal spray treatment on lower turbinate hypertrophy due to vasomotor rhinitis

WOS: 000233618400007PubMed: 16308253Conclusion. Fluticasone propionate ( FP) aqueous nasal spray was objectively found to be effective and safe for the treatment of lower turbinate enlargement in patients with vasomotor rhinitis. Objective. To assess the efficacy of FP aqueous nasal spray treatment in lower turbinate hypertrophy due to vasomotor rhinitis using CT. Material and methods. Of 35 patients with hypertrophic lower turbinates due to vasomotor rhinitis, 20 were treated twice daily with FP aqueous nasal spray ( 200 mu g/day) for 3 months continuously and 15 were treated with placebo vehicle as a control group. The local effect of the nasal spray was studied using CT and visual analog scales. Results. Treatment with FP provided significantly greater relief from the symptom of nasal obstruction compared with placebo over the entire 3-month treatment period ( p< 0.001). When the change from baseline was compared between the two groups, FP produced statistically significant reductions in the mucosal area of the lower turbinates and in the thickness of the nasal mucosa after 3 months (p< 0.05)

Efficacy of topotecan treatment on antioxidant enzymes and TBA-RS levels in submandibular glands of rabbits: An experimental study

KISA, Ucler/0000-0002-8131-6810WOS: 000226216300025PubMed: 15632925OBJECTIVE: The aim of this study was to investigate the effects of topotecan (Hycamtin), a topoisomerase I inhibiting anticancer agent, on antioxidant enzymes (SOD, CAT, and GSH-Px) and TBA-RS values of the submandibular glands of the rabbits. STUDY DESIGN AND SETTING: The study was conveyed in two groups (Group I, II) and control with a total of 24 rabbits. Eight rabbits in group I received intravenous (i.v.) topotecan (0.25 mg/kg once daily) for 3 days. Eight rabbits in group II received i.v. topotecan (0.5 mg/kg once daily) for 3 days. On the 15th day after administration of topotecan, submandibular glands were removed and levels of the SOD, CAT, and GSH-Px and the TBA-RS in the submandibular glands of the rabbits were examined. RESULTS: SOD, CAT, and GSH-Px values were significantly higher in high-dose topotecan group compared to control group (P < 0.05). SOD and TBA-RS values were significantly higher in high-dose topotecan group compared to low-dose topotecan group (P < 0.05). CONCLUSION: It was concluded that, to prevent the hazardous effects of oxygen free radicals due to topotecan, antioxidant enzymes SOD, CAT, and GSH-Px were increased. The higher levels of the TBA-RS values in group II showed that permanent damage was present because of high-dose topotecan administration in the submandibular glands of the rabbits

A survey on chronic rhinosinusitis: opinions from experts of 50 countries

Chronic rhinosinusitis (CRS) is a very prevalent inflammatory disease. Treatments vary in different countries. In the present study, we explored the approaches of physicians in 50 countries. In this cross-sectional study, a rhinosinusitis survey (RSS) was completed by Honorary and Corresponding Members (otorhinolaryngologists) of the Italian Society of Rhinology. In 79.1 % of the 50 countries, the proportion of patients suffering from CRS was 15 %. Nasal symptoms were more intense in winter (46 % of countries), and spring and autumn (22 %). The most common symptoms were nasal obstruction (86 %), postnasal drip (82 %) and headache (52 %). The most common investigative modalities in the assessment of CRS are paranasal sinus CT, fiberoptic endoscopy, and anterior rhinoscopy. CRS patients were principally treated by otorhinolaryngologists (70 %). Medical treatments included nasal corticosteroids (90 %), nasal washes (68 %), and nasal decongestants (32 %). In 88 % of countries, more than 50 %, or "about 50 %", of all patients reported subjective symptom improvement after treatment. In most of the countries, surgery was required by 20-35 % of all CRS patients. During post-surgery follow-up, nasal washes (90 %), nasal corticosteroids (76 %), and systemic antibiotics (32 %) were prescribed. In 20-40 % of all patients, CRS was associated with nasal polyps. In such patients, the medical treatment options were nasal corticosteroids (90 %), systemic corticosteroids (50 %), nasal washes (46 %), and systemic antibiotics (34 %). Treatment of CRS patients varies in different countries. Paranasal sinus CT is the most common investigative modality in the assessment of CRS, and nasal corticosteroids are the first-line treatment, in the absence or presence of nasal polyps