Will all children have allergic rhinitis in next decades?

Congress of the European-Academy-of-Allergy-and-Clinical-Immunology (EAACI) -- MAY 26-30, 2018 -- Munich, GERMANYWOS: 000441690405268…European Acad Allergy & Clin Immuno

Olfactory Bulb Volume and Olfactory Sulcus Depth in Patients With OSA: An MRI Evaluation

PubMed: 31608681Objectives: We evaluated olfactory functions in patients with obstructive sleep apnea (OSA). Methods: The cranial magnetic resonance images of 58 adult patients (36 males and 22 females) aged 27 to 79 years were retrieved from the hospital picture archiving and communication system (PACS) system. There were 29 patients with OSA (17 males and 12 females), diagnosed according to the polysomnography results. A control group consisted of 29 healthy patients without OSA. Olfactory bulb (OB) volume and olfactory sulcus (OS) depth measurements were performed. Nasal septal deviation (SD) was also evaluated and recorded as no SD, deviation to the right, and deviation to the left in all groups. Results: Olfactory bulb volumes of the OSA group were significantly lower than those of the control group (P .05). There was a positive correlation between the right and left OB volumes and right and left OS depth values (P .05) Conclusion: In patients with OSA, OB volumes decreased bilaterally. It may be related to intermittent nocturnal hypoxia/reoxygenation episodes, which may be a trigger for upper airway inflammation; and proinflammatory mediators maybe harmful on olfactory neuroepithelium and olfactory impairment may occur. © The Author(s) 2019

Consensus on Methodology for Experimental Studies of Nasal Mucosal Injury

PubMed: 31449221Objectives:The way wounds heal involves significant complexity, resulting in restoration of functional and anatomical integrity to tissues damaged as a result of trauma (whether mechanical, chemical, or radiation-induced). The authors reviewed the consensus on methodology for experimental studies of nasal mucosal injury.Methods:The review aims to find where consensus exists amongst different experimental studies in nasal wound healing about the use of animal models. To achieve this, the authors queried the Pubmed, Proquest Central and Google databases for the last 20 years (i.e. 1996-2016). The search terms were: "mucosa injury," "nasal mucosa injury," "injury," "wound healing," "nasal," "nasal wound healing," "experimental," "animal," "model," "rat," "rabbit," "guinea pig," and "mice." These terms were searched for whether they occurred singly or in combination. The search uncovered 18 papers, on the basis of which this review has been prepared.Results:The choice of an appropriate animal model is key in investigating nasal mucosal injury. Suitable animals include rodents such as rats or guinea pigs. There are reports in the literature concerning mechanical injury in rat nasal mucosae without attempts to treat it. Mechanical injury was induced unilaterally by means of an interdental brush. Other techniques involved the use of distilled water or irradiating the tissue to induce trauma.Conclusion:In this review, the use of a rat, guinea pig or rabbit model for human nasal mucosal injury is reviewed. Such models are suitable for use in well-designed experimental studies. © 2019 by Mutaz B. Habal, MD

Olfactory function in patients undergoing hemodialysis as assessed by Sniffin’ Sticks testing

OBJECTIVE: This study evaluated olfactory function in patients undergoing hemodialysis. The evaluation utilized the Sniffin’ Sticks test. PATIENTS AND METHODS: The study enrolled 56 individuals undergoing hemodialysis for chronic renal failure alongside 54 healthy controls. The Sniffin’ Sticks battery was used to assess olfactory function in all subjects. The battery included 12 separately identifiable odors. A score below 6 was considered anosmia, whilst scores ranging from 7 to 10 were classed as hyposmia. A score of at least 11 indicated normal olfaction. RESULTS: There was a statistically significant difference in scores between the two groups. The hemodialysis patients scored 9.12±2.77 compared to 10.72±1.94 in the controls. In the hemodialysis patients, scores for males and females did not differ significantly. Furthermore, there was no correlation between score and age, sex or length of renal failure. Some 12.5% of hemodialysis patients were anosmic, whilst 50% were hyposmic. The corresponding rates in the control group were 7.4% and 20.4%. CONCLUSIONS: Undergoing hemodialysis is associated with a decreased total score on the Sniffin’ Sticks battery, with anosmia in 12.5% of patients and hyposmia in 50.0%. Thus, olfactory impairment is present in 62.5% of hemodialysis patients. According to previous research, renal transplantation results in an improved ability to smell, depending on how plastic the neurons involved in olfaction are

A new preservation technique for dehumping the dorsum

OBJECTIVE: We aimed to offer a new preservation strategy for dehumping the dorsum by using a variation of the cartilage push-down (Ishida) technique. PATIENTS AND METHODS: Three hundred patients (42 males and 258 females) had surgical procedures. All procedures were closed-surgery-type, primary-case procedures performed through a closed incision. Low cartilaginous septal strip resection was performed on 269 individuals, whereas high septal strip resection was performed on the remaining 31 patients. The bony cap is shielded as a separate unit and preserved, so protected from any potential damage. The cartilage roof is separated from the bone roof and lowered while wearing the bony cap component. As a result, less concealment is required. However, it is ineffective on dorsal profiles that are sharp or S-shaped, as opposed to flat. Thus, the modified cartilage push-down with bony cap rasping procedure can be carried out. The sharp hump on the bony crown of the skull is smoothed out and filled. Therefore, the bony cap above the central cartilage roof is much thinner. Because the hump is less likely to appear again, concealment is unnecessary. A median of 8.5 months was spent following-up (6-14 months). RESULTS: According to our method, among men (n=42), the hump size ranged from minor (n=5) to medium (n=25) to big (n=12). There were 258 women, 88 of whom had a little hump, 160 had a medium hump, and 10 had a huge hump. Indicative of surgeon satisfaction with low cartilaginous septal strip excision vs. high septal strip resection include the following: with a total of 269 patients, 35 males, and 234 females had low cartilaginous septal strip resections, with 98 and 96% success rates, respectively, for the surgeons. There were 31 patients, seven men and 24 women, who all underwent high septal strip resections, with a 98% and 96% success rate for the surgeons. It was found that there was a correlation between the size of the hump and the level of satisfaction felt by its bearers. Rates of male satisfaction with humps ranged from 100% for little humps to 100% for medium humps to 99% for huge humps. Satisfaction percentages among women ranged from 98% in the case of little humps to 96% among medium humps and 95% among large humps. CONCLUSIONS: Our technique of modification of the cartilage push-down (Ishida)1 method is applied for dehumping the dorsum. High satisfaction percentages were obtained from the patients and surgeons. This technique may be a good option for patients who need dehumping

Success rates for various graft materials in tympanoplasty – A review

Objectives: The aim of this paper is to review how successful each type of grafts is in tympanoplasty. Methods: Pubmed, Google and the Proquest Central Database at Kırıkkale University were queried using the keywords “graft”, “success” “tympanoplasty”, “success rate” with the search limited to the period 1955 to 2017. Results: Various types of graft materials including temporalis fascia, cartilage, perichondrium, periosteum, vein, fat or skin have been used in the reconstruction of tympanic membrane (TM) perforation. Although temporalis fascia ensures good hearing is restored, there are significant concerns that its dimensional stability characteristics may lead to residual perforation, especially where large TM perforations are involved. The “palisade cartilage” and “cartilage island” techniques have been stated to increase the strength and stability of a tympanic graft, but they may result in a less functional outcome in terms of restoring hearing. Smoking habits, the size and site of a perforation, the expertise level of the operating surgeon, age, gender, the status of the middle ear mucosa and the presence of myringosclerosis or tympanosclerosis are all important in determining how successful a graft is. Conclusion: Although temporal fascia is the most commonly used graft material for tympanoplasty, poor graft stability may cause failure. This failure is due to the inclusion of connective fibrous tissue containing irregular elastic fibers present in the grafted fascia. Cartilage grafts offer better ability to resist infection, pressure, and cope with insufficient vascular supply. This means that cartilage grafts are suitable for use in revision cases. © 2020 PLA General Hospital Department of Otolaryngology Head and Neck SurgeryWith exception of data collection, preparation of this paper including design and planning was supported by Continuous Education and Scientific Research Association

Endoscopic ear surgery

Objectives: This article reviews the advantages and disadvantages of endoscopic ear surgery (EES). Method: Pubmed, Google and the Proquest Central Database at Kırıkkale University were queried using the keywords “endoscopic ear surgery”, “ear surgery” and “endoscopy” to identify the literature needed for the review. Results: Endoscopes allow for enhanced surgical visualisation. The distal part of the apparatus is illuminated and contains lenses angled to allow a wider view of the operative area. Transcanal endoscopic techniques have transformed the external ear canal (EAC) into an operative gateway. The benefits EES can offer include wider views, enhanced imaging capabilities and increased magnification, and ways to see otherwise poorly visualisable portions of the middle ear. EES permits surgeons to operate using minimally invasive otological techniques. When compared with microscope-assisted surgery, endoscopic tympanoplasty has been shown to require a shorter operating time in some instances. There are a number of drawbacks to EES, however, which include the fact that it is a single-handed technique, that the light source may produce thermal injury and that visualisation using the endoscope is severely curtailed if bleeding is profuse. Conclusion: EES is a safe and effective technique. The current literature supports the idea that the results achieved by endoscopic methods are usually comparably beneficial to results obtained using conventional microscopic methods. © 2019 PLA General Hospital Department of Otolaryngology Head and Neck Surgery“With exception of data collection, preparation of this paper including design and planning was supported by Continuous Education and Scientific Research Association.” There is no financial support. There is only scientific support

Time-dependent middle ear pressure changes under general anaesthesia in children: N2O-O2 mixture versus air-oxygen mixture

PubMed: 23909121Time-dependent middle ear pressure changes under general anaesthesia in children: N2O-O2mixture versus air-oxygen mixture. Objectives: The aim of this study was to investigate the effects of N 2O-O2 mixture (Inspired O230%) on middle ear pressure (MEP) in children compared with the effects of an air-oxygen mixture (Inspired O250%). Method: The study included thirty child patients who underwent general anaesthesia for different reasons, with the exception of ENT problems and ear interventions. They were randomly divided into two groups. Group 1(15 children: 10 male and 5 female) received a N2O-O 2 mixture (Inspired O2 30%); and group 2(15 children: 10 male and 5 female) were given an air-oxygen mixture (Inspired O2 50%). MEP was measured using a portable impedance analyser before the operation (PreO),10 minutes after intubation (10AEn), 30 minutes after intubation (30AEn), 10 minutes before extubation (10BEx), 15 minutes after the operation (PO15), 30 minutes after the operation (PO30), 1 hour after the operation (POlh) and 6 hours after the operation (PO6h). Results: The pressure and compliance values were the same in groups 1 and 2. The pressure-time graphs for the two groups were different: in Group 2, MEP rose quickly at l0AEn and positive pressure values were seen in the middle ear. MEP then fell rapidly until the end of the surgery and lower and negative pressures (Mean-50 daPa) were observed at PO6h. In Group 1, MEP was elevated at l0AEn and positive pressure was found (but not as high as in Group 2). MEP then fell more slowly. In other words, positive pressure in the middle ear persisted longer and the middle ear was subjected to positive pressure and nitrogen over a longer period. Separate analyses were made in Groups 1 and 2 of pressure differences and of compliance values at eight measurement points using the Friedman test. Differences in pressure values were found to be statistically significant in both Group 1 (p = 0.000) and Group 2 (p = 0.000). In Group 1, all the lOAEn and 30AEn values were significantly higher than the PreO, PO30, POlh and P06h values. The lOBEx value was significantly higher than the PreO and POlh values. The PO15 value was significantly higher than the PreO value. In Group 2, the PO6h value was significantly lower than the lOBEx, l00AEn and 30AEn values. The POlh value was significantly lower than the 30AEn values. The MEP values increased in Group 1 in younger and taller children and in children receiving anaesthesia for shorter periods. MEP values increased in Group 2 in younger and taller children, and in heavier children. MEP values fell with the length of anaesthesia. Conclusion: In brief anaesthesia, nitrogen was not removed from the middle ear quickly in Group 1: middle ear pressure values were higher. The nitrous oxide remained in the middle ear longer and so the possibility of ear toxicity may increase. In Group 2,50% O2was rapidly absorbed and removed from the middle ear and so middle ear pressure was not as high. It may be concluded that air-oxygen mixture (Inspired O2 50%) anaesthesia should be recommended as being more reliable in tympanoplasties and other middle ear interventions than a N 2O-O2mixture (Inspired O2 30%)

Fillers around the nose

OBJECTIVE: The aim of this paper is to investigate the efficacy of filler applications which were evaluated in terms of nasal deformity and quality of life of the patients, and to review the fillers around the nose. PATIENTS AND METHODS: Forty patients who underwent filler application were included into the study and were divided into Group 1 (Deep Radix), Group 2 (Minor irregularities due to rhinoplasty), Group 3 (Shallow dorsum) and Group 4 (Dorsal irregularity). There were 10 patients in each of the groups. In all groups, nasal deformity score was evaluated with a 1 to 5 scale as following: 1- No deformity, 2- Hardly visible deformity, 3- Visible deformity, 4- Moderate deformity, 5- Apparent deformity. Quality of life was evaluated by a 1 to 10 scale, 1 showing very low and 10 showing very high. RESULTS: Our results showed that there were statistically significant improvements (decreased) in nasal deformity evaluation scores after the procedure compared to the before the procedure scores in Group 1 (Deep Radix), Group 3 (Shallow dorsum) and Group 4 (Dorsal irregularity) (p0.05). For nasal deformity evaluation after the procedure, Group 1 (Deep Radix), Group 3 (Shallow dorsum) and Group 4 (Dorsal irregularity) scores were significantly lower (better) than Group 2 (Minor irregularities due to rhinoplasty) scores (padjusted <0.0125). In all four groups (Deep Radix, Minor irregularities due to rhinoplasty, Shallow dorsum, Dorsal irregularity), quality of life scores were significantly improved (increased) after the procedure compared to before the procedure (p<0.05). For Quality of life (VAS) before the procedure, Group 3 (Shallow dorsum) scores were significantly higher (improved, increased) than Group 1 (Deep Radix) and Group 4 (Dorsal irregularity) (padjusted <0.0125). CONCLUSIONS: Filler applications improved (decreased) nasal deformity evaluation scores and improved (increased) quality of life scores. Fillers can be applied for deep radix, minor irregularities due to rhinoplasty, shallow dorsum and dorsal irregularity. It is essential to choose carefully appropriate materials and procedures for patients to obtain optimum results

Chronic Rhinosinusitis—Could Phenotyping or Endotyping Aid Therapy?

PubMed: 30353741Objectives: We reviewed the phenotyping and endotyping of chronic rhinosinusitis (CRS) and treatment options. Methods: We searched PubMed, Google, Google Scholar, and the Proquest Central Database of the Kırıkkale University Library. Results: Phenotypes are observable properties of an organism produced by the environment acting upon the genotype, that is, patients with a particular disorder are subgrouped according to common characteristics. Currently, CRS is usually phenotyped as being with (CRSwNP) or without (CRSsNP) nasal polyps. However, this is not immutable as some individuals progress from nonpolyp to polypoid CRS over time. Phenotypes of CRS are also based on inflammatory patterns, generally CRSwNP is eosinophilic, CRSsNP neutrophilic; but there is a spectrum, rather than a clear-cut division into 2 types. An endotype is a subtype of a condition defined by a distinct functional or pathobiological mechanism. Endotypes of CRS can be (1) nontype Th2, (2) moderate type Th2, and (3) severe type Th2 immune reactions, based on cytokines and mediators such as IL4, 5, 13. CRS endotyping can also include a (1) type 2 cytokine-based approach, (2) eosinophil-mediated approach, (3) immunoglobulin E-based approach, and (4) cysteinyl leukotriene-based approach. Subdivisions of CRSwNP can be made into nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, allergic fungal sinusitis, and eosinophil pauci-granulomatous arteritis by testing. General treatment for all CRS is nasal douching. The place of surgery needs careful reconsideration. Endotype-directed therapies include glucocorticosteroids, antibiotics, aspirin, antifungals, anticytokines, and immunoglobulin replacement. The recognition of united airways and the co-occurrence of CRSwNPs and severe asthma should lead to common endotyping of both upper and lower airways in order to better direct therapy. Conclusion: Endotyping can allow for the identification of groups of patients with CRS with a high likelihood of successful treatment, such as patients with a moderate type 2 immune reaction or those with acquired immune deficiency. © The Author(s) 2018.With exception of data collection, preparation of this paper including design and planning was supported by Continuous Education and Scientific Research Association. There is only scientific support