Analyses and treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms.

In this study, we analyze and discuss the treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms (PNs). We performed 129 endonasal transsphenoidal resections of PNs and analyzed and treated cases with nasal complications. After endonasal transsphenoidal resection of PNs, there were 26 cases of postoperative nasal complications (20.1%), including nasal hemorrhage (4.8%), cerebrospinal fluid rhinorrhea (6.9%), sphenoid sinusitis (2.3%), atrophic rhinitis (1.6%), olfactory disorder (1.6%), perforation of nasal septum (0.8%), and nasal adhesion (2.3%). All patients clinically recovered after therapy, which included treatment of the cavity through nasal endoscopy, intranasal corticosteroids, and nasal irrigation. We propose that regular nasal endoscopic review, specific nasal medications, and regular nasal irrigation can effectively clear nasal mucosal hyperemia-induced edema and nasal/nasoantral secretions, as well as promote regeneration of nasal mucosa, prevent nasal adhesion, maintain the sinus cavity drainage, and accelerate the recovery of the physiological function of the paranasal sinus. Timely treatment of patients with nasal complications after endonasal transsphenoidal resections of PNs could greatly relieve the clinical symptoms. Nasal cleaning is very beneficial to patients after surgery recovery.

Empty nose syndrome.

Empty nose syndrome (ENS) is a rare, late complication of turbinate surgery. The most common clinical symptoms are paradoxical nasal obstruction, nasal dryness and crusting, and a persistent feeling of dyspnea. Little is known about the pathogenesis of ENS, though it is speculated that anatomical changes leading to alterations in local environment, disruption of mucosal cooling, and disruption of neurosensory mechanisms are strongly implicated. The diagnosis is clinical, though often difficult to make due to the poor correlation between subjective and objective findings. Medical therapies include mucosal humidification, irrigations, and emollients. Surgical therapy should be reserved for refractory cases and may involve turbinate reconstruction, most commonly using implantable biomaterials. Ultimately, prevention of this feared complication through turbinate-sparing techniques is essential.

Rinitis atrófica / Atrophic rhinitis

La rinitis atrófica es una enfermedad crónica y progresiva de etiología desconocida. Se caracteriza por atrofia de la mucosa nasal y hueso subyacente, dilatación anormal de las cavidades nasales, obstrucción nasal paradójica, y formación de secreciones viscosas y costras secas; produciendo fetidez. Sus manifestaciones clínicas más frecuentes son obstrucción nasal, secreción purulenta, costras nasales y mal olor nasal. Se ha separado en dos entidades: primaria y secundaria. El tratamiento es principalmente conservador, y se han propuesto diversas terapias farmacológicas y quirúrgicas. La rinitis atrófica unilateral es una condición infrecuente, con escasos reportes en la literatura científica. Se puede asociar a la desviación septal, por lo que su corrección quirúrgica es una alternativa terapéutica disponible.

Atrophic rhinitis is a chronic disease of unknown etiology. This condition is characterized by progressive nasal mucosal and underlyng bone atrophy, abnormal widening of the nasal cavities, paradoxical nasal congestion and formation of viscid secretions and dried crusts, leading to a characteristic fetor (ozaena). The main clinical manifestations include nasal obstruction, purulent discharge, daily nasal crusting, nasal dryness and foul smell. It has been divided into two separate entities; primary and secondary. Treatment is mostly conservative, although pharmacological and surgical therapies have been proposed. Unilateral atrophic rhinitis is an uncommon condition, with few reports in the scientific literature. It is associated with septum deviation, so surgical correction is one of the therapeutic options available.

Regeneration of toxigenic Pasteurella multocida induced severe turbinate atrophy in pigs detected by computed tomography.

BACKGROUND: Atrophic rhinitis is a widely prevalent infectious disease of swine caused by Bordetella bronchiseptica and Pasteurella multocida. The course of the disease is considered to be different depending on the principal aetiological agents distinguishing B. bronchiseptica induced non-progressive and toxigenic P. multocida produced progressive forms. In order to compare the pathological events of the two forms of the disease, the development of nasal lesions has longitudinally been studied in pigs infected by either B. bronchiseptica alone or B. bronchiseptica and toxigenic P. multocida together using computed tomography to visualise the nasal structures. RESULTS: B. bronchiseptica infection alone caused moderately severe nasal turbinate atrophy and these lesions completely regenerated by the time of slaughter. Unexpectedly, complete regeneration of the bony structures of the nasal cavity was also observed in pigs infected by B. bronchiseptica and toxigenic P. multocida together in spite of seeing severe turbinate atrophy in most of the infected animals around the age of six weeks. CONCLUSIONS: B. bronchiseptica mono-infection has been confirmed to cause only mild to moderate and transient lesions, at least in high health status pigs. Even severe turbinate atrophy induced by B. bronchiseptica and toxigenic P. multocida combined infection is able to be reorganised to their normal anatomical structure. Computed tomography has further been verified to be a useful tool to examine the pathological events of atrophic rhinitis in a longitudinal manner.

Atrophic rhinosinusitis: progress toward explanation of an unsolved medical mystery.

PURPOSE OF REVIEW: Atrophic rhinosinusitis is a chronic condition associated with considerable morbidity and decreased quality of life. This review describes progress in the characterization of primary and secondary atrophic rhinosinusitis and the development of diagnostic criteria for both syndromes. RECENT FINDINGS: Primary atrophic rhinitis usually develops as a consequence of an acute febrile illness in members of lower socioeconomic groups in developing areas of the world. The clinical setting and presence of culturable Klebsialla ozenae in the purulent, foul-smelling, nasal discharge of these patients forms the basis for diagnosis. An animal model for the disease exists in swine in which case an effective vaccine has been developed. Secondary atrophic rhinosinusitis is a condition that follows destruction of the nasal mucosa by any of a number of inflammatory processes including inflammatory diseases nasal/sinus surgery, and antiangiogenic therapy. Diagnostic criteria include patient reported recurrent epistaxis or episodic anosmia; or physician documented nasal purulence, nasal crusting, chronic inflammatory disease involving the upper airway (e.g. sarcoidosis, Wegener's granulomatosis, etc.) or two or more sinus surgeries. Patients with two more of these have secondary atrophic rhinitis with a sensitivity of 0.95 and a specificity of 0.77. SUMMARY: Atrophic rhinosinusitis results from destruction of the normal respiratory epithelium and transition to a nonciliated squamous epithelium, loss of mucociliary clearance, accumulation of stagnant mucous. That milieu facilitates acute and chronic infection (wet phase), and eventual sclerosis with epistaxis and chronic bloody crusts (dry phase).

Rhinitis sicca, dry nose and atrophic rhinitis: a review of the literature.

Despite the fact that many people suffer from it, an unequivocal definition of dry nose (DN) is not available. Symptoms range from the purely subjective sensation of a rather dry nose to visible crusting of the (inner) nose (nasal mucosa), and a wide range of combinations are met with. Relevant diseases are termed rhinitis sicca anterior, primary and secondary rhinitis atrophicans, rhinitis atrophicans with foetor (ozena), and empty nose syndrome. The diagnosis is based mainly on the patient's history, inspection of the external and inner nose, endoscopy of the nasal cavity (and paranasal sinuses) and the nasopharynx, with CT, allergy testing and microbiological swabs being performed where indicated. Treatment consists in the elimination of predisposing factors, moistening, removal of crusts, avoidance of injurious factors, care of the mucosa, treatment of infections and where applicable, correction of an over-large air space. Since the uncritical resection of the nasal turbinates is a significant and frequent factor in the genesis of dry nose, secondary RA and ENS, the inferior and middle turbinate should not be resected without adequate justification, and the simultaneous removal of both should not be done other than for a malignant condition. In this paper, we review both the aetiology and clinical presentation of the conditions associated with the symptom dry nose, and its conservative and surgical management.

Anhidrotic ectodermal dysplasia presenting as atrophic rhinitis.

Ectodermal dysplasia is a complex group of familial disorders with numerous clinical characteristics, with an incidence of 7 in 10000 born alive children. Ectodermal dysplasia affects structures of ectodermal origin like the skin and its appendages as well as other non-ectodermal structures. The most common sites of involvement are the defects in the skin, hair, teeth, nails and sweat glands,which are of ectodermal origin. Though the dermatologists and paediatricians often manage such cases, we report one case of ectodermal dysplasia presenting with atrophic rhinitis.

Empty nose syndrome: what are we really talking about?

The problem with empty nose syndrome is probably not that it does not exist, it is that we cannot adequately explain its existence by what we currently understand about the nose. The result of empty nose syndrome or iatrogenic atrophic rhinitis as a consequence of turbinectomy remains a controversial topic that deserves further scrutiny. It is clear from the literature, that not everyone undergoing a turbinectomy procedure suffers from the debilitating symptoms of either atrophic rhinitis or empty nose syndrome. Thus, it behooves us to evaluate this latter entity with a more critical eye, so that we can avoid creating future sufferers and provide relief to those who have already been afflicted.

Nasal septal perforation and antiphospholipid syndrome (Hughes syndrome).

We present the case of a 19-year-old woman who developed a nasal septal perforation and atrophic rhinitis following septal surgery. During the subsequent five years, she also experienced intermittent episodes of swelling and ischaemia of the left foot, as well as livedo reticularis. Ultimately, haematological investigations revealed the presence of lupus anticoagulant and elevated antiphospholipid immunoglobulin M levels. A diagnosis of antiphospholipid syndrome (Hughes syndrome) was made.A search of the literature revealed that nasal septal perforation has been described in up to 0.8 per cent of patients with antiphospholipid syndrome. However, it is undescribed in the otorhinolaryngological literature. The impact of this syndrome on otorhinolaryngology practice is examined.

The aetiology and management of atrophic rhinitis.

Atrophic rhinitis is a chronic, debilitating and recalcitrant disease of the nasal cavities that is prevalent in several parts of the world. It has unique epidemiological features and clinical characteristics. Clinicians and researchers for decades have tried to postulate theories for the aetiology of the primary form of the disease. Management of the disease has seen several medical therapeutic regimens including alternative forms of medicine. Surgical options for the condition are also not completely satisfactory with a number of failures and recurrences. The authors provide here a comprehensive review of the existing literature as regards the aetiology and management of this refractory condition.

Atrophic rhinitis in a patient with anhidrotic ectodermal dysplasia.

We would like to present the rare case of a now 37-year old female patient with autosomal-recessively inherited anhidrotic ectodermal dysplasia being treated in our ENT department for atrophic rhinitis. The clinical appearance very much resembled the picture of an "empty nose" with distinct hypoplasia of the turbinates and extensively wide nasal cavities. We want to point out the possible existence of atrophic rhinitis against the background of an underlying syndromatic disease in adults and also the pediatric patient.

[Nasal mucosa in patients with diabetes mellitus]. / Stan blony sluzowej nosa u chorych na cukrzyce.

Diabetes mellitus is the most common endocrinologic disease all over the world. 150 million people suffer from this disease, in Poland about 2 million. The disease on the basis of the onset and pathophysiology may be divided into type I and type II. Pathophysiologic changes include diabetic microangiopathy, macroangiopathy and neuropathy. The most common presentations in head and neck are otitis externa, hypoacusis, vertigo, disequilibrium, xerostomia, dysphagia, fungal and recurrent infections. The changes in nasal mucosa are not very well known. Only few papers concerned the problem. The main complaints of patients regarding the nose are xeromycteria, hyposmia and various degree of decreased patency of the nose. Chronic atrophic rhinitis, septal perforation, ulceration of nasal mucosa, alar necrosis, symptoms of staphylococcal or fungal infection can be found during otolaryngologic examination. The treatment in this group of patients should consist of systemic therapy of diabetes mellitus and on the other hand focal therapy with the use of a solution to moisten the nasal mucosa.

Atrophic rhinitis: a review of 242 cases.

Atrophic rhinitis is a debilitating nasal mucosal disease of unknown etiology. It is characterized by progressive nasal mucosal atrophy, nasal crusting, fetor, and enlargement of the nasal space with paradoxical nasal congestion. Primary atrophic rhinitis has decreased markedly in incidence in the last century. This probably relates to the increased use of antibiotics for chronic nasal infection. Secondary atrophic rhinitis resulting from trauma, surgery granulomatous diseases, infection, and radiation exposure accounts for the majority of cases encountered by the rhinologist today. Excessive turbinate surgery has been both acquitted and accused in the literature as an etiology for secondary atrophic rhinitis. We saw 242 patients with the diagnosis of atrophic rhinitis between 1982 and 1999. The diagnosis was confirmed by physical examination, biopsy, and imaging studies. Patients were diagnosed with primary atrophic rhinitis if their condition developed in a previously healthy nose and secondary atrophic rhinitis if their condition developed after sinonasal surgery, trauma, or chronic granulomatous disease. Prevention and treatment of the disease is discussed.

[Empty nose syndrome].

OBJECTIVE: The aim of this article is to present the concept of empty nose syndrome(ENS) and help ENT doctors take care of regular nasal turbinate surgery. METHODS: Fourteen patients who was diagnosed as ENS in our department were reviewed retrospectively. All patients had undergone various forms of nasal surgery (all had had turbinectomy). Their age ranged from 13 to 52 years. All patients were treated conservatively, among these patients 5 subjects who had more serious symptoms received submucous and subperiostal nasal implantation with ilium. RESULTS: All patients had nasal obstruction and dryness of nasal cavity, nasopharynx and oto-pharynx in 6 months--5 years after their first nasal surgery, some presented symptoms of depression. Nasoscope examination showed all patients had a cylindrically enlarged nasal cavity. Conservative treatment was effective in most cases. The effectiveness of operative treatment was encouraging during short-term follow-up. CONCLUSION: Extensive turbinectomy may cause secondary nasal mucosal atrophy and a series of subsequent symptoms. The presentation of this concept is to remind the ENT doctors prudently performing turbinectomy to avoid the occurrence of irreversible injury to the nasal cavity.

Contributory and exacerbating roles of gaseous ammonia and organic dust in the etiology of atrophic rhinitis.

Pigs reared commercially indoors are exposed to air heavily contaminated with particulate and gaseous pollutants. Epidemiological surveys have shown an association between the levels of these pollutants and the severity of lesions associated with the upper respiratory tract disease of swine atrophic rhinitis. This study investigated the role of aerial pollutants in the etiology of atrophic rhinitis induced by Pasteurella multocida. Forty, 1-week-old Large White piglets were weaned and divided into eight groups designated A to H. The groups were housed in Rochester exposure chambers and continuously exposed to the following pollutants: ovalbumin (groups A and B), ammonia (groups C and D), ovalbumin plus ammonia (groups E and F), and unpolluted air (groups G and H). The concentrations of pollutants used were 20 mg m-3 total mass and 5 mg m-3 respirable mass for ovalbumin dust and 50 ppm for ammonia. One week after exposure commenced, the pigs in groups A, C, E, and G were infected with P. multocida type D by intranasal inoculation. After 4 weeks of exposure to pollutants, the pigs were killed and the extent of turbinate atrophy was assessed with a morphometric index (MI). Control pigs kept in clean air and not inoculated with P. multocida (group H) had normal turbinate morphology with a mean MI of 41.12% (standard deviation [SD], +/- 1. 59%). In contrast, exposure to pollutants in the absence of P. multocida (groups B, D, and F) induced mild turbinate atrophy with mean MIs of 49.65% (SD, +/-1.96%), 51.04% (SD, +/-2.06%), and 49.88% (SD, +/-3.51%), respectively. A similar level of atrophy was also evoked by inoculation with P. multocida in the absence of pollutants (group G), giving a mean MI of 50.77% (SD, +/-2.07%). However, when P. multocida inoculation was combined with pollutant exposure (groups A, C, and E) moderate to severe turbinate atrophy occurred with mean MIs of 64.93% (SD, +/-4.64%), 59.18% (SD, +/-2.79%), and 73.30% (SD, +/-3.19%), respectively. The severity of atrophy was greatest in pigs exposed simultaneously to dust and ammonia. At the end of the exposure period, higher numbers of P. multocida bacteria were isolated from the tonsils than from the nasal membrane, per gram of tissue. The severity of turbinate atrophy in inoculated pigs was proportional to the number of P. multocida bacteria isolated from tonsils (r2 = 0.909, P < 0.05) and nasal membrane (r2 = 0.628, P < 0.05). These findings indicate that aerial pollutants contribute to the severity of lesions associated with atrophic rhinitis by facilitating colonization of the pig's upper respiratory tract by P. multocida and also by directly evoking mild atrophy.

[Nasal localization of the Crohn's disease]. / La localisation nasale de la maladie de Crohn.

Crohn's diseases is a chronic granulomatous inflammatory disease of the gastrointestinal tract. Any part of the gastrointestinal tract may be affected, and 9% of cases have oral lesions (1). Nasal involvement is exceptionally rare. We report a case of nasal involvement revealed by chronic atrophic rhinitis in a patient with known Crohn's disease.