Viral rhinitis and asthma.

Upper respiratory tract infections are among the most common infectious diseases. Approximately 80% of the common colds are caused by rhinoviruses. Recently, rhinovirus colds have been linked with lower airway illnesses such as asthma exacerbations resulting in a considerable interest in the pathogenesis of lower respiratory tract pathology. The important role that allergic airway disease plays in virally induced changes in airway function has been experimentally shown in several studies. Unfortunately, the precise mechanisms by which viruses could induce lower airway symptoms have not yet been determined.

Clinical characteristics and diagnostic delay of head and neck cancer: results from a prospective study in Belgium.

A prospective study of head and neck cancer patients was started to gather information about topographic and clinical characteristics of head and neck cancer, alcohol and nicotine abuse and the delay in diagnosis. More than half of the patients consulted our institution with an advanced stage of disease. As was expected, we found a positive association between the size of the tumour and the clinical stage of the neck. Concerning nicotine and alcohol abuse, our results support the hypothesis that tobacco smoking is more strongly associated with lesions in sites heavily exposed to inhaled smoke, whereas alcohol consumption has a stronger effect on structures belonging to the 'food channel' and reservoir systems. We found no association between delay and tumour stage at diagnosis, but a statistically significant correlation was found between the delay and the tumour site. This leads us to conclude that the tumour stage is determined mostly by the biology of the tumour.

Multiple primary malignant tumors in patients with head and neck cancer: results of a prospective study and future perspectives.

Multiple primary tumors are a known phenomenon in head and neck cancer. They are partially responsible for the limited improvement in survival of head and neck cancer during the past 20 years. Only a few prospective data have been published about the incidence of metachronous tumors. The authors prospectively studied 127 patients with squamous cell carcinoma of the head and neck. The overall incidence of second primary tumors was 13.5% (simultaneously, 3%; synchronously, 5.5%; and metachronously, 8%). More than 90% of the recurrences of the first primary tumor occurred within the first 2 years following primary treatment, but the second primary tumors continued to occur gradually in the course of follow-up. Most of the second primary tumors were discovered because the patients developed symptoms (14/17). Survival after detection of the second primary tumor was poor. The development of a second primary tumor was of equivalent prognosis to a recurrence of the primary tumor. Future directives include the development of more adequate screening methods. Identification of potential early markers for the development of a squamous cell carcinoma at the level of the mucosa at risk and in serum could be of value for the early detection of individuals at risk.

Cineradiography of the pharyngoesophageal segment in postlaryngectomy patients.

The use of tracheoesophageal voice prostheses has gained wide acceptance in the field of vocal rehabilitation after total laryngectomy. In a randomized study with 3 arms, alaryngeal speech proficiency was assessed in 60 postlaryngectomy patients: 20 patients underwent primary unilateral pharyngeal myotomy, 21 patients underwent neurectomy of the pharyngeal plexus in addition to pharyngeal myotomy, and 19 patients did not undergo an additional surgical procedure. Pharyngoesophageal (PE) dynamics were examined during esophageal and tracheoesophageal speech. A single vibrating PE segment was seen in good alaryngeal speakers. Hypertonicity, spasm, strictures, and hypotonicity of the PE segment were correlated significantly with poor or moderate alaryngeal speech. Unilateral myotomy with or without unilateral neurectomy prevented hypertonicity or spasm of the PE segment. The acquisition of alaryngeal speech did not differ significantly between the 2 groups who had undergone an additional surgical procedure. Evaluation of anatomic and physiological factors may be helpful in subsequent clinical management to achieve effective alaryngeal speech.

Clinical use of rhinomanometry in children.

To investigate Passive Anterior Rhinomanometry (PAR), several clinical experiments were set up to explore in children aged 3-6 years the nasal resistance in various normal and pathological situations, in order to determine the role of rhinomanometry in clinical situations in young children. It was shown that the nasal cycle in children differs greatly from that in adults, showing a regular undulating pattern of nasal resistance, but without alternating phenomena. There are also quite regular fluctuations with a short period of about 90 s. Physical exercise and changes in body position have also, in children, a definite influence on nasal resistance. PAR in various pathological situations of the nasal cavity gave a wide range of individual results. It was, however, found that children with a nasal septum deviation, with a pronounced nasal edema, and with serous and purulent nasal secretions had a higher nasal resistance than children without nasal pathology. Because of the spontaneous and evoked changes in nasal resistance in children and because of the large standard deviations of nasal resistance values in pathological situations, clinicians should interpret the results of a one-time rhinomanometrical measurement very carefully.

Intratemporal and intracranial complications of acute suppurative otitis media in children: renewed interest.

In recent years, a rise in the incidence of intratemporal and intracranial complications of acute otitis media (AOM) has been mentioned in the literature. Lack of a well-developed immune system and difficulties in diagnosing AOM, can account for part of the rise in the incidence of complications of purulent middle ear infections in young children. Antibiotic treatment of AOM is certainly not an absolute safeguard against the development of complications. Antibiotic therapy may have a masking effect on significant signs and symptoms of complications, causing delay in diagnosis. Myringotomy, especially in young children, should not be forgotten for drainage and to provide material for culture. Increased virulence of the causative pathogens cannot be ruled out, but to date there is no evidence suggesting it. We have to maintain a high level of clinical awareness. If there is insufficient improvement of the patient with the appropriate conservative treatment, radioimaging followed by the necessary surgical procedures should be performed.

The adenoid as a key factor in upper airway infections.

The adenoids (and the nasopharynx) play a key role in the normal functioning and in various pathologies of the upper respiratory tract. In this paper the role of adenoidal pathology and the beneficial effect of adenoidectomy in some upper respiratory tract and facial anomalies and diseases are discussed; otitis media with effusion, recurrent acute otitis media, sinusitis, snoring and sleep apnea and abnormal patterns in the midface growth and development.

Epidemiology of common cold.

The epidemiology of common cold and the role of some predisposing factors were studied by examining 2065 healthy children, aged 2.5-6 years. The examination included a questionnaire, completed by the parents, a general physical examination, a clinical E.N.T.-examination and various technical investigations. The mean annual incidence of common cold was 2.43 (as was reported by the parents) and 5 when taking into consideration the time span between the last episode of common cold and the date of examination. Mucoid and purulent rhinitis were less frequently found in older children. A positive history of upper respiratory tract infections in the parents showed to be the most important risk factor for the occurrence of infectious rhinitis in the children. The higher the weight of the child, the lower the incidence of common cold and the fewer pathological rhinoscopical findings. Children with a head circumference below the 2.5 percentile had the highest incidence of infectious rhinitis. Humid housing conditions showed to be connected with a higher incidence of infectious rhinitis. Children of parents with a higher profession had more rhinitis than children of labourers. Smoking habits of the parents had only little effect on the rhinological status of children.

Relationship between nasal patency and clearance.

Nasal airway patency and nasal clearance were measured bilaterally on six different test days in ten subjects. Nasal patency was evaluated using anterior rhinomanometry and clearance was measured using a dyed saccharin method. The results showed large intra- and inter-subject variances in the clearance times. Clearance times determined by the saccharin taste method were shorter than those determined by the dye method, but these measures were positively correlated. Also, the mean clearance rate was directly related to the mean nasal conductance. In seven of ten subjects, the clearance rate for a given side of the nasal passage was relatively faster when that side was the more patent. These results suggest that the clearance rate is a function of the patency of the nasal passage and may also exhibit alternating cyclic fluctuations.

Oncocytoma of the nasopharynx.

The case of a patient with a nasopharyngeal oncocytoma is described. The diagnostic and therapeutic aspects of oncocytoma are reviewed in light of the present literature.

Choice of a tone-pip envelope for frequency-specific threshold evaluations by means of the middle-latency response: normally hearing subjects and slope of sensorineural hearing loss.

The effects of stimulus rise-fall and plateau times on the middle-latency response (MLR) waveform (Na-Pa amplitude and Pa latency) were investigated in 14 normally hearing subjects and an objective MLR threshold was evaluated at low and middle frequencies in ten normally hearing subjects and ten patients with slope of sensorineural hearing loss, using a selected stimulus-envelope time. After analyzing the effects of envelope times on the MLR waveform and the spectra of tone-pips, it was found that a rise-fall time of 4 ms with a plateau of 2 ms (4-2-4) is an acceptable compromise between a synchronous discharge and frequency specificity for estimating the MLR threshold. The MLR threshold produced by 4-2-4 tone-pips approximated the psychoacoustic threshold at low and middle frequencies in the normal and hearing impaired subjects. This demonstrates the clinical usefulness of the MLR in estimating low- and middle-frequency thresholds.

[Revised terminology for allergies and related conditions]. / Herziene terminologie voor allergie en verwante aandoeningen.

The European Academy of Allergology and Clinical Immunology has proposed a revised terminology for allergic and allergy-related reactions that can be used independently of target organ or patient age group. The proposed terminology is based on the present knowledge of the mechanisms which initiate and mediate allergic reactions. 'Hypersensitivity' is an umbrella term, 'allergy' involves a hypersensitivity reaction which is initiated by an immunological mechanism, and 'atopy' is an individual or familial tendency to produce IgE antibodies in response to low doses of allergens, and is accompanied by the typical symptoms or asthma rhino-conjunctivitis or eczema/dermatitis. Each condition should be categorised as 'allergic/not allergic', and the allergic conditions should be further categorised as 'IgE-mediated/non IgE-mediated' (sometimes: 'IgE-associated'). Terms which are no longer in use include: 'idiosyncrasy' (this will now become 'hypersensitivity'); 'pseudo-allergy' ('non-allergic hypersensitivity'); 'extrinsic', 'intrinsic', 'endogenous' and 'exogenous asthma' ('allergic' (possibly 'IgE-mediated') and 'non-allergic asthma'); 'atopic eczema' ('atopic eczema/dermatitis syndrome': 'allergic (possibly 'IgE-mediated') or 'non-allergic'); 'intrinsic' and 'cryptogenic variants of eczema' ('non-allergic atopic eczema/dermatitis syndrome'); 'food intolerance' ('non-allergic food hypersensitivity') and 'anaphylactoid reaction' ('non-allergic anaphylaxis').

[Revised terminology for allergies and related conditions]. / Herziene terminologie voor allergie en verwante aandoeningen.

The European Academy of Allergology and Clinical Immunology has proposed a revised terminology for allergic and allergy-related reactions that can be used independently of target organ of patient age group. The proposed terminology is based on the present knowledge of the mechanisms which initiate and mediate allergic reactions. 'Hypersensitivity' is an umbrella term, 'allergy' involves a hypersensitivity reaction which is initiated by an immunological mechanism, and 'atopy' is an individual or familial tendency to produce IgE antibodies in response to low doses of allergens, and is accompanied by the typical symptoms or asthma, rhino-conjunctivitis or eczema/dermatitis. Each condition should be categorised als 'allergic/not allergic', and the allergic conditions should be further categorised as 'IgE-mediated/non IgE-mediated' (sometimes: 'IgE-associated'). Terms which are no longer in use include: 'idiosyncrasy' (this will now become 'hypersensitivity'); 'pseudo-allergy' ('non-allergic hypersensitivity'); 'extrinsic', 'intrinsic', 'endogenous' and 'exogenous asthma' ('allergic' (possibly 'IgE-mediated') and 'non-allergic asthma'); 'atopic eczema' ('atopic eczema/dermatitis syndrome'; 'allergic (possibly 'EgE-mediated') or 'non-allergic'); 'intrinsic' and 'cryptogenic variants of eczema' (non-allergic atopic eczema/dermatitis syndrom'); 'food intolerance' (non-allergic food hypersensitivity') and 'anaphylactoid reaction' ('non-allergic anaphylaxis').