Correlation of intensity-modulated radiation therapy at a specific radiation dose with the prognosis of nasal mucous damage after radiotherapy.

Objective of the present study was to investigate the tolerant radiation dose of nasal mucosa by observing and analyzing patients who received intensity-modulated radiation therapy (IMRT). Patients with nasopharyngeal carcinoma (N = 66) were selected for this study. The modified saccharin assay, endoscopy test, magnetic resonance imaging, and sino-nasal outcome test-20 (SNOT-20) survey were performed for the patients before and at 0 (T0), 3 (T1), 6 (T2), and 12 (T3) months after radiotherapy. The threshold doses of IMRT before radiotherapy and at T0, T1, T2, and T3 were determined as, respectively, 37 Gy, 37 Gy, 39 Gy, and 37 Gy for the saccharin test; 38 Gy, 37 Gy, 40 Gy, and 38 Gy for the endoscopy test; and 39 Gy, 37 Gy, 39 Gy, and 39 Gy for the nasal-related symptom scoring test. The modified saccharin assay, endoscopy test, and SNOT-20 survey revealed that a low dose (< threshold dose) of IMRT was associated with higher mucocilia transport rate (MRT), better endoscopy test score, and improved SNOT-20 score. The patients who received IMRT at a dose less than the threshold had the least damaged nasal mucosa morphology, and functional impairment scores were highest at T1 of IMRT. We conclude that nasal mucosa showed the most serious damage within 3 months after IMRT. If the radiation dose can be controlled within the threshold, the nasal mucosa can recover in the following few months, but recovery will be difficult otherwise.

Effects of irradiation with narrowband-ultraviolet B on up-regulation of histamine H1 receptor mRNA and induction of apoptosis in HeLa cells and nasal mucosa of rats.

Narrowband-ultraviolet B (NB-UVB) phototherapy is used for the treatment of atopic dermatitis. Previously, we reported that irradiation with 200 mJ/cm2 of 310 nm NB-UVB suppressed phorbol-12-myristate-13-acetate (PMA)-induced up-regulation of histamine H1 receptor (H1R) gene expression without induction of apoptosis in HeLa cells. However, the effect of NB-UVB irradiation on nasal symptoms is still unclear. Here, we show that low dose irradiation with 310 nm NB-UVB alleviates nasal symptoms in toluene 2,4-diisocyanate (TDI)-sensitized allergy model rats. Irradiation with 310 nm NB-UVB suppressed PMA-induced H1R mRNA up-regulation in HeLa cells dose-dependently at doses of 75-200 mJ/cm2 and reversibly at a dose of 150 mJ/cm2 without induction of apoptosis. While, at doses of more than 200 mJ/cm2, irradiation with 310 nm NB-UVB induced apoptosis. Western blot analysis showed that the suppressive effect of NB-UVB irradiation on H1R gene expression was through the inhibition of ERK phosphorylation. In TDI-sensitized rat, intranasal irradiation with 310 nm NB-UVB at an estimated dose of 100 mJ/cm2 once a day for three days suppressed TDI-induced sneezes and up-regulation of H1R mRNA in nasal mucosa without induction of apoptosis. These findings suggest that repeated intranasal irradiation with low dose of NB-UVB could be clinically used as phototherapy of AR.

Contemporary Treatment Approaches to Sinonasal Mucosal Melanoma.

Sinonasal mucosal melanoma (SNMM) is a rare oncological entity that comprises most head and neck mucosal melanomas. SNMM has distinctive genetic background, different from cutaneous melanoma. Survival outcomes among SNMM patients are poor; while there is no clear consensus on the optimal management of SNMM, the primary treatment modality is generally considered to be wide surgical excision, and radiation therapy (RT) is often used in the postoperative adjuvant setting to improve locoregional control. Systemic therapies have demonstrated little or no survival benefit, and most SNMM patients die of distant metastatic disease. Owing to the rarity of the disease, the literature describing treatment approaches for SNMM is lacking and largely limited to isolated case reports and retrospective series. Here, we describe contemporary diagnostic and therapeutic approaches to SNMM based on the most recent molecular and outcome data.

Conditioned medium from umbilical cord mesenchymal stem cells improves nasal mucosa damage by radiation.

OBJECTIVES: To explore therapeutic effects of conditioned medium from human umbilical cord mesenchymal stem cells (hUC-MSCs) on nasal mucosa radiation damage both in vivo and in vitro. RESULTS: The mucus cilia clearance time (7 and 30 days), degree of mucosal edema (7, 30, 90 and 180 days), cilia coverage (180 days) of concentrated conditioned medium group improved compared with radiotherapy control group. The proliferation and migration abilities of irradiated and non-irradiated nasal epithelial cells significantly increased after culture in bronchial epithelial cell growth medium (BEGM) containing 10% conditioned medium of hUC-MSCs compared to cells cultured in BEGM alone. CONCLUSIONS: Soluble factors secreted by hUC-MSCs may promote nasal epithelial cell proliferation and migration. Intranasal administration of hUC-MSC conditioned medium effectively repairs nasal mucosa radiation damage.

Oncocytic Schneiderian Papilloma of the Sinonasal Tract Treated With Radiotherapy.

A 66-year-old man visited the ophthalmology department due to epiphora and was subsequently diagnosed with oncocytic schneiderian papilloma. Surgical removal was recommended to the patient; however, he refused this option. Therefore, a radiation of 64 gray (Gy) was administered in 32 daily doses (2 Gy daily) over 45 days using intensity-modulated radiotherapy. Four months after radiotherapy, the tumor had disappeared. Two years postradiotherapy, the patient was healthy, without tumor recurrence or the development of orbital complications. The authors suggest that radiotherapy could be an adjuvant or definite treatment modality for patients of oncocytic schneiderian papilloma unsuitable for complete surgical removal, or those associated with a high risk of surgery-related complications.

Clinical target volume design and dose in carbon-ion radiation therapy for sinonasal mucosal melanoma.

BACKGROUND AND PURPOSE: No guidelines exist for the clinical target volume (CTV) and radiotherapy dose in sinonasal mucosal melanoma (SNMM). Thus, we aimed to determine the carbon-ion radiotherapy (CIRT) CTV and dose for SNMM. MATERIALS AND METHODS: In total, 135 patients with SNMM who received CIRT were reviewed. The relative biological effectiveness-weighted dose was 57.6 or 64 Gy in 16 fractions. CTV was classified into small CTV, which included the gross tumor and visible melanosis with a certain margin, and extended CTV, which included the tumor site and adjacent anatomical structures. Local recurrence (LR) patterns were pattern I, II, and III, defined as recurrence over the gross tumor, visible melanosis and subclinical area, which would be covered if extended CTV was applied, and outside the extended CTV, respectively. RESULTS: The 5-year LR rate was 35.3 %. The prescribed dose was not a significant risk factor for pattern I LR; however, 57.6 Gy for a large tumor was insufficient for local control. Using an extended CTV was significantly associated with a lower risk of pattern II LR, and these recurrences did not occur in regions that received > 40 Gy. The 5-year pattern III LR rate was 6.4 %. CONCLUSION: Utilizing an extended CTV in CIRT for SNMM is appropriate even for small tumors. Using a smaller CTV after an extended CTV of at least 40 Gy is recommended to reduce adverse events. Although the optimal dose for gross tumors remains unclear, the latest technology with 64 Gy showed good outcomes.

Efficacy and Safety of Postoperative Adjuvant Radiation Therapy in Resected Nasal Cavity and Paranasal Sinus Mucosal Melanoma: A Combined Analysis.

PURPOSE: Mucosal melanoma of the nasal cavity and paranasal sinuses (NPMM) is a highly aggressive disease. The role of postoperative adjuvant radiation therapy is controversial. METHODS AND MATERIALS: A total of 300 patients with NPMM treated between March 2009 and January 2020 were divided into surgery alone (SA; 158 patients) and surgery plus radiation therapy (SR; 142 patients) groups. Postoperative radiation therapy was recommended, with a total dose of 65 to 70 Gy/30 to 35 fractions to the gross tumor volume and 60 Gy/30 fractions to the clinical target volume. The primary endpoint was relapse-free survival. Secondary endpoints included local recurrence-free survival, distant metastasis-free survival, and overall survival. RESULTS: At a median follow-up of 50.0 months, relapse-free survival in the SA and SR groups was 9.8 and 15.2 months (hazard ratio [HR], 0.714; 95% CI, 0.546-0.933; P = .014). Distant metastasis-free survival in the SA and SR groups was 23.8 and 21.3 months (HR, 0.896; 95% CI, 15.7-31.9 vs 13.3-29.3; P = .457). Overall survival in the SA and SR groups was 31.0 and 35.1 months (HR, 0.816; 95% CI, 25.7-36.3 vs 27.1-43.2; P = .178). For patients with stage IVA NPMM, radiation therapy reduced the incidence of relapse by 0.43-fold. CONCLUSIONS: Postoperative radiation therapy played a crucial role in the local control of resected NPMM, especially in patients with stage T4a or IVA disease.

Molecular response of nasal mucosa to therapeutic exposure to broad-band ultraviolet radiation.

Ultraviolet radiation (UVR) phototherapy is a promising new treatment for inflammatory airway diseases. However, the potential carcinogenic risks associated with this treatment are not well understood. UV-specific DNA photoproducts were used as biomarkers to address this issue. Radioimmunoassay was used to quantify cyclobutane pyrimidine dimers (CPDs) and (6-4) photoproducts in DNA purified from two milieus: nasal mucosa samples from subjects exposed to intranasal phototherapy and human airway (EpiAirway) and human skin (EpiDerm) tissue models. Immunohistochemistry was used to detect CPD formation and persistence in human nasal biopsies and human tissue models. In subjects exposed to broadband ultraviolet radiation, DNA damage frequencies were determined prior to as well as immediately after treatment and at increasing times post-treatment. We observed significant levels of DNA damage immediately after treatment and efficient removal of the damage within a few days. No residual damage was observed in human subjects exposed to multiple UVB treatments several weeks after the last treatment. To better understand the molecular response of the nasal epithelium to DNA damage, parallel experiments were conducted in EpiAirway and EpiDerm model systems. Repair rates in these two tissues were very similar and comparable to that observed in human skin. The data suggest that the UV-induced DNA damage response of respiratory epithelia is very similar to that of the human epidermis and that nasal mucosa is able to efficiently repair UVB induced DNA damage.

Bacteriology of postradiotherapy chronic rhinosinusitis in nasopharyngeal carcinoma patients and chronic rhinosinusitis.

The purpose of this study was to investigate and compare the bacteriology of postradiotherapy chronic rhinosinusitis (postRT-CRS) and chronic rhinosinusitis (CRS) by evaluating the aspiration materials of the maxillary sinus of patients with postRT-CRS and patients with CRS. We collected the secretions of the maxillary sinus from 30 nasopharyngeal carcinoma patients with postRT-CRS and 30 patients with CRS for aerobe/facultative anaerobe bacteria culture. The most common isolates in the postRT-CRS group were Streptococcus viridans, Staphylococcus aureus and Haemophilus influenzae, while those in the CRS group were Haemophilus influenzae, Pseudomonas aeruginosa and Staphylococcus aureus. Isolated gram-positive coccus rate in postRT-CRS patients was significantly higher than in CRS patients (62.50% compared with 30.00%, respectively; P < 0.05), and isolated gram-negative bacilli rate in postRT-CRS patients was significantly lower than in CRS patients (31.25% compared with 70.00%, respectively; P < 0.05). However, the incidence of positive cultures was not significantly different between the postRT-CRS group and the CRS group (P > 0.05). This study found that there were some differences in bacteriology between postRT-CRS and CRS. Gram-positive coccus was the predominant aerobic/facultative anaerobe pathogenic bacterium in patients with postRT-CRS, and gram-negative bacilli was predominant in CRS patients.

Development of mucosal thickening after radiotherapy in contralateral sinuses of patients with nasal cavity and/or paranasal sinus carcinoma.

OBJECTIVES: The aim of this study was to investigate the development of radiotherapy (RT)-induced mucosal thickening (MT) of the contralateral sinuses in patients with nasal cavity and/or paranasal sinus carcinoma. METHODS: We retrospectively reviewed the medical records and the initial and follow-up computed tomography (CT) scans of 37 patients with RT and 10 controls without RT. The CT scans were scored on the Lund-Mackay (LM) staging system. RESULTS: Fifteen of the 37 patients had MT before RT, and the mean LM score was 0.68. The MT incidence significantly increased, to 72.9% (p = 0.009), and the LM score significantly increased, to 2.84 (p < 0.001), by 3 months after RT, after which the LM score decreased gradually to 1.73 at 36 months after RT. Four of the 10 controls had MT before treatment, and their mean LM score was 0.7. Their MT incidence and LM score had not changed significantly at 3 months after treatment. The pretreatment LM scores of the patient group and the control group were not significantly different, but their posttreatment LM scores were significantly different at the 3-month follow-up (p = 0.033). CONCLUSIONS: Use of RT in patients with nasal cavity and/or paranasal sinus carcinoma may cause a significant increase in the incidence of MT and in the LM scores in all sites of the paranasal sinuses by 3 months after RT, after which the LM score decreases gradually.

Non-thermal plasma treated solution with potential as a novel therapeutic agent for nasal mucosa regeneration.

Adequate and rapid mucosal regeneration is one of the most important factors in the healing process of nasal mucosa after surgery or trauma. In particular, delayed mucosal regeneration after surgery is an important cause of surgical failure. However, no effective treatment is available yet. Non-thermal plasma (NTP) has several medical effects, but the existing probe type is limited to local direct treatment. Therefore, we investigated the various effects using liquid type plasma to overcome this limitation. In addition, the therapeutic effects of non-thermal plasma treated solution (NTS) on nasal mucosa have yet to be determined. Experiments were carried out using BEAS-2B, a human bronchial epithelial cell line similar to nasal mucosa epithelium. NTS had no cytotoxicity to the BEAS-2B cells and enhanced cell proliferation. NTS also promoted migration of BEAS-2B cells. NTS increased cell proliferation and migration via epidermal growth factor receptor (EGFR) activities and epithelial-to-mesenchymal transition (EMT) signaling. Furthermore, NTS enhanced wound healing of nasal mucosa in an animal model. Accordingly, NTS promotes nasal mucosa wound healing by increasing cell proliferation and migration. These findings suggest the therapeutic potential of NTS in nasal mucosa wound healing.

A phase 3 trial of mometasone furoate sinus implants for chronic sinusitis with recurrent nasal polyps.

BACKGROUND: Topical intranasal corticosteroid sprays (INCSs) are standard treatment for nasal polyps (NPs), but their efficacy is reduced by poor patient compliance and impaired access of drug to the sinus mucosa. A corticosteroid-eluting sinus implant was designed to address these limitations in patients with recurrent polyposis after sinus surgery by delivering 1350 µg of mometasone furoate (MF) directly to the ethmoid sinus mucosa over approximately 90 days. METHODS: A randomized, sham-controlled, double-blind trial was undertaken in 300 adults with refractory chronic rhinosinusitis with NPs (CRSwNP), who were candidates for repeat surgery. Eligible patients were randomized (2:1) and underwent in-office bilateral placement of 2 implants or a sham procedure. All patients used the MF INCS 200 µg once daily. Co-primary efficacy endpoints were the change from baseline in nasal obstruction/congestion score and bilateral polyp grade, as determined by an independent panel based on centralized, blinded videoendoscopy review. RESULTS: Patients treated with implants experienced significant reductions in both nasal obstruction/congestion score (p = 0.0074) and bilateral polyp grade (p = 0.0073) compared to controls. At day 90, implants were also associated with significant reductions in 4 of 5 prespecified secondary endpoints compared to control: proportion of patients still indicated for repeat sinus surgery (p = 0.0004), percent ethmoid sinus obstruction (p = 0.0007), nasal obstruction/congestion (p = 0.0248), and decreased sense of smell (p = 0.0470), but not facial pain/pressure (p = 0.9130). One patient experienced an implant-related serious adverse event (epistaxis). CONCLUSION: Significant improvements over a range of subjective and objective endpoints, including a reduction in the need for sinus surgery by 61%, suggest that MF sinus implants may play an important role in management of recurrent NP.

Local high-dose radiotherapy and sparing of normal tissue using intensity-modulated radiotherapy (IMRT) for mucosal melanoma of the nasal cavity and paranasal sinuses.

PURPOSE: To evaluate the clinical outcome of intensity-modulated radiotherapy (IMRT) in patients with mucosal melanoma (MM) of the nasal cavity and paranasal sinuses. PATIENTS AND METHODS: Between January 1999 and September 2004, eight patients with histologically proven MM of the nasal cavity and paranasal sinuses were treated with IMRT. A median dose of 66 Gy was applied to the macroscopic tumor (gross tumor volume [GTV]; range, 60-68 Gy) as an integrated boost and a median dose of 59 Gy (range, 54-64 Gy) to the clinical target volume (CTV) with IMRT. RESULTS: Treatment-related toxicity was very mild in most patients. Overall survival was 80% at 5 years. Calculated from treatment with IMRT as primary radiotherapy, survival was 100% at 1 year and 75% at 3 years. After IMRT, local progression-free survival was 71.4% at 1 year and 57.1% at 3 years, respectively. Distant progression-free survival after IMRT was 57.1% at 1 year and 28.6% at 3 years. CONCLUSION: Local dose escalation with IMRT yields good treatment results with respect to local and distant tumor control as well as survival, while treatment-related toxicity can be minimized.

Postirradiation sinus mucosa disease in nasopharyngeal carcinoma patients.

OBJECTIVES/HYPOTHESIS: We sought to determine the incidence, progression, and risk factors for postirradiation sinus mucosa diseases (SMD) incidentally found on follow-up magnetic resonance images MRIs) in nasopharyngeal carcinoma (NPC) patients. STUDY DESIGN: RETROSPECTIVE. METHODS: The medical records, pre- and postradiotherapy (RT) MRIs were reviewed in NPC patients. Lund-Mackay system for staging of rhinosinusitis (Lund score) was used as a tool for investigation. RESULTS: One hundred twelve NPC patients (77 males and 35 females) were recruited in this study. The distribution of tumor staging in these patients were 39 (34.8%) patients in T1,23(20.5%) in T2, 31(27.7%) in T3, and 19 (17.0%) in T4 by MRI staging before RT. In these 62 patients with normal sinus ventilation before RT, 42 (67.7%) patients returned to having SMDs 3 months after RT. The maxillary,anterior ethmoid, and posterior ethmoid sinuses were most readily affected. In patients with SMDs at 3 months postRT, advanced tumor stage (P = .013) and smoking habit (P =.047) were the two factors that significantly influence Lund score. When comparing Lund score with different times after radiation therapy, a trend of decrease in Lund score could be noted from 3 months to 3 years after irradiation. CONCLUSIONS: The incidence and severity of SMD was found to be highest at 3 months postRT and decreased gradually with time. Conservative management with clinical symptom correlation should be attempted first in these patients. In these NPC patients,advanced tumor stage and smoking habit would predispose them to SMD development.

Effects of intranasal phototherapy on nasal mucosa in patients with allergic rhinitis.

RATIONALE: Rhinophototherapy has been shown to be effective in the treatment of allergic rhinitis. Considering that phototherapy with ultraviolet light (UV) induces DNA damage, it is of outstanding importance to evaluate the damage and repair process in human nasal mucosa. METHODS: We have investigated eight patients undergoing intranasal phototherapy using a modified Comet assay technique and by staining nasal cytology samples for cyclobutane pyrimidine dimers (CPDs), which are UV specific photoproducts. RESULTS: Immediately after last treatment Comet assay of nasal cytology samples showed a significant increase in DNA damage compared to baseline. Ten days after the last irradiation a significant decrease in DNA damage was observed compared to data obtained immediately after finishing the treatment protocol. Difference between baseline and 10 days after last treatment was not statistically significant. Two months after ending therapy, DNA damage detected by Comet assay in patients treated with intranasal phototherapy was similar with that of healthy individuals. None of the samples collected before starting intranasal phototherapy stained positive for CPDs. In all samples collected immediately after last treatment strong positive staining for CPDs was detected. The number of positive cells significantly decreased 10 days after last treatment, but residual positive staining was present in all the examined samples. This finding is consistent with data reported in skin samples after UV irradiation. Cytology samples examined two months after ending therapy contained no CPD positive cells. CONCLUSION: Our results suggest that UV damage induced by intranasal phototherapy is efficiently repaired in nasal mucosa.

Performance of the 808-nm diode laser on equine upper airway tissue is enhanced by intravenous administration of indocyanine green.

OBJECTIVE: The objective was to develop a protocol whereby 808-nm diode laser irradiation combined with intravenous (IV) indocyanine green (ICG) could be used in non-contact mode with equal surgical efficacy to the Nd:YAG on equine tissues. BACKGROUND DATA: The 808-nm diode laser, delivering 20-40 W of power, has been produced for veterinary medical applications. This laser's power output is less than that of most neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers. ICG is absorbed at a wavelength of 810 nm, which when concentrated in tissue should be an excellent absorber for the energy produced by the 808-nm diode laser. METHODS: This study compares the depths and widths of thermal penetration achieved with the 808-nm diode laser in equine respiratory tissue after intravenous injection of ICG. ICG was administered at two doses: 1.5 mg/kg and 3 mg/kg. The 808-nm diode laser and Nd:YAG laser were set to deliver 200 J of energy. The depths and widths of thermal penetration obtained were compared. RESULTS: Lesion depth and width tended to be greater in the ICG + 3 mg/kg group than in the ICG + 1.5 mg/kg group. Even so, the 1.5-mg/kg dose substantially increased the efficacy of the diode laser. Plasma ICG concentrations peaked at 5 min post-administration and then dropped markedly; lesion depth decreased after peaking at 7 min post-administration. CONCLUSION: This study demonstrated that the 808-nm diode laser, when augmented with intravenous ICG, will be as effective a surgical tool as the Nd:YAG laser on equine upper airway tissues when applied using a non-contact fiber.

How does radioactive iodine affect the nose?

OBJECTIVES/HYPOTHESIS: To determine the effect of radioactive iodine (RAI) treatment on the nasal mucosa and nasal functions. STUDY DESIGN: Prospective clinical study. METHODS: This study included 41 patients (31 female and 10 male) who were treated with RAI for papillary thyroid carcinoma. A visual analogue scale (VAS) was used for subjective evaluation of nasal symptoms. The saccharine test, nasal Schirmer test, and acoustic rhinometry were used for objective evaluation of nasal functions. All tests were administered at baseline (before RAI treatment), and then 1 month and 1 year post-RAI treatment. Only 21 of the patients could be evaluated after 1 year of treatment and were included in the study's analysis. RESULTS: VAS obstruction and dryness scores 1 month and 1 year post-RAI were significantly higher than the baseline scores (P < .05 and P < .05, respectively). Mean cross-sectional area values 1 month and 1 year post-RAI did not differ significantly from baseline values (P > .05 and P > .05, respectively). Schirmer test results 1 month and 1 year post-RAI treatment were significantly lower than at baseline (P < .05 and P < .05, respectively). Saccharine test results 1 month and 1 year post-RAI were significantly higher than at baseline (P < .05). CONCLUSIONS: RAI treatment can adversely affect the nasal mucosa. Nasal dryness and obstruction can occur immediately after RAI treatment. Additional research is warranted to further elucidate the effects of RAI treatment on nasal function. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2698-2702, 2017.

Treatment for retropharyngeal metastatic undifferentiated squamous cell carcinoma from an unknown primary site: results of a prospective study with irradiation to nasopharyngeal mucosa plus bilateral neck.

Background and Objetive: To evaluate treatment outcomes for patients with retropharyngeal metastatic undifferentiated squamous cell carcinoma (SCC) from an unknown primary site. METHODS: From January 2005 to January 2015, patients who presented with enlarged retropharyngeal nodes underwent transoral sonography-guided fine-needle aspiration to confirm histology. Those with metastatic undifferentiated SCC with unknown primary tumors were treated with radical radiotherapy to nasopharyngeal mucosa plus bilateral neck. Chemotherapy was administered for patients staged N2-3. Endpoints included metastatic nodes control, the appearance of primary tumor, overall survival and treatment-related toxicities. RESULTS: A total of 49 patients were recruited into this study. Retropharyngeal and cervical nodal disease was controlled in 96% of all patients. The incidence of occult primary cancer appearance was 8%. No primary cancer other than of the nasopharynx was detected during the course of follow-up. Ten patients developed distant metastases. The 5-year overall survival, progression-free survival, regional relapse free survival, distant metastasis free survival were 79.6%, 61.1%, 83.4%, 73.8%, respectively. Common late adverse effects included xerostomia (57%) and hearing impairment (35%). CONCLUSION: Radical radiotherapy to both the nasopharynx and bilateral neck can achieve excellent outcome with mild toxicities for patients with retropharyngeal metastatic undifferentiated squamous cell carcinoma from an unknown primary site.

Correlation among ocular surface disease, xerostomia, and nasal symptoms in patients with differentiated thyroid carcinoma subjected to radioiodine therapy: A prospective comparative study.

BACKGROUND: Some complications of radioiodine therapy have been reported, but the involvement of the eyes and adnexa is rarely discussed. The purpose of this study was to determine the correlation among ocular surface changes, xerostomia, and changes in the nasal mucosa associated with radioiodine therapy. METHODS: Patients subjected to radioiodine therapy (group 1) or not subjected (group 2) were prospectively evaluated by examinations of the ocular surface and tear film, saliva production, and nasal endoscopy. Ocular and nasal symptoms and xerostomia were evaluated using questionnaires. RESULTS: Evaluation of the ocular surface did not indicate significant differences between the groups. Nasal endoscopy revealed higher mucosal pallor in group 1 and worsening of the endoscopic appearance. Worsening of ocular symptoms and nasal symptoms, xerostomia, and a significant decrease in salivary production was also observed in group 1. CONCLUSION: Subjective worsening of xerostomia, xerophthalmia, nasal symptoms, and changes in the nasal mucosa in group 1 was observed.

[Allergo-immunology]. / Allergo-immunologie.

Allergic rhinitis is a frequent illness. New therapeutic options are being developed to counteract its impact on quality of life and health costs. This article presents two of these options, laser rhinophototherapy and Butterbur Ze 339, a drug derived from petasites. The immunodepressing effect of phototherapy has been tested in nasal mucosa. This application has shown satisfactory anti-inflammatory results in nasal cleaning fluid and, consequently, has enabled to reduce allergic rhinitis. The effect of butterbur on the symptoms of allergic rhinitis has to be understood in relation with the inhibition of cysleucotrienes synthesis, as well as its action on eosinophils and mastocytes. However, long-term studies involving large cohorts of patients are needed if we want to prescribe these treatments without restrictions.