The Global Allergy and Asthma European Network (GALEN rhinosinusitis cohort: a large European cross-sectional study of chronic rhinosinusitis patients with and without nasal polyps.

BACKGROUND: Chronic rhinosinusitis (CRS) is a common yet under-recognised chronic inflammatory disease of the nose and paranasal sinuses that is classified according to the presence (CRSwNP) or absence (CRSsNP) of nasal polyps. METHODS: This paper reports the methodology and descriptive results of the Global Allergy and Asthma European Network (GALEN) rhinosinusitis cohort. We established a large CRS cohort within the GALEN consortium (European FP6 research initiative) to identify inflammatory endotypes, the natural disease course, and its impact on health-related quality of life (HRQoL). Detailed information on the impact of CRS on HRQoL, comorbidity incidence, objective disease measures, and medical and surgical treatments were collected. RESULTS: This multicentre cross-sectional case-control study recruited 935 adults (869 eligible for analysis: 237 CRSsNP; 445 CRSwNP; 187 controls [reference group]). Comorbidities such as asthma, allergy, eczema, food allergy, urticaria, and chronic obstructive pulmonary disease were significantly more frequent in CRS patients. Nasal corticosteroids, antibiotics, and oral corticosteroids were the most common treatments. Significantly more CRSwNP patients reported previous sinonasal surgery. CONCLUSIONS: This study provides detailed information that facilitates studying CRS and its main phenotypes. However, patient distribution of this study does not necessarily reflect disease distribution in the general population.

The GALEN rhinosinusitis cohort: chronic rhinosinusitis with nasal polyps affects health-related quality of life.

BACKGROUND: Chronic rhinosinusitis (CRS) significantly affects health-related quality of life (HRQoL). Few multinational observational studies have evaluated the impact of CRS with nasal polyps (CRSwNP) on patients’ HRQoL. This study aimed to assess HRQoL outcomes (including analyses by disease severity and impact of comorbidities and refractory disease) in CRSwNP patients from a large European database. METHODOLOGY: Data were analysed from the Global Allergy and Asthma European Network (GALEN) Rhinosinusitis Cohort, including sociodemographic data, patient-reported disease severity (visual analogue scale), and scores on the 36-Item ShortForm Health Survey (SF-36) questionnaire. Differences in mean SF-36 scores were evaluated between patients with CRSwNP and population norms and between subgroups of interest (disease severity, comorbidity, and refractory disease, defined by a history of sinonasal surgery). RESULTS: Patients with CRSwNP (N = 445) had significantly lower mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores vs population norms, demonstrating that CRSwNP negatively affects HRQoL. The presence of comorbidities affected HRQoL, as shown by significant differences in PCS scores in patients with asthma or non-steroidal antiinflammatory drug-exacerbated respiratory disease, compared with patients without asthma. Patients with moderate-to-severe disease had significantly lower PCS scores than patients with mild disease. Severe disease had a significant impact on MCS score. History of surgery had a clinically meaningful negative effect on HRQoL compared with no history of surgery. CONCLUSIONS: CRSwNP patients have significantly lower HRQoL compared with population norms. The impact is greater in patients with greater disease severity, comorbidities, or refractory disease.

Impaired virus replication and decreased innate immune responses to viral infections in nasal epithelial cells from patients with allergic rhinitis.

The aim of this study was to assess the immune response to parainfluenza virus type 3 (PIV3), rhinovirus 1B (RV1B) and intracellular Toll-like receptors (TLR) agonists in nasal epithelial cells (NECs) from patients with allergic rhinitis and healthy controls. NECs were obtained from eight patients with allergic rhinitis (AR) and 11 non-atopic healthy controls (HC) by nasal scraping, grown to confluence and exposed to PIV3, RV1B infection or TLR-3 and TLR-7/8 agonists. Interferon (IFN)-λ1, IFN-α, IFN-ß and regulated on activation, normal T expressed and secreted (RANTES) release into the cell culture supernatants was assessed at 8, 24 and 48 h upon infection or 8 and 24 h after stimulation with poly(I:C) and R848. mRNA levels of IFNs, RANTES, interferon regulatory transcription factor (IRF)3, IRF7 and viral gene copy number were determined using real-time polymerase chain reaction (RT-PCR). PIV3 but not RV1B replication 48 h after infection was significantly lower (P < 0·01) in NECs from AR patients compared to HC. PIV3 infection induced significantly less IFN-λ1 (both protein and mRNA) in NECs from AR compared to HC. IFN-ß mRNA expression and RANTES protein release and mRNA expression tended to be smaller in AR compared HC cells in response to both viruses. Stimulation with TLR-3 agonist [poly (I:C)] induced similar IFN-λ1 and RANTES generation in AR and HC subjects. Viral infections in NECs induced IRF7 expression, which correlated with IFN and RANTES expression. These data suggest that virus proliferation rates and the immune response profile are different in nasal epithelial cells from patients with allergic rhinitis compared to healthy individuals.

Important research questions in allergy and related diseases: 3-chronic rhinosinusitis and nasal polyposis - a GALEN study.

Chronic rhinosinusitis is one of the most common health care challenges, with significant direct medical costs and severe impact on lower airway disease and general health outcomes. The diagnosis of chronic rhinosinusitis (CRS) currently is based on clinical signs, nasal endoscopy and CT scanning, and therapeutic recommendations are focussing on 2 classes of drugs, corticosteroids and antibiotics. A better understanding of the pathogenesis and the factors amplifying mucosal inflammation therefore seems to be crucial for the development of new diagnostic and therapeutic tools. In an effort to extend knowledge in this area, the WP 2.7.2 of the GA(2)LEN network of excellence currently collects data and samples of 1000 CRS patients and 250 control subjects. The main objective of this project is to characterize patients with upper airway disease on the basis of clinical parameters, infectious agents, inflammatory mechanisms and remodeling processes. This collaborative research will result in better knowledge on patient phenotypes, pathomechanisms, and subtypes in chronic rhinosinusitis. This review summarizes the state of the art on chronic rhinosinusitis and nasal polyposis in different aspects of the disease. It defines potential gaps in the current research, and points to future research perspectives and targets.

Histopathological verification of clinical indications to partial inferior turbinectomy.

Surgical treatment in cases where disturbances of the nasal patency causes changes in the nasal inferior turbinates is controversial. The authors performed light- and electron microscopy and morphometric examinations of the mucous membrane of the nasal inferior turbinates obtained after partial inferior turbinectomy in patients with vasomotor and perennial allergic rhinitis and compensation hypertrophy of the nasal inferior turbinate accompanied by nasal deviation of the septum. In specimens obtained from patients with vasomotor rhinitis, a small number of glands and fibrosis of the lamina propria was observed. In specimens obtained from perennial allergic rhinitis patients, plenty of glands and large oedema was observed. In the group with compensatory hypertrophy of the inferior turbinate, normal glands and fibred areas around the vessels were observed. The largest histopathological changes of degeneration and hypertrophy of the nasal mucosa were observed in vasomotor rhinitis patients. Histopathological examination of nasal mucosa slides confirmed the usefulness of a partial inferior turbinectomy, but only in vasomotor rhinitis patients.

Tinnitus suppression by electrical promontory stimulation (EPS) in patients with sensorineural hearing loss.

OBJECTIVE: Almost 10-15% of the population suffer from chronic tinnitus. There are clinical indications that a 'pathological sound' may be induced by any level of the auditory pathways. Theraupeutical difficulties and many hypotheses about tinnitus and places from which they originate might indicate various methods of treatment. Electrostimulation tinnitus suppression was achieved by many authors from 22 (Graham, Hazell) to 87% (Portman). The aim of our study was to define the usefulness of electrostimulation in treatment of persistent noise induced cochlear lesion tinnitus (group I - 43 men) and compare the results with the non noise induced tinnitus group II (68 patients). METHODS: Otolaryngological and audiological examination of the patients was made before and after electrostimulation, and at 90 days. The stimulation system consisted of a prototype tinnitus suppressor, the active platino-iridium needle electrode and silver surface electrode located on the forehead. Transtympanal electrical stimulation was performed using positive polarity direct current. Parameters of electrical impulse were individually different and depended on tinnitus parameters and patients sensation. The current levels ranged from 20 to 600 microA and frequency ranged from 60 to 10000 Hz. Average time of EPS was 60 s. RESULTS: The control examination 90 days after stimulation in group I showed subjective improvement in 18 (41.9%) patients, 22 (51.2%) did not notice any change and tinnitus deteriorated in 3 (6.9%) of the patients. In the comparative group II improvement was occurred in 34 (50%) persons including 2 (17.6%) in whom tinnitus was abolished, in 30 (44.1%) tinnitus was unchanged and 4 (0.6%) became worse. In both groups our method did not have a destructive influence on hearing. Electrical stimulation to relieve tinnitus has been used for nearly 200 years, but it is unclear how electrical stimulation works to suppress tinnitus. CONCLUSION: In our opinion electrical stimulation by using positive DC changes the spontaneous activity of cochlear nerve fibres. According to our results it is suggested that the mechanism of beneficial effects is due to increased microcirculation in part of the auditory pathways. Poorer results in patients with noise induced tinnitus could be explained by greater damage of the cochlea outer hair cells. In our opinion EPS could be a method of treatment for persistent tinnitus in cases which fail to respond to other methods.

[Treatment results of acoustic trauma]. / Wyniki leczenia ostrych urazów akustycznych.

20 patients aged from 18 to 42 treated in the past few years because of acoustic trauma. Together the investigations concerned 24 years. Therapeutic schema comprised intravenous infusion--Sermion (Nicergoline--amp. a 4 mg) or Cavinton (Vinpocetine--amp. a 10 mg) 1 amp.--twice a day for 10 days. The treatment of 60% of the patients started in the first week after the trauma occurred, of 20% in the second week and the remaining 20% later on after 15 days when the trauma took place. The obtained results of treatment both of improvement of hearing (79.2%) and tinnitus (66.6%), support the necessity of treatment of acoustic trauma independently from the time that passed after trauma had occurred. Better results of audiometric improvement of hearing (54.2%) and tinnitus disappearance (50%) were obtained in the patients whose treatment started in the first week after trauma. The improvement of hearing and tinnitus disappearance was more observed in patients after treatment by using Sermion than Cavinton.

[The evaluation of granulocyte function before and after surgical treatment in patients with chronic inflammation of the middle ear and palatine tonsils]. / Ocena funkcji granulocytów (PMNL) przed i po leczeniu operacyjnym u chorych z przewleklym ropnym zapaleniem ucha srodkowego i migdalków podniebiennych.

The aim examinations was the evaluation of granulocytes (PMNL) pre- and postsurgical treatment in patients with chronic inflammation of middle ear and palatine tonsils. The examined 40 persons and divided into three groups: I--18 patients with chronic inflammation of middle ear, II--10 ones with chronic tonsillitis and III--12 healthy persons. There were evaluated: "in vivo" and "in vitro" migration, bactericidal index and absorption of S. aureus labeled 14C isotope (phagocytic index) in the own modification. Preoperative treatment in patients with chronic inflammation of middle ear and palatine tonsils in comparison to the healthy were noticed: characteristic increase of the migration area, the MIF liberation and the phagocytic index, decrease in the bactericidal index (but more in group II). After a year postsurgical treatment the function of granulocytes in patients of group II was more similar to the healthy than in group I.

[Histopathological verifications clinical indications in the inferior turbinoplasty]. / Weryfikacja histopatologiczna wskazan klinicznych do turbinoplastyki dolnej.

Surgical treatment in cases of disturbances of nasal patency caused changes in the nasal inferior turbinates are controversial. The authors performed the microscopic (light microscope) and morphometric examinations of mucous membrane of the nasal inferior turbinates obtained after inferior turbinoplasty in patients with vasomotor and perennial allergic rhinitis and compensation hypertrophy of nasal inferior turbinate accompanied of nasal deviation septum. Analysing of morphologic changes in mucous membrane of the nasal inferior turbinates verified of clinic indications to inferior turbinoplasty.

[Clinical and immunohistoenzymatic investigations in patients with vasomotor and perennial allergic rhinitis]. / Badania kliniczne i immunohistoenzymatyczne u chorych z naczynioruchowym i calorocznym alergicznym niezytem nosa.

The aim of our study was evaluation of the results of clinical examination in patients with vasomotor and perennial allergic rhinitis and assessment of number of blood vessels, nerve fibres and mast cells on the basis of immunohistoenzymatic examination. There were 42 patients examined aged from 18 to 50 and divided into three groups: I--16 patients with vasomotor rhinitis and II--14 patients with perennial allergic rhinitis and III--12 patients (control) with nasal septum deviation. On the basis of the patient's history data, clinical otorhinolaryngologic examination and active anterior rhinomanometry the patients were qualified to bilateral inferior turbinectomy. The nasal mucosa removed during surgery underwent immunohistoenzymatic examination using the monoclonal antibody against the tryptase of mast cells (MCT company, DAKO), the endothelin of blood vessels (EC - DAKO) and the neurospecific enolase (NSE - DAKO). In examined groups of patients with vasomotor and perennial allergic rhinitis and control group similar escalation of clinical symptoms expressed by means of points index were stated. In immunohistoenzymatic studies the differences in mean number of blood vessels and nerve fibres between examined groups were not statistically significant, however statistically significant difference concerned higher number of mast cells patients with vasomotor rhinitis in comparison to perennial allergic rhinitis.

[Clinical evaluation of Olbas oil effect on nasal mucosa in acute rhinitis patients during common cold]. / Ocena kliniczna dzialania olejku olbas na blone sluzowa nosa u chorych z ostrym katarem w przebiegu choroby przeziebieniowej.

The aim of the study was the clinical evaluation of the effect of Olbas oil on nasal mucosa in patients with acute rhinitis during common cold. 15 patients with 2-3 days history of acute rhinitis during common cold, both sexes, in the age between 23-47 were investigated. All the examinations were done before using, after the first inhalation, and after 7 days of Olbas oil administration. The investigation before using Olbas oil was comprised of: history data, general and otorhinolaryngological examination with particular evaluation of nasal mucosa, anterior rhinomanometry, saccharin translocation time, olfactometry, microbiological cultures, histamine nasal provocation test. At the end, after 7 days of Olbas oil inhalation 3 times a day for 4 minutes 4 drops of Olbas oil applied into a handkerchief, all the test were done again, as at the beginning. The study showed a good of the effect of Olbas oil on nasal mucosa in patients with acute rhinitis during common cold.

[Clinical studies of Olbas oil tolerance and its effect on nasal mucosa in healthy volunteers]. / Badania kliniczne nad tolerancja i wplywem olejku Olbas na blone sluzowa nosa u zdrowych ochotników.

The aim of the study was the clinical examinations of the tolerance and effect of Olbas oil on nasal mucosa in healthy volunteers during permanent 4 weeks administration. 23 healthy volunteers both sexes in the age between 20-50 were investigated. This investigations consisted of: history data, general and otorhinolaryngological examination, with particular evaluation of nasal mucosa, anterior rhinomanometry, olfactometry, saccharin translocation time, microbiological cultures, histamine nasal provocation test. Besides, each patient has follow up self evaluating chart of symptoms and adverse effect from the eyes, nose, pharynx and others. All the examined persons showed a very good tolerance of Olbas oil after 28 days of inhalation.

[The influence of phleum pratense and secale cercale allergens on selected functions of PMNL granulocytes]. / Wplyw alergenów phleum pratense i secale cercale na wybrane funkcje granulocytów obojetnochlonnych (PMNL).

The evaluation of granulocytes function (PMNL) at patients with pollinosis. There were 59 people examined and divided into: 30 patients with pollinosis, 29 healthy people. There were evaluated: absorption of isotope (phagocytic index) in our modification migration in vivo and the bacteriotoxic index. The function of granulocytes (postpreincubation) of allergens Phlenum pratens and Secale cercale in patients with pollinosis were changed more in comparison with the healthy people.

[Evaluation of oxygen free radical generation and antioxidative enzymatic activity in blood of patients with carcinoma of the larynx (preliminary report)]. / Ocena generacji anionorodnika ponadtlenkowego oraz antyoksydacyjnej aktywnosci enzymatycznej we krwi obwodowej chorych z rakiem krtani (doniesienie wstepne).

The aim of the study were the evaluation of generation of oxygen free radical and antioxidative enzymatic activity in blood of patients with carcinoma of larynx (7 persons, aged 48-68) in comparison with healthy persons (15, aged 21-28). The superoxide anion generation of blood granulocytes described by the rate of the reducted cytochrom C at rest and after stimulation with opsonized zymosan according to Bellavite et al. were measured. The enzymatic activity of superoxide dismutase in blood (method of Misra and Fridovich), catalase (method of Beers and Sizer) and malonyl dialdehyde (method of Placer et al.). The obtained data pointed at the growth of generation of oxygen free radical in blood (at rest and after stimulation with opsonized zymosan) of patients with carcinoma of larynx in comparison with the healthy ones. At the same patients with carcinoma of larynx observed at significant reduction of antioxidative enzymatic activity against the oxygen species generation in blood and significant growth of peroxidation lipids and disturbances of function of cells the human body.

[Evaluation of granulocyte (PMNL) function in patients with chronic inflammation of the middle ear and palatine tonsils]. / Ocena funkcji granulocytów (PMNL) u chorych z przewleklymi zmianami zapalnymi ucha i migdalków podniebiennych.

The evaluation of granulocytes function (PMN) in patients with chronic inflammation of middle ear and palatine tonsils. There were 39 people examined and divided into: 28 patients with chronic inflammation of middle ear and palatine tonsil, 11 healthy persons. The function of granulocytes in patients with chronic inflammation of middle ear and palatine tonsil were changed more in comparison with the healthy people.

[Oxygen-derived free radicals of granulocytes in the blood of patients with chronic inflammation of the middle ear and palatine tonsils]. / Wolne rodniki ponadtlenkowe granulocytów krwi obwodowej u chorych z przewleklymi zmianami zapalnymi ucha srodkowego i migdalków podniebiennych.

The evaluation of oxygen species generation in blood granulocytes of patients with chronic inflammation of middle ear and palatine tonils. There were 38 patients tested (10 with chronic inflammation of palatine tonsil, 18 with chronic inflammation of middle ear and 10 healthy ones). There were statistically significant differences between the superoxide anion generation in patients with chronic inflammation of palatine tonsil and middle ear in comparison with to the healthy ones.

[The evaluation of granulocyte (PMNL) function of patients with chronic hypertrophy of larynx and paranasal sinuses]. / Ocena funkcji granulocytów (PMNL) u chorych ze zmianami rzerostowymi krtani i zatok przynosowych.

The evaluation of granulocytes function (PMNL) at patients with chronic hypertrophy of larynx and paranasal sinuses. There were 40 people examined and divided into: 10 patients with hypertrophy of larynx, 13 patients with hypertrophy of paranasal sinuses and 17 healthy people. There were evaluated: emission of chemiluminescence (CL), absorption of isotope (phagocytic index) in our modification migration in vivo and in vitro and the bacteriotoxic index. The function of granulocytes in patients with hypertrophy of larynx and paranasal sinuses were changed more in comparison with the healthy people.

[The generation of oxygen free radicals in blood in patients with hypertrophy of paranasal sinuses and larynx]. / Generacja anionorodnika ponadtlenkowego w krwi obwodowej u chorych ze zmianami przerostowymi zatok przynosowych i krtani.

The evaluated of oxygen specious generation in blood granulocytes of patients with hypertrophy of paranasal sinuses and larynx. There were 33 patients tested (13 with hypertrophy of paranasal sinuses, 10 with hypertrophy of larynx and 10 healthy). The superoxide anion generation of peripheral blood granulocytes described by the rate of the reduced cytochrome C at rest and after stimulation with opsonized zymosan according to Bellavite were measured. There were statistically significant differences between the superoxide anion generation in patients with hypertrophy of paranasal sinuses and larynx in comparison with the healthy ones.