Aeroallergens in West Crete, Greece: A five year (2010-2014) aerobiological study.

The objective of the analytic observational study was to present air-pollen counting program results for a 5-year period. Airborne pollens and fungi collection, from both urban and sub-urban areas, were obtained using a special Burkard pollen trap installed on the roof of Chania General Hospital. Aeroallergen concentration measurement was made in a standardized way with fixation of the material collected and then counting using an optical microscope. Annual and total circulating pollen and fungi counts for the study period are presented. In the year 2014, the highest total annual count was recorded, while 2013 was the year with the lowest one. Months with the highest average concentrations were June for the years 2010 and 2011 (1291 and 1114.6 grains/m(3), respectively) and May for the consecutive 3 years 2012-2014 (1120, 890 and 1353.1 g/m(3), respectively). Peak periods for circulating aeroallergens were April-June. Trees pollen accounted for the majority of circulating aeroallergens (615.9 and 677.1 g/m(3) during peak periods in the years 2012 and 2014), while fungi accounted for the majority of circulating aeroallergens (818.5, 729.4, 890.7 spores/m(3)), during the peak periods in the years 2010, 2011 and 2013. Variability in peak airborne allergen periods could be partly explained by the differences in climatic conditions during the study period.

The effects of smoking on quality of life recovery after surgery for chronic rhinosinusitis.

BACKGROUND: The effects of smoking on quality of life (QoL) results in chronic rhinosinusitis (CRS) patients still remain a matter of debate. OBJECTIVE: To explore the impact of smoking on QoL and determine how quantity of daily smoking and duration affect QoL results after endoscopic sinus surgery (ESS). METHODOLOGY: Patients with CRS were prospectively asked to evaluate their QoL pre- and after ESS. All subjects' QoL was evaluated by means of validated questionnaires either specific (Questionnaire of Olfactory Deficits), for assessing psychology (Zung Anxiety Scale, State -Trait Anxiety Inventory, Zung Depression Scale and Beck Depression Inventory) or generic (Short-Form-36). Smoking habits were expressed in pack-years. RESULTS: No statistically significant differences were found in the pre-treatment scores in any of the questionnaires between smokers and non smokers. Post-operatively, all QoL questionnaires' results were significantly improved among both groups, although non smokers exhibited significantly greater improvement compared to smokers. There was a negative impact of the number of pack-years on the changes of QoL results; less improvement was observed as the number of pack-years was increasing. CONCLUSION: Although smoking did not improve preoperative QoL results and proved not to be a contra-indication factor for ESS regarding QoL, smokers presented worse treatment outcomes. Quantity and duration of smoking were significantly associated with worse postoperative results in all QoL questionnaires.

Predictors of quality of life outcomes in chronic rhinosinusitis after sinus surgery.

The predictive value of olfaction for quality of life (QoL) recovery after endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) is still underestimated. The aim of this study was to explore the proportion of patients suffering from CRS who experience clinically significant QoL improvement after ESS and identify pre-operative clinical phenotypes that best predict surgical outcomes for QoL, focusing mainly on the role of patients' olfaction. One hundred eleven patients following ESS for CRS and 48 healthy subjects were studied. Olfactory function was expressed by the combined "Threshold Discrimination Identification" score using "Sniffin' sticks" test pre-treatment and 12 months after treatment. All subjects completed validated, widely used QoL questionnaires, specific for olfaction (Questionnaire of Olfactory Deficits: QOD), for assessing psychology (Beck Depression Inventory: BDI) and for general health (Short Form-36: SF-36). Statistically significant improvement of olfactory function by 41.8% and of all QoL questionnaires scores (all p < 0.001) was observed on the 12-month follow-up examination. Clinically significant improvement for QoL was measured in a proportion of 56.8% of patients on QOD, 64.9% on SF-36 and 49.5% on BDI scales results. Although olfactory dysfunction, nasal polyps, female gender, high socio-economic status and non-smoking habits were significantly associated with better QoL results, multivariate logistic regression analysis revealed that only olfactory dysfunction and nasal polyps were independent predictors significantly associated with higher likelihood of clinically significant improvement in all QoL questionnaire results. Olfactory dysfunction and nasal polyps were independent pre-operative predictors for surgical outcomes with regard to QoL results.

Olfactory dysfunction and asthma as risk factors for poor quality of life in upper airway diseases.

BACKGROUND: The study of olfaction/quality of life (QoL) interaction has not been adequately discussed and remains to be further explored. Determination of clinical predictors for poor QoL may support consultation of respective patients. This study explores QoL of patients with olfactory dysfunction and evaluates associated clinical risk factors for QoL prediction. METHODS: One hundred eight patients suffering from chronic rhinosinusitis (CRS) and allergic rhinitis (AR) and 30 healthy subjects were studied. Olfactory function was evaluated using objective olfactory test. All patients completed six validated questionnaires either specific for olfaction (Questionnaire of Olfactory Deficits [QOD]) and for assessing psychological state (Zung Anxiety Scale [ZAS], State-Trait Anxiety Inventory, Zung Depression Scale, and Beck Depression Inventory [BDI]) or a generic one (Short Form 36). RESULTS: Significantly poorer QoL and more severe anxiety and depression symptoms were observed in anosmic (all p < 0.001) and hyposmic patients compared with controls. Anosmic patients presented significantly worse results compared with hyposmic and normosmic patients. However, higher scores were observed in hyposmic compared with normosmic patients only in the QOD, ZAS, and BDI scale. Patients with CRS presented significantly poorer QoL than patients with AR only. The presence of nasal polyps or concomitant AR in patients with CRS did not show any differentiation in the results. Asthma was associated with significantly worse scores in all the psychometric questionnaires. CONCLUSION: Olfactory dysfunction was found to decrease QoL among patients. Anosmia, CRS disease, and asthma as clinical predictors were proved to be independently correlated with QoL, anxiety, and depression levels.

Inflammatory patterns in upper airway disease in the same geographical area may change over time.

BACKGROUND: Inflammatory patterns of nasal polyps (NPs) may vary. Changes over time have not been investigated so far. This study was designed to evaluate the inflammatory patterns of NPs in Thailand at two time points 12 years apart, explore differences in Staphylococcus aureus (SA) mucosal carriage rates over time, and the latter's relationship with the inflammatory patterns. METHODS: Formalin-fixed nasal tissue was obtained from 89 (47 in 1999 and 42 in 2011) patients suffering from chronic rhinosinusitis with NPs (CRSwNPs). Tissues were evaluated for eosinophils, neutrophils, IgE(+) cells, IgE and macrophage mannose receptors, interleukin (IL)-5 and IL-17 cytokine profile, and the presence of SA, using automated immunohistochemistry and peptide nucleic acid-fluorescence in situ hybridization. RESULTS: We found a significant increase in the absolute values of eosinophils and IgE(+) cells in the 2011 CRSwNP tissue series compared with 1999 and a significant but smaller increase in neutrophils. Semiquantitative evaluation revealed significantly higher mean values of positive cells for all studied inflammatory markers in the 2011 group of patients, except for the high-affinity IgE receptor. This "eosinophilic shift" of inflammation was accompanied by higher SA carriage, as well as higher frequencies of SA invasion (54.8% versus 10.6%; p < 0.001) in the 2011 compared with 1999 subjects. Patients with asthma were more likely to have higher SA carriage rates compared with nonasthmatic patients. CONCLUSION: There was a shift from predominantly neutrophilic to eosinophilic CRSwNPs in Thai patients within 12 years, with an increase in various inflammatory markers including IgE, which is associated with an increase in intramucosal presence of SA.

Improvement of olfactory function for quality of life recovery.

OBJECTIVES/HYPOTHESIS: To explore quality of life (QoL) improvement after treatment of patients with chronic olfactory disorders; and to correlate QoL with olfactory rehabilitation and evaluate olfactory improvement values over which QoL outcomes are significantly recovered. STUDY DESIGN: Prospective clinical study. METHODS: Eighty-nine patients following endoscopic sinus surgery for chronic rhinosinusitis (CRS) and immunotherapy for allergic rhinitis (AR) were studied. Olfactory function was evaluated using Sniffin' Sticks test pre-and 12 months after treatment. All patients completed six validated QoL questionnaires either specific for olfaction (Questionnaire of Olfactory Deficits-QOD) and for assessing mental health (Zung Anxiety Scale, State-Trait Anxiety Inventory, Zung Depression Scale, Beck Depression Inventory), or generic one (Short Form-36). RESULTS: Significant improvement (all P < 0.001) of olfactory function by 27.4% in total cohort (AR: 10.4%, P = 0.004; CRS: 39.9%, P < 0.001), expressed by the combined Threshold-Discrimination-Identification (TDI) score-and of all QoL questionnaires scores (all P < 0.01) as well, was observed after treatment. There was a positive correlation between olfactory recovery and improvement of patients' QoL. ROC analysis revealed that an increase in the TDI score by 3.50 points in AR and 4.75 points in CRS was necessary for a clinically significant improvement in all QoL questionnaires results. CONCLUSIONS: QoL and mental health of patients suffering from chronic sinonasal diseases are totally recovered after treatment, presenting a direct positive relationship with smell improvement. An increase of olfactory function by 3.50 points for AR and 4.75 points for CRS might be considered the cutoff point for patients' QoL significant recovery.

Involution of a large parotid hemangioma with oral propranolol: an illustrative report and review of the literature.

Propranolol has emerged as a new treatment option for infantile hemangiomas. We describe a 20-month-old boy with a large right parotid hemangioma diagnosed at the age of 37 days. Starting at the age of 2.5 months, he received oral propranolol for 6.5 months. Although the mass regressed, it recurred when propranolol was discontinued. He was successfully retreated at the age of 11 months with propranolol for another 5.5 months without further recurrences. Treatment was tolerated well. Our paper and a review of the literature demonstrate that propranolol appears to be safe and effective for symptomatic infantile parotid gland hemangiomas.

Biometric predictive models for the evaluation of olfactory recovery after endoscopic sinus surgery in patients with nasal polyposis.

BACKGROUND: Determination of predictive factors and specific values of olfactory function after endoscopic sinus surgery (ESS) using objective diagnostic methods may support consultation of respective patients. This study was designed to assess the longitudinal olfactory functional outcome after ESS in patients with severe chronic rhinosinusitis (CRS) with nasal polyposis, to evaluate associated clinical factors and to provide statistical models for prediction of olfactory recovery. METHODS: One hundred sixteen patients with nasal polyposis refractory to medical treatment underwent ESS. Olfactory testing was performed preoperatively and 1, 3, and 6 months after surgery using "Sniffin' Sticks" (Burghardt, Wedel, Germany). Using multivariate linear and logistic regression analysis, statistical models were generated to predict (i) the 6th-month composite threshold-discrimination-identification (TDI) score and (ii) the probability of attaining normal olfaction at 6 months. RESULTS: A significant stepwise increment of all olfactory function indices was found over time. Factors influencing final olfactory recovery were patients' age, duration of olfactory deficit, previous paranasal sinus surgery, and aspirin-exacerbated respiratory disease. The first model explained 70% of the observed variation in postoperative TDI scores. The second model correctly classified 76% of the patients. CONCLUSION: A significant progressive improvement of olfaction for at least 6 months was observed after ESS. The statistical models developed may be useful for consultation of ESS candidates in clinical practice.

Evaluation of prognostic factors for olfaction in nasal polyposis treated by endoscopic sinus surgery.

AIM: This prospective study aimed to assess treatment outcome on olfaction in patients undergoing Endoscopic Sinus Surgery (ESS) for nasal polyposis, and to evaluate the role of previous sinus surgery and the duration of olfactory deficit as prognostic factors for olfaction improvement. METHODS: In total, 116 patients with nasal polyposis who underwent ESS were studied. Olfactory testing was performed using the Sniffin' Sticks test, preoperatively and 1-, 3- and 6-month postoperatively. RESULTS: The values of the composite threshold discrimination identification score were significantly lower in patients with long duration of olfactory deficit and history of previous sinus surgery in all testing sessions. Adjustment for preoperative olfactory measures and all potential confounders revealed that both parameters remained strong independent predictors of normal olfactory function; a successful outcome was more frequent in patients with short duration of olfactory deficit and in patients who had not undergone previous sinus surgeries. However all patients achieved a significant stepwise increment of all indices of olfactory function over time, after ESS. CONCLUSIONS: Duration of olfactory deficit and previous sinus surgery presented highly significant predictive value for the short-term outcome of the olfactory function after ESS. However all patients suffering from nasal polyposis will probably improve olfaction significantly in a period up to six months after surgery.

Improvement of olfaction after endoscopic sinus surgery in smokers and nonsmokers.

OBJECTIVES: The aim of this prospective study was to examine the short-term benefit of endoscopic sinus surgery (ESS) on the olfactory function of patients operated on for nasal polyposis. We also studied the predictive value of smoking for the recovery of the olfactory function in these patients. METHODS: We studied 116 patients with nasal polyposis who underwent ESS. Olfactory testing was performed with the Sniffin' Sticks test before operation and 1, 3, and 6 months after operation. RESULTS: All patients achieved a statistically significant stepwise increment of all of the indices of olfactory function over time. The composite threshold-discrimination-identification score was lower in smokers than in nonsmokers in all testing sessions, but none of these differences reached statistical significance. After adjustment for preoperative olfactory measures and all other potential confounders, the effect of smoking on the 6-month postoperative measurement was not significant. However, we did find a statistically significant adverse effect of the quantity of smoking on the olfactory threshold scores. CONCLUSIONS: Both smokers and nonsmokers achieve a highly significant improvement on their olfactory function from ESS. Although smoking is not a major predictive factor for the short-term outcome of the olfactory function after ESS, a greater quantity of smoking may have an effect on the 6-month postoperative odor thresholds.

Aesthetic reconstruction of a crooked nose via extracorporeal septoplasty.

BACKGROUND: The aim of this study was to evaluate the effectiveness, indications, and contraindications of the extracorporeal approach in treating a severely deviated nose. METHODS: Sixty-four patients operated on for aesthetic correction of a severely deviated nose were studied. Forty-six of them were first operations and 18 were revision cases. The surgical procedure of choice was the closed technique. Septal cartilage was prepared and then dislocated, followed by external alignment and reimplantation. Hump reduction with lateral osteotomies and, occasionally, medial dislocation of nasal bones was carried out. RESULTS: Cosmetic results were satisfactory in all first operation cases. In 11 of the 18 revision cases, septal preparation was impossible; in 2, septal sagging was observed; and in 1, perforation was noted. CONCLUSIONS: Extracorporeal septoplasty is an effective, safe, and reliable technique, especially for twisted noses undergoing surgery for the first time. However, it is strongly contraindicated in a revised deviated nose.

The effect of smoking on the olfactory function.

Although smoking is a widely spread habit, its effect on olfaction has not been clearly established. The aim of this study was to investigate the effect of cigarette smoking on the olfactory function, using the "Sniffin' Sticks" test. Sixty-five smokers were studied, with a median period of smoking of 10 years (range: 1-45 years) and a median number of 15 cigarettes smoked per day (range: 5-20). Forty-nine non-smokers were used as controls. Olfactory function was evaluated using the "Sniffin' Sticks" test, which consists of odour threshold (OT), odour discrimination (OD) and odour identification (OI) and its overall results may be presented as a composite threshold-discrimination-identification (TDI) score. Multivariate linear and logistic regression analyses were performed. All OT, OD, OI and TDI scores were statistically significantly lower in smokers compared to non-smokers, even when controlled for gender and age. Low OT, OD, OI and TDI scores were more prevalent among smokers than non-smokers. Multivariate logistic regression analysis, adjusted for gender and age, revealed that smoking remained a strong independent risk factor for low OT, OD, OI and TDI scores. Among smokers, statistically significant negative relationships were found between pack-years and OT, OD, OI and TDI, controlling for age. In conclusion, smoking was found to be adversely associated with the olfactory ability in a dose-related manner. Smokers were found to be nearly six times as likely to evidence an olfactory deficit as non smokers, depending on the duration and the amount of cigarettes smoked.

Pneumatized superior turbinate as a cause of headache.

BACKGROUND: A pneumatized superior turbinate is a rare cause of headache. Nasal endoscopy alone, does not provide us with adequate information for this inaccessible area of the superior nasal cavity. A coronal computed tomography (CT) must be obtained to confirm the diagnosis. CASE PRESENTATION: We present a 40-year-old female with migraine-type headache and nasal obstruction. Nasal endoscopy revealed a mild septal deviation, a right middle concha bullosa and a paradoxically curved middle turbinate on the left side. Coronal CT-scan showed also the presence of a superior concha bullosa on the left, which was in close contact with the nasal septum. The patient underwent septoplasty and bilateral endoscopic sinus surgery, including partial removal of both the pneumatized middle turbinates in conjunction with gentle lateralization and resection of the lower half of the left superior turbinate. Prompt relief from headache and nasal symptoms was obtained. CONCLUSION: Pneumatized superior concha causing migrainous headache is a rare finding. Endoscopic surgery may provide permanent relief of symptoms.

Ethmoidal osteoma with intraorbital extension: excision through a transcutaneous paranasal incision.

PURPOSE: To describe a case of conjunctival hyperaemia and proptosis of the right eye. METHODS: Three-dimensional computed tomography (CT) was performed to reveal the size and position of a lesion of osseous density extending into the right orbit. The lesion was then excised using a right paranasal transcutaneous approach. RESULTS: The pathology report suggested ethmoidal osteoma. The postoperative course was uncomplicated and the lesion did not recur during a 5-year follow-up period. Repeated postoperative ophthalmic examinations revealed preservation of visual acuity and visual fields postoperatively. DISCUSSION: Diagnosis is based on imaging studies, especially CT and three-dimensional CT scans. A three-dimensional CT scan is critical in understanding the actual dimensions of the tumour and its relations with other structures. Surgical removal is indicated in cases with orbital matrix compression and displacement. A transcutaneous paranasal approach allows for increased exposure of affected structures.