Impact of human papillomavirus status on survival in patients with oral cancer.

Objectives: To examine the association between the human papillomavirus (HPV) infection and overall survival rate in patients with oral cancer. Methods: This retrospective cohort study examined HPV status in 454 patients who were diagnosed with oral squamous cell carcinoma (OSCC) using the records of patients who underwent an initial treatment for OSCC between 2012 and 2021 at our institution as retrieved from the Cancer Registry database. The survival rates of the HPV-positive and HPV-negative groups were assessed and compared, and independent factors associated with survival were analyzed using multivariate Cox regression models. Results: Of the 454 patients with OSCC included in this study, 73 were excluded for invalid HPV tests. Of the remaining patients, 39 and 342 patients were categorized into HPV-positive and HPV-negative groups, respectively. The prevalence of HPV-positive in the patients with OSCC was 10.2% (95% confidence interval 7.2%-13.2%). The 3-year overall survival rates were 56.2% and 53.9% in the HPV-positive and HPV-negative groups, respectively. The 3-year disease-specific survival rates in the HPV-positive and HPV-negative groups were 60.2% and 56.9%, respectively. The survival differences were not statistically significant. HPV-positive status was not a significant predictor of overall survival in the multivariable Cox regression analyses (p = 0.728). Conclusion: The prevalence of HPV-positivity among patients with OSCC in the study was 10.2%. No association was found between HPV-positive status and 3-year overall survival in patients with oral cancer. Level of evidence: Level 3.

Kimura's disease presenting with intraparotid and neck nodes: A case report and review of literature.

Kimura's disease (KD) is a rare chronic inflammatory disorder of unknown etiology. The purpose of this article is to increase the awareness of clinicians regarding KD presenting with intraparotid and neck nodes which can mimic various inflammatory and neoplastic conditions. A 22-year-old man presented with a slow-growing left parotid swelling for 3 years. Ultrasound and computed tomography showed multiple enlarged intraparotid and neck nodes. Fine needle aspiration results showed lymphoid tissue hyperplasia. A diagnosis of KD was based on characteristic histopathological findings after a superficial parotidectomy in conjunction with peripheral eosinophilia. KD should be included in the differential diagnosis especially in young Asian men with slow-growing lesions and peripheral eosinophilia. Cytology by fine needle aspiration is useful to exclude malignancy but the results may be inconclusive. Surgical excision is best for definitive histopathological diagnosis, and has been the mainstay of treatment of KD.

Prognostic value of pretreatment lymphocyte-to-monocyte ratio in patients with advanced oral cavity cancer.

Introduction: Lymphocyte-to-monocyte ratio (LMR) has been reported as a prognostic factor in many cancers but the data are to date limited for its use in oral cavity cancer. The purpose of this study was to evaluate the prognostic value of LMR in advanced-stage oral cavity cancer. Methods: Data from 211 advanced-stage oral cancer patients treated with curative intent between January 2009 and December 2015 were obtained from the hospital information system. Pretreatment LMR and other hematologic parameters were recorded and an LMR cutoff value was calculated. Overall survival between the groups above (high LMR) and below (low LMR) the cutoff was compared and hazard ratios from univariate and multivariate analyses using a Cox proportional hazards model calculated. Results: Overall survival and disease-specific survival were better in the high LMR group. The 5-year overall survival rates were 31.6% and 15% in the high LMR and low LMR groups, respectively. Multivariate analysis using a Cox proportional hazards model showed that treatment modality and LMR were the only factors associated with overall survival. Conclusion: Low LMR was associated with poor survival outcome in patients with advanced-stage oral cavity cancer. Level of Evidence: 2b.

A multicenter survey on the effectiveness of nasal irrigation devices in rhinosinusitis patients.

BACKGROUND: Nasal irrigation is widely used as an adjunctive treatment for rhinosinusitis. However, there is little information available regarding the efficacy of the devices used in this procedure. The objective of this study was thus to evaluate the effectiveness of nasal irrigation devices based on the experiences of patients with rhinosinusitis. METHODS: We conducted a multicenter survey study between November 2017 and December 2019. The questionnaire was developed based on the available literature and expert opinion and submitted to the otolaryngology residents and staff of each center as well as those in their networks. RESULTS: Four hundred eighteen patients were enrolled in this study: 76 with acute viral rhinosinusitis (18%), 53 with acute bacterial rhinosinusitis (13%), 156 with chronic rhinosinusitis without nasal polyps (37%), and 133 with chronic rhinosinusitis with nasal polyps (32%). We found that high-volume devices were most effective in helping to clear secretion in patients with acute viral rhinosinusitis, chronic rhinosinusitis without nasal polyps, and acute bacterial rhinosinusitis (P = .017, .009, .002, respectively) and in reducing post-nasal drip in those with acute bacterial rhinosinusitis (P = .040). There were no statistically significant differences among devices in patients with chronic rhinosinusitis with nasal polyps. CONCLUSIONS: Nasal irrigation with high-volume devices was an effective treatment for rhinosinusitis and was more effective at clearing nasal secretion and reducing post-nasal drip than that with other types of devices. LEVEL OF EVIDENCE: 2C.

Platelet to lymphocyte ratio and red cell distribution width as prognostic factors for survival and recurrence in patients with oral cancer.

Although platelet to lymphocyte ratio (PLR) and red cell distribution width (RDW) have been reported as good predictors for survival outcomes in various cancers, there is limited data supporting these as reliable predictors in oral cancer. This study thus aimed to assess the prognostic value of PLR and RDW markers in predicting survival and recurrence rates in patients with oral cancer. The records of 374 oral cancer patients treated with curative intent over a 7-year period (2009-2015) were reviewed. Survival and recurrence outcomes were compared between those with low and high PLR (≤135 vs. >135) and those with low and high RDW (≤14.05 vs. >14.05) using hazard ratios (HR). The 5-year disease-specific survival was significantly higher and recurrence rate significantly lower among the low PLR group compared to the high PLR group (65.7 vs. 37.6%; p < 0.001 and 34.4 and 57.5%; p < 0.001), respectively. There were no significant differences between the low and high RDW groups for disease-specific survival (53.6 vs. 54.7%, p = 0.408) and recurrence (40.0% vs. 53.8%, p = 0.079). Multivariate analysis showed that PLR was associated with disease-specific survival (HR = 2.05, p < 0.001) and recurrence (HR = 1.69, p < 0.005) after adjusting for other factors, but not RDW. High PLR shows promise as a prognostic predictor for poor survival and recurrence in patients with oral cancer, but further studies are required. RDW has no prognostic value on any outcome.

Treatment outcome of advance staged oral cavity cancer: concurrent chemoradiotherapy compared with primary surgery.

Concurrent chemoradiotherapy (CCRT) has been reported as effective and has become an acceptable treatment in advanced oral cancer. However, to date there is insufficient data to conclude that CCRT provides a good survival outcome. The purpose of this study was to compare survival rates and complications in patients with resectable advanced oral cavity squamous cell carcinoma treated with either CCRT or surgery with adjuvant radiotherapy (RT)/chemoradiotherapy (CRT). Stage III or IVa oral cavity carcinoma patients treated with curative intent by either CCRT or surgery with adjuvant RT were identified over a 7-year period (2009-2015). Survival rates and treatment complications were analyzed and compared between the two groups. 61 patients underwent CCRT and 128 patients underwent surgical excision and received postoperative RT. There was no statistically significant difference in survival outcome between the two treatment groups. 5-year overall survival rates (OS) were 33 versus 24% (P = 0.191) and the disease-specific survival rates (DSS) were 27 versus 25% (P = 0.857) when comparing the CCRT group and surgery with adjuvant RT/CRT group, respectively. Long-term complications were comparable between the two groups. CCRT has comparable survival outcome and complications for the treatment of advanced oral cavity squamous cell carcinoma, compared to surgery with adjuvant RT/CRT.

Does oxymetazoline increase the efficacy of nasal steroids in treating nasal polyposis?

BACKGROUND: Although nasal steroids are the mainstay treatments in nasal polyposis, up to one-half of patients do not respond and need surgical treatment. This study aimed to evaluate whether oxymetazoline administration produces any additive effect on nasal steroid therapy and whether rebound congestion develops after oxymetazoline treatment. METHODS: Sixty-eight patients with nasal polyposis were randomly assigned in a 1:1 ratio to receive either oxymetazoline plus mometasone furoate nasal spray (MFNS) or placebo plus MFNS, 2 sprays per nostril twice daily, with an interval of 5 minutes between each medication for 4 weeks. All the patients were then treated with MFNS, 2 sprays per nostril twice daily for 2 weeks. The nasal symptoms score, peak inspiratory flow index, nasal mucociliary clearance time (NMCCT), and total nasal polyps score were used to evaluate treatment outcomes. An intention-to-treat analysis was performed, and a worst case sensitivity analysis was applied to missing cases. RESULTS: Thirty-four patients were allocated to the oxymetazoline-MFNS group, and 34 to the placebo-MFNS group. One patient in each group was lost to last-visit follow-up. At 4 weeks after beginning treatment, the oxymetazoline-MFNS group showed significantly greater improvement in blocked nose, hyposmia, peak flow, NMCCT, and total nasal polyps score than the placebo-MFNS group. During the nasal steroid phase, both groups showed continuing improvement in all outcome variables. However, the oxymetazoline-MFNS group still showed significantly greater improvement in blocked nose, hyposmia, NMCCT, and total nasal polyps score, but not peak flow, than the placebo-MFNS group at the end of the study. CONCLUSION: The use of nasal steroids with oxymetazoline was more effective over 6 weeks than nasal steroids alone in improving blocked nose, hyposmia, nasal mucociliary clearance, and polyp size in treatment of nasal polyposis. There was no evidence of rebound congestion after 4 weeks of oxymetazoline treatment.

Does oral prednisolone increase the efficacy of subsequent nasal steroids in treating nasal polyposis?

BACKGROUND: Although combined oral and nasal steroid therapy is widely used in nasal polyposis, a subset of patients show an unfavorable therapeutic outcome. This study aimed to evaluate whether oral prednisolone produces any additive effects on subsequent nasal steroid therapy and to evaluate if any clinical variables can predict therapeutic outcome. METHODS: Using a 3:2 randomization ratio, 67 patients with nasal polyposis received 50 mg of prednisolone and 47 patients received placebo daily for 2 weeks, followed by mometasone furoate nasal spray (MFNS) at 200 micrograms twice daily for 10 weeks. Clinical response was evaluated by nasal symptom score (NSS), peak expiratory flow index (PEFI), and total nasal polyps score (TNPS). Potential predictor variables were assessed by clinical history, nasal endoscopy, allergy skin test, and sinus radiography. RESULTS: At the end of the 2-week oral steroid phase, the prednisolone group showed significantly greater improvements in all nasal symptoms, nasal airflow, and polyp size than the placebo group. In the nasal steroid phase, while the MFNS maintained the outcome improvements in the prednisolone group, all outcome variables in the placebo group showed continuing improvements. At the end of the nasal steroid phase, there were no significant differences of most outcome improvements between the two groups, except in hyposmia, PEFI, and TNPS (p = 0.049, p = 0.029, and p = 0.005, respectively). In the prednisolone group, patients with polyps grade 3 and endoscopic signs of meatal discharge showed significantly less improvement in total NSS, PEFI, and TNPS than patients with grade 1-2 size and negative metal discharge. CONCLUSION: In the 12-week treatment evaluation of nasal polyposis, pretreatment with oral steroids had no significant advantage for most nasal symptoms other than earlier relief; however, combined oral and nasal steroid therapy more effectively improved hyposmia, polyps size, and nasal airflow. Polyps size grade 3 and/or endoscopic signs of meatal discharge predisposed to a poorer treatment outcome.

Clinical efficacy of a short course of systemic steroids in nasal polyposis.

BACKGROUND: Although oral steroids are widely used for the treatment of nasal polyposis, a subset of patients shows an unfavorable therapeutic outcome. The aim of this study was to evaluate the efficacy of a short course of oral prednisolone in nasal polyposis and to evaluate which, if any, clinical variables can predict treatment outcome in these patients. METHODOLOGY/PRINCIPAL: Using a 3:2 randomization ratio, 63 patients with nasal polyposis received 50 mg of prednisolone and 46 patients received placebo daily for 14 days. Clinical response was evaluated by total nasal symptoms score (TNSS), peak expiratory flow index (PEFI) and total nasal polyps score (TNPS). Potential predictor variables were assessed by clinical history, nasal endoscopy, allergy skin test and sinus radiography. RESULTS: The prednisolone-treated group showed significantly greater improvements in all nasal symptoms, nasal flow and polyp size than the placebo-treated group (p < 0.001, all). In the prednisolone-treated group, patients with grade 3 polyps and positive nasal endoscopy showed significantly less improvement in TNSS, PEFI and TNPS than patients with grades 1-2 size and with negative nasal endoscopy. CONCLUSIONS: A short course of oral steroids showed good clinical efficacy in the treatment of nasal polyposis, however, polyps size grade 3 and/or positive nasal endoscopy predispose to a poorer treatment outcome.

Impact of IgE-mediated hypersensitivity on nasal mucociliary clearance.

OBJECTIVE: To evaluate the effect of IgE-mediated hypersensitivity on mucociliary clearance time (MCCT) and clinical severity, as indicated by total nasal symptoms score (TNSS) and peak expiratory flow index (PEFI). DESIGN: A prospective cross-sectional study. SETTING: Tertiary medical center. PARTICIPANTS: One hundred twenty-nine patients with rhinitis and 48 healthy control subjects. MAIN OUTCOME MEASURES: Results of an allergy skin prick test in the patients with rhinitis categorized them as allergic (AR) or nonallergic (non-AR). We evaluated TNSS and PEFI in the patient group and assessed MCCTs from the patients in the rhinitis groups and the healthy controls. RESULTS: The AR group patients had the longest MCCT, followed by patients in the non-AR group and the healthy controls (mean MCCTs, 14.36, 10.87, and 6.55 minutes, respectively). The AR group patients had significantly higher TNSS and worse PEFI compared with patients in the non-AR group (P = .002 and P = .03, respectively). We found a significant positive correlation of MCCTs with TNSS, and MCCTs showed a tendency to be inversely correlated with PEFI (rho = 0.43 [P < .001] and r = -0.22 [P = .05], respectively). In AR group patients, the wheal responses to Dermatophagoides pteronyssinus, Dermatophagoides farinae, American cockroach, and Bermuda grass were fairly correlated with the MCCTs (r = 0.39 [P = .001], r = 0.40 [P = .001], r = 0.34 [P = .01], and r = 0.36 [P = .02], respectively). The maximal wheal response among various positive allergen responses was well correlated with the MCCTs (r = 0.54 [P < .001]). CONCLUSION: A prolonged MCCT, significant correlation between MCCTs and the magnitude of allergen reactivity, and clinical severity suggest an impact of IgE-mediated hypersensitivity on mucociliary clearance function.

Impact of pretreatment nasal symptoms on treatment outcome in allergic rhinitis.

OBJECTIVE: The Allergic Rhinitis and its Impact on Asthma (ARIA) classification of allergic rhinitis (AR) is based on the severity and duration of nasal symptoms. Whether nasal symptoms have an impact on treatment outcome is unclear. The aim of this study was to evaluate the correlation between pretreatment nasal symptoms and therapeutic response in AR. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Sixty-nine AR patients were classified according to ARIA class: mild or moderate-severe intermittent AR (MIAR or MSIAR) and mild or moderate-severe persistent AR (MPAR or MSPAR). All patients were treated over 28 days with 220 microg of intranasal triamcinolone acetonide once daily. Nasal symptoms, peak expiratory flow index, and global symptom control were used to evaluate treatment outcome. RESULTS: At 28 days after treatment, MSPAR patients showed the worst global symptom control, followed by MSIAR, MPAR, and MIAR (mean global symptom controls were 76.5%, 83.8%, 87.7%, and 89.0%, respectively). Pretreatment total nasal symptom score was inversely correlated with global symptom control (rho = -0.405, P < 0.001), but positively correlated with percent total nasal symptom score and peak expiratory flow index improvements (rho = 0.271, P = 0.024; and rho = 0.371, P = 0.002, respectively). Blocked nose had the best inverse correlation with global symptom control (rho = -0.389, P = 0.001). CONCLUSION: A worse treatment outcome despite more clinical improvements during the treatment period in a higher severity score suggests the therapeutic predictive value of pretreatment nasal symptom scoring and the need for more dosing and continuing medication in higher scores, especially in blocked nose.

Dose-related effect of intranasal corticosteroids on treatment outcome of persistent allergic rhinitis.

OBJECTIVES: To evaluate the efficacy of the self-adjustable dosing regimen and explore potential dose-response relationships of intranasal corticosteroids in persistent allergic rhinitis. STUDY DESIGN: Prospective cohort study. SUBJECTS AND METHODS: Sixty-nine persistent allergic rhinitis patients were treated with 220 mcg of intranasal triamcinolone acetonide for 28 days. Patients with mild, intermittent symptoms were instructed to use the medication only after symptoms occurred once a day. Patients with symptoms that lasted more than 1 day and/or interrupted daily activities/sleep were instructed to continue the morning daily dose until they were symptom-free for 24 hours before stopping usage. RESULTS: All nasal symptom scores and peak expiratory flow index (PEFI) showed statistically significant improvements after treatment. At 28 days after treatment, the number of puffs and weight of steroids used were positively correlated with percentages of improvement in total symptoms score (TSS) and PEFI (rho = 0.529, r = 0.571 and rho = 0.350, r = 0.509 respectively). When at least 1400 mcg or 44 puffs were used, 60% TSS and 10% PEFI improvement were achieved. CONCLUSION: A self-adjustable dosing approach proved to be an efficacious approach to controlling allergic rhinitis.

Effect of genetic background on the response to bacterial sinusitis in mice.

OBJECTIVE: To study the importance of ongoing allergen exposure and TH1/TH2 genetic background in augmented bacterial and inflammatory responses in allergic and infected mice. DESIGN: BALB/c and C57BL/6 mice were made allergic to ovalbumin. After 1 day of intranasal allergen exposure, they were inoculated intranasally with Streptococcus pneumoniae. The numbers of bacteria and inflammatory cells in the sinuses were determined, and nasal responsiveness to histamine was assessed. RESULTS: Infected BALB/c and C57BL/6 mice that received ongoing ovalbumin challenge following intraperitoneal sensitization showed significantly greater bacterial load and phagocyte level compared with the infected-only mice. Differences were diminished after the allergen challenge was stopped. Allergic and infected C57BL/6 mice showed fewer bacteria and phagocytes compared with the allergic and infected BALB/c mice. Surprisingly, in contrast to the nonallergenic C57BL/6 mice, the infected BALB/c mice showed a larger number of bacteria 28 days after infection. CONCLUSIONS: Ongoing allergic reaction augments bacterial load in both BALB/c and C57BL/6 mice and induces nasal hyperreactivity to histamine. Allergic and infected C57BL/6 mice show less allergic inflammation and bacterial load compared with allergic and infected BALB/c mice. Stopping allergen exposure reduces the response. Infected BALB/c mice, which favor a TH2 response, were less able to clear infection than C57BL/6 mice, which favor a TH1 response. Inflammation and bacterial load are affected by genetic background of mice and ongoing allergen stimulation.

Nasal polyposis: role of allergy on therapeutic response of eosinophil- and noneosinophil-dominated inflammation.

BACKGROUND: It is considered that allergy, at least in some cases, is associated with nasal polyps and affects recurrence rate. Our purpose was to determine the effects of aeroallergen hypersensitization on therapeutic response of eosinophil- and noneosinophil-dominated inflammation. METHODS: Sixty-eight patients were enrolled. Histopathological investigation and a skin-prick test were done and categorized as eosinophil-dominated inflammation with positive (ESPT+) or negative skin test (ESPT-) and nonesoinophil-dominated inflammation with positive (NESPT+) or negative skin test (NESPT-). Patients were treated over 6 weeks with budesonide nasal spray, 400 microg/day. At 0, 3, and 6 weeks after treatment, nasal symptoms, polyp size, nasal and oral peak expiratory flow (PEF) index and overall assessment within and between groups were evaluated and compared. RESULTS: At 3 and 6 weeks after treatment, the ESPT- group showed the most, and the NESPT+ group showed the least therapeutic improvement. In comparing between the positive and negative skin tests in each histopathology, the positive skin tests tended to have less improvement than the negative skin tests in all variables. The differences increased over time and reached statistical significance at 6 weeks in the PEF index and overall assessment of eosinophil-dominated inflammation (p = 0.004 and 0.033, respectively) and in sneezing score, postnasal drip score, and overall assessment of noneosinophil-dominated inflammation (p = 0.019, 0.035, and 0.013, respectively). CONCLUSION: Nonallergic eosinophilic polyps had the best and allergic noneosinophilic polyps had the worst therapeutic response. Within each histopathology, allergic nasal polyps had less therapeutic response than nonallergic nasal polyps. This augmented effect could be caused by concomitant allergic inflammation.

Evaluation of importance of Toll-like receptor 4 in acute Streptococcus pneumoniae sinusitis in mice.

OBJECTIVES: To investigate the effect of RC-527, a synthetic toll-like receptor 4 (TLR4) agonist, on stimulating the immune response before acute Streptococcus pneumoniae sinusitis in a mouse model, and to determine the importance of TLR4 in modulating the response to S. pneumoniae. Toll-like receptor 4 agonists have been shown to induce protective innate immune responses when administered before some bacterial or viral challenges in mice. DESIGN: We intranasally inoculated BALB/c, TLR4 complex-deficient C3H/HeJ, and wild-type C3H/HeOuJ mice with S. pneumoniae 24 hours after treatment with 10 or 1 microg of RC-527 or vehicle. Bacterial counts from nasal lavage culture and the cell markers GR1, CD11b, CD3, CD4, and CD8 in sinus tissue were quantified at postinoculation days 2, 5, and 14. MAIN OUTCOME MEASURE: Immune response induced by RC-527. RESULTS: Treatment with RC-527 induced an immune response through TLR4, as demonstrated by recruitment of phagocytes in uninfected wild-type C3H/HeOuJ mice, but not in TLR4 complex-deficient C3H/HeJ mice. The immune response was also demonstrated by a significant increase of CD3+, CD4+, and CD8+ T cells in infected and uninfected wild-type C3H/HeOuJ mice, but not in TLR4 complex-deficient C3H/HeJ mice. However, the enhancement of the immune response induced by the TLR4 agonist showed a limited effect on bacterial clearance. CONCLUSIONS: Our studies in mice suggest that stimulation of TLR4 plays a minor role in the overall response to S. pneumoniae infection of the upper airway, and stimulating this receptor before infection does not significantly enhance the immune response of immunocompetent mice to clear S. pneumoniae infection.

Acute bacterial rhinosinusitis causes hyperresponsiveness to histamine challenge in mice.

OBJECTIVES: To develop a physiologic test of nasal responsiveness in mice and to evaluate whether mice with acute bacterial sinusitis develop nasal hyperresponsiveness. DESIGN: Several experimental studies will be described. The first was a titration pilot study. The second was a randomized, placebo-controlled study. The remainder were before-and-after trials. SPECIES: BALB/c or C57BL/6 mice. INTERVENTIONS: For these experiments, we exposed mice to histamine intranasally, then counted the number of sneezes and nose rubs as the primary outcome measure of nasal responsiveness. First, we constructed a dose-response curve. Second, we treated the mice with desloratadine, a histamine 1 receptor antagonist, prior to histamine exposure. Third, we challenged, with intranasal histamine, mice made allergic using 2 techniques. Fourth, we infected mice with Streptococcus pneumoniae to determine whether acute sinusitis causes nasal hyperresponsiveness to histamine exposure. RESULTS: Nasal histamine challenge led to a reproducible, dose-dependent increase in sneezing and nose rubs. The response to histamine exposure was blocked by desloratadine (P < or = .05). Allergic mice had a significant increase in responsiveness (P < or = .05) over baseline after exposure to antigen. Mice with acute sinusitis had a sustained increase in responsiveness, although less severe than after allergy, compared with baseline values that lasted 12 days after infection (P < or = .05). CONCLUSIONS: Nasal challenge with histamine is a physiologic test of nasal responsiveness. The hyperresponsiveness of allergic mice to histamine exposure parallels the response to nonspecific stimuli during the human allergic reaction. In addition, we showed that acute bacterial sinusitis causes nasal hyperresponsiveness in mice.

Update on nasal polyps: etiopathogenesis.

PURPOSE OF REVIEW: Nasal polyps is a common ENT disease with high medical failure and recurrence rate, reflecting unknown pathogenesis. The present review is an update on the etiopathogenesis of nasal polyps. RECENT FINDING: Several mechanisms have been proposed for the formation of nasal polyps, including allergy, mucosal allergy, autonomic imbalance, nitric oxide, superantigens, infection, abnormal transepithelial ion transport, mucopolysaccharide abnormality, mechanical obstruction and epithelial rupture. Eosinophils comprises more than 60% of the cell population. Activated T cells, mast cells and plasma cells are also increased compared with the normal nasal mucosa. The stroma has numerous mediators, including cytokines, growth factors, adhesion molecules, and immunoglobulins. Both Th1 and Th2 types of cytokines are upregulated independent of the atopic status. An increased production of GM-CSF, IL5, RANTES and eotaxin can contribute to chronic eosinophilic inflammation by regulating the migration, survival and activation of eosinophils. CONCLUSION: Nasal polyps is a multifactorial disease, with infectious, noninfectious, inflammation, anatomic and genetic abnormalities. Chronic inflammation remains the central major factor in nasal polyps.

A comparison between endoscopically middle meatal aspiration culture using modified aspiration instrument and direct maxillary antral tap culture in chronic rhinosinusitis.

OBJECTIVES: To evaluate the accuracy of endoscopically guided middle meatal aspiration culture by comparing the culture results between middle meatal aspiration using the modified aspiration instrument and direct maxillary antral tap. MATERIAL AND METHOD: Sixteen patients with chronic rhinosinusitis underwent functional endoscopic sinus surgery (FESS) were enrolled. Both endoscopically middle meatal aspiration culture (EMAC) using modified aspiration instrument and direct antral tap culture (ATC) were performed before FESS. Microbiologic data were compared and analyzed for any statistical differences between EMAC and ATC. RESULTS: The positive culture rates were 93.75% in both EMAC and ATC groups. Aerobic and facultative anaerobic bacteria were found in 87.5% of EMAC group and 81.25% of ATC group. The two most common bacteria in both groups were coagulase-negative Staphylococcus and Staphylococcus aureus. The association between EMAC and ATC was strong to moderate (13/16) 81.25%. CONCLUSION: EMAC appears to be a valuable alternative to ATC for guiding bacterial-specific therapy in chronic rhinosinusitis. This modified aspiration instrument should be useful in clinical practice and serve as a cost effective procedure.

Nasal polyps: the relationship to allergy, sinonasal infection and histopathological type.

OBJECTIVE: To evaluate the relationship of nasal polyps to allergy, sinonasal infection and histopathological type by examining the prevalences of these factors among nasal polyps patients. STUDY DESIGN: Prospective descriptive study. MATERIAL AND METHOD: A total of 73 patients were enrolled between October 1st, 1999 and August 31st, 2002 at the Allergy and Rhinology Clinic, Faculty of Medicine, Songklanagarind Hospital. The medical history was recorded. Allergy skin prick test, nasal endoscopy with biopsy and plain film paranasal sinus were performed. Positive allergy skin test was defined by at least 1 aeroallergen with a wheal size > or = 3 mm greater than the negative control. Rhinosinusitis was diagnosed by clinical symptoms, positive nasal endoscopy and/or positive plain film paranasal sinus. Histopathological investigation was classified as eosinophil- or neutrophil-dominated inflammation. RESULTS: 68.5 per cent of patients with nasal polyps had a positive allergy skin test, 67.1 per cent had rhinosinusitis. Eosinophil-dominated inflammation was presented in 69.9 per cent and neutrophil-dominated inflammation in 30.1 per cent, respectively. Within each histopathological type, 62.7 per cent of patients with eosinophil-dominated inflammation and 81.8 per cent of patients with neutrophil-dominated inflammation had a positive allergy skin test. There was no statistically significant difference in prevalence of positive allergy skin test between eosinophil- and neutrophil-dominated inflammations (p = 0.107). 60.8 per cent of patients with eosinophil-dominated inflammation and 81.8 per cent of patients with neutrophil-dominated inflammation had rhinosinusitis. There was no statistically significant difference in prevalence of rhinosinusitis between eosinophil- and neutrophil-dominated inflammations (p = 0.079). CONCLUSION: Nasal polyps had association with positive allergy skin test (68.5%), rhinosinusitis (67.1%) and eosinophil-dominated inflammation (69.9%). There were no statistically significant differences in prevalence of positive allergy skin test and rhinosinusitis between eosinophil- and neutrophil-dominated inflammations (p = 0.107 and p = 0.079, respectively).