Nasal response to stress test in healthy subjects: an experimental pilot study.

PURPOSE: Stress has been suspected to play a role in rhinitis. The role of stress on nasal patency has been not yet elucidated. The aim was to evaluate the potential effects of stress on nasal patency in healthy subjects. METHODS: We conducted a prospective pilot study including 12 healthy subjects. Experimental protocol was divided in three periods (pre-task, task and recovery). In the task period, subjects were exposed to the "Trier Social Stress Test" (TSST), a standardized laboratory stressor. Different parameters including Spielberger State Anxiety Inventory (SSAI) score, visual analogic scale (VAS) of nasal patency feeling, heart rate, acoustic rhinometry measurements have been compared between the three different periods. The study population was divided into two groups according to the Spielberger Trait Anxiety Inventory (STAI) score: A "non anxious" group and a "weakly anxious" group. RESULTS: Seven subjects were in the "non anxious" group and five in the "weakly anxious" group. TSST significantly increased heart rate in all volunteers. SSAI score was significantly increased (p = 0.04) after the task period (36.6 ± 11.3) when compared to the SSAI score in pre-task period (31.9 ± 12.6). VAS score of nasal patency feeling significantly decreased from pre-task to task and recovery periods. Mean minimal cross-sectional areas and mean volumes of the nasal cavities were not significantly different between the three periods, except in "weakly anxious" group, but the small number of subjects does not allow to draw a definite conclusion. CONCLUSION: We observed that stress influenced the feeling of nasal patency in healthy subjects. However, the objective effects of stress on nasal geometry were globally non-significant except in "weakly anxious" group. This latter result of our pilot study needs to be confirmed in a larger cohort.

[Invasive fungal rhinosinusitis in an apparently immunocompetant patient]. / Une rhinosinusite fongique invasive chez un patient immunocompétent.

The incidence of invasive fungal rhinosinusitis is constantly increasing, due to the growing number of immunocompromised patients. We report the case of a 73-year-old patient with a severe aortic stenosis whose preoperative evaluation revealed a recurrence of a left maxillary sinusitis operated many years ago. The patient underwent meatotomy and drainage. Pathologic examination of the sinus mucosa revealed the presence of septate and branched fungal hyphae invading the blood vessels. The diagnosis of invasive aspergillosis was thus established and the patient was treated by oral voriconazole. Our report describes the case of an invasive chronic form of a fungal rhinosinusitis occurring in an immunocompromised patient, and exposes the different forms of invasive fungal rhinosinusitis. The diagnosis of an invasive form of fungal rhinusinusitis should be suspected in immunocompromised patients in particular, but also in immunocompetent patients. The appropriate treatment should be promptly set up, given the bad prognosis of acute and fulminant cases.

Follow-Up and Management of Chronic Rhinosinusitis in Adults with Primary Ciliary Dyskinesia: Review and Experience of Our Reference Centers.

Chronic rhinosinusitis is the foremost manifestation in adult patients with primary ciliary dyskinesia (PCD). We present a retrospective series of 41 adult patients with a confirmed diagnosis of PCD followed in our reference centers. As part of the diagnostic work up in our centers, sinus computed tomography scans (CTs) are systematically performed. All patients also undergo a sampling of purulent secretions sampled from the middle meatus under endoscopic view for bacteriological analysis. In our series, CT opacities were consistent in all the patients, as well as mainly partial and located in ethmoid cells (100% of patients) and in maxillary sinuses (85.4% of patients), and stayed stable over time. In the 31 patients who had purulent secretions, bacteriological culture showed at least one bacterium in 83.9% (n = 26). There was no significant difference in positive cultures for Pseudomonas aeruginosa in patients >40 years old versus those <40 (p = 0.17; Fisher). Surgical management was performed in only 19% of patients in order to improve sinonasal mechanical drainage. Our data support the hypothesis that the sinuses can be considered as a bacterial reservoir. From this retrospective study, we have introduced several changes into our routine clinical practice in our reference centers. Based on our analyses, medical and surgical treatments benefit from incorporating bacteriological information and sinonasal symptoms much more than CT scan evaluation alone. All patients now undergo systematically an annual simultaneous bacteriological sampling of the middle meatus and sputum to follow the relationship between ENT and lung disease and to help to antibiotic therapy strategy.

Critical Evaluation of Sinonasal Disease in 64 Adults with Primary Ciliary Dyskinesia.

To date, no study precisely described ear, nose and throat (ENT) disease in adults with primary ciliary dyskinesia (PCD) and its relationship with ciliary function/ultrastructure. A retrospective study of standardized ENT data (exam, audiogram, sinus Computed tomography (CT), and bacteriology) was conducted in 64 adults with confirmed PCD who were followed in two ENT reference centers. Rhinorrhoea and hearing loss were the main symptoms. Symptom scores were higher in older patients. Nasal endoscopy was abnormal in all patients except one, showing nasal polyps in one-third of the patients and stagnant nasal mucus secretions in 87.5% of the patients. Sinus CT opacities were mainly incomplete and showed one-third of the patients with sinus hypoplasia and/or agenesis. Middle meatus mainly grew Haemophilus influenzae, Streptoccocus pneumoniae and Pseudomonas aeruginosa. Otitis media with effusion (OME), which is constant in childhood, was diagnosed in less than one-quarter of the patients. In two-thirds of the patients, audiogram showed hearing loss that was sensorineural in half of the patients. ENT disease severity was not correlated with ciliary function and ultrastructure, but the presence of OME was significantly associated with a forced expiratory volume (FEV1) < 70%. Rhinosinusitis is the most common clinical feature of PCD in adults, while OME is less frequent. The presence of active OME in adults with PCD could be a severity marker of lung function and lead to closer monitoring.

Investigating hyperventilation syndrome in patients suffering from empty nose syndrome.

OBJECTIVES/HYPOTHESIS: Patients with empty nose syndrome (ENS) following turbinate surgery often complain about breathing difficulties. We set out to determine if dyspnea in patients with ENS was associated with hyperventilation syndrome (HVS). We hypothesized that lower airway symptoms in ENS could be explained by HVS. STUDY DESIGN: Observational prospective study. METHODS: All consecutive patients referred to our center for ENS over 1 year were invited to participate. Patients completed the Nijmegen score and underwent a hyperventilation provocation test (HVPT) and arterial blood gas and cardiopulmonary tests. HVS was defined by a delayed return of the end-tidal partial pressure of carbon dioxide in the expired gas to baseline during HVPT. Patients with HVS were asked to complete the Sinonasal Outcome Test (SNOT)-16 questionnaire before and after a specific eight-session respiratory rehabilitation program. RESULTS: Twenty-two of the 29 patients referred for ENS during the study period were eligible for inclusion and underwent a complete workup. HVS was diagnosed in 17 of these patients (77.3%). In the five patients who completed the SNOT-16, the score was significantly lower after rehabilitation. CONCLUSIONS: This study suggests that HVS is frequent in patients with ENS, and that symptoms can be improved by respiratory rehabilitation. Pathophysiological links between ENS and HVS deserve to be further explored. LEVEL OF EVIDENCE: 2b Laryngoscope, 127:1983-1988, 2017.

A functional tool to differentiate nasal valve collapse from other causes of nasal obstruction: the FRIED test.

Nasal valve collapse is a dynamic abnormality that is currently diagnosed purely on the basis of clinical features and thus subject to certain interpretation. The aim of this study was to develop a new and reliable functional test to objectively characterize nasal valve collapse. This was an observational prospective study including consecutive patients referred to our center for exploration of chronic nasal congestion. The patients were classified into two groups according to their symptoms and clinical abnormalities: the nasal valve collapse (NV+) group when nasal valve collapse was clinically detected during moderate forced inspiration and/or when the feeling of nasal congestion improved during passive nasal lateral cartilage abduction (n = 32); and the no-nasal valve collapse (NV-) group for the others (n = 23). All patients underwent nasal functional tests (posterior rhinomanometry and acoustic rhinometry) before and after topical nasal decongestion. We compared the difference between the pressure flow of the inspiratory and expiratory phases during posterior rhinomanometry [flow rate inspiratory-expiratory difference (FRIED) test] between the two groups. The difference between the absolute value of inspiratory and expiratory flow was significantly higher in the NV+ group than in the NV- group both before and after topical decongestion. The cutoff value for the FRIED test was -0.008 l/s with a good sensitivity (82%) and a specificity of 59%. We suggest that the FRIED test constitutes an objective and easy-to-apply technique to diagnose nasal valve collapse in daily practice.

An uncommon cause of allergic fungal sinusitis: Rhizopus oryzae.

We report what we believe is the first case of allergic fungal rhinosinusitis (AFRS) caused by the fungus Rhizopus oryzae. Our patient was a 32-year-old woman who presented with unilateral nasal polyps and chronic nasal dysfunction. Computed tomography of the sinuses detected left-sided pansinusitis and bone erosion. T2-weighted magnetic resonance imaging demonstrated a signal void that suggested the presence of a fungal infection. The patient underwent unilateral ethmoidectomy. Histologic examination of the diseased tissue identified allergic mucin with 70% eosinophils and no fungal hyphae. Mycologic culture detected R oryzae. After a short period of improvement, the patient experienced a recurrence, which was confirmed by radiology. A second surgery was performed, and the same fungal hyphae were found in the mucus and on culture, which led us to suspect AFRS. Since no IgE test for R oryzae was available, we developed a specific immunologic assay that confirmed the presence of specific IgG, which identified a high degree of immunologic reaction against our homemade R oryzae antigens. With a long course of systemic antifungal treatment, the patient's symptoms resolved and no recurrence was noted at 5 years of follow-up.

Polypectomy compared with ethmoidectomy in the treatment of nasal polyposis.

OBJECTIVE: To compare the 3-year results of 2 endoscopic surgical approaches in the management of nasal polyposis. DESIGN: Retrospective medical record review. SETTING: Private or institutional practice. PATIENTS: A total of 127 patients with nasal polyposis were operated on by the same surgeon between January 1, 2003, and September 31, 2005. INTERVENTION: The patients underwent radical ethmoidectomy (n = 77) and polypectomy (n = 50). MAIN OUTCOME MEASURES: Outcome measures were global functional score, calculated by summing the scores (0-3) of each symptom (congestion, rhinorrhea, anosmia, hyperreactivity, and pain); global anatomical score (GAS), calculated by summing the score of polyp development for each nasal cavity; computed tomography score; adherence to corticosteroid therapy; oral corticosteroid consumption; and complication and subsequent operation rate. Efficacy was evaluated by comparing these data preoperatively and postoperatively (at 3 months, 1 year, and 3 years). RESULTS: The global functional score and GAS were significantly improved 3 years after these techniques were performed (global functional score changes from 8.65 to 3.11 for ethmoidectomy and from 8.15 to 4.2 for polypectomy; GAS, from 5.95 to 1.83 for ethmoidectomy and from 6.57 to 3.58 for polypectomy). Congestion, pain, and GAS were improved to a significantly greater extent in the ethmoidectomy group. The subsequent operation rate for symptomatic polyp recurrence was comparable (9.1% vs 8.0%), with fewer local complications in the polypectomy group. CONCLUSION: Polypectomy seems to represent a valuable alternative in the armamentarium of first-hand surgical procedures for treating nasal polyposis.