Short-term efficacy of anti-IgE monoclonal antibody in patients with recurrent chronic rhinosinusitis with nasal polyps combined with asthma / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the short-term efficacy of anti-IgE monoclonal antibody (Omalizumab) in the treatment of recurrent chronic rhinosinusitis with nasal polyps (CRSwNP) complicated with asthma. Methods: Patients with recurrent CRSwNP and comorbid asthma in Beijing TongRen Hospital from May to December of 2020 were continuously recruited and received a 4-month therapy of stable background treatment plus Omalizumab. Results of visual analog scales (VAS) of nasal symptoms, sino-nasal outcome test-22 (SNOT 22) and nasal polyp scores were collected at baseline and post-treatment (1, 2, 3 and 4 months after treatment). Blood routine tests, total nasal resistances (TNR), minimum cross-sectional areas (MCA), total nasal cavity volumes (NCV), forced expiratory volumes in one second (FEV1)/forced vital capacity (FVC) and adverse events were collected at baseline and 4 months after treatment. All results were evaluated for short-term efficacy of Omalizumab. GraphPad Prism 8.2.1 was used for statistic analysis. Results: Ten patients were collected, including 3 males and 7 females, aged (41.13±12.64) years old (x¯±s). Compared to results at baseline, the VAS scores of nasal obstruction, rhinorrhea, hyposmia and headache after 4 months treatment were significantly decreased (1.80±1.48 vs 6.70±2.83, 2.40±1.27 vs 6.40±3.44, 2.70±2.91 vs 8.20±2.25, 0.60±1.08 vs 3.60±2.72, t value was 5.045, 4.243, 5.312, 3.402, respectively, all P<0.01). The scores of SNOT-22 (25.6±20 vs 61.3±33.32, t=4.127, P=0.002 6), nasal polyp scores (2.20±0.92 vs 4.60±0.84, t=9.000, P<0.01) and the count and percentage of eosinophils in peripheral blood were significantly decreased ((94.10±97.78)×109/L vs (360.00±210.80)×109/L, (32.90±27.06)% vs (64.40±20.73)%, t value was 3.678, 2.957, respectively, all P<0.05). NCV (0-5 cm and 0-7 cm) of patients were improved from baseline ((12.62±2.84) cm3 vs (10.40±2.09) cm3, (27.50±14.15) cm3 vs (16.81±6.40) cm3, t value was 2.371, 2.445, respectively, all P<0.05). Conclusions: The 4-month treatment of Omalizumab can significantly improve the nasal symptoms and quality of life of patients with recurrent CRSwNP complicated with asthma, shrink nasal polyps size and reduce the number of peripheral blood eosinophils. Omalizumab can be used as an alternative therapy for refractory CRSwNP patients in the future.

Suppression of Immunotherapy on Group 2 Innate Lymphoid Cells in Allergic Rhinitis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Group 2 innate lymphoid cells (ILC2s) are regarded as a novel population of lineage-negative cells that induce innate Type 2 responses by producing the critical Th2-type cytokines interleukin (IL)-5 and IL-13. ILC2s as key players in the development of allergic rhinitis (AR) have been proved, however, the effect of subcutaneous immunotherapy (SCIT) with dermatophagoides pteronyssinus extract (Der p-SCIT) on ILC2s in AR patients is not clear. This study aimed to investigate the response of ILC2s of peripheral blood in house dust mites (HDM)-sensitized Chinese patients with AR who received SCIT with Der P extract.</p><p><b>METHODS</b>Seven healthy controls without symptoms of AR who had negative reactions to any of the allergens from skin-prick testing, nine patients diagnosed with persistent AR according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, and 24 AR patients who received Der p-SCIT for 1.0-3.5 years were recruited for the study. ILC2s in the peripheral blood were evaluated using flow cytometry. The severity of their symptoms of all participants was rated based on the Total 5 symptom score.</p><p><b>RESULTS</b>Among 40 participants, 9 AR patients were assigned to the untreated group, 24 AR patients receiving Der p-SCIT were assigned to the immunotherapy group, and 7 healthy controls without symptoms of AR were assigned to healthy control group. The mean Total 5 symptom score of immunotherapy group was significantly lower than that of untreated group (4.3 ± 1.4 vs. 10.1 ± 2.5, P< 0.001). Similarly, the levels of ILC2s in the peripheral blood of immunotherapy group were significantly reduced compared with that in untreated group (P < 0.001), but were not significantly different from healthy controls (P = 0.775). Further subgroup analysis based on the duration of SCIT therapy (1.0-2.0 years [SCIT1-2], 2.0-3.0 years [SCIT2-3], and 3.0-3.5 years [SCIT3-3.5]) showed that the percentage of ILC2s was not significantly different between SCIT1-2, SCIT2-3, and SCIT3-3.5groups (SCIT1-2 vs. SCIT2-3: P = 0.268; SCIT1-2vs. SCIT3-3.5: P = 0.635; and SCIT2-3 vs. SCIT3-3.5: P = 0.787).</p><p><b>CONCLUSIONS</b>The present study highlighted the suppression of Der p-SCIT on ILC2s in HDM-AR patients. ILC2s identified in peripheral blood can be used as an effective biomarker for Der p-SCIT.</p>

Removal of Schwannoma in the pterygopalatine and infratemporal fossa via endoscopic prelacrimal recess approach / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To sum up and analyze the results of surgical removal of Schwannoma in the pterygopalatine and infratemporal fossa (PPF and ITF) through postero-lateral wall via prelacrimal recess approach (PLRA). The surgical technique and indications were presented and discussed.</p><p><b>METHODS</b>Six patients aged from 29-59 year-old with Schwannoma in the PPF and ITF, who received the tumor resection via PLRA under endoscope, were enrolled in this paper. Three were female and 3 were male. All of them received preoperative CT and MRI. The PPF and ITF were approached via prelacrimal recess endoscopically under general anesthesia. Schwannoma was histopathologically confirmed after surgery. The postoperative periodical CT and MRI follow up was conducted.</p><p><b>RESULTS</b>The tumors were removed completely in these 6 patients. No recurrence was found during 19.3 months follow up on the average. Three patients had obvious numbness in the V2 innervation area 1 or 2 weeks after operation and disappeared afterwards. Only 1 patient had mild altercation numbness at the end of follow up.</p><p><b>CONCLUSIONS</b>Schwannoma involved PPF and ITF can be removed endoscopically via PLRA. The lateral wall of nasal cavity might be kept intact. It is a novel minimally transnasal invasive approach to PPF and ITF with less damage and complications.</p>

CT and MRI diagnosis of lesions in unilateral maxillary sinus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the CT and MRI findings of lesions in unilateral maxillary sinus, and to compare the effect of CT and MRI in the differential diagnosis of lesions in unilateral maxillary sinus.</p><p><b>METHODS</b>Retrospective analysis of CT and contract-enhanced MRI imaging data from 34 patients with lesions in unilateral maxillary sinus which were diagnosed by endoscopic sinus surgery and postoperative pathology. The CT and contract-enhanced MRI's value in the differential diagnosis in lesions in unilateral maxillary sinus was analysed.</p><p><b>RESULTS</b>All 34 patients had unilateral maxillary sinus lesions. On CT: soft tissue density shadow in the unilateral maxillary sinus was found in all 34 cases. Five cases showed spot high density with thickening bone in the maxillary sinus wall. Eleven cases showed expansion of the opening of maxillary sinuses. Two cases showed broken lateral wall of nasal cavity . One case showed soft tissue density shadow in the maxillary sinus with curve edge with high density shadow which had a tooth shadow in it. Other 14 cases showed only soft density shadow in the maxillary sinuses. On MRI: all 34 cases revealed lower signals on T1WI compared to gray matter. Little loss signal were found in the inner of the maxillary sinus fungal balls on T1WI. Enhanced MR imaging showed no enhanced in nasal sinusitis, sinus cysts and polyp of posterior naris. In homogenous enhancing and "the cerebral convolution sign" were found in the hemorrhagic and necrotic nasal polyp, the nasal inverted papilloma and the malignant tumor cases. Higher signals were seen in the nasal sinusitis, fungal balls and the polyp of posterior naris cases on T2WI. In homogenous signal with different levels were found in the hemorrhagic and necrotic nasal polyp, the nasal inverted papilloma and the malignant tumor cases on T2WI.</p><p><b>CONCLUSIONS</b>CT and MRI examination are important in the diagnosis of the unilateral maxillary sinus lesions. Both CT and MRI had more differential diagnostic value in the unilateral maxillary sinus lesions than only CT used.</p>

Intranasal endoscopic prelacrimal recess approach to maxillary sinus / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The inferior turbinate (IT) and nasolacrimal duct (NLD) are often sacrificed while managing the diffuse lesion of maxillary sinus (MS). We report a new approach to MS without ablation of NLD and IT.</p><p><b>METHODS</b>This retrospective study enrolled 19 hospitalized patients (aged from 42 to 68 years) who underwent endoscopic sinus surgery between 2003 and 2008. Twelve patients had inverted papilloma (IP), two had nasal polyps, two had Kubo's postoperative cyst of MS, one had recurrent bone cyst of maxilla, one had dentigerous cyst and one had bleeding of internal maxillary artery secondary to Caldwell-Luc operation respectively. Two IP patients were excluded from this group since the follow-up time was less than 12 months. The NLD was dissected after removing the anterior bony portion of nasal lateral wall. The prelacrimal recess approach (PLRA) to MS was established when IT-NLD flap was raised medially. The flap was repositioned when MS lesion was removed.</p><p><b>RESULTS</b>All the 17 patients had unilateral lesions. Ten MS IP patients were at the T3 Krouse stage. The follow-up ranged from 7 to 60 months. No recurrence was seen in 16 patients. Only one IP patient had a local recurrence in MS. All of them had no any complications.</p><p><b>CONCLUSION</b>The diffuse or severe diseases of MS may be the potential indications for PLRA.</p>

Clinical implication of global osteitis score system and its role in evaluation of osteitis of chronic rhinosinusitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical application of Global Osteitis Score System (GOSS). To determine the association between GOSS, Lund-Mackay scores and Lund-Kennedy scores and to investigate the incidence of osteitis in patients with chronic rhinosinusitis (CRS).</p><p><b>METHODS</b>Three hundreds and thirty-four patients with CRS were enrolled prospectively in a large tertiary referral center. The paranasal sinus bone Hounsfield unit (HU), thickness, scope were measured by PHILIPS MxLiteView software. Nasal endoscopy Lund-Kennedy score was analyzed in all patients. Sinus CT scans of all patients were analyzed for Lund-Mackay score and for osteitis using the GOSS. Association between GOSS and Lund-Mackay, Lund-Kennedy was examined.</p><p><b>RESULTS</b>The incidence of osteitis in patients with chronic rhinosinusitis was from 33.83% to 53.89%. Average GOSS score of osteitis was 7.51 ± 7.27. The highest incidences of osteitis were in the maxillary and anterior ethmoid sinuses. The left anterior ethmoid sinuses was 37.2%. The right anterior ethmoid sinuses was 32.8%. The left maxillary sinuses was 46.1%. The right maxillary sinuses was 42.2%. Global osteitis score were significantly correlated with Lund-Mackay and Lund-Kennedy scores (r value were 0.497 and 0.409 respectively, all P < 0.001).</p><p><b>CONCLUSIONS</b>GOSS can define and evaluate the extent and the severity of osteitis in patients with CRS by using CT, and can also reflect the extent and the severity of CRS.</p>

Transnasal endoscopic removal of orbital apex cavernous hemangioma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the strategy and indications of endoscopic transnasal resection of orbital apex cavernous hemangiomas (OACH).</p><p><b>METHODS</b>Eleven patients aged from 30 to 62 years-old diagnosed as OACH bypostoperative histopathology were reviewed retrospectively. Four males and 7 females were included. Both ophthalmological examination and rhinologic evaluation were adopted preoperatively. The surgeries were carried out under general anesthesia endoscopically by the same senior surgeon. After ethmoidectomy, the orbital lamina papyracea was opened, and the orbital fat and muscles were pushed back into the orbit by using the brain cotton, and then the orbital tumor was removed. The patients were kept follow-up both in ophthalmologic and rhinologic departments.</p><p><b>RESULTS</b>As suggested by preoperative imagings, 4 lesions located in the extraconal space (nasal side), 6 between the optic nerve and the internal rectus muscle of the intraconal space, and 1 outside the optic nerve in the intraconal space. Total resection was achieved in 9 cases, and orbital decompressions were done in 2 cases. Meanwhile, orbital wall reconstruction was done in 7 cases. The follow up ranged from 6 to 47 months. Seven patients achieved visual acuity improvement and no deteriorations were found in other 4 patients. Defects of vision field in 3 patients disappeared after 2 weeks. No operative or postoperative complications occurred.</p><p><b>CONCLUSIONS</b>The OACH located in the nasal side of extraconal space and between the optic nerve and the internal rectus muscle of the intraconal space can be accessed endoscopically by intranasal approach. Using the brain cotton to push the orbital fat and muscles back into the orbit and an experienced endoscopic surgeon are important to access a successful intranasal endoscopic removal of orbital apex tumor.</p>

Clinical and histopathologic features of biofilm-associated chronic rhinosinusitis with nasal polyps in Chinese patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Biofilms have given new insights to the understanding of pathogenesis of chronic rhinosinusitis (CRS). However, the link between biofilms formation and local inflammatory response remains poorly defined in CRS with nasal polys. The aim of this study was to determine the potential association of the presence of biofilms in the nasal mucosal tissues with clinical features in Chinese patients, which had CRS with nasal polyps (CRSwNP).</p><p><b>METHODS</b>A total of 19 patients with CRSwNP and 12 patients with non-CRS were subjected to endoscopic surgery and their nasal mucosal tissue specimens were examined histologically and by scanning electron microscopy (SEM). Their demographic and clinical features were recorded.</p><p><b>RESULTS</b>Thirteen (68.4%) out of the 19 specimens from patients with CRSwNP, but none from control patients, were positive for biofilms that displayed typical characteristics of bacterial and fugal structures. The presence of biofilms in the nasal mucosal tissues was associated with significantly greater values of purulent nasal discharge and preoperative Lund-Kennedy scores, higher levels of serum total IgE and percentages of subjects with endoscopic surgery (ESS) history in patients with CRSwNP, and more severe inflammation in the nasal mucosal tissues of patients with CRSwNP.</p><p><b>CONCLUSION</b>Our study demonstrated the presence of biofilms in the nasal mucosal tissues of many patients, contributing to the understanding of the pathogenic process of CRSwNP in Chinese patients.</p>

Clinical application of Draf IIb frontal sinusotomy and it's modified procedures / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To summarize the follow-up outcomes of Draf IIb frontal sinusotomy and it's modified procedures, and to discuss the surgical indications and prognostic factors.</p><p><b>METHODS</b>Thirty-two patients treated between 2004 and 2010 were enrolled in this study. There were 15 patients for recurrent frontal inverted papilloma (IP), 6 for mucocele, 4 for recurrent frontal sinusitis, 3 for osteoma, 2 for meningoencephalocele with cerebrospinal fluid rhinorrhea, 1 for meningoencephalocele alone and 1 for acute frontal sinusitis. All patients underwent preoperative paranasal sinus computed tomography (CT) scans. Patients with tumor accepted magnetic resonance imaging (MRI). The patients with meningoencephalocele and cerebrospinal fluid rhinorrhea received magnetic resonance cisternography (MRC). The Draf IIb frontal sinusotomy and it's modified Draf IIb-1-3 procedures were applied endoscopically under general anesthesia mainly by high speed bur and power system. The postoperative CT scan was obtained as a base line for follow-up 1 week after the operation. Postoperative follow-up was performed under endoscope.</p><p><b>RESULTS</b>Among 19 cases of Draf IIb, 12 were recurrent IP of frontal sinus, 4 were mucocele, 2 were recurrent frontal sinusitis and 1 were osteoma. Five cases received Draf IIb-1, 2 for each recurrent IP of frontal sinus and recurrent frontal sinusitis and 1 for osteoma. Six cases received Draf IIb-2, 3 for meningoencephalocele, 1 for each IP, acute frontal sinusitis and osteoma. Two cases received Draf IIb-3 were mucocele. The follow-up ranged from 8 to 73 months. Twenty-two cases of the frontal nepostium were widely opened, 7 were stenosis and 3 were closed. Revision surgery was seen in 2 cases with IP. All of them had no complications.</p><p><b>CONCLUSIONS</b>The Draf IIb frontal sinusotomy and it's modified procedures are suitable for complex frontal sinus disease, which can be selected according to pathological and anatomical features, and have a good prospect for clinical application.</p>

Analysis of follow-up outcomes of endoscopic modified Lothrop procedure / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To sum up the follow-up outcomes of endoscopic modified Lothrop procedure (EMLP) and retrospectively analyze the indications, methods and prognostic factors of EMLP.</p><p><b>METHODS</b>The collected data of 73 cases who received EMLP with frontal sinus diseases were analyzed in this paper. The mean age was 45.6 (ranging from 14 to 72 years). There were 52 males and 21 females. Only patients with follow-up time greater or equal to 6 months were included. Paranasal sinus CT scan was adopted for all cases and MRI for tumor patients. All patients were followed under endoscope.</p><p><b>RESULTS</b>There were 21 inverted papilloma in the frontal sinus, 16 chronic sinusitis with asthma, 12 frontal sinusitis, 9 chronic sinusitis with or without polyps, 7 osteoma of the frontal sinus, 4 frontal mucocele, 3 allergic fungal sinusitis and 1 congenital encephalocele. Sixty-one cases had prior surgical history (1.8 times on the average). Their mean follow-up was 25.0 months, (ranging from 6 to 122 months). At the end of follow-up, 44 cases (60.3%) had well opened frontal drainage pathway. Twenty-five (34.2%) was re-stenosed and 4 (5.5%) closed. Seven cases (9.6%) underwent revision surgeries. There were no surgical complications.</p><p><b>CONCLUSIONS</b>EMLP is an effective and salvage procedure in dealing with tumor of frontal sinus and recurrent frontal sinusitis. Combined with medical treatment, EMLP will have a better results for chronic sinusitis with or without polyps and asthma. The degree of diseases, mucosal loss, anatomic variability and prior surgeries are important prognostic factors.</p>

Long-term efficacy of Dermatophagoides pteronyssinus immunotherapy in patients with allergic rhinitis: a 3-year prospective study / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the long-term efficacy of subcutaneous immunotherapy with Dermatophagoides pteronyssinus (DerP) in patients with allergic rhinitis.</p><p><b>METHODS</b>Ninety-two patients with allergic rhinitis to DerP were randomly allocated to receive either specific immunotherapy (n = 46) or medical treatment (n = 46). Symptom and medication scores and skin response to Derp were assessed to evaluate the clinical efficacy in the baseline and after three years treatment. DerP-specific IgE and IgG4 were measured.</p><p><b>RESULTS</b>After three years treatment, the immunotherapy group showed sustained reductions in symptom scores (before treatment 9.20 [7.50;11.13], after treatment 3.32 [2.49;5.12], Z = -5.13, P < 0.05), medication scores (before treatment 0.72 [0.47;0.83], after treatment 0.31 [0.28;0.45], Z = -5.78, P < 0.05) and specific skin response to Derp (t = 6.37, P < 0.05) when compared with control group. There were no differences in the level of serum specific IgE before and after three-year treatment (before treatment 16.32 [4.34;38.65] kU/L, after treatment 15.85 [4.93;46.27] kU/L, Z = -0.84, P > 0.05), but the level of serum specific IgG4 increased significantly after one year treatment in immunotherapy group (before treatment 486 [319;1439] AU/L, after treatment 8387 [7732;16 634] AU/L, Z = -2.81, P < 0.05). After three-year treatment, 7.5% (3/40) of patients had asthma in immunotherapy group compared to 27.8% (10/36) in the control group (χ(2) = 5.50, P < 0.05), and 15.0% of the initially DerP nonsensitized patients in immunotherapy group had developed new sensitization compared to 47.2% in the control group (χ(2) = 9.32, P < 0.05).</p><p><b>CONCLUSION</b>Three years immunotherapy improves allergic rhinitis symptoms, increases the level of serum specific IgG4, reduces the development of asthma and new sensitization.</p>

Prevalence of sensitization to aeroallergens in 10 030 patients with allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the main inhaled allergens in patients with allergic rhinitis.</p><p><b>METHODS</b>Forty-three standardization allergens were used to perform skin prick test in 54 813 patients with chronic rhinitis. According to different gender and age groups, 10 030 patients with allergic rhinitis were divided into eight groups. The distributions of different allergens in the eight groups were analyzed.</p><p><b>RESULTS</b>(1) The most common four allergens in male patients with allergic rhinitis were Dermatophagoides farina (Der f), Dermatophagoides pteronyssinus (Der p), Mugwort and Blaterlia Germanica. Der f, Der p, Mugwort and Chenopodium album were the most common in female patients. (2) In all groups, patients with dual positive allergens were the most common, followed by triple positive allergens and single positive allergen. (3) In single positive allergen group, the top four allergen in male 3-17 year group were Der f, Der p, Alternaria tenuis and Mugwort. In other male groups, the most common positive allergen were Der f, Der p, Mugwort and Blaterlia Germanica. Meanwhile, the top four positive allergens in female 3-17 year group were Der f, Der p, Mugwort and Alternaria tenuis, in 18-39 year group were Der f, Der P, Mugwort and Dandelion, in 40-59 year group were Der f, Der p Mugwort and mixed tree 1, in ≥60 year group were Derf, Der P, mixed animal hair and Mugwort. (4) In dual positive allergens group, the most common allergen combination was Der f+Der p, followed by Alternaria tenuis in patient of 3-17 year group. (5) In triple positive allergens group, the most common allergen combination was Der f+Der p+Blaterlia Germanica, followed by Der f+Der p+mixed animal hair.</p><p><b>CONCLUSIONS</b>Dust mites, flowers pollen, herbs, Alternaria tenuis and Blaterlia Germanica were the most common allergens in patients with allergic rhinitis. However, the frequencies of the allergens were different in different age groups.</p>

Comparative study on cluster and conventional immunotherapy with Dermatophagoides pteronyssinus in patients with allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the efficacy and safety of a 6-week cluster schedule of specific immunotherapy with that of a 14-week conventional schedule for the treatment of subjects with persistent allergic rhinitis (AR).</p><p><b>METHODS</b>The trial was a prospective and randomized study involving 80 patients with persistent AR, who were allergic to Dermatophagoides pteronyssinus. While 40 patients were randomly assigned to the cluster schedule reaching the maintenance dose within 6 weeks, the other 40 patients were randomly assigned to the conventional schedule reaching the maintenance dose within 14 weeks. Symptom scores and medication scores were used to evaluate the clinical efficacy. Serum specific IgG4 level was examined to mark immunologic change, adverse reactions were recorded during the treatment.</p><p><b>RESULTS</b>Cluster group achieved clinical efficacy (reducing symptom scores and medication score) and increasing serum specific IgG4 sooner (after 6 weeks treatment). During the incremental dose phase, there were 6 systemic adverse reactions (1.12% of all injection) in 3 patients in cluster group and there were 5 systemic adverse reactions (0.85% of all injection) in 3 patients in conventional group. No severe systemic reactions occurred in both group. There was no difference between the 2 groups in frequency or type of systemic reaction (χ(2) = 0.333, P > 0.05).</p><p><b>CONCLUSION</b>The cluster schedule is a safe alternative to the conventional schedule with the advantage of achieving clinical efficacy sooner.</p>

Clinical efficacy and immunological changes in children with allergic rhinitis receiving specific immunotherapy with Dermatophagoides pteronyssinus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and immunological changes of children receiving subcutaneous immunotherapy with Dermatophagoides pteronyssinus.</p><p><b>METHODS</b>Sixty-four children with allergic rhinitis to Dermatophagoides pteronyssinus (Der p) were randomly allocated to receive either specific immunotherapy (n = 32) or medical treatment (n = 32). Symptom and medication scores were assessed to evaluate the clinical efficacy in the baseline and after one year treatment. Total IgE, Der p-specific IgE, and specific IgG4 were measured.</p><p><b>RESULTS</b>Immunotherapy reduced the symptom (the scores reduced from 10[9;11] to 4[3;6]) and medication score (the scores reduced from 0.76[0.61;0.90] to 0.35[0.30;0.43]) in children with allergic rhinitis significantly(Z value were -4.80 and -4.74, respectively, each P < 0.01). There was a significant difference in symptom and medication scores between both groups after one year treatment (U value were 155.00 and 139.50, respectively, each P < 0.01). There were no differences in levels of serum total IgE, specific IgE before and after one year treatment, but the level of serum specific IgG4 increased significantly after one year treatment.</p><p><b>CONCLUSIONS</b>Immunotherapy with standardized extract is efficacious to treat children sensitive to Der p, allergen-specific IgG4 is significant as immunological marker to predict efficacy of immunotherapy.</p>

Correlation between FOXP3 gene polymorphisms and allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the correlation between polymorphisms in the FOXP3 locus and the susceptibility of allergic rhinitis.</p><p><b>METHODS</b>Two polymorphisms in FOXP3 locus were genotyped in 193 subjects with allergic rhinitis and 191 healthy controls. The polymorphisms were chosen in terms of the information from Hapmap website as well as Haploview version 4.1 program implemented results. PCR-resequencing methods was performed for genotyping. SPSS program version 13.0 was used for statistical analysis.</p><p><b>RESULTS</b>Heterozygotes of rs3761547 and rs3761548 appeared significant, while only rs3761548 (P = 0.020, OR = 3.12, 95%CI were 1.21 - 8.04) remained significant following application of the Bonferroni correction for multiple testing. Subgroup analysis for the presence of different allergen allergy also showed significant association for house dust mites (rs3761547, P = 0.013, OR = 2.00).</p><p><b>CONCLUSION</b>Heterozygous allele in rs3761548 is associated with allergic rhinitis and rs3761547 is related to house dust mites allergic rhinitis.</p>

Treatment of allergic rhinitis with nasal mometasone furoate / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effects of nasal mometasone furoate on moderate to severe allergic rhinitis.</p><p><b>METHODS</b>Patients with moderate to severe allergic rhinitis were enrolled and received mometasone furoate nasal spray 200 microg once daily for four weeks. Four hundreds and sixty-three patients completed the study. We weekly interviewed the patients to evaluate the symptoms, and the affection of disease on night sleep and daily life. Mini Rhinoconjunctivitis Quality of Life Questionnaire (Mini-RQLQ) and Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ) were used to evaluate the quality of life.</p><p><b>RESULTS</b>The individual and total symptomatic scores of week 1, week 2 and week 4 decreased compared with baseline. The scores of Mini-RQLQ and NRQLQ of week 1, week 2 and week 4 decreased compared with baseline too. The scores of the next visit were significantly lower than those of the previous visit (P < 0.01).</p><p><b>CONCLUSIONS</b>A four-week administration of mometasone furoate nasal spray can effectively treat allergic rhinitis.</p>

Endoscopic management of the inverted papilloma involving frontal sinus and its drainage pathway / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The endoscopic management of inverted papilloma has gained increasing popularity over the last 15 years. However, the appropriate management of lesions involving the frontal sinus and its drainage pathway still has to be determined.</p><p><b>METHODS</b>We performed a retrospective review of the results of the patients with inverted papilloma in the Otolaryngology Head and Neck Surgery department, Beijing Tongren Hospital from 2004 to 2007 to identify the patients with lesions involving frontal sinus and its drainage pathway. By its appearance on nasal endoscopic examination and CT scanning, the tumors were defined using Krouse staging system. Sinus endoscopy was used to screen for disease after endoscopic resection. And their clinical outcomes were analyzed.</p><p><b>RESULTS</b>A total of nine patients (8 males and one female) with inverted papilloma who had frontal sinus and its drainage pathway involvement were identified. All tumors were defined as T3 lesions. Preoperative and postoperative pathologic examinations revealed inverted papilloma as the diagnosis. Four cases with lateral wall of frontal recess attachment underwent endoscopic Draf II A frontal sinusotomy. Three cases with either lateral and posterior walls of frontal recess and frontal infundibulum attachment or medial and posterior walls of frontal recess and frontal infundibulum attachment underwent Draf II B procedure. Two cases with either posterior wall of frontal recess and frontal infundibulum attachment or medial, lateral and posterior walls of frontal recess and frontal infundibulum attachment underwent Draf III procedure. All patients remain disease free with an average follow-up of 13 months.</p><p><b>CONCLUSIONS</b>Extensive inverted papilloma (Krouse T3 lesions) can be treated successfully with an endoscopic approach.</p>

Efficacy and safety of cluster immunotherapy for 154 patients with allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of cluster immunotherapy with Dermatophagoides pteronyssinus for allergic rhinitis.</p><p><b>METHODS</b>One hundred and fifty-four patients with allergic rhinitis to Dermatophagoides pteronyssinus were allocated to receive specific immunotherapy in a 6-week cluster schedule during the incremental-dose phase. Thereafter, these patients received maintenance-dose injection at 6-week intervals until the end of 1 year of treatment. Symptom scores and medication scores were used to evaluate the clinical efficacy and adverse reactions were recorded. A rhinoconjunctivitis quality of life questionnaire (RQLQ) was completed in the baseline and after one year treatment.</p><p><b>RESULTS</b>Cluster immunotherapy significantly reduced the symptom scores and total medication score of patients enrolled (P < 0.01). The immunotherapy group also had a significant improvement in the Rhinoconjunctivitis Quality of Life Questionnaire. During the one-year of treatment, there were 26 systemic adverse reactions (0.75% of all injection) in 9 patients (5.9%) and no fatal systemic reactions occurred.</p><p><b>CONCLUSIONS</b>The cluster immunotherapy is efficacious and safe to treat allergic rhinitis.</p>

Impacts of socioeconomic and environmental factors on self-reported prevalence of allergic rhinitis in eleven cities in China / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Recent findings suggest that environmental factors play important roles in the etiology of allergic rhinitis, however, data on the impacts of socioeconomic and environmental factors on self-reported prevalence of allergic rhinitis in China is sparse, which is the aim of this study.</p><p><b>METHODS</b>Telephone interviews were performed in 11 cities throughout the mainland of China, and the association between environmental factors and self-reported prevalence of allergic rhinitis were evaluated by multiple linear correlation tests.</p><p><b>RESULTS</b>In total, there was no association between the adjusted self-reported prevalence of allergic rhinitis and socioeconomic factors such as GDP, GDP per capita, gross output value of industry and gross output value of industry per capita, while the adjusted self-reported prevalence of allergic rhinitis was positively correlated with the concentration of SO2, and no association was found between adjusted self-reported rate of allergic rhinitis and either meteorological factors including annual average temperature, annual average relative humidity, annual hours of sunshine and annual precipitation or other air pollution factors including NO2 and PMl0.</p><p><b>CONCLUSIONS</b>The study demonstrates that the self-reported prevalence of allergic rhinitis in 11 cities in China was positively correlated with the concentration of SO2, and the strategy of prevention for allergic rhinitis could be conducted according to the results. Prevalence;</p>

CT evolution of nasal steroid management of chronic rhinosinusitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of topical steroid treatment of nonpolypoid chronic sinusitis.</p><p><b>METHODS</b>Two cohorts of adult and children with nonpolypoid chronic sinusitis were investigated. The first cohort consisted of 11 pediatric patients [mean age, (11.8 +/- 3.2) years] with a mean Lund score of 10.3 +/- 5.7 (x +/- s). The second cohort consisted of 13 adult patients [mean age, (36.7 +/- 11.0) years] with a mean Lund score of 12.2 +/- 5.7. The mean duration of the nasal budesonide (Rhinocort) treatment was (7.5 +/- 3.2) weeks for adult patients (256 microg/d) and (7.0 +/- 3.4) weeks for pediatric patients (128 microg/d). Each Lund score and the patient's assessment of nasal symptoms were evaluated after treatment.</p><p><b>RESULTS</b>The average Lund score was significantly decreased to 6.5 -/+ 7.5 (t = 3.82, P < 0.01) in adult patients and to 2.6 +/- 3.7 (t = 5.08, P < 0.01) in pediatric patients after treatment. Thirty-eight percent of the adult patients and 73% of the pediatric patients were cured on CT images. The patient's self-assessment of efficacy was positively correlated with pretreatment Lund score in adult patients (r = 0.676, P < 0.05), but not so in pediatric patients.</p><p><b>CONCLUSIONS</b>These findings demonstrate that most of patients with nonpolypoid chronic sinus did well with topical steroid treatment. Therefore, surgery was required in few patients.</p>