Correlation between some parameters in active seasonal allergic rhinitis: a controlled clinico-immunological study

Allergic rhinitis is a global disease with increasing prevalence worldwide. It is characterized by inflammatory cells and mediators of which, eosinophil and IgE, are playing a central role. IgA with its two forms [serum IgA and secretory IgA] is one of the respiratory system defense mechanisms against pathogens, however, its role and its relation to other allergic inflammatory parameters is still under investigation. This study was conducted on twenty allergic rhinitis patients and ten apparently healthy persons as a control to test the correlation between different parameters in allergic rhinitis including; eosinophil count, IgE, IgA levels and symptoms score in active symptomatic seasonal allergic rhinitis. Results showed that blood eosinophil percentage and nasal eosinophil count as well as serum IgE were significantly increased in patients than controls. Secretory IgA [sIgA] in nasal secretion but not serum IgA was significantly increased in patients group indicating excess local production; which is probably a part in the allergic reaction. There was a positive correlation between serum eosinophil percentage and eosinophil count in nasal secretion and serum IgE levels, which may suggest that eosinophil count in nasal secretions; could be a reliable tool in diagnosis of allergic rhinitis. sIgA in nasal secretions increased in patient's group and is found to be positively correlated to nasal eosinophil count, which may suggest a role of sIgA in the pathogenesis of allergic rhinitis. Although there was a positive correlation between nasal obstruction score and nasal eosinophil count, however, as it is a subjective scoring, it can't be relied on until accurate objective scoring is used to measure nasal obstruction. The present study stressed on the importance of meticulous history taking [symptoms score]. The results stressed on the opinion that serum IgE and eosinophil count are good markers for allergic rhinitis, also, nasal cytology for eosinophil count could be used to assist in diagnosis; it is easy, simple and east to help in differentiation of allergic from non allergic rhinitis. The findings of IgA raise the point that it's measurement could be a good tool to be added to the battery of parameters for diagnosis or evaluation of the severity of allergic rhinitis together with follow up of patients. IgE, IgA, IgG: immunoglobulin E, A, G., sIgA: secretory IgA., HDM: House dust mites, Fc: fraction crystalline, ELISA: Enzyme linked Immunosorbent Assay, ECP: eosinophilic cationic protein, PO: eosinophil peroxidase, EDN: eosinophil- derived neurotoxin, TNF-alpha: tumor necrosis factor alpha, SAR=seasonal allergic rhinitis, HPF: high power field

Comparison between two techniques for adenoidectomy: a randomized prospective clinical study

An adenoidectomy can be performed with a variety of techniques, such as an adenoid curette, an adenotome, an adenoid punch, suction cautery, microdebrider or even laser. All these methods have their advantages and disadvantages, and the choice of instrument is usually based solely on the surgeon's personal preference; however, direct visualization during surgery and achieving complete resection of adenoids tissue without inadvertent injury of the surrounding structures are very important. The objectives and methodology of this study was to compare between the conventional Curette Adenoidectomy [CA] and Power Assisted Adenoidectomy [PAA] techniques as regards to actual operating time, estimated blood loss and completeness of adenoids resection. This prospective randomized study included 64 patients; 34 PAA and 30 CA, study was done in Green Crescent Hospital, Riyadh, Saudi Arabia. Results in this study showed that PAA was more faster than CA [P<0.05]; PAA operative time ranged between [10-20] minutes, mean=12 minutes, while CA ranged between [10-30] minutes, mean= 17 minutes. Regarding blood loss estimation, in PAA group blood loss ranged between [20-180 ml], mean= 35ml, while in CA group blood loss ranged between [30-220 ml], mean=45ml. There was a statistically significant difference between PAA and CA groups in estimated blood loss in favor of PAA. [P<0.05] Postoperative endoscopic assessment of the nasopharynx showed that PAA provided a significantly more complete resection around the choanae and torus tubaris and significantly better control of the depth of the resection for large adenoids [P<0.05] and intranasal extension [P<0.001] than curette adenoidectomy. In comparison with conventional CA technique, PAA provided significant advantages that are subjectively and objectively apparent. In this study it has been concluded that PAA saved actual operating time and reduced blood loss and provided surgeon with more satisfaction of direct visualization and complete resection of adenoids specially, in the areas of choanae, torus tubaris and intranasal extensions, however, some of the limitations of this procedure is that it is costly and needs more experience of the surgeon with the use of the microdebrider. Therefore it should be used in selected cases of large adenoids or those adenoids with intranasal extensions where it is suspected that conventional techniques fail to achieve complete resection of adenoids. Power Assisted Adenoidectomy = PAA, Curette Adenoidectomy = CA, Bovine Spongiform Encephalopathy = BSE, round per minute=rpm