Exhaled and nasal nitric oxide in chronic rhinosinusitis patients with nasal polyps in primary care.

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder associated with lower airway disease. However, only few studies of CRSwNP from outside secondary/tertiary care centres have been published. We recently reported an asthma frequency of 44% and 65% in primary and secondary care patients respectively. Therefore, we hypothesise that inflammation of the lower airways could be present in all CRSwNP patients, even without asthma. Here, we assessed the degree of lower and upper airway inflammation using exhaled and nasal nitric oxide (NO) in primary care CRSwNP patients with and without asthma. METHODS: Fifty-seven patients who met the EPOS criteria for CRSwNP were prospectively recruited from primary care ear, nose and throat clinics. Nasal endoscopy was performed by an ear, nose and throat specialist upon enrolment. Additionally, 30 healthy controls were enrolled. Expiratory and nasal NO measurements and thorough pulmonary evaluation were performed. Pulmonary disease was diagnosed by a respiratory physician. RESULTS: Fifty-nine percent of CRSwNP patients with asthma showed elevated expiratory NO; the same was seen in 29% of non-asthmatic CRSwNP patients. Compared with controls, a high level of exhaled NO was significantly more prevalent in CRSwNP irrespective of asthma-status. Nasal NO was significantly lower in patients with CRSwNP compared with controls. CONCLUSION: Subclinical eosinophilic lower airway inflammation is common in CRSwNP in the primary sector, even in the absence of asthma.

Prevalence of eardrum pathology in a cohort born in 1955.

The aim of this study was to compare the prevalence of the different types of eardrum pathology in a cohort of adults not previously treated by grommet insertion with corresponding findings obtained in a cohort previously treated with grommet insertion. A cohort born in 1955 were invited to a screening examination including otomicroscopy. In the untreated cohort, retraction of Shrapnell's membrane was found in four per cent of the ears compared to 20 per cent in the cohort treated with grommets. Tensa pathology, including atrophy and myringosclerosis, was found in six per cent of the ears in the untreated cohort and in 17 per cent in the treated cohort. Normal eardrums were found in 91 per cent of the ears. Despite the increased awareness of secretory otitis, as well as the increased rate of surgical treatment, the prevalence of eardrum pathology seems to be increasing. The reasons for this are discussed.

[Occurrence of eardrum pathology in a cohort of adults born 1955]. / Forekomst at trommehindepatologi hos en kohorte af voksne født i 1955.

The aim of this study was to estimate the prevalence of the different types of eardrum pathology in a cohort (cohort 1955) who were children before the era of ventilation tubes, and to compare these findings with the prevalence of eardrum pathology in a previous published cohort study on 222 children followed since the age of four years (cohort 1975) in the era of ventilation tubes. All inhabitants of Hillerød county born in 1955 were invited to a screening examination including otomicroscopy, tympanometry and audiometry. All eardrum pathology was recorded. In cohort 1955, 59% of 460 possible, attended the examination. In addition 9% returned a questionnaire enquiring their otologic history. In the cohort with no grommets, retraction of Shrapnell's membrane was found in 4% of the ears compared to 20% in the cohort with grommets. Tensa pathology was found in 6% of the ears in the old cohort and in 24% in the young cohort. Despite the increased attention to the diagnosis of secretory otitis, and the increased rate of surgical treatment, the prevalence of eardrum pathology seems to have increased. The reason for this increase is discussed.

Results in treatment of carcinoma of the external auditory canal and middle ear.

Of 31 patients treated for carcinoma of the external auditory canal and/or middle ear, 19 patients (61%) presented with a long-term history of otitis. Thirteen patients (42%) had cranial nerve involvement. The patients were treated by surgery, radiotherapy, or a combined treatment of surgery and radiotherapy. The overall 5-year crude survival rate was 29%. Irrespective of the final outcome, 19 patients (61%) obtained pain relief after initial treatment. Three of the patients with facial nerve involvement survived 5 years after the initial treatment. Postmortem examinations of ten patients revealed distant metastases in four patients.