ABSTRACT
Demonstrate the histological remodeling changes in the turbinates, identify the frequency of the two forms of rhinitis in the samples studied and determine the remodeling differences found in the two variants. Patients attended an otolaryngology service at the Social Security Hospital of city Sangolqui-Ecuador from February 2016 to June 2017. The allergic variant was determined when eosinophils were found by higher magnification field and non-allergic when they were not found in the submucosal segment. Epithelial, inflammatory, and stromal markers were analyzed. One hundred twenty histopathological samples were analyzed, 75% presented allergic rhinitis, the age averaged 36.2 years. When we compared between the allergic and non-allergic variants: epithelial and stromal markers we had significant differences, as well as between each of its components; except fibrosis. In relation to the inflammatory pattern, there were significant differences between the number of mast cells and stromal markers with eosinophils > 10 by field. The allergic type corresponded to 75% of patients with persistent severe rhinitis who underwent turbinectomy. Regarding remodeling, there was a statistically significant difference in favor of the allergic variant. Eosinophilia greater than 10 was directly related to mastocytosis and subepithelial edema.
ABSTRACT
Introdução: A rinite vasomotora (RVM), também denominada idiopática, é um tipo de rinite não alérgica. Pode ser muitas vezes ativada por mudanças de temperatura, especialmente com o ar frio e outras irritantes de vias aéreas. A dosagem de IgE e o citograma nasal são normais, e os testes de inalantes são negativos. A etiologia pode estar associada à desregulação de nervos simpáticos e parassimpáticos da mucosa nasal, onde aumenta a rinorreia e a obstrução nasal. Objetivo: Avaliar a eficácia da amitriptilina no controle da rinorreia vasomotora. Método: Através de estudo retrospectivo, avaliaram-se pacientes com RVM (n = 110), no qual um grupo de n = 12 (11%) apresentava rinorreia profusa há mais de um ano, não controlada, na sua totalidade, com corticosteroide nasal. Usou-se a amitriptilina, um antidepressivo tricíclico, com intensa atividade anticolinérgica com dose de 25 mg/50 mg diária para a rinorreia nesses pacientes. Resultados: Foram avaliados através de uma escala de sintomas (modificada de Wilson AM): 0 = ausente, 1 = leve, bem tolerado, 2 = desconforto interferindo com a concentração, 3 = forte intensidade interferindo no sono e na concentração. Dez pacientes catalogados apresentaram sintomas no grau 3, e dois, no grau 2. A pontuação foi reduzida para grau 0-1 após 4-6 semanas com o uso de amitriptilina por sintomas reflexivos matinais e noturnos. Conclusão: Futuros estudos controlados e com maior número de pacientes seriam necessários para confirmação do efeito farmacológico da amitriptilina na rinorreia da RVM.
Background: Vasomotor rhinitis (VMR), also referred to as idiopathic rhinitis, is a type of nonallergic rhinitis. It can often be triggered by changes in temperature, especially with cold air and other airway irritants. Immunoglobulin E (IgE) levels and nasal cytograms are normal, and inhalant skin tests are negative. The etiology may be associated with dysregulation of the sympathetic and parasympathetic nervous systems in the nasal mucosa, with increased rhinorrhea and nasal obstruction. Objective: To evaluate the efficacy of amitriptyline in the control of VMR-related rhinorrhea. Method: We retrospectively evaluated 110 patients with VMR, of whom 12 (11%) had profuse rhinorrhea for more than 1 year, not completely controlled with nasal corticosteroids. In these 12 patients, rhinorrhea was treated with amitriptyline, a tricyclic antidepressant with intense anticholinergic activity, at a daily dose of 25 mg/50 mg. Results: Patients were evaluated using a symptom scale (modified from Wilson AM): 0 = absent; 1 = mild, well tolerated; 2 = discomfort interfering with concentration; and 3 = severe intensity interfering with sleep and concentration. Ten patients had grade 3 symptoms, and 2 had grade 2 symptoms. The score decreased to grade 0-1 after 4-6 weeks of amitriptyline use for reflex symptoms in the morning and at night. Conclusion: Further controlled studies with a larger sample size are needed to confirm the pharmacological effect of amitriptyline on VMRrelated rhinorrhea.
Subject(s)
Humans , Retrospective StudiesABSTRACT
Se presentan los resultados de un estudio hecho en 38 pacientes con diagnostico clinico y por laboratorio de Rinitis Vasomotora y 14 controles, que asistieron a la consulta externa otorrinolaringologica del Hospital Universitario San Vicente de Paul, en Medellin, Colombia, entre mayo de 1987 y diciembre de 1988. Se encontro que la RV en nuestro medio es una enfermedad que predomina en mujeres jovenes entre 12 y 34 anos con obstruccion nasal de mas de un ano de evolucion como principal motivo de consulta y tumefaccion de cornetes con buena respuesta vasoconstrictora como hallazgo predominante al examen fisico. Los estudios realizados (IgE serica total, prueba de Anderson, espirometria, recuento de celulas metacromaticas en raspado de mucosa nasal y biopsia de cornete inferior) no fueron de valor diagnostico. Como hallazgo importante se encontro mediante la espirometria, en el 73% de los pacientes, obstruccion pulmonar en ausencia de sintomatologia respiratoria inferior. p<0.05).8
We performed a case-control study of 38 cases of vasomotor rhinitis (VR) diagnosed at the Otorrhinolaryngology Outpatient Clinic at Hospital Universitario San Vicente de Paúl, Medellin, Colombia, between May 1987 and December 1988. These cases were proved both clinically and by laboratory evaluation and were compared to 14 controls. VR was predominant in young women aged 12 to 34 years (75%). Nasal congestion of more than one year evolution was the outstanding symptom and edematous turbinates with good vasoconstriction retraction was the predominant sign on physical examination. The tests performed (serum total lgE, Anderson's test, pulmonary function tests, nasal metachromatic cell counts and turbinate biopsy) had no diagnostic value. One Important finding was the spirometric detection of pulmonary obstruction without clinical manifestations that was observed in 73% of the cases (p