Chronic rhinosinusitis: allergy and sinus computed tomography relationships.

The management of chronic or recurrent rhinosinusitis problems is multifaceted and should include consideration of contributory and potentially correctable medical and anatomic factors. To date, the relationship between allergy and rhinosinusitis has not been clearly defined. The purpose of this study is to improve understanding of the relative roles of perennial and seasonal allergens in the cause of chronic rhinosinusitis. A retrospective review of 200 consecutive patients was carried out on patients who had chronic rhinosinusitis refractory to medical therapy and who subsequently underwent functional endoscopic sinus surgery. All of these patients had allergy testing for common perennial and seasonal inhalant allergens before surgery. Each patient had sinus CT imaging before undergoing the surgery. The CT scans of each patient were staged according to a validated, standardized grading system by investigators blinded to allergic profile. Allergy testing indicated that 84% of all patients tested positive for allergies. Moreover, 60% of all patients had significant allergic sensitivity; 52% of all patients had multiple allergen sensitivities. Furthermore, there was a predominance of perennial allergens, especially house dust mite over seasonal allergens. The vast majority of our patients undergoing functional endoscopic sinus surgery had concomitant allergy. This study highlights the potential contribution of perennial allergies to the development of rhinosinusitis. Given this direction, future studies may reveal that in the care of patients with perennial allergic rhinitis, early intervention with identification of the offending allergen(s), and subsequent treatment through avoidance, pharmacotherapy, and/or immunotherapy may help in the prevention of recurrent and chronic rhinosinusitis.

In vitro testing for allergy diagnosis. Comparison of methods in common use.

In vitro assays for the measurement of specific IgE have been available for the last 30 years. Over this time there have been significant changes in their technology, ranging from a long 3-day test to a short 3-hour test and from a labor intensive test to a fully automated test. These new innovations have enabled today's in vitro assays to be far more efficient, reliable, and reproducible.

A comparison of in-vitro allergy diagnostic assays.

Investigation, comparison, and discussion of various assays, both old and new, is beneficial for physicians using, or intending to use, an in-vitro assay for allergy diagnosis. Such investigation can prevent abuse and ensure the reliability of in-vitro testing for atopic allergy as a method of diagnosis.

Malignant lymphoma presenting as a parotid mass.

Three cases of maglignant lymphoma presenting as a parotid mass have been presented. Head and neck surgeons should be aware of this condition both as a possible variant of lymphoma presenting in the head and neck region, and also as a part of the differential diagnosis of parotid gland enlargement. Early diagnosis is essential in these cases, as this has a beneficial effect on both the prognosis and management of these patients. The histopathology and staging of these tumors has been discussed with regards to the prognosis and management, and the difficulty of making the diagnosis and the chances to improve this are also discussed.