Role of α-Tocopherol Acetate on Nasal Respiratory Functions: Mucociliary Clearance and Rhinomanometric Evaluations in Primary Atrophic Rhinitis.

Primary atrophic rhinitis is a disease of the nose and of paranasalsinuses characterized by a progressive loss of function of nasal and paranasal mucosa caused by a gradual destruction of ciliary mucosalepithelium with atrophy of serous-mucous glands and loss of bonestructures.The aim of this study was to evaluate the therapeutic effects of topic α-tochopherol acetate (vitamin E) in patients with primary atrophicrhinitis based on subjective and objective data.We analyzed 44 patients with dry nose sensation and endoscopic evidence of atrophic nasal mucosa. We analyzed endoscopic mucosascore, anterior rhinomanometry, and nasal mucociliary clearance before and after 6 months of topic treatment with α-tochopherol acetate. For statistical analysis, we used paired samples t test (95% confidence interval [CI], P < .05) for rhinomanometric and muciliary transit time evaluations and analysis of variance 1-way test (95% CI, P < .05) for endoscopic evaluation. All patients showed an improvement in "dry nose" sensation and inperception of nasal airflow. Rhinomanometric examination showed increase of nasal airflow at follow-up (P < .05); nasal mucociliaryclearance showed a reduction in mean transit time (P < .05); and endoscopic evaluation showed significative improvement of hydration of nasalmucosa and significative decreasing nasal crusts and mucusaccumulation (P < .05). Medical treatment for primary atrophic rhinitis is not clearly documented in the literature; in this research, it was demonstrated that α-ochopherol acetate could be a possible treatment for atrophic rhinitis.

Use of intranasal submucosal fillers as a transient implant to alter upper airway aerodynamics: implications for the assessment of empty nose syndrome.

BACKGROUND: Empty nose syndrome (ENS) is a debilitating condition associated with inferior turbinate tissue loss. Surgical augmentation of the inferior meatus has been proposed to treat ENS, although efficacy data with validated, disease-specific questionnaires is limited. Instead we evaluated submucosal injection of a transient, resorbable filler into the inferior meatus to favorably alter nasal aerodynamics in ENS patients. METHODS: Patients with a history of inferior turbinate reduction, diagnosed with ENS via Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) and cotton testing, were enrolled and underwent submucosal injection of carboxymethylcellulose/glycerin gel (Prolaryn®) into the inferior meatuses between July 2014 and May 2018. This material likely resorbs over several months. Outcomes included comparisons of preinjection and postinjection symptoms at 1 week, 1 month, and 3 months using the ENS6Q, 22-item Sino-Nasal Outcome Test (SNOT-22), Generalized Anxiety Disorder 7-item scale (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). RESULTS: Fourteen patients underwent injections. Mean ENS6Q scores significantly decreased from baseline at 1 week (20.8 vs 10.5; p < 0.0001), and remained reduced but upward-trending at 1 month (13.7, p = 0.002) and 3 months (15.5, p > 0.05) following injections. Mean SNOT-22 scores significantly decreased at 1 week (p = 0.01) and 1 month (p = 0.04), mean GAD-7 at 1 month (p = 0.02) and 3 months (p = 0.02), and mean PHQ-9 at 1 week (p = 0.01) and 1 month (p = 0.004) postinjection. CONCLUSION: Transient, focal airway bulking via submucosal filler injection at sites of inferior turbinate tissue loss markedly benefits ENS patients, suggesting that aberrant nasal aerodynamics from inferior turbinate tissue loss contributes to (potentially reversible) ENS symptoms.

Is submucosal fat injection effective in atrophic rhinitis? An experimental animal study.

Atrophic rhinitis (AR) is a disease characterized by the extensive dilatation of the nasal cavity and atrophy of the mucosa, submucosa and bone tissue. Its etiological factors are unknown. There is not a satisfying treatment yet and the treatment of the functional impairment in the atrophic cells is still subject to investigation. The objective of this study is to determine at the histopathological level the possible effects of the submucosal fat injection in an experimental model of AR. 12 albino Wistar-Hannover male rats were included in the study. AR was induced with the Pasteurella multocida toxin, which was diluted with saline. As one of the rats died during the study, it was excluded from the evaluation. The right nasal cavities of all rats (11 nasal cavities) were defined as the control group (Group 1). Fat tissue obtained from the abdominal area was injected in the seven left nasal cavities (Group 2). All injections, which were done to the abdominal regions were also done in the left nasal cavities of the remaining four rats, which constituted the sham group (Group 3). After 14 days, all rats were decapitated and the squamous metaplasia and keratinization in the superficial epithelium, degeneration, vacuolar changes in the basal layer, congestion, inflammatory infiltration, vascular proliferation and glandular atrophy in the submucosa are histopathologically classified. The results were analyzed with statistical methods. Although glandular atrophy was significantly regressed in the fat injection group (Group 2) compared to other groups (p < 0.05), the remaining parameters did not show any significant difference among these three groups. The histopathological effect of the fat injection was modest. We concluded that fat injection treatment has no or at the most a very limited effect in the treatment of atrophic rhinitis.

Chemosensory function assessed with psychophysical testing and event-related potentials in patients with atrophic rhinitis.

Atrophic rhinitis (AR) is a chronic inflammation of the nose characterized by an atrophy of the nasal mucosa. This is typically associated with an impaired sense of smell and a subjective sensation of poor nasal breathing. The aim of this study is to assess chemosensory function in patients suffering from AR using psychophysical testings and event-related potentials (ERP) responses. A cohort of nine patients was extensively studied. Eight out of nine had secondary AR sequela of a bilateral total inferior turbinectomy whereas one patient had a primary AR. All the patients had a clinical evaluation using Sniffin' Sticks test and a retro-olfaction test and an electrophysiological evaluation based upon ERPs obtained after both olfactory and trigeminal stimuli. All the patients complained of a poor nasal breathing and presented a distortion of the chemosensory function. Actually, the orthonasal psychophysical testing showed that four patients out of nine had anosmia, three out of nine had hyposmia and two out of nine were normosmic. All the patients demonstrated retro-olfaction scores inferior to the normal values. The chemosensory ERP showed that seven patients had no olfactory response whereas six had no trigeminal response. Four patients had neither olfactory nor trigeminal ERP response. In conclusion, this study demonstrates that most patients with AR secondary to a total bilateral inferior turbinectomy have a reduction of the chemosensory function measured objectively by psychophysical testings and ERP [corrected].

Hyaluronic acid gel in the treatment of empty nose syndrome.

BACKGROUND: Empty nose syndrome (ENS) along with atrophic rhinitis are disease entities that are bothersome for patients and difficult for their doctors to treat. The purpose of this study was to evaluate the usefulness of intranasal injection of hyaluronic acid (HA) gel in patients with symptoms of ENS. METHODS: Three patients suffering from ENS and atrophic rhinitis underwent trial treatment consisting of submucosal injections of HA preparations into the inferior nasal concha and under the mucous membrane of the septum. RESULT: As a result of treatment, the patients' symptoms improved for several months and no complications were recorded. CONCLUSION: Because of its simplicity, safety, and fairly good, but impermanent clinical effects, HA injections appear to be worth considering in less severe forms of ENS.

Overview of the treatment of allergic rhinitis and nonallergic rhinopathy.

Allergic rhinitis (AR) and nonallergic rhinopathy (NAR) represent common nasal conditions affecting millions of individuals across the world. Although patients present with similar symptomatology, those with NAR are frequently affected only after childhood and present with a lack of other comorbid atopic disorders such as asthma, atopic dermatitis, and food allergies. Patients with pure NAR usually have no identifiable specific allergen sensitivity, whereas those with mixed (allergic and nonallergic) rhinitis are sensitized to aeroallergens in a manner that does not fully explain the duration or extent of their symptoms. This review presents the diverse options of currently available pharmacologic agents for the treatment of AR and NAR, including intranasal corticosteroids, H(1)-antihistamines, decongestants, cromolyn sodium, antileukotrienes, anticholinergics, capsaicin, anti-IgE, and intranasal saline, in addition to subcutaneous immunotherapy. Furthermore, treatment algorithms for AR and NAR are presented with a stepped-up, stepped-down scheme to aid the clinician in choosing appropriate therapy.

Rhinitis sicca, dry nose and atrophic rhinitis: a review of the literature.

Despite the fact that many people suffer from it, an unequivocal definition of dry nose (DN) is not available. Symptoms range from the purely subjective sensation of a rather dry nose to visible crusting of the (inner) nose (nasal mucosa), and a wide range of combinations are met with. Relevant diseases are termed rhinitis sicca anterior, primary and secondary rhinitis atrophicans, rhinitis atrophicans with foetor (ozena), and empty nose syndrome. The diagnosis is based mainly on the patient's history, inspection of the external and inner nose, endoscopy of the nasal cavity (and paranasal sinuses) and the nasopharynx, with CT, allergy testing and microbiological swabs being performed where indicated. Treatment consists in the elimination of predisposing factors, moistening, removal of crusts, avoidance of injurious factors, care of the mucosa, treatment of infections and where applicable, correction of an over-large air space. Since the uncritical resection of the nasal turbinates is a significant and frequent factor in the genesis of dry nose, secondary RA and ENS, the inferior and middle turbinate should not be resected without adequate justification, and the simultaneous removal of both should not be done other than for a malignant condition. In this paper, we review both the aetiology and clinical presentation of the conditions associated with the symptom dry nose, and its conservative and surgical management.

[Surgery of the turbinates and "empty nose" syndrome]. / Nasenmuschelchirurgie und "Empty Nose" Syndrom.

Surgical therapy of the inferior and/or middle turbinate is indicated when conservative treatment options have failed. The wanted goal is a reduction of the soft tissue volume of the turbinates regarding the individual anatomic findings and simultaneously conserving as much mucosa as possible. As the turbinates serve as a functional entity within the nose they take care of climatisation, moistening and cleaning of the inhaled air. Thus a free nasal breathing means a decent quality of life as well. Regarding the multitude of different surgical techniques we confirm that no ideal standard technique for turbinate reduction has been developed so far. Moreover there is a lack of prospective and comparable long-term studies which makes it difficult to recommend evidence-based surgical techniques. However, the anterior turbinoplasty seems to fulfil the preconditions of limited tissue reduction and mucosa-preservation and therefore it is the method of choice today. Radical resection of the turbinates may lead to severe functional disturbances developing a secondary atrophic rhinitis. The "empty nose" syndrome is a specific entity within the secondary atrophic rhinitis where intranasal changes in airflow result in disturbed climatisation and also interferes with pulmonary function. Results deriving from an actual in vivo study of climatisation and airflow in "empty nose" patients are presented.

Alterations in epithelial barrier function and host defense responses in chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is characterized by a chronic symptomatic inflammation of the nasal and paranasal sinus mucosae and is one of the most frequently reported chronic diseases in the United States, with an estimated prevalence of greater than 10% of the general population. Although the pathogenesis of CRS remains poorly understood, there is evidence for a role of bacteria and fungi, as well as the presence of a robust adaptive immune response in the upper airways and sinuses. Recent studies of CRS, as well as several other diseases in the skin and respiratory epithelium, have uncovered evidence that deficiencies in epithelial immune barrier function might compromise the interaction between the host and external immune stimuli. Recent studies suggest the hypothesis that reduced expression of antimicrobial S100 proteins, particularly psoriasin and calprotectin, might lead to increased susceptibility to bacterial and fungal colonization in patients with CRS. The main emphasis of this review will be to highlight the current literature that suggests that a defect in the expression of a broad set of epithelially derived genes might lead to barrier compromise and subsequently a dysfunctional host immune response to environmental agents in patients with CRS.

Interindividual variability in nasal filtration as a function of nasal cavity geometry.

BACKGROUND: Interindividual variability in nasal filtration is significant due to interindividual differences in nasal anatomy and breathing rate. Two important consequences arise from this variation among humans. First, devices for nasal drug delivery may furnish quite different doses in the nasal passages of different individuals, leading to different responses to therapeutic treatment. Second, people with poor nasal filtration may be more susceptible to adverse health effects when exposed to airborne particulate matter (PM) due to greater lung deposition. Although interindividual variability of nasal filtration has been reported by several authors, a relationship for predicting filtration efficiency from nasal anatomy and ventilation is still lacking. Such a relationship is needed to (1) devise nasal drug delivery systems and (2) define limits of exposure to PM that are effective for the human population at large. METHODS: Anatomically correct nasal replicas of five adults (four healthy individuals and one atrophic rhinitis patient) were used in aerosol experiments to measure nasal deposition of 1-12-microm particles. The dependence of nasal filtration on nasal anatomy and breathing rate was investigated using various definitions of the Stokes number as well as phenomenological Impaction Parameters proposed in the literature. RESULTS: Interindividual variability among the healthy adults was nearly eliminated when nasal filtration was plotted against a specific definition of the Stokes number or against a pressure-based Impaction Parameter. Nasal filtration in the atrophic rhinitis patient was lower than in the healthy subjects. CONCLUSIONS: The new definition of the Stokes number introduced in this study, which is based on a new definition of the characteristic diameter of the nasal passages, nearly eliminated interindividual differences in nasal filtration. Our results suggest that it is possible to estimate nasal filtering efficiency using measurements of transnasal pressure drop.

Empty nose syndrome: what are we really talking about?

The problem with empty nose syndrome is probably not that it does not exist, it is that we cannot adequately explain its existence by what we currently understand about the nose. The result of empty nose syndrome or iatrogenic atrophic rhinitis as a consequence of turbinectomy remains a controversial topic that deserves further scrutiny. It is clear from the literature, that not everyone undergoing a turbinectomy procedure suffers from the debilitating symptoms of either atrophic rhinitis or empty nose syndrome. Thus, it behooves us to evaluate this latter entity with a more critical eye, so that we can avoid creating future sufferers and provide relief to those who have already been afflicted.

The diagnosis and management of empty nose syndrome.

Empty nose syndrome (ENS) is a poorly understood and rare iatrogenic disorder resulting from the destruction of normal nasal tissue. In severe forms, it can be debilitating. In this article, the authors elucidate the distinction between ENS and atrophic rhinitis, and provide a systematic approach to the diagnosis and management of ENS. They urge a judicious and cautious approach to turbinate resection, to help better prevent this sequela of nasal surgery. They state that patients with ENS can be rehabilitated and their quality of life substantially improved with nasal augmentation as a means to help restore nasal anatomy toward the premorbid state.

Atrophic rhinitis: a CFD study of air conditioning in the nasal cavity.

Atrophic rhinitis is a chronic disease of the nasal mucosa. The disease is characterized by abnormally wide nasal cavities, and its main symptoms are dryness, crusting, atrophy, fetor, and a paradoxical sensation of nasal congestion. The etiology of the disease remains unknown. Here, we propose that excessive evaporation of the mucous layer is the basis for the relentless nature of this disease. Airflow and water and heat transport were simulated using computational fluid dynamics (CFD) techniques. The nasal geometry of an atrophic rhinitis patient was acquired from computed tomography scans before and after a procedure to narrow the nasal cavity. Simulations of air conditioning in the atrophic nose were compared with similar computations performed within the nasal geometries of four healthy humans. The excessively wide cavity of the patient generated abnormal flow patterns, which led to abnormal patterns of water fluxes across the wall. Geometrically, the atrophic nose had a much lower surface area than the healthy nasal passages, which increased water fluxes per unit area. Nevertheless, the simulations indicated that the atrophic nose did not condition inspired air as effectively as the healthy geometries. These simulations of water transport in the nasal cavity are consistent with the hypothesis that excessive evaporation of mucus plays a key role in the pathophysiology of atrophic rhinitis. We conclude that the main goals of a surgery to treat atrophic rhinitis should be 1) to restore the original surface area of the nose, 2) to restore the physiological airflow distribution, and 3) to create symmetric cavities.

Do chronic changes in nasal airflow have any physiological or pathological effect on the nose and paranasal sinuses? A systematic review.

.A reduction in nasal airflow associated with anatomical defects of the nose such as nasal septal deviation has been proposed to cause nasal pathology. . The majority of animal experiments where one nasal passage is surgically closed over several months report only minor changes in the histology of the nasal epithelium and no rhinitis or sinusitis. .Complete abolition of nasal airflow associated with laryngectomy or the treatment of atrophic rhinitis is not associated with the development of rhinitis or sinusitis. . Radiological studies have shown a lack of association between the degree of nasal septal deviation and evidence of rhinosinusitis. .Such studies provide evidence that reduced nasal airflow causes no significant nasal disease. . There is no convincing evidence that a reduction in nasal airflow is a causative factor for rhinitis or sinusitis.

Association of growth performance with atrophic rhinitis and pneumonia detected at slaughter in a conventional pig herd in Hungary.

The influence of atrophic rhinitis (AR) and pneumonia on growth performance was assessed in a conventional farrow-to-finish pig farm affected by both diseases. All tested pigs (n = 138) were individually weighed at birth, at weaning, at moving to the growing/finishing unit, and at slaughtering. The extent (grade) of turbinate atrophy and lung consolidation attributable to pneumonia was determined in each pig at slaughter. A negative correlation was found between birth weight and the prevalence of nasal lesions at slaughter, suggesting that pigs born with smaller weight may be more susceptible to AR. The growth performance of the pigs also showed a negative correlation with the degree of turbinate atrophy. In the nursery period, the average daily gain (ADG) of pigs with moderate/severe turbinate atrophy was 13.3% lower than that of animals with healthy snouts. In the finishing period, pigs with mild AR lesions had an ADG reduction of 6.2%, while pigs with severe AR lesions had a significant, 9.4% reduction in ADG as compared to the AR-free pigs. The extent of weight gain reduction over the whole life cycle was very similar (approximately 6%) in the pigs having either AR or pneumonia alone. In those pigs where both respiratory diseases were present, their effects seemed to be added up (11.5%); however, nasal lesion scores and percentage of lung consolidation did not show statistically apparent interactive effects on growth performance.

[Comparison of the mucociliary transport rate of rhinitis sicca and atrophic rhinitis].

OBJECTIVE: To study the mucociliary transport function of rhinitis sicca and atrophic rhinitis, and to explore the standard of diagnosis. METHOD: The MTR of normal control group, the rhinitis sicca group and the atrophic rhinitis were determined by using saccharin, and then compared. Then MTR of rhinitis sicca treatment group were compared before and after treatment. RESULT: The MTR of normal group: (9.15 +/- 0.86) mm/min; the rhinitis sicca group: (5.84 +/- 0.48) mm/min and the atrophic rhinitis group: (3.36 +/- 0.07) mm/min. There were significant difference among them (P < 0.05). 25 patients of rhinitis sicca were treated by administering the pill of Gelomyrtol forte in 2 weeks. The MTR of rhinitis sicca were no significant difference before and after treatment (P > 0.05). CONCLUSION: Rhinitis sicca is a separate nasal disease, which is different from atrophic rhinitis. It is important to find an effective treatment for the disease.

Characterization and comparison of Pasteurella multocida strains associated with porcine pneumonia and atrophic rhinitis.

One hundred and fifty-eight porcine strains of Pasteurella multocida, recovered primarily from cases of pneumonic pasteurellosis or progressive atrophic rhinitis (PAR) in England and Wales, were characterized by determination of their capsular types, presence or absence of the toxA gene and molecular mass heterogeneity of the heat-modifiable (OmpA) and porin (OmpH) proteins. Eighteen groups (clones) of strains were identified on the basis of specific combinations of capsular type, toxA status and outer-membrane protein (OMP)-type. The data provided evidence that different subpopulations of P. multocida are responsible for pneumonia and PAR in pigs. The majority (88 %) of cases of pneumonia were associated exclusively with non-toxigenic capsular type A strains of OMP-types 1.1, 2.1, 3.1 and 5.1 and capsular type D isolates of OMP-type 6.1. These strains were recovered from widespread geographical locations within England and Wales over a 12-year period and represented mostly single sporadic cases. The association of a small number of P. multocida variants with the majority of cases of porcine pneumonia suggests that these strains are not opportunistic pathogens of low virulence but represent primary pathogens with a relatively high degree of virulence. In contrast, the majority (76 %) of cases of PAR were associated with toxA-containing capsular type D strains of OMP-type 4.1 and capsular type A and D strains of OMP-type 6.1. Toxigenic capsular type A strains associated with PAR and non-toxigenic capsular type A strains associated with pneumonia represent distinct subpopulations of P. multocida that can be differentiated by their OMP-types. The association of capsular types A and D with strains of the same OMP-types, and the absence and presence of the toxA gene in strains of the same OMP-types, suggest that horizontal transfer of capsular biosynthesis and toxA genes has occurred between strains representing certain subpopulations of P. multocida.

Progressive atrophic rhinitis in a medium-scale pig farm in Kiambu, Kenya.

Forty-two pigs in a herd of 117 displayed various clinical signs of progressive atrophic rhinitis. The main signs included sneezing, coughing, lachrymation, serous to mucopurulent nasal discharge, and nasal bleeding in 1 pig. Three pigs had lateral deviation of the snout, while 4 had brachygnathia superior with obvious deformation of the face. Four acutely affected weaner pigs appeared weak, while the 7 chronically-affected pigs appeared smaller than their apparently unaffected penmates of the same age. Treatment of the acutely affected pigs with long-acting oxytetracycline at 20 mg/kg body weight intramuscularly, repeated once after 7 days, reduced the severity but did not clear the sneezing from all the pigs. Fifteen pigs were slaughtered 2 months after the clinical diagnosis was made. The carcasses of the chronically affected pigs were about 15% lighter than those of the apparently normal pigs of the same age and from the same pen, which translated to a loss of 921.00 Kenya shillings per pig (US$13.7). Diagnosis of progressive atrophic rhinitis was confirmed by sectioning the snouts of randomly selected slaughtered pigs with obvious deformation of the snout. Sections were made at the level of the 1st/2nd upper premolar tooth. Varying degrees of turbinate atrophy, from mild to complete, were noted. Histopathology of the turbinates revealed metaplasia of nasal epithelium and fibrosis in the lamina propria.

Application of endoscopic sinus surgery to primary atrophic rhinitis? A clinical trial.

The aetiology of primary atrophic rhinitis (AR) is still unclear. Based on the sinus infection theories, endoscopic sinus surgery (ESS) was applied to treat AR. ESS was performed on 14 patients following Stammberger's techniques along with middle turbinectomy. Patients were evaluated using clinical symptoms, radiological sinus images, saccharine time tests, bacterial cultures and mucosal ultrastructures, before and 2 years after ESS. Three patients had good recoveries, 6 had partial recoveries and another 5 had persistent disease. Good recovery patients showed clear nasal cavities and mucociliary transport system normalisation. Patients possess in meagre infectious signs or crusting extending to their nasopharynx had poor outcomes. Patients with evidence of obvious infections (cloudy sinus images, mucopus presence in the sinuses and positive culture for Klebsiella ozaenae) had good recoveries following ESS. Candidate selection is critical for the success of ESS treatment in AR. Although further clinical trials are required to prove this strategy.

[Clinical and microbiological investigations of atrophic rhinitis of Upper Austrian swine herds]. / Klinische und mikrobiologische Untersuchungen über die Rhinitis atrophicans in oberösterreichischen Schweinebeständen.

The aim of this study was to determine the distribution of the progressive and non-progressive atrophic rhinitis of Upper Austrian swine herds. Further on the resistance pattern of the pathogens involved to chemotherapeutics was tested. In the period of May 1993 to June 1996 a total of 56 Upper Austrian swine herds were examined and on the occasion of the animal herd health management 997 nasal swab-samples of young pigs taken. The area of this investigation included 14 Upper Austrian districts and the herds examined were divided into 3 types. Type 1 were swine herds of the swine breeding association (SZV), type 2 piglet producing farms (FP) and type 3 closed swine herds (GB). Sucking- and weaning piglets aged from 4 to 10 weeks were selected for these examinations. On the average 10 nasal swab-samples (2 swabs per animal) per herd were taken, microbiologically examined and the toxin by means of ELISA-tests determined. In terms of resistance testing (antibiogram) 20 different chemotherapeutics, which consisted of 11 different groups of drugs, were used. As a result of 997 nasal swab-samples examined, 304 (30.5%) P. m., 111 (11.1%) tox. P. m. and 35 (3.5%) B. b. were isolated. 50% of the Upper Austrian swine herds showed PAR by means of microbiological examination and ELISA-tests as well. The resistance pattern of P. m. and B. b. exhibited significant differences. Penicillin and lincospectin were highly resistant concerning isolates of B. b., but were highly sensitive for P. m. Enrofloxacin turned out as the most effective drug to the P. m.-toxin-negative- and B. b.-strains tested, because no resistance was observed. Finally efficient PAR control programmes of swine herds belonging to the Upper Austrian swine herd health service are described.