The evaluation of pattern and quality of sleep in patients with chronic rhinosinusitis with nasal polyps.

OBJECTIVE: The goal of this study is to evaluate the impact of chronic rhinosinusitis with nasal polyps (CRSwNP) on sleep pattern and sleep quality before and after functional endoscopic sinus surgery using subjective and objective parameters. METHODS: Twenty-two patients with CRSwNP were evaluated. All subjects underwent assessment by nasal endoscopy, rhinomanometry and computed tomography. Sleep pattern and sleep quality were evaluated by Pittsburgh sleep quality index (PSQI) and polysomnography (PSG). All patients were reassessed 6 months after surgery. RESULTS: Nasal resistance decreased after the surgery (p<0.001). Postoperative PSQI scores were significantly lower than preoperative scores (p<0.001). The preoperative mean values of total apnea index and apnea-hypopnea index were 25.4 and 13.3, respectively. After surgery, the total apnea and apnea-hypopnea index had decreased significantly to 7.8 and 11.2, respectively (p=0.009 and 0.019, respectively). CONCLUSION: In patients with CRSwNP, functional endoscopic sinus surgery significantly ameliorates sleep pattern and sleep quality. CRSwNP may be a predisposing factor for sleep related respiratory disorders.

The "physician on call patient engagement trial" (POPET): measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients.

BACKGROUND: In this prospective, multicenter, randomized, controlled, double-blind study, we investigated the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis (AR) and asthma patients. METHODS: In total, 327 patients with diagnoses of persistent AR or mild-to-severe persistent asthma were randomized into 2 intervention groups and 2 control groups upon their admission at outpatient clinics. The intervention groups (POPET-AR and POPET-Asthma) received a mobile phone application ("physician on call patient engagement trial" [POPET]), enabling them to communicate with their physician, and record their health status and medication compliance. The AR groups completed the Rhinitis Quality of Life Questionnaire (RQLQ) at initiation and at the first month of the study. The asthma groups completed the Asthma Control Test (ACT) at initiation and at the third month of the study. RESULTS: The POPET-AR group showed better clinical improvement than the control group in terms of the overall RQLQ score as well in measures of general problems, activity, symptoms other than nose/eye, and emotion domains (p < 0.05). In the POPET-Asthma group, more patients (49%) achieved a well-controlled asthma score (ACT > 19) compared with the control group (27%); this was statistically significant (p < 0.05). CONCLUSION: Use of a mobile engagement platform, such as POPET, can have a significant impact on health outcomes and quality of life in both AR and asthma, potentially decreasing the number of hospital admissions, repeat doctor visits, and losses in productivity. Improvements were seen in domains related to activity, productivity, perception of disease, and emotion.

Effects of thymoquinone and montelukast on sinonasal ciliary beat frequency.

BACKGROUND: Herbal remedies predate written history and continue to be used more frequently than conventional pharmaceutical medications. Thymoquinone (TQ) is a traditional herb that has been used for its anti-inflammatory, antioxidant, and chemopreventive effects. Montelukast is a conventional medication used to treat allergic rhinitis and asthma. The aim of this research was to evaluate the effects of TQ and montelukast on human respiratory epithelium specifically addressing effects on cilia beat frequency (CBF). METHODS: Well-differentiated human sinonasal epithelial cultures, grown at an air-liquid interface were treated with varying concentrations of TQ and montelukast. Changes in CBF were determined using the Sissons-Ammons Video Analysis system. RESULTS: When applied to the basolateral surface, TQ showed a statistically significant dose-dependent increase in CBF with maximal stimulation at 30 minutes. Effects of montelukast on CBF showed both time and dose dependence with maximal stimulatory effect measured at 6 hours. CONCLUSION: The results of our study indicate that TQ and montelukast have dose-dependent effects on CBF, extending their mechanism of action in respiratory diseases.

Nonmelanoma skin cancer of the head and neck: surgical treatment.

This article focuses on the surgical treatment of nonmelanoma skin cancers of the head and neck. The risk factors of nonmelanoma skin cancers for recurrence and metastases that are important for choosing the best treatment option are summarized. Surgical treatment options including surgical excision with standard margins, frozen section, staged surgery, and Mohs micrographic surgery are described. Indications, techniques, outcomes, and advantages and disadvantages of each approach are reviewed. Finally, management of incomplete excisions is discussed.

Nonmelanoma skin cancer of the head and neck: prevention.

The importance and effectiveness of prevention efforts and strategies for skin cancers are reviewed. Topical sunscreens and their proper use are presented. Topical and ingested forms of natural, synthetic, or biologic chemical agents that are potentially efficacious for chemoprevention are listtdldted and discussed.

Chronic inflammation: a poor prognostic factor for endoscopic dacryocystorhinostomy.

Endoscopic endonasal dacryocystorhinostomy (En-DCR) success can be affected by many factors. In this study, we aimed to determine the effect of chronic inflammation on the surgical outcome of En-DCR. A series of 25 primary En-DCR cases and their lacrimal sac specimens were involved in the study. The surgical outcomes were assessed subjectively (satisfied and unsatisfied) and objectively (successful and unsuccessful). All the specimens were examined for the chronic inflammation related histopathological features (inflammatory cell infiltration, fibrosis and capillary proliferation) and graded according to their severity. Moreover, a "chronic inflammation score" was established to determine the intensity of chronic inflammation using the grade of histopathological features. A quantitative and statistical analysis of histopathological features and chronic inflammation were performed between patients with satisfactory and unsatisfactory outcome; and patients with successful and unsuccessful outcome. The overall success rate according to subjective and objective assessment was 60%. However, 9 of 10 patients with unsatisfactory and/or unsuccessful outcome (90%) had severe chronic inflammation of lacrimal sac. In subjective assessment, inflammatory cell infiltration (p = 0.050), fibrosis (p = 0.037), capillary proliferation (p = 0.007) and chronic inflammation (p = 0.003) had a statistically significant difference between patients with satisfactory and unsatisfactory outcome. In objective assessment, statistically significant differences were detected between patients with successful and unsuccessful outcome when they compared according to inflammatory cell infiltration (p = 0.027), capillary proliferation (p = 0.007) and chronic inflammation (p = 0.003). Chronic inflammation related histopathological features of variable degree may have a role on En-DCR outcome. Chronic inflammatory score can be used as an indicator of En-DCR success.

The histopathological effect of thymoquinone on experimentally induced rhinosinusitis in rats.

BACKGROUND: Rhinosinusitis is a common disorder and its treatment includes a variety of topical and systemic drugs. This study was designed to determine the histopathological effect of thymoquinone on experimentally induced rhinosinusitis in rats. METHODS: Sixty rats were randomly allocated into 3 test and 2 control groups, each of which consisted of 12 animals. The rhinosinusitis model was induced using intranasal application of platelet-activating factor. In test groups, the animals were separated into groups: (1) rhinosinusitis-antibiotherapy, (2) rhinosinusitis-thymoquinone, (3) rhinosinusitis-combination therapy. The positive and negative control groups were defined: rhinosinusitis group without any treatment and the group without rhinosinusitis, respectively. The histopathological features (vascular congestion, inflammation, and epithelial injury) in nasal respiratory and olfactory mucosa of animals were examined and graded according to their severity. A quantitative and statistical analysis of histopathological features was performed. RESULTS: All histopathological features showed statistically significant differences between negative and positive control groups, respectively. Conversely, neither the group with rhinosinusitis-antibiotherapy nor the group with rhinosinusitis-thymoquinone had a statistically significant difference with the negative control group. Moreover, none of the histopathological features showed a statistically significant difference, when the group with rhinosinusitis-antibiotherapy and the group with rhinosinusitis-thymoquinone were compared. A statistically significant difference was not determined when the group with rhinosinusitis-combination therapy was compared with the group with rhinosinusitis-thymoquinone. The histopathological features did not show a statistically significant difference between the group with combination therapy and the negative control Conclusion: Thymoquinone is a promising bioactive agent for the treatment of rhinosinusitis, and its histopathological effect is as equivalent as an antibiotic.

Impact of nasal polyposis on erectile dysfunction.

BACKGROUND: Our male patients with chronic rhinosinusitis with nasal polyposis (NP) declare a better sexual function after functional endoscopic sinus surgery (FESS) with polypectomy. This study was planned to conduct the first prospective, controlled trial evaluating the possible relation between erectile dysfunction (ED) and NP by subjective and objective parameters. METHODS: Thirty-three male patients with NP and thirty randomly selected male control subjects were evaluated. All subjects underwent assessments of nasal endoscopy, rhinomanometry, body mass index (BMI), Epworth Sleepiness Scale, full in-laboratory polysomnograpy and serum levels of glucose, thyroid hormones, lipid profile, and testosterone. ED was evaluated by the erectile function domain of the International Index of Erectile Function (IIEF-EF) subjectively and nocturnal penile tumescence (NPT) objectively. The NP group was reassessed 6 months after FESS. RESULTS: The mean age, BMI, and laboratory tests of the patients and the control subjects had no significant difference. The well-recognized risk factors for ED were eliminated. Preoperative evaluation of the patients revealed that ED was present in 34 and 24% of the patients by IIEF-EF and NPT, respectively, which was significantly higher than the control group (p = 0.009 and p = 0.018, respectively). There was a significant improvement of ED in the assessment of IIEF-EF and NPT postoperatively (p = 0.014 and p = 0.037, respectively). CONCLUSION: ED was determined in a high percentage of patients with NP and significantly ameliorated after FESS. NP might present a risk factor in the development of ED.

[Our experience in nasal reconstruction with local nasal and regional flaps]. / Nazal rekonstrüksiyonda lokal nazal ve bölgesel flep uygulamalarimiz.

OBJECTIVES: In this study, we evaluated the patients, who underwent nasal reconstruction with local nasal or regional flaps and compared our approach with the algorithms of nasal reconstruction in literature. PATIENTS AND METHODS: Twenty-seven patients (15 males, 12 females; mean age 68.7 years; range 42 to 86 years) who underwent nasal reconstruction with local nasal or regional flaps due to excision of skin cancers on the nose, between November 2007 and December 2009 were included in this study. The demographic data (age, sex and occupation), the location, histopathologic type, subtype and size of the tumor, the size and thickness of the defect area, the reconstruction technique and complications were recorded. All patients were photo-documented pre-, intra- and postoperatively, and were followed up at regular intervals. RESULTS: Basal cell carcinoma was detected in 23 patients and squamous cell carcinoma was detected in four patients. The tumors were most frequently located on the nasal dorsum (n=8, 29%) and the side walls (n=6, 22%). The tumor size was >15 mm in 14 (52%) patients. The size of the nasal defect was >20 mm in 18 (66%) patients. Reconstruction was performed with local nasal flaps in 10 patients and with regional flaps in 17 patients. CONCLUSION: The surgical flaps for nasal reconstruction should be selected individually. The ideal technique of nasal reconstruction should be determined based on the location, size, and thickness of the nasal defects, the preferences of the patients and the surgeon's experience.

Intranasal steroids or radiofrequency turbinoplasty in persistent allergic rhinitis: effects on quality of life and objective parameters.

Nasal congestion is a cardinal symptom of allergic rhinitis (AR). It is associated with decreased quality of life and difficult to treat as perceived by the patients. The purpose of this study is to evaluate the mid-term objective and subjective outcomes of management of nasal congestion using intranasal steroid (INS) therapy or radiofrequency turbinoplasty (RFT) in patients with persistent AR who have mucosal hypertrophy of the inferior turbinate. Fifty-five adult patients with AR, who claimed nasal congestion refractory to oral antihistamine (desloratadine) therapy, were randomized to INS (mometasone furoate) or temperature-controlled RFT treatment groups. Outcomes were determined by active anterior rhinomanometry, visual analog scale (VAS), and rhinoconjunctivitis quality of life questionnaire (RQLQ) at least 12 months after treatment. The median total nasal resistance decreased from 0.49 ± 0.17 to 0.39 ± 0.12 Pa/cm(3)/s (p = 0.42), and from 0.51 ± 0.18 to 0.29 ± 0.07 Pa/cm(3)/s (p = 0.003) with INS and RFT, respectively. RFT provided a better reduction in the perception of congestion in VAS scores. RQLQ scores improved significantly in both groups 1 year after treatment (mean follow-up 14.2 months) (p < 0.05). No adverse reactions were encountered in either group. Nasal congestion refractory to antihistamine appears to be improved by INS at some point, while reduced significantly by RFT in objective and subjective parameters. Both options are also effective in increasing the quality of life in patients with AR. RFT might be a safe and effective treatment of option in AR compared with INS.

A comparative analysis of the decongestive effect of oxymetazoline and xylometazoline in healthy subjects.

BACKGROUND: Oxymetazoline and xylometazoline are locally effective and direct acting drugs that relieve nasal congestion. The aim of this study was to objectively determine and compare the decongestive effects of oxymetazoline and xylometazoline in healthy subjects. METHODS: The study population comprised thirty healthy adults. All subjects underwent active anterior rhinomanometry (AARhm) and acoustic rhinometry (AR) tests following the application of oxymetazoline, xylometazoline, or placebo (physiological saline). The change in nasal resistance, nasal airflow, and different cross-sectional areas (CSAs) of the nasal cavity in the subjects were examined for each solution separately. The measurements were obtained over a 1-h period (baseline and 1, 15, 30, and 60 min post-dosing). All results were analyzed using the Kruskal-Wallis test and the Mann-Whitney U test. RESULTS: A total of 6,300 measurements of AARhm and AR were obtained. The application of placebo did not cause a statistically significant change in nasal resistance, nasal airflow, and CSAs (CSA1, 2, and 3, respectively) of the nasal cavity. In contrast, statistically significant changes in nasal resistance (inspiration p = 0.000 and p = 0.004; expiration p = 0.000 and p = 0.000), nasal airflow (inspiration p = 0.000 and p = 0.004; expiration p = 0.000 and p = 0.000), and CSAs of the nasal cavity (CSA2 p = 0.000 and p = 0.000, CSA3 p = 0.000 and p = 0.00), with the exception of CSA1 (p = 0.982 and p = 0.994), were obtained after the application of oxymetazoline and xylometazoline. A comparison of oxymetazoline and xylometazoline based on nasal resistance, nasal airflow, and CSAs of the nasal cavity demonstrated no statistically significant difference, except for CSA3. CONCLUSION: Oxymetazoline and xylometazoline are fast-acting and potent topical decongestants that have similar decongestive effects.

Does maxillary arch remodeling exist in nasal polyposis?

BACKGROUND: The potential transformation in the maxillary complex morphology is mostly complete during childhood. Recent studies suggest a nasal tissue remodeling both in the overlying mucosa and in the underlying sinus bone in nasal polyposis (NP). Our evaluation of computed tomography (CT) revealed that the maxillary arch is more flat and shallow in patients with chronic rhinosinusitis with NP. The purpose of this study was to determine the possible effects of NP to the maxillary arch morphology in adulthood and to investigate a possible remodeling of the maxillary bone during the course of NP. METHODS: A prospective study was performed on 25 patients. Grading of the polyps, acoustic rhinometry and rhinomanometry assessments, and CT scans were documented initially, 1 year after diagnosis, and 2 years postoperatively. Twenty-five subjects' CT scans randomly selected from our CT database formed the comparison group. The plane angle between the maxillary alveolar processes (MAP) and the palatine process of the maxillary bone (MPP), and the depth of the maxillary arch of both groups were compared. RESULTS: The results pointed out that the maxillary arch was shallower and the bilateral angles between MAP and MPP were significantly greater than those of the comparison group in all evaluation periods. This difference was less at the end of the postoperative follow-up period. CONCLUSION: Although it is a common belief that maxillofacial formation expires in childhood, this may not be the case under some special conditions such as NP in adulthood. NP might cause maxillary arch remodeling in adults.

Efficacy of leukotriene antagonists as concomitant therapy in allergic rhinitis.

OBJECTIVES/HYPOTHESIS: The symptoms of allergic rhinitis result from an immunoglobulin E-dependent mast cell activation cascade, marked by the release of inflammatory mediators, including histamine. Patients with perennial allergic rhinitis also have elevated levels of cysteinyl leukotrienes (CysLTs) in nasal lavage fluid. Histamine and CysLTs produce different responses in the pathogenesis of allergic rhinitis, and this study tested the hypothesis that the effects of combined antihistamine and leukotriene antagonist therapy would be more effective than antihistamine alone. STUDY DESIGN: Multicentered, prospective, randomized, placebo-controlled, parallel-group. METHODS: Three groups totaling 275 patients using: 1) fexofenadine alone, 2) fexofenadine with montelukast, or 3) fexofenadine with placebo, participated in a 21-day trial conducted during the spring pollen season. Objective analysis included pre- and poststudy physical examination findings and nasal resistance measurements. Subjective data gathered included a daily patient diary and pre- and poststudy patient satisfaction measurements. RESULTS: The group using both fexofenadine and montelukast showed significantly better control of nasal congestion both subjectively, using patient diary and visual analog scale evaluations, and objectively, using rhinomanometry and physical examination, compared to groups using antihistamine alone or with placebo. CONCLUSIONS: Our data provided both objective and subjective evidence that leukotriene receptor antagonist-antihistamine combination therapy is more effective than antihistamine alone in the control of allergic rhinitis symptoms.

Long-term results in endoscopic dacryocystorhinostomy: is intubation really required?

OBJECTIVE: The long-term (median follow-up eight years) results of endoscopic dacryocystorhinostomy approach and silicone intubation were evaluated by various aspects. STUDY DESIGN: Case series with planned data collection of 38 procedures for postsaccal stenosis were analyzed. SUBJECTS AND METHODS: Silicone intubation was not used in 19 of the randomly selected procedures. Anatomical and functional surgical success was evaluated subjectively and objectively. RESULTS: The patients' complaints improved in 84.2 percent of eyes in the intubation group, and in 94.7 percent of the group without intubation, with a mean follow-up of 112 and 96 months after surgery, respectively. Postoperative endoscopic examinations revealed that the rhinostomy opening was visible in 17 sides with intubation (89.5%) and 18 sides without intubation (94.7%). CONCLUSIONS: Considering the similar surgical success rates, and disadvantageous factors such as granulation formation, patient discomfort, and cost related to intubation, we recommend endoscopic dacryocystorhinostomy without intubation as the treatment of choice in cases of chronic epiphora due to postsaccal stenosis of the lacrimal drainage system.

Herpes zoster oticus associated with varicella zoster virus encephalitis.

Ramsay-Hunt syndrome, herpes zoster oticus (HZO), derived its name from James Ramsay Hunt, who first described it in 1907. It is classically characterized by acute peripheral facial paralysis, herpetic eruptions on the auricle, and vestibulocochlear dysfunction due to the reactivation of varicella zoster virus (VZV). In this Case Report, the authors describe an HZO patient with simultaneous VZV encephalitis. To date, only eight cases of HZO associated with VZV encephalitis have been reported in the English literature. Therefore, the authors discuss all the aspects of this rare entity, including clinical examination, radiological evaluation, laboratory evaluation, and treatment options.

Comparison of propofol and sevoflurane anesthesia by means of blood loss during endoscopic sinus surgery.

OBJECTIVE: The purpose of the present investigation is to examine whether induced hypotension with propofol or sevoflurane anesthesia improves the dryness of surgical field in endoscopic sinus surgery (ESS). METHODS: The study was performed between 1999 and 2002 in Celal Bayar University and Afyon Kocatepe University Hospitals, Turkey. Thirty-two patients (American Society of Anesthesiologists physical status I and III) with chronic sinusitis undergoing outpatient endoscopic sinus surgery under general anesthesia were studied to determine if anesthetic technique had an impact on estimated blood loss. The patients were allocated randomly into 2 groups. None of the patients were premedicated. Anesthesia was induced with propofol in both groups and maintained with propofol/fentanyl in the first group and sevoflurane/fentanyl in the second group. In both groups, controlled hypotension was used to improve surgical condition. RESULTS: There were no differences between the duration of surgery and intraoperative mean arterial blood pressure when comparing the 2 groups. The average estimated blood loss in the propofol group was 128.1 +/- 37.3 ml compared with an average estimated blood loss of 296.9 +/- 97.8 ml in the sevoflurane group (p<0.01). CONCLUSION: General anesthesia based on propofol infusion may have the advantage of decreased bleeding compared with conventional inhalation agents. Therefore, making endoscopic surgery technically easier and safer by improving endoscopic visualization of the surgical field.

Increased expression of angiogenic markers in patients with seasonal allergic rhinitis.

BACKGROUND: Increased vascularity due to neo-angiogenesis is an essential part of airway remodelling. Vascular endothelial growth factor (VEGF), CD34 and von Willebrand's factor (FvW) are known angiogenic markers. Angiogenesis and airway remodelling has been documented in asthma but not in allergic rhinitis. OBJECTIVE: We aimed to investigate the presence of increased angiogenesis and its relation to angiogenic molecules, namely VEGF, CD34 and FvW, in endothelial cells of nasal mucosa in patients with seasonal allergic rhinitis (SAR), using three different immunohistochemical analysis methods, namely HSCORE, microvessel density (MVD) and vascular surface density (VSD). The findings in allergic rhinitis were compared with the findings in nasal septal deviation (NSD), which is not associated with increased angiogenesis. METHODS: Twenty patients with symptomatic SAR, who were not under treatment, were enrolled in the study. Ten patients with NSD, who needed surgical therapy, served as the control group. Demographic characteristics did not differ between the two groups. Inferior turbinate biopsy was obtained from SAR patients and control patients, under local anaesthesia and during surgery respectively. All biopsies were evaluated for angiogenesis on the basis of VEGF, CD34 and FvW by two blinded histologists using three immunohistochemical analysis methods (HSCORE, MVD and VSD).Results. HSCORE, estimated on the basis of each staining technique, showed statistically significant differences among the two groups (p=0.002; p=0.045; p=0.016, respectively). Anti-CD34 and anti-VEGF showed higher MVD values in SAR when compared to the controls (p=0.038; p=0,009, respectively). No statistically significant difference was found in Anti-FvW-based MVD between SAR patients and controls (p=0.071). The measurements of VSD for FvW and VEGF from nasal biopsy specimens displayed a statistically significant difference between the two groups (p=0.004; p=0.0001, respectively). However, measurement of VSD for CD-34 was not significantly different between the groups (p=0.086). On the other hand, morphometric data obtained by all three methods did not correlated. CONCLUSION: There are a few studies that have investigated the essential role of angiogenesis in the pathogenesis of allergic rhinitis. We conclude that, increased angiogenesis may be as prominent in patients with allergic rhinitis as in patients with non-allergic nasal pathologies and may play an important role in the remodelling of nasal mucosa of subjects with SAR.