EAACI Position paper on the standardization of nasal allergen challenges.

Nasal allergen challenge (NAC) is an important tool to diagnose allergic rhinitis. In daily clinical routine, experimentally, or when measuring therapeutic success clinically, nasal allergen challenge is fundamental. It is further one of the key diagnostic tools when initiating specific allergen immunotherapy. So far, national recommendations offered guidance on its execution; however, international divergence left many questions unanswered. These differences in the literature caused EAACI to initiate a task force to answer unmet needs and find a consensus in executing nasal allergen challenge. On the basis of a systematic review containing nasal allergen challenges of the past years, task force members reviewed evidence, discussed open issues, and studied variations of several subjective and objective assessment parameters to propose a standardized way of a nasal allergen challenge procedure in clinical practice. Besides an update on indications, contraindications, and preparations for the test procedure, main recommendations are a bilaterally challenge with standardized allergens, with a spray device offering 0.1 mL per nostril. A systematic catalogue for positivity criteria is given for the variety of established subjective and objective assessment methods as well as a schedule for the challenge procedure. The task force recommends a unified protocol for NAC for daily clinical practice, aiming at eliminating the previous difficulty of comparing NAC results due to unmet needs.

Non-allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology.

This EAACI position paper aims at providing a state-of-the-art overview on nonallergic rhinitis (NAR). A significant number of patients suffering from persistent rhinitis are defined as nonallergic noninfectious rhinitis (NANIR) patients, often denominated in short as having NAR. NAR is defined as a symptomatic inflammation of the nasal mucosa with the presence of a minimum of two nasal symptoms such as nasal obstruction, rhinorrhea, sneezing, and/or itchy nose, without clinical evidence of endonasal infection and without systemic signs of sensitization to inhalant allergens. Symptoms of NAR may have a wide range of severity and be either continuously present and/or induced by exposure to unspecific triggers, also called nasal hyperresponsiveness (NHR). NHR represents a clinical feature of both AR and NAR patients. NAR involves different subgroups: drug-induced rhinitis, (nonallergic) occupational rhinitis, hormonal rhinitis (including pregnancy rhinitis), gustatory rhinitis, senile rhinitis, and idiopathic rhinitis (IR). NAR should be distinguished from those rhinitis patients with an allergic reaction confined to the nasal mucosa, also called "entopy" or local allergic rhinitis (LAR). We here provide an overview of the current consensus on phenotypes of NAR, recommendations for diagnosis, a treatment algorithm, and defining the unmet needs in this neglected area of research.

Smell functions in patients with multiple sclerosis: a prospective case-control study.

Smell functions in patients with multiple sclerosis: a prospective case-control study. OBJECTIVES: The aim of this study is to evaluate the smell function in patients with multiple sclerosis (MS). METHODS: Twenty subjects (six males, 14 females) who were diagnosed as having MS, based on the 2010 Revised McDonald criteria, and 20 healthy individuals (six males, 14 females) were included in this study. In order to measure smell identification abilities, each subject completed the 12-item Brief Smell Identification Test (BSIT). Central and peripheral regions of smell were measured using cranial magnetic resonance (MR) images. The central regions of smell (the temporal lobe insular gyrus and the corpus amygdala) and the peripheral regions of smell (the olfactory bulb, tract and sulcus) were examined in the cranial MR images. Regions of smell were also evaluated for the presence of MS lesions (plaques). RESULTS: The total BSIT scores of the subjects in the MS group were found to be significantly lower than those of the control group (p<0.05). In the MS group, measurement values of the central regions of smell (right corpus amygdala diameter, right and left corpus amygdala) were significantly higher than those of the control group (p<0.05). There were no MS 'lesions in the peripheral regions of smell, but MS lesions were observed in the central regions: the right temporal lobe insular gyrus (four patients, 20.0%); the left temporal lobe insular gyrus (two patients, 10.0%); and the right corpus amygdala (one patient, 5.0%). While these results are not sufficient for statistical analysis, the total smell scores of these patients were found to be low. CONCLUSION: There is a deterioration in the smell functions of patients with MS. Therefore, we highly recommend that ENT specialists use the easily accessible and reliable BSIT for the diagnosis of smell disorders.

Do viral infections have a role in benign paroxysmal positional vertigo?

OBJECTIVES: To investigate the role of viral infection in benign paroxysmal positional vertigo (BPPV). METHODS: In this retrospective study, 483 patients with BPPV were included in the study group. The control group consisted of 461 healthy subjects. In both groups, serologic analysis of viral agents (HSV1, HSV2, Herpes zoster, EBV, CMV, adenovirus, influenza, and parainfluenza virus) was performed. RESULTS: With the exception of influenza and parainfluenza, all viral serology values were higher in the BBPV group than the control group. We also observed seasonal variation. The BPPV group exhibited elevated values for HSV1 and adenovirus in March and May, for Herpes zoster, adenovirus, and influenza in April, for HSV1 in June, and for HSV1 and CMV in September, compared to the control group. In October, the BPPV group showed increased values for all of the viruses studied, compared to the control group. CONCLUSION: BPPV is associated with positive viral serology, particularly during certain months of the year, mainly in spring and autumn. Viral infection might promote BPPV attacks due to the development of vestibulopathy or induce secondary BPPV via viral infection-related neurolabyrinthitis.

Nasal septal body and inferior turbinate sizes differ in subjects grouped by sex and age.

OBJECTIVES: To compare the size of the nasal septal body (SB) and inferior turbinate (IT) of subjects grouped by sex and age. METHOD: We measured SB and IT areas (in cm2) bilaterally in computed tomography (CT) sections of 150 para nasal sinuses from 72 males and 78 females. RESULTS: The right and left SB areas were smaller in females than in males. In the s25-year-old group, the right IT (RIT) was significantly smaller in females than in males. In the 26-35 and 46-45 age groups, the right SB (RSB) was significantly smaller in females than in males. CONCLUSION: The nasal SB may play a role in nasal physiology similar to a turbinate and help support optimal airflow. The vascular and glandular structures of the SB should be investigated in detail, and minimal invasive procedures should be performed in nasal surgery to avoid damaging essential structures.

Milestones of language development in Turkish children.

OBJECTIVES: Language delays are common in childhood, may be associated with delays in other areas of development, and can affect school performance. Various tests designed for general developmental screening or specifically for language are used to assess developmental status in preschool children. Knowledge of the probabilities of normal developmental milestones may simplify detection of problems and delays. The aim of this study was to determine the milestones of language development in Turkish children. PATIENTS AND METHODS: We assessed data from application of the Denver II Developmental Screening Test's Turkish standardization to 1,993 children, 976 (49.0%) boys and 1,017 (51.0%) girls aged 0.6-82.0 months. We used binary logistic regression to analyze the predicted probability of accomplishing the language items on the Denver II Developmental Screening Test. RESULTS: We determined the sequence of assessed language items and the ages associated with accomplishing those items, as well as the ages at which 25, 50, 75, and 100% of children passed the items. Language items followed a sequential route. Graphs had polynomial slopes. CONCLUSION: Curves for normal development allow detection of aberrations in the predicted course of language development, and may facilitate earlier diagnosis of delays in language.

Treatment of rhinophyma with radiofrequency: a case report.

PROBLEM: Rhinophyma is characterized by a slow progressive enlargement of the nasal skin that cannot resolve spontaneously. Clinically, the lower two-thirds of the nose becomes enlarged and hypervascular, developing a reddish-purple discoloration and a nodular appearance. It is believed that rhinophyma represents the end stage of acne rosacea. The treatment modalities are medical and surgical. CASE: This study describes a 62-year-old man with rhinophyma that was treated with a radiofrequency technique. The pathological examination was compatible with acne rosacea. After surgery, a broad-spectrum sunscreen was applied until reepithelialization was complete. CONCLUSION: We recommend the radiofrequency technique for treatment of rhinophyma.

Effects of subjective tinnitus on sleep quality and Mini Mental Status Examination scores.

OBJECTIVES: We investigated the effects of subjective tinnitus on sleep quality and Mini Mental Status Examination (MMSE) scores of participants. METHODS: The study group consisted of 15 patients, including 21 ears with tinnitus (6 bilateral, 9 unilateral). The control group consisted of 8 healthy patients with normal hearing and no tinnitus (16 ears). We assessed sleep quality using the Mini Sleep Questionnaire (MSQ) and mental health using the MMSE. RESULTS: Sleep delay (SD) was significantly higher in tinnitus patients (5.28 +/- 2.23) compared to controls (3.25 +/- 2.56) (p = 0.018). Subjective tinnitus loudness level (STLL) scores were higher and sleep quality was impaired in females, older patients, and patients with lower MMSE scores. Sleep quality was also worse in patients with longer tinnitus duration. In younger and well educated patients, MMSE scores were higher. Higher STLL scores and shorter tinnitus duration were associated with lower MMSE scores. Patients with newly developed tinnitus reported more disturbances and showed greater effects on mental and cognitive functioning. CONCLUSION: In subjective tinnitus patients, sleep delay values increased. Long tinnitus duration and high STLL scores may affects patients' cognitive functions as shown by decreased MMSE scores. Furthermore, mental status changes in tinnitus patients were frequently overlooked.

Is it possible to define the ideal lips?

SUMMARY: The lips are an essential component of the symmetry and aesthetics of the face. Cosmetic surgery to modify the lips has recently gained in popularity, but the results are in some cases disasterous. In this review, we describe the features of the ideal lips for an individual's face. The features of the ideal lips with respect to facial anatomy, important anatomical landmarks of the face, the facial proportions of the lips and ethnic and sexual differences are described. The projection and relative sizes of the upper and lower lips are as significant to lip aesthetics as the proportion of the lips to the rest of the facial structure. Robust, pouty lips are considered to be sexually attractive by both males and females. Horizontal thirds and the golden ratio describe the proportions that contribute to the beauty and attractiveness of the lips. In young Caucasians, the ideal ratio of the vertical height of the upper lip to that of the lower lip is 1:1.6. Blacks, genetically, have a greater lip volume. The shape and volume of a person's lips are of great importance in the perception of beauty by humans. The appearance of the lips in part determines the attractiveness of a person's face. In females, fuller lips in relation to facial width as well as greater vermilion height are considered to be attractive.

Multi-morbidities of allergic rhinitis in adults: European Academy of Allergy and Clinical Immunology Task Force Report.

This report has been prepared by the European Academy of Allergy and Clinical Immunology Task Force on Allergic Rhinitis (AR) comorbidities. The aim of this multidisciplinary European consensus document is to highlight the role of multimorbidities in the definition, classification, mechanisms, recommendations for diagnosis and treatment of AR, and to define the needs in this neglected area by a literature review. AR is a systemic allergic disease and is generally associated with numerous multi-morbid disorders, including asthma, eczema, food allergies, eosinophilic oesophagitis (EoE), conjunctivitis, chronic middle ear effusions, rhinosinusitis, adenoid hypertrophy, olfaction disorders, obstructive sleep apnea, disordered sleep and consequent behavioural and educational effects. This report provides up-to-date usable information to: (1) improve the knowledge and skills of allergists, so as to ultimately improve the overall quality of patient care; (2) to increase interest in this area; and (3) to present a unique contribution to the field of upper inflammatory disease.

The results of national newborn hearing screening (NNHS) data of 11,575 newborns from west part of Turkey.

OBJECTIVE: In this study, we aimed to review the National Newborn Hearing Screening (NNHS) programme data obtained from Corlu, located in west part of Turkey for the last 4 years. SUBJECTS AND METHODS: A total 11575 newborns that were either born in Çorlu State Hospital or referred from other Health Care Centers, between September 2009 and November 2012 were included into the study. Automated-Transient Evoked Otoacoustic Emission (A-TEOAE) test and Automated-Auditory Brainstem Response (A-ABR) were used as screening tests. When the newborn had failed at the initial A-TEOAE test, then the test was repeated after 15 days. If the same result was obtained at the second test; the newborns were referred for ENT examination. A-TEOAE and A-ABR screening tests were performed as the third stage evaluation. The failed newborns were referred for clinical ABR test. RESULTS: Out of 11575 newborns, 593 (5.12%) had failed the test and they were referred for clinical ABR. Out of these 593 neonates, 470 had passed the diagnostic ABR test at the referral center. Bilateral and unilateral sensori-neural hearing loss (SNHL) was detected at 15 and 7 babies respectively, 10 of 22 of these babies had risk factors such as family history of hearing loss, and parental consanguinity. CONCLUSIONS: The final hearing impairment and risk factor rates of our study was similar with literature. Although referral rates and the number of default babies gradually decreased in the last 4 years; definitive diagnosis and hearing aid initiation times need to improvement.