Clinical-Cytological-Grading and phenotyping in patients with chronic rhinosinusitis with nasal polyps: the relevance in clinical practice.

Chronic rhinosinusitis (CRS) includes two main phenotypes: without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP). CRSwNP may be associated with comorbidity, mainly concerning asthma, aspirin intolerance, and allergy. CRSwNP patients may also be evaluated by clinical-cytological grading (CCG). The current study investigated the prevalence and characteristics of the different CCG and phenotypes in CRSwNP outpatients examined in clinical practice. This retrospective cross-sectional study enrolled 791 consecutive CRSwNP outpatients (424 males, mean age 48.8 years). In the total population, asthma was a common comorbidity (30.8%) as well as aspirin intolerance (24.8%), and allergy (50.8%). As concerns CCG-grading, 210 (26.5%) outpatients had low-grade, 366 (46.3%) medium, and 215 (27.2%) high. As regards cytological phenotypes, 87 (11%) had neutrophilic type, 371 (46.3%) eosinophilic, 112 (14.2%) mast cell, and 221 (27.9%) mixed. High-grade CCG was significantly associated with more frequent asthma, aspirin intolerance, allergy, recurrent surgery, and mixed cytological phenotype. Low-grade CCG was characterized by fewer comorbidities and operations, and neutrophilic phenotype. Therefore, the present study confirmed that CCG is a useful tool in the management of outpatients with CRSwNP. CRSwNP is frequently associated with asthma, aspirin intolerance, and allergy comorbidity. High-grade CCG is frequently characterized by a mixed cytological phenotype, thus, by more severe progress. These real-world outcomes underline that CRSwNP deserves adequate attention for careful management and optimal identification of the best-tailored therapy; CCG and cytological phenotyping could be fruitful tools in clinical practice. Asthma and aspirin intolerance should be adequately investigated in all CRS patients.

Dental Disorders and Salivary Changes in Patients with Laryngopharyngeal Reflux.

Background: Laryngopharyngeal reflux (LPR) is a common inflammatory condition of the upper aerodigestive tract tissues related to the effects of gastroduodenal content reflux, characterized by a wide variety of clinical manifestations. The aim of our study was to evaluate the possible association between dental disorders and LRP, focusing on the role of salivary changes. Methods: Patient's dental status was evaluated according to Schiff Index Sensitivity Scale (SISS), Basic Erosive Wear Examination (BEWE) and Decayed, Missing, and Filled Teeth (DMFT) scores. Reflux-associated symptoms were assessed according to Reflux symptom index (RSI). A qualitative and quantitative examination of saliva was performed. Results: Patients suffering from LPR had a higher incidence of dental disorders, regardless the presence of salivary pepsin, and thus, statistically significant higher scores of RSI (p = 0.0001), SISS (p = 0.001), BEWE (p < 0.001) and VAS (p < 0.001). Moreover, they had lower salivary flow compared with healthy patients. Conclusions: The finding of demineralization and dental caries on intraoral evaluation must raise the suspicion of LRP. Reflux treatments should also be aimed at correcting salivary alterations, in order to preserve the buffering capacity and salivary pH, thus preventing mucosal and dental damage.

The role of an internal nasal dilator in athletes.

The nasal valve area has the minimal cross-sectional area of the upper airways. Nasal dilators have been found able to improve sport performance in athletes. The aim of this study was to investigate whether the use an internal nasal dilator may be able to affect respiratory pattern in a group of athletes. The use of internal nasal dilator induced a significant reduction of fatigue perception (p=0.000) and was optimally accepted. In conclusion, the present study demonstrates that Nas-air® is an internal nasal dilator able to reduce the fatigue perception and is preferred to external nasal dilator.

The role of the fern test in the treatment of rhinitis.

BACKGROUND: The fern test is a method for assessing the characteristics of the nasal section in the treatment of patients with mucous dysfunction of the airway. OBJECTIVE: The aim of this study was to investigate the role of the fern test in patients with rhinitis and to assess the classification of each type of rhinitis (types I-IV) in clinical practice. METHODS: A cross-sectional study, which included consecutive patients from a third level Rhinology Unit, worked with 182 patients with rhinitis and 30 healthy subjects as control. The patients were subdivided according to their type of rhinitis: allergic rhinitis (59), infectious rhinitis (32), polyps (31), NARES (Non-allergic rhinitis with eosinophilia syndrome) (30) and NARNE (non-allergic rhinitis with neutrophils) (30). RESULTS: The control subjects had only type I or II rhinitis, whereas patients with rhinitis usually showed type III or IV. Allergic rhinitis and nasal polyps had the most serious deterioration according to the fern test (type IV). CONCLUSIONS: The fern test is effective for assessing mucus alterations in patients with rhinitis and it could be included as a new parameter in the study of rhinitis as a potential biomarker of the function of damaged epithelial cells.

Antecedentes: La prueba de "helecho" es un método que sirve para evaluar las características de la secreción nasal en el tratamiento de pacientes con disfunción de la mocosa de la vía aérea. Objetivo: El objetivo del presente estudio fue investigar el papel de la prueba de helecho en pacientes con rinitis y evaluar la clasificación de cada tipo de rinitis (tipos I a IV) en la práctica clínica. Métodos: Estudio transversal en el que se incluyeron pacientes consecutivos de una unidad de rinología de tercer nivel. Se incluyeron 182 pacientes con rinitis y 30 sujetos sanos como controles. Los pacientes se subdividieron según el tipo de rinitis: alérgica (59), infecciosa (32), pólipos (31), rinitis eosinofílica no alérgica (30) y rinitis no alérgica con neutrófilos (30). Resultados: Los sujetos control solo presentaron rinitis tipo I o II, mientras que los pacientes con rinitis generalmente mostraban tipo III o IV. La rinitis alérgica y los pólipos nasales tuvieron el deterioro más grave según la prueba de helecho (tipo IV). Conclusiones: La prueba de helecho es efectiva para evaluar las alteraciones del moco en pacientes con rinitis y podría incluirse como un nuevo parámetro en el estudio de la rinitis como biomarcador potencial de la función de las células epiteliales dañadas.

Internal and external nasal dilatator in patients who snore: a comparison in clinical practice.

Snoring is a common symptom. The nasal valve area has the minimal cross-sectional area of the upper airways. So, nasal dilation may significantly reduce resistance to airflow and consequently could reduce snoring. Mechanical dilators may be used: they are external or internal. Nas-air® is a new internal nasal dilator. It was compared to a nasal strip (Rinazina Breathe Right®) in 41 outpatients who snore in an open study conducted in clinical practice. Snoring duration, assessed by smartphone, and visual analogue scale for the perception of sleep quality were measured before and during Nas-air® or nasal strip use. A significant reduction of snoring time and an improvement of sleep quality were achieved by wearing both devices. However, Nas-air® was effective in a larger number of patients and induced a better sleep quality than nasal strip. In conclusion, the present study demonstrates that Nas-air® is an internal nasal dilator able to reduce snoring time and to improve sleep quality, and may be preferred to the nasal strip by snoring patients.

The role of the nasal valve in patients with obstructive sleep apnea syndrome.

The nasal valve area has the minimal cross-sectional area of the upper airways. A problem at this level may easily induce impaired breathing. Obstructive sleep apnea syndrome (OSAS) is a common disorder. It has been reported that nasal obstruction may be associated with OSAS. The aim of this study was to investigate the role of nasal valve in a group of OSAS patients. Polysomnography was performed. Patients with bilateral valve incontinence had lower SaO2-nadir than patients with unilateral (or no) one. In conclusion, the present study demonstrates that a bilateral nasal valve incontinence is associated with more severe nocturnal respiratory pattern in patients with OSAS.

Internal nasal dilator in patients with obstructive sleep apnea.

The nasal valve area has the minimal cross-sectional area of the upper airways. Obstructive sleep apnea (OSA) is a common disorder. It has been reported that nasal obstruction may be associated with OSA. The aim of this study was to investigate whether the use an internal nasal dilator may be able to affect respiratory pattern in a group of patients with OSA. The use of internal nasal dilator was able to significantly reduce two relevant respiratory outcomes, such as the apnea-hypopnea index and the oxygen desaturation index, notably there was also a positive trend for the reduction of total sleep time with HbO2 <90%). Nas-air® was also able to significantly improve restorative sleep performance. In conclusion, the present study demonstrates that Nas-air® is a new internal nasal dilator potentially capable to significantly improve respiratory outcomes and sleep quality.

Internal nasal dilator in patients with obstructive sleep apnea syndrome and treated with continuous positive airway pressure.

The nasal valve area has the minimal cross-sectional area of the upper airways. Obstructive sleep apnea syndrome (OSAS) is a common disorder. It has been reported that nasal obstruction may be associated with OSAS. The aim of this study was to investigate whether the use an internal nasal dilator may be able to affect respiratory pattern in a group of patients with OSAS and treated with continuous positive airway pressure (CPAP). The use of internal nasal dilator significantly reduced the pressure of CPAP (from 11.4±1.5 to 10.8±1.5; p=0.012) able to resolve apnea episodes. In conclusion, this study showed that Nas-air® is a new internal nasal dilator potentially capable to significantly improve adherence and compliance to CPAP.