Sensations from the nose (symptoms) are more important to the patient than objective measures of nasal function obtained by rhinomanometry and acoustic rhinometry. In order to understand nasal symptoms, the definitions of terms such as ‘nasal congestion’, ‘nasal obstruction’ and ‘nasal sensation of airflow’ are put forward for discussion. The concept of ‘nasal sensation of airflow’ as measured by a visual analogue scale has helped in the understanding of the effects of menthol on the nose and demonstrated that there is no relationship between the objective and subjective effects of menthol on the nose. Studies on patients have found little or no relationship between objective and subjective measures of nasal function when both nasal passages are considered together, and only a poor relationship when the nasal passages are studied separately. Progress in this area is dependent on standardising the methods and terminology used for subjective measures of nasal function and a better understanding of the factors that influence the patients perception of nasal disease.
Choanal polyps are conventionally divided into two groups, antrochoanal and sphenochoanal. The paper presents a series of 5 choanal polyps originating from posterior ethmoidal cells and protruding into the nasopharynx through the natural ostium of the posterior ethmoids in the superior nasal meatus. In two of these cases the polyps were bilateral, in three-unilateral. Two cases presented solitary ethmochoanal polyps (ECP) and posterior ethmoids as the only diseased sinuses. In the other three patients ECP was associated with polyps in the middle meatus, anterior ethmoids and maxillary sinuses. Computerized tomography and nasal endoscopy allow correct diagnosis of ECP as well as differentiation between ECP and other types of choanal polyps in most but not in all the cases. Endoscopic sinus surgery through the superior nasal meatus with the use of a microdebrider is the method of choice in treatment of ECP.
We investigated 89 patients who underwent paranasal sinus surgery and followed up for at least 180 days in our hospital. It is widely recognized that in patients who are opereted on for chronic otitis media, prognosis is better if ear discharge is eliminated preoperatively. We confirmed that the recurrence rate of nasal polyps was lower in patients who underwent surgery after control of nasal discharge. The preoperative treatment is important for prevention of the postoperative recurrence of nasal polyps. Duaring the postoperative course, patients shold be observed frequently and over a long period if they showed no preoperative improvement of nasal discharge. The preoperative presence of nasal discharge is important as a risk factor for recunence of nasal polyps.
For investigation of allergens in nasal allergy, there are several methods; skin test, nasal provocation test and measurement of specific IgE antibodies. Skin tests or nasal provocation tests sometimes cause trouble to the clinicians or patients, because the conditions can affect the results, or the tests may make allergic symptoms worse. A simpler examination is desired. The measurement system of IgE antibodies is expected to be a usuful method to approximate diagnosis, because we only have to take one blood sample from the patient. Many systems are developed to measure IgE antibodies. Indications are that the CAP system is one reliable way and AlaSTAT, an enzyme-immunoassay method developed by Diagnostic Products Corporation in recent years, may be another. In this study, we measured the three IgE antibodies by AlaSTAT and CAP system, and compared the results with that of skin tests or nasal provocation tests. The three IgE antibodies were house dust (HD1), Dermatophagoides pteronyssinus (D1) and Dermatophagoides farinae (D2) which were major allergens of perennial nasal allergy. These methods obtained negative results in normal donors. In patients with perennial nasal allergy, the resurts of AlaSTAT were as follows; The positive rates were 85.7% on HD1, 80.0% on D1 and 85.7% on D2. The sensitivity, specificity and correspondence rate to skin test were 87.9%, 50%, 85.7% on HD1 and 96.4%, 57.0%, 88.6% on D2, respectively. The sensitivity and correspondence rate to nasal provocation test were 87.5%, and 74.1% on HD1, respectively. At many points, there were excellent correlations with CAP system. These results indicate that AlaSTAT stands, in comparison with CAP system, as a reliable method of clinical diagnosis for perennial nasal allergy.
The Committee of Investigation of Olfactory Function Tests of Japan Rhinology Society developed a new standardized acuity test using a jet stream olfactometer (JSO). In this paper, its clinical usefulness was described. About 300 subjects participated in three experiments. The averages of detection and recognition threshold of JSO in normal subjects were 0.555±1.34 and 2.066±1.06. Those values were similar to that of a previous method. The recognition threshold of phenylethyl alcohol were elevated compared with those of methyl cyclopentanelone and isovaleric acid significantly. Evaluation of JSO and T & T olfactometry showed significant correlation in threshold results for both olfactometries in patients with some olfactory disturbance. These results indicated that a JSO can be used for a screening test of dysosmia in clinical setting.
Until now, an in vitro measurement of serum specific antibody is widely used for the diagnosis of symptomatic antigen of nasal allergy. When the serum contained more than 1 or 2 of score for a specific antigen, in whichever method used, it could be diagnosed positive. However, we experienced that some patients had no symptom or no nasal antigen provocative reaction especialy when they were sensitized with other antigen (s). We studied relationships between perennial, seasonal, and both symptoms, using the serum IgE measurement by CAP-RAST in 471 patients sensitized by HD/mite, Japanese ceder pollen (JCP), or both. The appearance rate for seasonal symptoms was dependent on the serum concentration of the JCP IgE. However, the rate of seasonal symptoms was reduced dependenting on the serum concentration of HD/mite IgE. The reverse was true between the perennial symptom rate in patients with serum HD/mite IgE and the serum JCP IgE. It was possible that the antigen induced histamine release from nasal mast cells of patients sensitied by only one antigen was different from patients sensitized by a second or other antigens. We studied the histamine releasability by using nasal scrapings from 10 patients. Mite-induced histamine releases from nasal scrapings of patients sensitized with HD/mite (score 2 and 3) and JCP (score 4) which were less than those of patients sensitized with only HD/mite (score 2 and 3) . From these results, we concluded that we could not diagnose a symptomatic antigen from an in vitro measurement of an antigen IgE but rather form IgE levels of at least several antigens, and using patients with detailed histories.
Interferon (IFN)-γ knockout (IFN-γ-/-) mice and background BALB/c (IFN-γ+/+) mice were intranasally immunized with outer membrane proteins P6 purified from nontypeable Haemophilus influenzae, and Th1/Th2 and B cell immune responses were compared to investigate the role of Th1-type cells in inducing mucosal IgA responses against H. influenzae in the nose. P6 dissolved in PBS was administered on days 0, 7, and 14. Antigen-specific antibody titers in serum, saliva, nasal wash, and fecal extract were determined by ELISA. On day 21, mononuclear cells isolated from mucosal tissues were analyzed by P6-specific ELISPOT. CD4+ T cells isolated from spleen were cultured with P6 for 4 days, and the concentrations of cytokines in the culture supernatants were examined by ELISA. Further, the number of cytokine-producing cells were determined by cytokine-specific ELISPOT. P6-specific IgA antibody titers in saliva, nasal wash, and fecal extract and the numbers of P6-specific IgA-producing cells in nasal passages and submandibular gland were lower in IFN-γ-/- mice than IFN-γ+/+ mice. Although IFN-γ-/- mice did not produce IFN-γ, the production of IL-2 and IL-6 was observed in the same manner as in IFN-γ+/+ mice. These findings suggest that IFN-γ plays an important role in inducing P6-specific IgA responses in nasal mucosa.
In this study, we analyzed the changes of nasal volume and nasal resistance induced by breath holding. The experiments were performed in normal adult volunteers (11 male and 2 female) who gave informed consent to participate in this study. After 20 minutes of resting period in sitting position, the subjects were instructed to hold their breaths as long as possible. Then, area-distance curve was depicted using acoustic rhinometry (NADAR, Aarhus University, Denmark) every 60 seconds for 10 minutes. The nasal volume increased just after breath holding and it returned to its control value by 4 minutes. These incureases in the nasal volume were similarly observed in the anterior (2.0-4.0cm posterior from the nostril), middle (4.0-6.0cm posterior from the nostril) and posterior (6.0-8.0cm posterior from the nostril) parts of the nasal cavities. Even after the repeated breath holding (twice per ten minutes), the nasal volume increased repeatedly. In 6 out of 13 subjects, the increase of nasal volume was observed bilaterally. On the other hand, in the rest of the subjects, the increase of nasal volume was observed unilatrally. The volume of unchanged nasal cavities (7 out of 26) during the control period was greater than 11cm3. These results suggested that breath holding increased the nasal volume, due to shrinkage of nasal membrane promptly and evenly within the nasal cavity. Furthermore, the nasal volume during the control period was also another prerequisite for the increase of nasal volume evoked by breath holding.
The styrylpyridinium dyes, which are nontoxic and water-soluble membrane probes, have been used both for investigating the mechanisms of activity-dependent membrane recycling and for visualizing the endocytosis phase in a wide range of species. In this study, we visualized cell membrane-internalization and transport in cultured human ethmoidal cells using a fluorescent probe FM4-64 and laser scanning confocal microscopy. After treatment for 5min at 30°C, FM4-64 labeling became apparent in the plasma membrane of ciliated cells. The labeling was pronounced on the apical side corresponding to the area where numerous cilia assembled. A different pattern was observed in non-ciliated cells where the plasma membrane was weakly fluorescent on their basolateral side. Using time-lapse conf ocal microscopy, we were able to follow vesicle internalization and augmented membrane turnover in some of the ciliated cells triggered by various concentrations of histamine (10-3M to 10-5M). The fluorescent labeling of these cells began to rise until 10 minutes concomitant with distinctly visualized beating cilia. We have shown that this dye serves as a sensitive vital reporter for membrane dynamics, detecting such events as endosome to membrane transport during receptor-mediated endocytosis in vitro.
We studied 68 cases of orbital blowout fracture in our department from October, 1981 to March, 1997. There were 58 males and 10 females (mean age 22.6 years). Sinus CT scan and Hess test were done before operation, and surgery was performed in 66 cases under general anesthesia. Seven cases of medial orbital wall fracture were treated by extranasal approach and 1 case of medial orbital wall fracture was treated by intranasal approach. In 40 cases of orbital floor fracture, approach from eyelid, or transantral, or a combination of these two were used. Defects of the orbital wall were reconstructed with autogenous bone grafts of the antherior wall of the maxillary sinus, or orbital floor, or iliac bone. Postoperative improvement of double vision was better in patients having surgery within two weeks of the injury than in those having surgery more than two weeks after injury.
The expression of Th1 markers, IFNγ and IL-12 receptor β2 (IL-12Rβ2), and Th2 markers, IL-4 and CD30, was investigated in the paranasal sinus mucosa of patients with chronic sinusitis in an attempt to elucidate the Th1-Th2 balance in situ in this disease. Anterior ethmoidal mucosae were surgically obtained from 27 patients with chronic sinusitis. The patients were classified into three group: those without atopic state (nonallergic group, n=13), those with allergic rhinitis (allergic rhinitis group, n=9) and those with bronchial asthma (asthma group, n=5). IFNγ+, IL-4+ and CD30+ cells were examined by immunohistochemistry, and IL-12Rβ2 mRNA was quantitatively analyzed by reverse transcription-polymerase chain reaction. The numbers of eosinophi-s, IL-4+ cells, CD30+ cells and the ratio of IL-4+ cells/IFNγ+ cells were significantly larger in the asthma group compared to the nonallergic group. This indicates that Th2 is more dominant in the asthma group than in the nonallergic group, which may be responsible for the intractability and the tendency to recurrence of sinusitis in asthmatic patients. Meanwhile, there were no significant differences in the numbers of eosinophi-s, IL-4+, CD30+ and IFNγ+ cells, and the expression leve-of IL-12Rβ2 mRNA between the nonallergic and allergic rhinitis groups. Subjects with high and low values of Th2/Th1 ratios, i. e., IL-4+ cells/IFNγ+ cells and CD30+ cells/IL-12Rβ2, were intermingled both in the nonallergic and allergic rhinitis groups, indicating the discrepancy between the clinical diagnosis of allergic sinusitis and the profile of inflammatory reactions in situ. It is concluded that allergic and nonallergic sinusitis should be diagnosed on the basis of direct evidence for the characteristics of inflammatory reactions in the paranasal sinus mucosa rather than indirect evidence such as nasal smear, rhinoscopic finding, skin tests, or serological tests. Accurate evaluation of the sinus mucosa would be useful for the choice of appropriate medication in the treatment of patients with chronic sinusitis.