Since 1986, our allergic rhinitis treatment method has been chemosurgery with application of 80w/v% trichloroacetic acid (TCA) to the bilateral inferior turbinates under topical anesthesia. We have previously reported our satisfactory clinical results. In this paper, we evaluated the treatment's effectiveness and usefulness by investigating eosinophils that were classified activated cells (EG2) and non-activated cells (EG1), and Eg2 was obtained from the nasal smears of the same subjects, and mast cells which were classified tryptase-positive, chymase-negative cells (MC_T) and tryptase-positive, chymase-positive cells (MC_TC) infiltration by counting the number of cells stained using immunohistochemical methods. The subjects were patients who gave their consent to have only one side of the inferior turbinate treated with TCA because of their deviated nasal septa that were treatment hindrances. Clinically the patients showed no improvement in their conditions, therefore, they underwent reconstructive septal surgery combined with bilateral turbinectomy. We compared the number of EG2 and EG1, and MC_T and MC_TC of the treated and non-treated sides. The number of EG2 and EG1 were significantly less in the treated side, and the Eg2 in nasal smears showed the same results. In addition, the number of MC_T and MC_TC were significantly less in the treated side. These results indicate that effective treatment of nasal allergies with TCA chemosurgery has been obtained by suppression of EG2 infiltration which is mobilized by cytokines, and by suppression of MC_T infiltration which is a major cause of reagin dependent allergy.

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Quantitative analysis of sialic acid, L-fucose, elastase and albumin in the post-nasal drip of patients with chronic sinusitis was performed. Sixty-five cases of post-nasal drip were collected from patients with chronic sinusitis, aged 16-88 years old. The patients were classified into two groups: i. e. nonallergic group (n=58, without allergic rhinitis), and allergic rhinitis group (n=7, with allergic rhinitis). Additionally four cases of post-nasal drip obtained from patients with acute sinusitis were examined.
The mean concentration of sialic acid in the post-nasal drip from allergic rhinitis group (625-1850μg/ml) was significantly lower than that of acute sinsitis group (85-7094μg/ml). However, there was no significant difference in the mean concentration of sialic acid in the post-nasal drip between acute sinusitis and nonallergic group (85-7094μg/ml). The mean concentration of L-fucose in the post-nasal drip showed no significant differences in the groups of acute sinusitis (359-567μg/ml), nonallergic group (33-33312μg/ml) and allergic group (166-2842μg/ml). The concentration ratios of sialic acid to fucose (S/F) in the post-nasal drip either nonallergic or allergic group were significantly lower than that of acute sinusitis. The activity of elastase in the post-nasal drip from nonallergic group was significantly lower than that of acute sinusitis. The mean concentration of albumin in the post-nasal drip in three groups showed statistically no significant difference.
In 8 cases with nonallergic group and in 4 cases with allergic group the analysis of the S/F ratio was performed before and after the administration of antibiotics. In five cases with nonallergic group of which the treatment were effective, the S/F ratio was lowerd significantly after the drug administration. These findings suggest that the S/F ratio may be an impotant index for understanding the condition of chronic sinusitis.

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Introduction: For the purpose of examining the direct effect of methacholine aerosol on nasal mucosa reaction, ipratropium bromide spray (IB) having an anticholinergic effect was sprayed in the nasal cavity. Before and after spraying, we studied the methacholine dose-response curve on breathing through the nose by Astograph and nasal resistance.
Subjects and methods: Twenty-two subjects, who were methacholine aerosol positive by Astograph through the nose, were selected for study.
Three parameters were extracted from the dose-response curve: patency, sensitivity and reactivity. Results: 1) Patency and reactivity showed no significant difference in response to IB nasal spray, but sensitivity demonstrated a significant decrease (p<0.01). 2) Nasal resistance was significantly increased after methacholine aerosol through the nose (p<0.01). Furthermore, nasal resistance measured after methacholine aerosol through the nose and after IB nasal spray was significantly decreased compared with nasal resistance measured after methacholine aerosol only (p<0.05).
Conclusion: Nasal mucosal irritation by methacholine increased the nasal respiratory resistance in a concentration dependent manner. The methacholine dose-response curve demonstrated that the nasal resistance decreased with IB nasal spray administration.
The inhibition of methacholine by IB nasal spray suggests that methacholine has a direct action on the nasal mucosa.

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We report a case of complication by rhinogenic sepsis after insertion of a Bellocq' s tampon. The patient was a 48-year-old man with a diagnosis of right nasal hemorrhage. The Bellocq' s tampon was inserted and hemostasis was achieved. The patient developed a fever the day after the Bellocq' s tampon was inserted. Antibiotics were administered, but his condition failed to improve. The fever persisted even after the Bellocq' s tampon was removed, and there was purulent nasal fluid on the right. Drug-resistant Staphylococcus aureus was detected by bacterial examination of the nasal fluid, and a paranasal sinus CT scan examination revealed a fluid level and inflammatory picture in the right maxillary sinus, ethmoid sinus, and sphenoid sinus. The drug-resistant Staphylococcus aureus was also detected by blood bacterial cultures. A diagnosis of nasal sepsis was made, and endoscopic endonasal sinus surgery was performed. Since all of the bacteria retrieved from the preoperative nasal fluid and blood cultures and intraoperatively from the ethmoid sinus were Staphylococcus aureus and they exhibited the same drug sensitivity and resistance, they were concluded to be the identical bacteria. On postoperative day 2 the fever resolved, four consecutive blood bacterial studies were negative, and the patient was discharged in good general condition. After discharge he returned to his normal routine. A sinus CT scan study 3 months postoperatively did not reveal any evidence of inflammation, and the wound area had healed well. No recurrences have been observed to date.

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We carried out statistical observation of 1110 patients who were examined in the outpatient allergy clinic in our department from January 1990 to December 1997. The change in the total number of patients was examined as well as the number of patients with respect to sex, age and antigen. The defference in the number of patients with respect to sex tended to diminish in recent years. Also, the ratio of patients who were positive only to house dust decreased. The number of patients showing positive reactions to multiple antigens, particularly to the four antigens of house dust, Japanese cedar, orchard grass and common ragweed, increased. The number of patients reacting positively to orchard grass and common ragweed antigens also increased.

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From June 1996 to August 1998, we performed endoscopic surgery using powered instrumentation on 2 patients with nasal and paranasal sinus inverted papilloma, 6 patients with postoperative maxillary cyst, 16 patients undergoing inferior turbinectomy, 7 patients undergoing adenidectomy, and 4 patients undergoing vocal cord polypectomy.
The shaver allowed us to removal of the inverted papilloma quickly with only slight bleeding. Therfore, the origin of the tumor identified easily.
We also debrided the origin of the tumor and lesion around the tumor for complete removal of the inverted papilloma using the drill bar of the XPS.
The same drill bar enabled easy dissection of the hard bony partition of the maxillary cyst.
An endoscopic technique for removing the inferior turbinate with the shaver proved to be safe, quick and enabled removal of an equal amount of tissue. The study group of 16 patients who underwent inferior turbinectomy with the shavers demonstrated faster healing and better improvement of nasal obstruction compared with a group of 10 patients who underwent standard procedures.
Furthermore, power-assisted adenoidectomy and vocal polypectomy were faster and more precise than standard procedures.

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Bacterial infection induces airway inflammation such as chronic sinusitis, and lipopolysaccharide (LPS) mimics bacterial infection. Airway fibroblast derived chemokines contribute to the migration and accumulation of inflammatory cells such as eosinophils in the airway. We stimulated airway fibroblasts (nasal, pharyngeal, tracheal, bronchial, lung fibroblasts) with LPS, and analysed mRNA expression and RANTES production. The expression of mRNA and the production of RANTES were detected only in nasal, but not in other airway fibroblasts, using RT-PCR and ELISA. Our data show that RANTES is inducible in nasal firoblasts by LPS, and that the responsiveness of nasal fibroblasts to LPS is distinct in the airways.
RANTES: Regulated And Normal T cell Expressed and presumably Secreted LPS: Lipopolysaccharide IL: Interleukin RT-PCR: reverse transcriptase-polymerase chain reaction TNF-α: tumor necrosis factor-α.

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1. Routine treatment of sinusitis in children using one antral puncture and irrigation, and examination of pituitous bacteria was carried out in 195 pediatric patients (122 boys and 73 girls, aged 3-15 years) between April and December, 1997.
2. This treatment was evaluated using nasal X-ray radiography conducted within 3 months after puncture when the patients noted no signs.
3. Of the 195 patients, 99 were kindergarten children (51%); and 153 were kindergarten or elementary students in the first to third grades (78%). Receiving treatment during this period, especially for kindergarten children, was considered to be important to their prognosis.
4. Among the 158 patients in whom a prognosis was confirmed, the symptoms disappered in 98 patients (62%), the condition was alleviated in 38 (24%), and the condition was unchanged in 22 (14%).
5. With respect to the prognosis for different causative bacteria, among the 103 patients in whom causative bacteria and a prognosis were found, 53 patients (51%) were infected by Haemophilus influenzae or Streptococcus pneumoniae, and 28 patients (27%) were infected by multiple bacteria, H. influenzae and S. pneumoniae. A poor prognosis (50%) was observed in patients who were infected by multiple bacteria, and in patients who were infected by β-lactamase (+) H. influenzae (25%).
6. Of these pediatric sinusitis cases, 87 (45%) were associated with acute otitis media or secretory otits media, and 8 (4%) were associated with asthma.

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Cancer rarely arises from the maxillary sinus where previously treated with surgery for chronic sinusitis. We report a case of maxillary sinus carcinoma found in a patient with a past history of radical surgery for chronic sinusitis. A brief review of the literature is also presented.
The inner surface of the maxillary sinus was principally covered with pseudostratified ciliated columnar epithelium, whereas maxillary sinus carcinoma is histologically classified as sqaumous cell carcinoma in most cases. In the process of carcinogenesis, maxillary epithelium may exhibit serial changes from squamous metaplasia, to atypism, then to carcinoma in situ, and finally to invasive carcinoma. A similar process of carcinogenesis was considered in the present case where cancer arose from nearly normal epithelium regenerated in the postoperative maxillary sinus.
Although cancer rarely arises from the maxillary sinus with a history of radical surgery for chronic sinusitis, we reported this case to remind clinicians of the possibility of malignancies to originate from postoperative sinuses. Care should be taken not to overlook carcinoma during surgery for recurrent sinusitis or postoperative maxillary cysts.

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Arachidonic acid cascade metabolites are known to exhibit numerous kinds of pathophysiological activities including manifestation and aggravation of allergy.
We studied changes in the nasal mucosal blood flow, total nasal volume and nasal airway resistance by topical application of arachidonic acid cascade metabolites in 10 adult volunteers (6 subjects allergic to house dust mites and 4 normal subjects).
The effect of test solutions (PGD₂, TxA₂ analogue U-46619) were studied by non-traumatic application of 100μl with a micropipette on the mucosal surface of the inferior turbinate. Blood flow in the nasal mucosa was measured by laser-doppler flowmeter (ALF21, Advance, Japan), nasal volume by acoustic rhinometer (RHIN2000, Rhinometrics, Denmark), and nasal airway resistance (NAR) by rhinomanometer (MPR2100, Nihon Kohden, Japan).
PGD₂ induced a significant increase in nasal blood flow, nasal airway resistance and a decrease in total nasal volume.
TxA₂ analog, U-46619, induced a dose dependent response increase in nasal blood flow and total nasal volume. In patients with allergic rhinitis, U-46619 was found to induce an increase in nasal airway resistance after 2 hours. PGD₂ was demonstrated to cause vasodilatation in vivo in this study.
Findings indicate that ischemia reperfusion injury may be due to reduction of local blood flow, occur in the nasal mucosa during a TxA₂ challenge, and result in edema and nasal blockage. The efficacy of TxA₂ antagonist against nasal blockage in patients with allergic rhinitis may be its ability to protect the nasal mucosa from TP-mediated ischemia-reperfusion injury following repeated antigen exposure.

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It is well known that unilateral nasal patency spontaneously changes over time in human beings, often referred to as 'nasal cycle', which was first reported over 100 years ago. However, the study of the nasal cycle has made slow progress with the major hindrance being a lack of numerical parameters which could precisely describe the changes of nasal patency over time. In this study, we investigated the effects of acute upper respiratory tract infection and seasonal allergic rhinitis on the nasal cycle using two numerical parameters of the correlation coefficient between unilateral nasal resistance (r) and the airflow distribution ratio between the two nasal airways (ADR).
Ten subjects (5 males and 5 females, aged 19-38 years) with acute upper respiratory tract infection (URTI) and thirteen subjects (5 males and 8 females, aged 19-33 years) with seasonal allergic rhinitis (hay fever) were recruited for the study, which involved serial measurements of unilateral nasal airway resistance using the technique of posterior rhinomanometry. In subjects with URTI, unilateral nasal resistance was measured hourly over a 6 hour period on one day when subjects had symptoms of URTI and 6-8 weeks later when they were healthy. In subjects with hay fever, unilateral nasal resistance was measured hourly over a 7 hour period in and out of the allergic season.
The nasal cycle of subjects with URTI was similar to that of normal human beings. The result indicates that the nasal cycle was not so much affected by URTI. On the other hand, the nasal cycle of subjects with hay fever not only in season but also out of season differed considerably from that of normal human beings and subjects with URTI. The results indicate that the nasal cycle may be affected by a disorder of the autonomic nervous system and/or by permanent changes of the nasal mucous membrane due to hay fever.

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A change in evoked responses to odorant stimulation was studied in eight young healthy subjects to investigate whether the test odorant was perceived as a comfortable mental or averse feeling.
An α wave was considered to be elicited by a comfortable sensation to the odorant stimulations and was discussed by our device as it introduced brief pulses of odorized air which were synchronized with a subject's respiration.
Alpha waves were recorded in two of the eight subjects in response to the odorant cinnamon indicating a comfortable feeling. On the other hand, E5 (the highest concentration of skatole) evoked no α waves in any of the eight subjects and five subjects an averse feeling.

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MY-1, a DNA fraction purified from Mycobacterium bovis BCG, induced interferon-γ (IFNγ) production by human peripheral blood mononuclear cells (PBMC). IFNγ has been well known as the down regulator of IgE production. In this study, we preliminarily investigated whether MY-1 regulates IgE production by human PBMC in vitro. We found that MY-1 inhibited IgE production in PBMC from normal donors stimulated with Interleukin-4 (IL-4) plus anti-CD40 monoclonal antibody (mAb). MY-1 enhanced IFNγ production by PBMC. The addition of anti-IFNγ or anti-IL-12 mAb canceled the inhibitory effect of MY-1 on the IgE production.
We found that the sequence including CGTTCG was the most effective in the suppression of IgE production by PBMC. These results suggest that exposure to MY-1 or the oligonucleotides including the CGTTCG sequence may be a novel strategy for the treatment of IgE-related allergic diseases.

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Leprosy patients with long-term quiescent conditions show symptoms such as purulent rhinorrhea, nasal crusting, and atrophy of the nasal conchae. These symptoms resemble those of atrophic rhinitis. In this report, X-ray examination, nasal discharge smear, saccharin test, bacteriologic studies of the nasal discharge, light micrography of the nasal mucosa, and transmission electron micrography of the nasal mucosa were performed in 21 leprosy patients. The results revealed that the nasal mucosa and the nasal discharge contained large numbers of eosinophils. Staphylococcus aureus and other bacteria were detected in the majority of nasal discharge samples. The plain X-ray films demonstrated that many patients had chronic sinusitis to a mild degree. Results of the saccahrin test indicated that mucociliary function was severely impaired in half of the patients, however, surface epithelial cells of the nasal mucosa retained histologically intact cilia as seen by electron microscopic examination. These findings indicate that leprosy patients in an inactive condition who present with various nasal symptoms should be treated with regular nasal treatments, such as oral administration of macrolide antibiotics, topical antibiotic nebulizer, and antiallergic agents.

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We investigated the relationship between the expression of apoptosis related prteins and the clinical outcome in maxillary squamous cell carcinomas (SCC). Twenty-seven cases of maxillary SCC were examined for the expression of p53, Bax, Bcl-2 and apoptosis, by using immunohistochemical staining and TUNEL method befor and after combined treatment with chemotherapy, radiotherap and operation. The expression of Bax was correlated with recurrence, death and metastasis after treatment. Furthermore, the positive expression of Bax before treatment was correlated with the apoptosis index (p=0.021). These results suggest that the positive expression of Bax is an important prognostic factor in maxillary SCC.

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We evaluated the correlations between the geometric parameters obtained by acoustic rhinometry (AR) and the sensation of nasal obstruction assessed by Visual Analogue Scale (VAS). Fifty-nine patients (35 males, 24 females) with nasal disease, complaints of stuffy nose, and sixty-seven normal subjects (54 males, 13 females) were selected for this study.
VAS was recorded according to sensation of nasal obstruction at the time AR was measured. An acoustic rhinometry (GM instrument) was used, and each subject were measured in a quiet sitting position.
With regards to the results by AR, no significant difference was seen between the two groups. The results obtained by VAS correlated poorly with the geometric data obtained by AR. However, when the values of VAS were classified in three categories according to severity (mild, moderate, severe), rough correlations between the date by AR and these categories were demonstrated. This tendency was more obvious in single nasal airway breathing than in two nasal airway breathing. In sensation of nasal obstruction, this study revealed that most cases (40/59 cases) felt a difference between each nasal airway. Therefore, to diagnose the sensation of nasal obstruction by AR, evaluation of each nasal cavity separately should be carried out.

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Fifteen patients with nasal allergy, undergoing antigen-specific immunotherapy were subjected to high frequency submucosal diathermy (HF-SD) of their inferior turbinates to resolve nasal obstructions. The short-term effect of HF-SD (n=15) was 93% and long-term effect (n=10) was 70% for decreasing nasal obstruction as evaluated by severity of the symptom in allergy diary. The average score of nasal obstruction at pre-operation in allergy diaries was 1.74±0.62, whereas, the postoperative score was 0.33±0.45, 0.37±0.41, 0.41±0.39 at 6 months, 1 year, and 3 years, respectively. The postoperative airway resistance was significantly decreased to 12.87±29.81cm H₂O/L/sec compared to pre-operation, 55.27±42.81. The histological changes of the nasal mucosa after HF-SD were also investigated. Continuous histological changes in the nasal mucosa at 1 month postoperation were mainly in the connective tissue of the lamina propria. Evaluation of the results shows that HF-SD of the nasal mucosa is an effective treatment for nasal obstruction in patients with nasal allergy undergoing antigen-specific immunothrapy.

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The long-term (7 years) effects of CO₂ laser surgery in 68 patients with perennial allergic rhinitis were obtained from answers to a questionnaire. Subjectively, excellent or good general improvement was obtained in 57% of patients even more than 7years after the surgery. Relief (no or mild symptoms) from sneezing attacks, nasal discharge, and nasal blockage were noted in 87%, 66%, and 69%, respectively. The mechanism of CO₂ laser surgery was investigated by using rhinomanometry, laser-doppler velocimetry, and by measuring the ECP (eosinophil cationic protein) of the nasal lavage fluid. The amount of ECP was significantly decreased after surgery in all patients, especially in those with a very good response to surgery. Nasal airway resistance was not altered by the surgery; however, its response to antigen provocation was significantly decreased. Nasal blood flow in patients with nasal allergy was less than that in normal subject, but the difference was decreased by laser treatment. These results suggest that laser surgery is effective for treatment of nasal allergy via the following mechanism: laser injury vaporizes the nasal mucosa to a limited depth secondarily producing a permanent scarred layer. This scar persists for as long as 5 years, preventing allergic reactions and inhibiting the release of chemical mediators. Evidence from our basic and clinical studies supports the conclusion that laser surgery is an effective and functional treatment for nasal allergy.

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