Nasal obstruction is an important symptom in allergic rhinitis. Several types of nasal surgery instruments have been reported useful in reducing nasal obstruction. Structural problems such as deviation of the nasal septum may, however, also influence nasal obstruction often necessitating septoplasty. This makes it important to clarify factors in nasal obstruction before deciding how to treat allergic rhinitis.
Acoustic rhinometry, introduced by Hilberg (1989) measures the degree of openness of the nose or its parts. Several authors have reported the responsiveness of nasal patency to methacholine provocation with acoustic rhinometry.
We measured the change in nasal patency and nasal responsiveness to acoustic rhinometry before nasal surgery in patients with allergic rhinitis and studied surgical options in allergic rhinitis.
Subjects were 30 patients with perennial allergic rhinitis and mild or severe nasal obstruction. Of these, 11 underwent inferior turbinectomy and septoplasty with the inspection of nasal symptoms and radiographic examination. The 19 underwent conservative therapy. Minimum nasal cross-sectional area and nasal response to methacholine nasal spray were compared between groups using an acoustic rhinometer (RHIN2100 Rhinometrics co. Denmark). Measurement with acoustic rhinometry was also studied after a topical nasal decongestant was administered.
We found values and parts of minimum nasal cross-sectional area in both groups to statistically the same. We found the difference in decongested minimum cross-sectional area between the left and right sides of the nose was useful in evaluating the degree of deviation in the nasal septum. The narrowed cross-sectional area in the surgical group was statistically wider than in the non-surgical group (p<005). Hyperresponsiveness to methacholine nasal provocative test did not differ between groups in our study. These results suggest, however, investigation of the effect of both mucosal and structural factors is important in deciding allergic rhinitis treatment.
In conclusion, evaluation of the value and wideness of cross-sectional area is useful in determining nasal surgery in patients with allergic rhinitis.

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Active anterior rhinomanometry is used most commonly for evaluating nasal airway patency because of its easy, noninvasive application. A visual analogue scale (VAS) is generally used for evaluating the sensation of nasal patency. We studied the relationship between nasal airway resistance (NAR) and VAS score for sensation of nasal patency. Subjects were 14 adult volunteers who gave informed consent. They were divided by age into those 50 or younger and those over 50 years of age. After 10 minutes of rest seated, each subject was measured for NAR and VAS scores before nasal application of oxymetazoline (OXY) or sodium nitroprusside (SNP), a nitric oxide donor. Measurements were repeated 5 and 10 minutes after nasal drug application. We did not test the effects of OXY and SNP on individual subjects on the same day.
Mean value of NAR in those aged less than 50 or less was higher than in those over 50. No significant correlation was seen between NAR and VAS score in subjects overalls, but a definite positive correlation was seen between NAR and VAS score in individual subjects aged 50 or less. No correlation was seen between NAR and VAS score recorded during nasal membrane swelling induced by local application of SNP. A positive correlation between NAR and VAS score was recorded during nasal membrane shrinkage induced by OXY application.
These results suggested that the VAS is useful for evaluating the sensation of nasal patency, and that VAS correlate with NRA in subjects aged less than 50. There are several limitations for practical use of this method to evaluate the sensation of nasal patency, such as objects, age, and changes in nasal patency.

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We conducted a retrospective clinical study of inverted papilloma in the nose and paranasal sinuses in 26 cases (28 sides) of inverted papilloma in the last 10 years. The subjects were 17 men and 9 women with a mean age of 54.6 years. Follow-up averaged 11 months to 10.4 years with a mean of 69.4 months (5.8 years) . Surgical excision is generally regarded as the treatment of choice for papilloma, however, the approach and extent of surgery have been much debated. We clarified the relationship between surgical invasion and disease recurrence. Six of 28 sides developed recurrence (21.4%), none developed malignant transformation, and 2 of 26 cases (7.7%) were diagnosed as with bilateral papillomas. In the endoscopic group, 2 of 8 cases (25.0%) recurred, compared to 4 of 20 cases (20.0%) in the non-endoscopic group. The amount of blood lost was significantly smaller in the endoscopic group. All 8 cases with aggressive endoscopic resection manifested no recurrence and minimum blood loss. We concluded that aggressive endoscopic resection is the best treatment in terms of recurrence rate and surgical invasion. In general, this approach is preferable for tumors in the nasal cavity or in those localized with a clear endoscopic view in the paranasal sinuses.

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Background: Although soluble CD23 and IgE in the serum of patients with rhinitis correlate significantly, studies on CD23 in nasal mucosa tissues are very limited and the role of CD23 remains unclear.
Objective: We studied the expression and distribution of CD23⁺ cells in nasal mucosa tissues from patients with rhinitis, including perennial mite-sensitive allergic rhinitis and chronic infective rhinitis, and observed the relationship between CD23 expression and the concentration of serum IgE in these patients.
Methods: Subjects were 26 patients studied by evaluating clinical characteristics and serum IgE concentration. Biopsy specimens of the inferior turbinate were collected and CD23 expression determined by immunohistochemical staining.
Results: CD23⁺ cells were distributed mainly in the shallow and deep layers of the lamina propria of the nasal mucosa in all patients with rhinitis. Only a few CD23⁺ cells were found in the mucosal epithelium. Compared to perennial mite-sensitive allergic patients, the number of CD23⁺ cells in chronic infective rhinitis patients was low. In perennial mite-sensitive allergic rhinitis, the number of CD23⁺ cells correlated significantly with serum IgE concentration. Anti-allergic treatment decreased the number of CD23⁺ cells in the nasal mucosa of patients with perennial mite-sensitive allergic rhinitis.
Conclusions: CD23 expression in nasal mucosa correlated significantly with clinical characteristics of patients with rhinitis and may reflect the effects of clinical therapy in these patients.

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We report a 65-year-old woman of fibrous dysplasia associated with a giant cell tumor of the left facial bone. She was diagnosed with polyostotic fibrous dysplasia in 1988. In 2001, a biopsy of the growing left maxillary mass show findings compatible with fibrous dysplasia. Palliative surgery was conducted to correct the cosmetic deformity and nasal obstruction. A histopathological examination showed fibrous dysplasia with a giant cell tumor. At present, the left maxillary tumor has not progressed and no evidence of lung metastases has been observed. We are continuing carefull follow-up.

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We examined the influence of antibiotics and topical treatment, such as the nebulizer and the Proetz method on the treatment period of acute sinusitis.
Subjects were 215 patients with acute sinusitis treated at Tokyo Women's Medical University Daini Hospital from January 1993 to December 2001.
The day when symptoms resolved and nasal and X-ray findings normalized was defined as the day when cure was achieved, and the treatment period was defined as the interval between the first examination and the day of cure.
The following factors were investigated: (1) gender, (2) age, (3) duration of illness, (4) side involved, (5) concomitant allergic rhinitis, (6) topical treatment, (7) use of antibiotics, (8) detected bacteria, and (9) deviation of nasal septum. The influence of these factors on the treatment period was investigated by multivariate analysis using Stat Partner for Windows Ver. 4.5 (NEC Software).
Factors significantly influencing on the treatment period were duration of illness, concomitant of allergic rhinitis, age, and topical treatment. Topical treatment was useful for acute sinusitis.
Penicillin was found to be the most useful antibiotic for acute sinusitis.
Macrolides prolonged the treatment period in young patients and in the elderly, but had the same effect as other antibiotics in patients in their thirties to fifties.

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We present 32 cases of orbital complication caused by sinusitis. Clinical parameters such as age, gender, affected sinus, eye symptoms, and treatment were evaluated. Cases involved 25 males and 7 females with a mean age of 32 years ranging from 3 to 71 years. On the first visit, He subjects were seen in ophthalmology in 16, internal medicine in 6, and otolaryngology in 6, and other in 4. Ethmoid sinus was most frequently encountered. Presenting eye symptoms consisted of combination, such as ocular pain in 26, diplopia in 10, proptosis in 8, and deterioration of visual acuity in 4. Of these 20 were treated conservatively and 10 surgically. Hospitalization lasted 4 to 30 days (mean 12.2 days). CT and MRI were useful in diagnosis. Cases with visual disorders need immediate surgical intervention.

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Recently in the USA, Canada, Australia, UK, and some European countries, a trend towards performing surgical procedures on an outpatient basis has been prompted by political, financial and medical forces. In such countries, the majority of elective surgery is performed on an ambulatory basis. In contrast, the Japanese medical service system seems to be reluctant to approve day-case surgery. Here, we describe the present status of nasal ambulatory surgery in Japan by presenting the data obtained from a questionnaire.
Questionnaires were sent to 337 major hospitals in Japan that were qualified as training institutes by the Otolaryngologic Society of Japan. Answers were received from 248 hospitals. In 194 out of 248 hospitals (78%), some nasal surgery was performed on an outpatient basis. However, in most of the hospitals providing a positive response, only minimally invasive surgeries, such as cauterization of the inferior turbinates or polypotomies, were performed. Other, more invasive procedures were only performed on an outpatient basis in about one-fourth of the hospitals. The main reason why nasal surgery was not performed on an outpatient basis in the remaining 54 hospitals was the fear of complications.
Although day-case septoplasty and turbinectomies were only performed in 6 and 30 institutes, respectively, nearly half of the chief otolaryngologists in the hospitals that responded to the questionnaire thought that these operations were safe to perform on an outpatient basis, which means surgeons are ready when opportunity is ripe.
When asked about the factors that are essential for day surgery, the most frequent reply was “less bleeding”. Eighty two percent of the chief otolaryngologists in the hospitals that responded the survey believed that the number of outpatient surgical procedures would increase in the near future.
According to the DECD Health Data 2001, Japan has fewer physicians and far more beds than most OECD member countries. Japan also has a longer average hospital stay and more outpatient consultation days. These factors produce a too busy clinical scene that does not favor the popularization of day surgery. Fear of medical mishaps is another factor inhibiting the widespread use of outpatient surgery.
According to medical literature, the complication rate for septoplasty is around 10%, which is quite low. However, the unexpected admission rate after septoplasty is between 4 and 25%, which is greater than the acceptable figure acquired for day case surgery, which is less than 2%. Thus, at present, septoplasty should be performed as a short-stay procedure. If the present trend continues, however, more and more surgical procedures will be performed on an ambulatory basis in Japan.

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Adult T-cell leukemia/lymphoma (ATLL) is induced by human T-lymphotropic virus type I (HTLV-I) infection. We report a case of ATLL in the sphenoid sinus. A 46-year-old woman reporting double vision and right prosopalgia was born in Kagoshima Prefecture, endemic ATLL area. Serologically, anti-HTLV-I was positive. Biopsy was done and the pathological diagnosis was malignant lymphoma with a T-cellular phenotype. PCR of the pX lesion in the paraffin specimen disclosed a monoclonal band. So-called ATLL cells with convoluted nuclei were demonstrated in the cerebrospinal fluid (CSF). She was diagnosed with ATLL and treated usingcombination chemotherapy with adriamycin, cyclophosphamido, vindesine, predonisolone, mitoxantorone, VP-16, procarbazine, and peplomycin. Six months after chemotherapy, her headaches returned. Atypical lymphocytes appeared in the peripheral blood and ATLL cells was demonstrated in her CSF. After craniospinal irradiation combined with intrathecal chemotherapy, her symptom disappeared. Eleven months have passed since the first chemotherapy.

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