Parosmia, a smelling disorder, is a symptom of allergic rhinitis. In allergic patients, histamine and leukotriene are released from mast cells or basophils and function as inflammatory mediators. Here, we hypothesized that histamine may modify olfactory information and affect the sense of smelling. We measured the histamine response in isolated olfactory receptor cells (ORCs) using a calcium imaging technique. ORCs were isolated enzymatically from amphibian (newt) or mammalian (mouse, rat) olfactory epithelium and were loaded with Fura-2, a fluorescent calcium indicator. Odorants (100μM amyl acetate, acetophenone, limonene, cineole, geraniol and citonellal) are known to increase intracellular calcium concentration in specific ORCs. A bath application of 100μM histamine also increased the intracellular calcium concentration by 28-33% in the ORCs. This result suggests that histamine receptors are expressed in some ORCs. Olfaction is determined by a combination of ORC responses. Since partial ORCs responded to histamine, the odorant response of ORCs may be altered in the presence of histamine. Therefore, we suggest that histamine-induced changes of a combination of ORC responses might be responsible for parosmia in patients with allergic rhinitis.
We report the clinical manifestation of a rare case of small cell neuroendocrine carcinoma (SNEC) originating in the right ethmoid sinus. Among malignant tumors in the nasal cavity and sinuses, adenocarcinomas, adenoid cystic carcinomas and mucoepidermoid carcinomas are common, while small cell carcinomas, which can be classified into small cell neuroendocrine carcinomas (SNECs), and small cell ductal carcinomas, are rare. A 31-year-old man consulted our hospital with a mass in the right cervical region. Anterior rhinoscopy showed a tumor in the right nasal cavity. MRI showed a mass in the right ethmoid sinus, maxillary sinus and nasal cavity, which extended to the skull base, and a mass 5cm in diameter in the right cervical lymph node. We biopsied the nasal tumor, and the diagnosis was SNEC. Fine needle aspiration of the tumor in the right cervical lymph node demonstrated class IV. The serum Neuron Specific Enolase (NSF) was 9.8ng/ml. Because the tumor extended to the skull base, we did not attempt radical surgery for the primary lesion, but we performed chemotherapy. Neither cisplatin nor irinotecan hydrochloride was effective. Radiotherapy with docetaxel effectively reduced the tumor size both in the primary lesion and metastatic lymph node. Small cell carcinomas are associated with a poor prognosis. The 3-year and 5-year survival rates are 38% and 13%, respectively from the literature, and the locoregional group is particularly statistically poorer than the local group. Although no evidence of progress has been found after the treatment in the case herein reported, strict observation of the tumor's progress is required.
We evaluated the effect of nasal and sinus surgery in 12 obstructive sleep apnea syndrome (OSAS) patients using polysomnography (PSG). The average body mass index (BMI) was 24.0±2.5. According to cephalography, 9 were classified as maxilla, 5 as mandibular retrusion, 2 as tonsil hypertrophy, and 3 as soft palate low position. The average apnea hypopnea index (AHI) before surgery was 46.1±54.2 and that after surgery was 37.8±7.0. The barely improved conitions was not significant (p=0.3716) either as a whole, in actual sleep time, in half awakening, in arousal index, nor in sleep phase (Stage 1 to 4 and REM). The 3 soft palate patients showed no improvement. Nasal and sinus surgery mainly improve nasal ventilation and induce oral breathing. The cases which nasal and sinus surgery independently AHI improves blockade (soft palate low position) at soft palate level were few, from oral breath induction possible in nasal breath. Nasal and sinus surgery assist in continuous positive nasal airway pressure, but surgery did not improve sleep. The degree of serious illness before surgery and formal cephalography diagnosis suggest expectation of improvement of nasal and sinus surgery independently which AHI becomes possible.
T & T olfactometry, a standard olfactory acuity test used in Japan, determines detection and recognition thresholds of five odorous substances. The visual analogue scale (VAS) determines subjective olfactory symptoms simply, and is clinically applied in patients with olfactory disturbance. A correlation exists between the VAS score and the T & T olfactometry recognition threshold. We studied why occasional discrepancies occurred between the VAS score and the average recognition threshold, finding that psychological factors such as stress, occupational considerations, and olfactory preference may influence results and must be taken into account. It is also important to note that T & T olfactometry used only 5 odorous substances, whereas VAS assessment includes a wide variety of smells a possible factor in the occurrence of discrepancies.
It is widely assumed that cytokines and chemokines play a significant role in the pathogenesis of inflammatory diseases such as allergic rhinitis. Much of the data supporting this concept has been generated under in vitro experimental conditions; a definitive proof of the involvement of these factors in inflammation would require the recovery of factors from inflammatory sites. Although washing and lavage of inflammatory sites is routinely done to detect factors at the site, relatively high concentrations of factors are only measurable by conventional methods. We attempted to detect chemokines in nasal secretion by filter paper and to determine possible mechanisms of chemokines in the development of allergic rhinitis. Small filter strips (7×30mm) were placed on nasal turbinates for 1min. After being air-dried strips were cut into small pieces and factors were extracted by rocking for 12h at 4°C. The eluate was collected and assayed for eotaxin and RANTES by ELISA. The eluate from normal control subjects contained detectable levels of both eotaxin and RANTES. These factor levels were significantly increased in patients with pollinosis. Levels of eotaxin, but not of RANTES, correlate closely with the presence of eosinophils in nasal mucosa. These results suggest that eotaxin is an important factor in nasal mucosal eosinophilia in pollinosis.
We reported treatment of frontal cysts using silicone stents in endoscopic sinus surgery (ESS). We treated 7 cases (8 sides) of frontal sinus cyst (6 men and 1 woman 28 to 70 years old), using silicone stents in endoscopic sinus surgery in the last 4 years and 3 months. A silicone tube was placed in a naso-frontal duct as a stent. We tried to leave it in place for at least three months. Drafs plastic surgery of a naso-frontal duct was conducted concomitantly with ESS in 4 cases (5 sides). Patients were followed up for 23 to 61 months (average 41.3 months). No recurrence was observed in CT and preoperative complaints disappeared in 7 of 8 sides. Silicone tubes were removed within 1 month in 2 of 8 sides because of spontaneous stent ejection (1), and headache (1). Spontaneous stent ejection was observed in 3 of 8 sides (38%). The bony closure of the naso-frontal duct and recurrent frontal sinusitis occurred in 1 of 8 sides (13%), and additional surgery was conducted using external incisions. Our study shows that ESS surgery with the placement of silicone stents is useful in the treatment of frontal cysts.