American Journal of Rhinology and Allergy

Publications in this journal

• Article: Perennial is more effective than preseasonal subcutaneous immunotherapy in the treatment of seasonal allergic rhinoconjunctivitis.

  D Tworek, M Bochenska-Marciniak, I Kuprys-Lipinska, M Kupczyk, P Kuna
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  ABSTRACT: BACKGROUND: Two different regimens of subcutaneous immunotherapy (IT), perennial or preseasonal, may be used in the treatment of seasonal allergy. The aim of this study was to compare the efficacy and safety of perennial IT (PIT) and preseasonal IT (PSIT) in patients suffering from seasonal rhinoconjunctivitis.METHODS: The study was planned as a randomized, double-blind, comparative study on the efficacy and safety of PIT and PSIT. The study group comprised120 patients allergic to grass and rye pollen. After the observational season they were randomized to receive PIT or PSIT for 3 years. The effect of IT wasassessed based on symptom severity and medication use recorded in diaries.RESULTS: Ninety-nine patients completed the study. No difference was seen between the groups regarding combined symptom medication score (SMS) inthe first season of IT. During the second season, the difference between PIT and PSIT regarding combined SMS was 27.9% (p = 0.063) and reached 42.7%(p = 0.012) in favor of PIT in the third season. Both treatments had a similar safety profile.CONCLUSION: PIT was more effective than PSIT in the treatment of rhinoconjunctivitis in patients allergic to grass and rye pollens.Clinicaltrials.gov registration number NCT01555736.
  American Journal of Rhinology and Allergy 04/2013;
• Article: Chronic sinusitis pathophysiology: The role of allergy.

  J L Kennedy, L Borish
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  ABSTRACT: BACKGROUND: Chronic hyperplastic eosinophilic sinusitis (CHES) is an inflammatory disease characterized by eosinophil infiltration of sinus tissue that canpresent with and without nasal polyps (NPs). Aeroallergen sensitization in CHES occurs regularly, but the causality between allergen sensitivity, exposure,and disease is unclear.METHODS: Allergen is unlikely to directly enter healthy sinuses either by diffusion or ciliary flow, and, even this is more problematic given the loss of patencyof the ostia of diseased sinuses. Inflammation and tissue eosinophilia can develop secondary to allergen exposure in the nares, with systemic humoralrecirculation of allergic cells including eosinophils, Th2 lymphocytes, and eosinophil precursors that are nonspecifically recruited back to the diseased sinuses.RESULTS: The possibility of an allergic reaction to peptides derived from bacteria (i.e., Staphylococcus or superantigens) or fungi that colonize the diseasedsinus also provides a plausible allergic mechanism.CONCLUSION: Treatments of this disease include agents directed at allergic mediators such as leukotriene modifiers and corticosteroids, although this doesnot necessarily signify that an IgE-dependent mechanism can be ascribed. However, more recently, omalizumab has shown promise, including in patientswithout obvious aeroallergen sensitization. Although many aspects of the role of allergy in CHES remain a mystery, the mechanisms that are being elucidatedallow for improved understanding of this disease, which ultimately will lead to better treatments for our patients who live daily with this disease.
  American Journal of Rhinology and Allergy 04/2013;
• Article: Comparative study of morphological and histological changes between differently structured expanded polytetrafluoroethylene implants in an animal model.

  J H Kim, J M Lee, H W Ju, J H Lee, A Y Jun, C H Park
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  ABSTRACT: BACKGROUND: Expanded polytetrafluoroethylene (e-PTFE) is a popular graft material used in augmentation rhinoplasty. New e-PTFE has thicker fibrils andis more compact than first developed e-PTFE. This study aimed to compare morphological and histological changes between differently structured e-PTFEimplants in a rat model.METHODS: Two types of e-PTFE were implanted in the cranial region of 30 adult male rats. En bloc specimens containing the implants and surroundingsoft tissues were sampled 1, 3, and 6 months after implantation. We measured the three-dimensional size of the implants over time and evaluated histologicalchanges using light and electron microscopy.RESULTS: Grossly, no implants were extruded, and there was no evidence of wound infection. All first developed e-PTFE samples were fixed to surroundingtissues after 1 month, whereas new e-PTFE samples tended to migrate and were easily separated from surrounding tissues until 3 months after implantation.The first developed e-PTFE height diminution rate was 14.7% of the initial value after 6 months; however, new e-PTFE size was not changed. Diameter andheight diminution rates for first developed e-PTFE were significantly greater than those for new e-PTFE after 6 months. Histologically, connective tissue ingrowth was observed in first developed e-PTFE after 1 month, and the internodal space decreased over time; however, connective tissue did not infiltrate intonew e-PTFE until 6 months and the internodal space was not significantly changed.CONCLUSION: First developed e-PTFE should be carefully trimmed in augmentation because of its potential to decrease in size over time, whereas new e-PTFEis more likely to show migration and instability.
  American Journal of Rhinology and Allergy 04/2013;
• Article: Toward photorealism in endoscopic sinus surgery simulation.

  Greg S Ruthenbeck, Jonathan Hobson, A Simon Carney, Steve Sloan, Raymond Sacks, Karen J Reynolds
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  ABSTRACT: Endoscopic sinus surgery (ESS) is the surgical standard treatment for chronic rhinitis/rhinosinusitis and nasal polyposis. There is a reported complication rate of 5-10% associated with this type of surgery. Simulation has been advocated as a means to improve surgical training and minimize the rates of complication and medical error. This study aimed to show how a virtual reality ESS simulator was developed, with particular emphasis on achieving satisfactory photorealism and surgical verisimilitude. Sinus computed tomography scans were processed to create a triangle-based three-dimensional mesh model; this was incorporated into a spring-damper model of thousands of interconnected nodes, which is allowed to deform in response to user interactions. Dual haptic handpiece devices were programmed to simulate an endoscope and various surgical instruments. Textures and lighting effects were added to the mesh model to provide an accurate representation of the surgical field. Effects such as vasoconstriction in response to "virtual" decongestant were added. The final simulated endoscopic view of the sinuses accurately simulates the moist and glossy appearance of the sinuses. The interactive tissue simulation system enables the user to interactively cut and remove tissue while receiving accurate haptic feedback. A working prototype of the simulator has been developed that leverages recent advances in computer hardware to deliver a realistic user experience, both visually and haptically. This new computer-based training tool for practicing ESS provides a risk-free environment for surgical trainees to practice and develop core skills. The novel use of customized precision force feedback (haptic) devices enables trainees to use movements during training that closely mimic those used during the actual procedure, which we anticipate will improve learning, retention, and recall.
  American Journal of Rhinology and Allergy 03/2013; 27(2):138-43.
• Article: Nasal septal perforation repair using intranasal rotation and advancement flaps.

  Joo Hyun Park, Dae Woo Kim, Hong Ryul Jin
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  ABSTRACT: We aimed to present our experience with and algorithm for septal perforation repair using advancement and rotation flaps. A retrospective chart review was performed on 14 patients who underwent septal perforation repair. Etiology, perforation size, presenting symptoms, reconstruction methods, combined operation, surgical results, and complications were evaluated. The mean postoperative follow-up duration was 36 ± 18 months. Among 14 cases, 9 had previous septoplasty or septorhinoplasty and 5 cases suffered from nasal trauma. The perforation sizes varied from 5 to 27 mm, with a 14-mm average. Two cases had multiple perforations. The main symptoms included nasal obstruction, crusting, epistaxis, and whistling. Perforations were repaired using advancement flaps in seven cases or combination of advancement and rotation flaps in seven cases, with or without an interposition graft. Bilateral mucosal closure was accomplished in all cases. Conchal cartilage, remnant septal cartilage, or septal bone was used for an interposition graft. Nine patients had a concurrent rhinoplasty with septal perforation repair. At last follow-up, complete perforation closure was achieved in 12 cases (85.7%). Septal perforation recurred in 2 large perforation cases, which were repaired without interposition grafts. Nasal symptoms disappeared or improved in 13 cases (92.9%). There were no serious complications after surgery. Combined use of intranasal advancement and rotation flaps is a safe and promising option for surgical repair of moderate to large septal perforation. Bilateral tension-free mucosal closure with an interposition graft is important for the surgical success.
  American Journal of Rhinology and Allergy 03/2013; 27(2):42-7.
• Article: Mometasone furoate nasal spray plus oxymetazoline nasal spray: Short-term efficacy and safety in seasonal allergic rhinitis.

  Eli O Meltzer, David I Bernstein, Bruce M Prenner, William E Berger, Tulin Shekar, Ariel A Teper
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  ABSTRACT: Allergic rhinitis (AR) and associated congestion adversely affect patients' lives. The intranasal corticosteroid mometasone furoate nasal spray (MFNS) is effective for AR symptoms including nasal congestion, and the intranasal decongestant oxymetazoline (OXY) is effective against nasal congestion, but the combination has not been fully studied. This study was designed to assess the efficacy of the combination of MFNS and OXY for the relief of seasonal allergic rhinitis (SAR) symptoms. This phase 2 controlled clinical trial randomized adolescent and adult subjects (≥12 years; 2-year SAR) to MFNS q.d. (200 μg) + 3 sprays/nostril of OXY 0.05% (MFNS + OXY3); MFNS q.d. + 1 spray/nostril of OXY (MFNS + OXY1); MFNS q.d.; OXY b.i.d.; or placebo for 15 days, with 1-week follow-up. Coprimary end points were change from baseline in morning/evening (A.M./P.M.) instantaneous (NOW) total nasal symptom score (TNSS) over days 1-15 and AUC (AUC[0-4 hr]) change from baseline in day 1 congestion. In 705 subjects, both combinations reduced A.M./P.M. NOW TNSS over days 1-15 significantly more than OXY b.i.d. or placebo (p ≤ 0.002). Mean standardized AUC(0-4 hr) day 1 congestion change from baseline was significantly greater in combination and OXY b.i.d. groups (MFNS + OXY3, -0.92; MFNS + OXY1, -0.80; OXY b.i.d., -1.06) versus placebo (-0.57) and MFNS q.d. (-0.63). Combinations and MFNS q.d. were significantly effective for A.M./P.M. NOW TNSS over each weekly period; OXY b.i.d. was superior to placebo in week 1. Adverse events (AEs) were few and similar across treatments; one MFNS q.d. and one placebo subject experienced a serious AE, with neither considered treatment related. Combining MFNS with OXY relieves SAR symptoms, including congestion, with faster onset of action than MFNS q.d. and better sustained efficacy than OXY b.i.d.
  American Journal of Rhinology and Allergy 03/2013; 27(2):102-8.
• Article: Role of α2-adrenoceptors in electrical field stimulation-induced contraction of pig nasal mucosa and pharmacologic characterization of a novel α2C-adrenoceptor agonist.

  Michel R Corboz, Maria A Rivelli, Himanshu Shah, Christopher W Boyce, Kevin D McCormick, Richard W Chapman, John C Hunter
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  ABSTRACT: Blood vessels of the nasal mucosa are richly innervated by sympathetic nerves and neural mechanism is of great interest in upper respiratory tract disorders. This study was designed to determine the role of α2-adrenoceptors and, more specifically, α2C-adrenoceptors, on neurogenic sympathetic vasoconstrictor responses in pig nasal mucosa, and to define the pharmacologic profile of a novel selective α2C-adrenoreceptor agonist. Electrical field stimulation (EFS) was applied to nasal mucosa strips placed in an organ bath and attached to force displacement transducers for continuous recording of isometric tension. The affinity and functional activity of compound B for α2C-adrenoceptors were determined by binding analysis and the ability of compound B to stimulate [(35)S]GTPγS binding to the receptors. Compound B was also tested in a postjunctional α2C-adrenoreceptor bioassay. EFS-induced contractions were partly blocked by the α2-adrenoreceptor antagonist yohimbine (41.1%) and the α2C-adrenoreceptor antagonist JP-1302 had no effect. The α2-adrenoreceptor agonist clonidine, but not compound B, exerted a significant blockade (70.6%). Compound B had high affinity (Ki = 18 nM), produced potent agonist (EC50 = 279 nM) and good efficacy (Emax = 73%) responses at the α2C-adrenoceptors, and displayed good functional agonist potency in the human saphenous vein α2C-adrenoreceptor bioassay (pD2 = 6.2). (1) Neurogenic vasomotor contractility is largely regulated through an α-adrenergic mechanism; (2) pig nasal mucosa possesses post- and prejunctional α2-adrenoceptors; (3) the α2C-adrenoreceptor subtype does not seem to be involved; and (4) compound B is a novel, highly selective, and potent α2C-adrenoreceptor agonist.
  American Journal of Rhinology and Allergy 03/2013; 27(2):84-90.
• Article: Mini-nasoseptal flap for recalcitrant sphenoid sinusitis.

  Christopher F Thompson, Adam S Deconde, Alexander G Chiu, John M Lee, Jeffrey D Suh
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  ABSTRACT: Recalcitrant sphenoid sinusitis occurs in 27% of patients undergoing revision functional endoscopic sinus surgery. One of the main causes of disease recurrence in the sphenoid is cicatricial scarring of the ostium. Highly inflammatory lesions such as fungal balls or chronic mucoceles can predispose patients to restenosis. We present a novel use of a modified nasoseptal flap to cover exposed bone after sphenoid wide sinusotomy to prevent restenosis and expedite healing. A case series was performed. The mini-nasoseptal flap was successful in preventing sphenoid ostium restenosis in nine patients undergoing endoscopic sinus surgery for highly inflammatory sphenoid sinus pathology with a mean postoperative follow-up of 8.4 months (range, 2-21 months). Patients had a mean of 2.3 prior sinus surgeries (range, 0-7 surgeries). Most common indications for the flap in this series included long-standing fungal sinusitis or fungal balls (n = 6) with or without significant sphenoid wall osteoneogenesis (n = 6). There were no significant side effects related to flap harvest or inset. The mini-nasoseptal flap decreases the risk of restenosis after sphenoid sinusotomy by preventing circumferential cicatricial scarring and offers an effective surgical option on the spectrum of sphenoid surgical interventions in select patients.
  American Journal of Rhinology and Allergy 03/2013; 27(2):144-7.
• Article: Effects of budesonide on the expression of the glucocorticoid receptor-α in nasal polyp epithelial cells.

  De-Sheng Wang, Qin-Song Liu, Hai-Chun Lai
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  ABSTRACT: This study explores effects of budesonide on the proliferation of nasal polyp epithelial cells and expression of the glucocorticoid receptor (GR) alpha in nasal polyp epithelial cells. Primary cultured, purified, and identified the epithelial cells collected from nasal polyps. The proliferation of nasal polyp epithelial cells was examined by a cell counting kit, and expression of GR-alpha mRNA in nasal polyp epithelial cells was examined by reverse transcription polymerase chain reaction, after training nasal polyp epithelial cells in budesonide solution. The average survival rate of nasal polyp epithelial cells was the lowest in 1 × 10(-6) M budesonide solution (29.284 ± 0.311%), compared with other concentrations. Budesonide at 1 × 10(-8) M caused down-regulation of GR-alpha mRNA expression levels at 6 and 12 ours, compared with the 0-hour group (p < 0.001); compared with the 0-hour group, there were significantly lower expression levels of GR-alpha mRNA at both 24 and 48 hours (p < 0.001); Expression of GR-alpha mRNA at either 48 or 12 hours was not significantly different from that at 24 hours. Budesonide can significantly inhibit the proliferation of nasal polyp epithelial cells, down-regulate the expression of GR-alpha mRNA in nasal polyp epithelial cells with time dependence.
  American Journal of Rhinology and Allergy 03/2013; 27(2):123-7.
• Article: The auricle's cavum conchae composite graft in nasal reconstruction.

  Marc O Scheithauer, Nicole Rotter, Joerg Lindemann, Melanie Schulz, Gerhard Rettinger, Johannes A Veit
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  ABSTRACT: Autologous transplants consisting of skin and cartilage, so-called composite grafts (CGs), are useful in nasal reconstruction of multilayered defects. A CG from the auricle's cavum conchae serves both functional and esthetic demands. This article outlines the indications and the requirements of the CG, making special considerations to improve wound healing, and discusses our results in consideration with recent publications. A retrospective case-control study assessing the functional and esthetic long-term results in the donor and recipient site is presented. Between 2005 and 2011, 91 patients received differently sized CGs of the auricle for nasal reconstruction. In 85/91 cases the donor site defect was closed using a retroauricular pedicled island flap. Six of 91 defects were closed primarily. Indications were multilayered defects of the nasal vestibule, the nasal floor, the inner nasal valve, and the lateral sidewall. The main indication for surgery was skin malignancies. One of 91 major and 14/91 minor complications were observed. Seventy-seven of 91 patients received a custom-made prosthesis to prevent stenotic scarring. The 2.5-year follow-up showed excellent results of stability and shape at the donor and recipient site. The auricular inner lining CG is a versatile and reliable autologous transplant, which is ideal for multilayered nasal reconstruction because of easy harvesting, little donor site morbidity, and its convex shape. Septal splints and custom-made prosthesis secure healing and prevent stenotic scarring.
  American Journal of Rhinology and Allergy 03/2013; 27(2):53-7.
• Article: The feasibility of (18)F-fluorodeoxyglucose-positron emission tomography uptake as a prognostic factor for paranasal sinus malignancy.

  Jeong-Hun Seol, Jinna Kim, Jong-Doo Lee, Jeung-Gweon Lee, Joo-Heon Yoon, Chang-Hoon Kim
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  ABSTRACT: There is a correlation between (18)F-fluorodeoxyglucose (FDG) uptake and the level of intracellular metabolic tumor activity, which in turn may be associated with active proliferation, invasion, and prognosis as well as distant metastases in head and neck cancer. This study was designed to assess whether tumor uptake of FDG positron emission tomography (PET) expressed as the maximum standardized uptake value (SUVmax) can be used to predict survival in subjects with paranasal sinus malignancy. We enrolled 42 consecutive subjects with a histological diagnosis of squamous cell carcinoma in paranasal sinus malignancy, into a retrospective institutional imaging trial. Thirty-eight subjects (90.5%) underwent a baseline FDG-PET scan before curative treatment and were eligible for analysis. A total of 38 subjects with paranasal sinus malignancy undergoing PET/computed tomography imaging in the initial stages were assessed separately for a potential correlation between SUVmax and T staging, histological grading, and overall survival. Log-rank testing revealed a significant correlation between overall survival and histological grading (p = 0.046); and there was some correlation between SUVmax and histological grading, but not significantly different. The receiver operation characteristic curve was identified for cutoff value of SUVmax as a prognostic factor. We compared the low tumor of the SUVmax group with the high tumor of the SUVmax group divided by the cutoff value of SUVmax. We did find a significant correlation between SUVmax and disease control and mortality (p = 0.003, p < 0.001). In our study, we concluded that subjects with higher tumor FDG uptakes should be considered for a more aggressive disease.
  American Journal of Rhinology and Allergy 03/2013; 27(2):118-22.
• Article: Some polymorphisms in Epstein-Barr virus-induced gene 3 modify the risk for chronic rhinosinusitis.

  Yuan Zhang, Chengshuo Wang, Yanming Zhao, Luo Zhang
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  ABSTRACT: Forkhead box protein 3 (FOXP3), a transcription factor required for development and function of regulatory T cell, and Epstein-Barr virus-induced gene 3 (EBI3), a downstream target of FOXP3, may be important in the development of chronic rhinosinusitis (CRS) with or without sinonasal polyposis (CRSwNP and CRSsNP, respectively). Our objective was therefore to examine the presence of any associations between specific single nucleotide polymorphisms (SNPs) in/around the FOXP3 and EBI3 genes and risk for CRS in Chinese subjects. A population-based case-control association analysis was performed. DNA extracted from peripheral blood leukocytes from 667 subjects with CRS (360 CRSwNP and 306 CRSsNP) and 330 healthy controls was assessed for SNPs selected and complemented with tagging SNPs. A total of seven SNPs (4 in FOXP3 and 3 in EBI3 genes) were genotyped and genetic association tests were performed. In the single-locus analyses of CRS risk, the allele frequencies of rs428253 (p = 0.0191) in EBI3 gene and rs2232365 (p = 0.0307) and rs3761548 (p = 0.0221) in FOXP3 gene were significantly different between the CRS cases and the controls. Furthermore, genotype association analysis showed a significant protective effect only between EBI3_rs428253 (CG/CC; p = 0.029) and CRS after adjustment. Similarly, stratified analysis of CRS risk on category showed rs428253 of the EBI3 gene to play a protective role among both CRSwNP (CG/CC; p = 0.002) and CRSsNP (GG/CC; p = 0.023) subjects. Haplotype analysis of the FOXP3 gene region further indicated that CRS risk was higher in individuals carrying the haplotype GG in rs2294018-rs2232365 block, compared with wild-type AG haplotype, and AG in rs3761548-4824747 block, compared with wild-type CG haplotype. The findings of this study suggest that SNPs in FOXP3 and EBI3 genes modify the risk for development of CRS.
  American Journal of Rhinology and Allergy 03/2013; 27(2):91-7.
• Article: A proposed model to study immunologic changes during chronic rhinosinusitis exacerbations: Data from a pilot study.

  Matthew A Rank, John B Hagan, Shefali A Samant, Hirohito Kita
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  ABSTRACT: One way to gain insight into the pathophysiology of chronic rhinosinusitis (CRS) is to study the immunologic changes that occur with exacerbation. This study describes the immunologic changes during CRS exacerbation Methods: We performed a prospective study to investigate the immunologic changes seen during exacerbation of CRS with nasal polyposis. We recruited adult subjects who met clinical criteria for CRS with sinus CT scan within the past 5 years with Lund-Mackay score of >5 and nasal polyps. Subjects underwent a baseline visit with collection of nasal secretion and nasal wash. With acute worsening of symptoms, subjects underwent 6 near-consecutive-day collections and one follow-up collection 2 weeks later. IL-6, IL-33, eosinophil major basic protein (MBP), eosinophil-derived neurotoxin (EDN), myeloperoxidase (MPO), and uric acid were measured on the nasal samples from each visit. A total of 10 subjects were recruited and 9 had acute worsening of CRS during the study period. Eight of the nine subjects were women and ages ranged from 26 to 56 years. At baseline, most inflammatory parameters were low and eight of the nine subjects were on intranasal corticosteroids. Compared with baseline measurements, IL-6, MBP, MPO, EDN, and uric acid were significantly elevated during CRS exacerbation. Levels of IL-6 and MBP (r = 0.47) levels as well as IL-6 and MPO (r = 0.75) were both significantly correlated (p < 0.01). Prospective study of CRS exacerbations is feasible and provides insights into the immunologic mechanisms of CRS.
  American Journal of Rhinology and Allergy 03/2013; 27(2):98-101.
• Article: Craniofacial osteoma: Clinical presentation and patterns of growth.

  Akaber M Halawi, Joan E Maley, Robert A Robinson, Casey Swenson, Scott M Graham
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  ABSTRACT: This study was designed to investigate the clinical features and the growth rate of craniofacial osteomas. Retrospective chart review was performed of 200 cases of craniofacial osteomas diagnosed from January 2001 to September 2011. Data pertinent to patient and osteoma lesion characteristics were collected. Histology of operated cases was reviewed. Computer tomography (CT) charts were reviewed and those with multiple images were analyzed for growth characteristics. One hundred forty-nine patients met our inclusion criteria. Eighty-nine percent of these osteomas were found incidentally. Forty-three percent were in the frontal sinus. Fifteen percent of the patients complained of headaches and only 6.71% of patients with osteoma had headaches congruent with osteoma location. Thirty-one percent of CT scans had sinus mucosal disease; only 8% had mucosal disease adjacent to the osteoma. Ten of the 149 patients underwent surgery for cosmetic and/or rapidly growing osteomas. Thirteen patients had intestinal tubular adenoma, and one was genetically positive for Gardner's syndrome. Fifty-two patients had multiple CT scans that were included in growth rate analysis. The mean linear growth rate of osteomas was estimated to be 0.117 mm/yr (95% CI, 0.004, 0.230) in maximal dimension, assuming linear growth. A descriptive analysis of osteoma growth divided the osteomas into several intervals and studied the growth rate separately in each interval. The median change in maximum dimension was different in each interval in a nonsystematic manner, ranging from -0.066 mm, over 3- to 9-month interval (interquartile range [IQR] = -0.404-1.069), to 0.369 mm over 9- to 15-month interval (IQR = -0.032-0.855), and 0.082 mm over 45- to 51-month interval (IQR = -0.000-0.197). There was no significant association between tumor size, location, or complications. Craniofacial osteomas are slow-growing lesions with no specific growth pattern and rare complications. Their clinical behavior is ill defined and justifies a conservative approach toward asymptomatic lesions with close radiological follow-up.
  American Journal of Rhinology and Allergy 03/2013; 27(2):128-33.
• Article: Expression of a disintegrin and metalloproteinase 8 by inflammatory cells in nasal polyps.

  Selim S Erbek, Evren Hizal, Hilal Erinanc, Seyra Erbek
  American Journal of Rhinology and Allergy 03/2013; 27(2):151.
• Article: Can patients with common variable immunodeficiency have allergic rhinitis?

  Rosana C Agondi, Myrthes T Barros, Cristina M Kokron, Andrea Cohon, Ana K B Oliveira, Jorge Kalil, Pedro Giavina-Bianchi
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  ABSTRACT: Rhinosinusitis is highly prevalent in patients with common variable immunodeficiency (CVID), and probably allergic rhinitis (AR) may be masked by a history of repeated respiratory infections. The diagnosis of AR is based on the patient's symptoms and detection of specific immunoglobulin E (IgE) to aeroallergens. This study was designed to identify rhinitis of probable allergic cause in patients with CVID. This study included 72 adult CVID patients. The patients were divided into three groups according to their history: suggestive of AR, nonallergic rhinitis, and without rhinitis. They were tested for total and specific IgE (in vivo and in vitro). The patients' mean age was 38.2 years. A history of chronic rhinitis was observed in 59 (81.9%) of the cases, 31 of which (43%) had a history suggestive of AR. Patients with a history of rhinitis (whether allergic or nonallergic) presented an earlier onset of symptoms and diagnosis of CVID. Total IgE was undetectable in 86.1% of patients. AR was confirmed by detection of specific IgE to aeroallergens in only 5.6% of the patients. In CVID patients, chronic rhinitis may be allergic, because many have personal and family histories suggestive of atopy. However, in this study, allergy was confirmed by specific IgE detection in only 5.6% of cases. CVID patients with a history suggestive of AR commonly present negative results on traditional testing, so additional experiments may be necessary. One suggestion for the investigation of AR in CVID patients would be nasal provocation with the most prevalent allergens.
  American Journal of Rhinology and Allergy 03/2013; 27(2):79-83.
• Article: Therapeutic equivalence of triamcinolone acetonide hydrofluoroalkane and chlorofluorocarbon nasal inhalers in patients with seasonal allergic rhinitis.

  Eric Schenkel, Kenneth B Newman
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  ABSTRACT: Triamcinolone acetonide (TAA) has been reformulated as an hydrofluoroalkane (HFA) aerosol for intranasal use in patients with seasonal allergic rhinitis (SAR). This study compared the TAA HFA formulation with the previously available chlorofluorocarbon (CFC) nasal inhaler in a dose-ranging study. This was a double-blind, parallel-group, multicenter study in 780 adults with SAR. Patients had a history of fall seasonal rhinitis and positive skin tests to ragweed. After meeting minimum symptom requirements during the run-in phase, patients were randomized to one of eight groups: TAA CFC or HFA at 14, 110, or 440 micrograms once daily or matching placebo. Treatment was continued for two weeks and patient completed a daily diary for reflective and instantaneous rating of nasal and ocular allergy symptoms. All active treatment groups were statistically superior to placebo with respect to the primary outcome variable, total nasal symptoms. Furthermore, the TAA HFA and TAA CFC formulations were statistically comparable over the dose range. Within each formulation, there was a significant mean reduction from baseline in the symptoms of rhinitis that increased with increasing dose. Ocular symptoms were also reduced with both formulations. Both preparations were well tolerated without any safety concerns. In conclusion, a new formulation of TAA with a HFA propellant was found to be effective in the treatment of SAR and comparable with the previously available TAA CFC formulation. There was a dose response to TAA, with doses as low as 7 micrograms per nostril once daily producing statistically significant improvement in rhinitis symptoms.
  American Journal of Rhinology and Allergy 03/2013; 27(2):109-12.
• Article: Nasal eosinophilia and serum soluble intercellular adhesion molecule 1 in patients with allergic rhinitis treated with montelukast alone or in combination with desloratadine or levocetirizine.

  Maciej Ciebiada, Marcin Barylski, Malgorzata Gorska Ciebiada
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  ABSTRACT: Because intercellular adhesion molecule (ICAM) 1 and recruitment of eosinophils are crucial in supporting allergic inflammation, their down-regulation may bring additional benefits in patients' recovery. We have assessed nasal eosinophilia and serum soluble ICAM-1 (sICAM-1) concentrations in relation to nasal symptoms in patients with persistent allergic rhinitis (AR) treated for 6 weeks with either desloratadine, levocetirizine, montelukast alone, or in combination. In this single-center, randomized, double-blind, placebo-controlled, crossover, two-arm study, 40 patients with persistent AR were randomized to receive either montelukast and/or levocetirizine or placebo (n = 20) or to receive treatment with montelukast and/or desloratadine or placebo (n = 20). Nasal eosinophilia and concentration of sICAM-1 in peripheral blood were assessed before and on the last day of each treatment period. All active treatments in both arms of the study resulted in the decrease of sICAM-1 and nasal eosinophilia, which correlated with the severity of nasal symptoms. In the montelukast/levocetirizine arm, montelukast decreased nasal eosinophilia more significantly than levocetirizine, whereas in reduction of sICAM-1 all active treatment options were equally effective. However, in the desloratadine/montelukast arm, the resulting improvement of combination therapy of sICAM-1 and the influx of eosinophils was not statistically significant. The improvement of nasal symptoms in patients with AR treated with antihistamines, with or without montelukast, may additionally result from the reduction of sICAM-1 and nasal eosinophilia. Because the combination therapy may bring inconclusive benefits in this area there is a strong need of further studies to find mechanisms that favor combination therapy.
  American Journal of Rhinology and Allergy 03/2013; 27(2):58-62.
• Article: Nasal provocation test using allergen extract versus cold dry air provocation test: Which and when?

  Young Hyo Kim, Tae Young Jang
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  ABSTRACT: Nasal provocation tests (NPTs) are useful for evaluation of patients with allergic rhinitis. The cold dry air (CDA) provocation test is useful for evaluation of patients with nonspecific nasal hyperreactivity (NHR). This study aimed to determine whether the NPT or CDA provocation would be more useful for patients with different clinical pictures. We evaluated changes in nasal symptoms (visual analog scale [VAS]) and acoustic parameters after NPT or CDA provocation in healthy volunteers (group A, n = 27), patients with allergic rhinitis (group B, n = 20), and subjects with nonallergic rhinitis (group C, n = 26). According to their subjective cold hyperresponsiveness (SCH), we compared changes in VAS and acoustic parameters after each protocol. The correlation between results of the skin-prick test (SPT) and changes in VAS after each protocol was analyzed. Finally, we performed an analysis of correlation between NPT and CDA provocation. After NPT, group B showed a larger change in VAS for rhinorrhea, sneezing, and itching (p < 0.01). After CDA challenge, the change in VAS for nasal obstruction was larger in group C (p < 0.05). Changes in acoustic parameters were larger in groups B and C after NPT (p < 0.01). After CDA challenge, the SCH(+) group (n = 49) showed a larger decrease of acoustic parameters than the SCH(-) group (n = 24; p < 0.01). Significant correlation was observed between the size of SPT and degree of change in VAS after NPT. No significant correlation was observed between NPT and CDA. CDA could be an adjunct tool for evaluating NHR in patients with self-reported SCH.
  American Journal of Rhinology and Allergy 03/2013; 27(2):113-7.