Antileukotriens: new adjunctive therapeutic option in allergic rhinitis and nasal polyposis

Allergic rhinitis is one of the most prevalent medical conditions. Almost 40% of the allergic rhinitis patients have lower airways involvement, whereas more than 80% of the allergic asthma patients have concomitant rhinitis symptoms. Therapeutic options include allergen avoidance, antihistamines and intranasal corticosteroids and recently, antileukotrienes. The objective of this study was to determine the efficacy of leukoriene receptor antagonist in the medical management of allergic rhinitis and nasal polyposis as an adjuctive therapy to antihistamines and corticosteroids. The 50 patients recruited for this study were divided into three groups; group I included 23 allergic rhinitis patients without nasal polyposis where antileukotrien [montelukast 10 mg once per day] was given in combination with the antihistaminic [loratadine] 10 mg for 6 months. Group II; included 11 patients with nasal polyposis who were undergoing daily intranasal steroid sprays fluticasone, 200 micro g and antileukotriene was given as an adjunctive therapy. Group III; included 16 nasal polyposis patients who underwent endoscopic ethmoidectomy and bilateral maxillary antrostomy. Treatment administered after surgery was 10 mg of montelukast once daily for 6 months in 9 patients and in a control group of 7 subjects; fluticasone 200 micro g nasal spray and loratadine tablets 10 mg once per day. Six months follow-up for the three groups included rhinoendoscopy, anterior rhinomanometry and computerized tomography [CT]. Group I. revealed clinical subjective improvement in 19 patients [82.6%]. Nasal symptoms; itching, postnasal discharge, headache sneezing and rhinorrhea were improved .There was also a significant improvement in objective assessment. Clinical subjective improvement in group II was experienced only by 3 patients [27%]. Patients in Group III showed in both subgroups total absence of any local recurrence and good nasal patency. Leukotriene synthesis inhibitors appear to be a novel treatment modality for patients with allergic rhinitis when used as adjunctive or alternative therapy. They might play a role in controlling polyposis and their symptoms, and might be an alternative to longterm steroid therapy and repeated surgical therapy

Critical analysis of recurrences after trans-oral endoscopic laser resection of laryngeal cancer

This study included 41 patients with recurrent squamous cell carcinoma of the larynx 3-14 months after failed transoral endoscopic laser resection [TLS]. They were subjected to diagnostic and staging work up. The initial diagnostic data before performing TLS were analyzed. The patients were treated surgically according to the presenting stage, either by conservative laryngeal surgery [CLS] or by total laryngectomy [TL] with or without neck dissection. Deep X-ray therapy [DXT] was given to patients who were presented with T3 and T4 lesions if a full dose of DXT was not given after initial TLS. The patients were followed up for at least two years. Initially, 13 patients were presented with T1 disease, 9 with T2, 17 with T3 and 2 with T4. Three to 14 months after failed TLS, 22 patients developed a recurrent disease but of the same initial stage, while 19 developed a more advanced stage