Research status and prospect of tissue engineering technology in treatment of atrophic rhinitis / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of the feasibility of a new treatment method for atrophic rhinitis (ATR) based on tissue engineering technology (seed cells, scaffold materials, and growth factors), and provide new ideas for the treatment of ATR.@*METHODS@#The literature related to ATR was extensively reviewed. Focusing on the three aspects of seed cells, scaffold materials, and growth factors, the recent research progress of ATR treatment was reviewed, and the future directions of tissue engineering technology to treat ATR were proposed.@*RESULTS@#The pathogenesis and etiology of ATR are still unclear, and the effectiveness of the current treatments are still unsatisfactory. The construction of a cell-scaffold complex with sustained and controlled release of exogenous cytokines is expected to reverse the pathological changes of ATR, promoting the regeneration of normal nasal mucosa and reconstructing the atrophic turbinate. In recent years, the research progress of exosomes, three-dimensional printing, and organoids will promote the development of tissue engineering technology for ATR.@*CONCLUSION@#Tissue engineering technology can provide a new treatment method for ATR.

Historia del manejo de rinitis atrófica / The history of the treatment of atrophic rhinitis

La rinitis atrófica es una enfermedad crónica progresiva caracterizada por dilatación anormal de las cavidades nasales con atrofia de la mucosa, submucosa y cornetes nasales subyacentes. Los factores etiopatogénicos aún son desconocidos. Su presentación clínica consiste en congestión nasal paradójica asociado a secreciones viscosas, con presencia de costras secas de mal olor. La higiene nasal con irrigación de alto volumen y baja presión es el estándar de tratamiento médico. El tratamiento quirúrgico busca reducir el tamaño de las cavidades nasales y promover la regeneración de la mucosa nasal así como también su vascularización y lubricación. A lo largo de la historia se han descrito múltiples procedimientos quirúrgicos que han buscado estrechar la cavidad nasal para permitir el paso de aire de forma más fisiológica. Por otra parte, se han propuesto intervenciones radicales como el cierre de las fosas nasales para disminuir los síntomas y mejorar la calidad de vida. En este artículo se resumen los principales manejos y procedimientos propuestos junto con sus resultados y conclusiones. Si bien la mayoría de las técnicas descritas ya no se utilizan en la actualidad, es importante conocerlas ya que aún existen pacientes que fueron sometidos a ellas pudiendo presentar complicaciones y/o efectos adversos.

Atrophic rhinitis is a chronic progressive disease characterized by abnormal dilatation of the nasal cavities with atrophy of the mucosa, nasal submucosa and underlying nasal turbinates. The etiopathogenic factors are still unknown. Its clinical presentation consists of paradoxical nasal congestion associated with viscous secretions, usually with the presence of dry, bad-smelling crusts. Nasal hygiene with high pressure irrigation remains the standard of medical treatment. Surgical treatment seeks to reduce the size of nasal cavities and promote regeneration of nasal mucosa as well as its vascularization and lubrication. Throughout history, multiple surgical procedures have been described that have sought the narrowing of the nasal cavity to allow the passage of air more physiologically. On the other hand, radical interventions have been proposed such as the closure of the nostrils to reduce symptoms and improve quality. This article summarizes the main proposed procedures along with their results and conclusions. Although most of the techniques described are no longer used today, it is important to know them since there are still patients who were subjected to them and may present complications and / or adverse effects.

Evaluation of the immunobiological effects of a regenerative far-infrared heating system in pigs

Thermal conditions are an important environmental factor in maintaining healthy pigs because they affect feed intake, growth efficiency, reproduction and immune responses in pigs. RAVI, a regenerative far-infrared heating system, can effect pig production by emitting an optimal far-infrared wavelength. Far-infrared radiation has been reported to increase microvascular dilation and vascular flow volume. The purpose of this study was to evaluate the immunobiological differences between pigs raised with the RAVI system and the gasoline heater system. Twenty-six-week-old weaned pigs were raised in two rooms that were equipped with a RAVI system or a gasoline heater for 8 weeks. A porcine atrophic rhinitis vaccine was administered after two weeks and transcriptome analysis in whole blood were analyzed at 2-week intervals. Signaling pathway analyses of the RAVI group at 8 weeks showed the activation of pathways related to nitric oxide (NO) production. This suggests that the application of RAVI might induce the production of NO and iNOS, which are important for increasing the immune activity. Similar to the result of microarray, phenotypic changes were also observed at a later period of the experiment. The increase in body weight in the RAVI group was significantly higher than the gasoline heater group at 8 weeks. The antibody titer against the vaccine in the RAVI group was also higher than that the gasoline heater group at 4 weeks and 8 weeks. This evaluation of the use of a far-infrared heating system with pigs will be helpful for applications in the pig farm industry and pig welfare.

Pulmonary tuberculosis occurred in patient with Tracheobronchopathia Osteochondroplastica / 고신대학교의과대학학술지

Tracheobronchopathia osteoplastica (TO) is a rare benign disease in which the anterior inner wall of the tracheobronchus changes because of abnormal chondrogenesis or ossification, while the posterior wall of the trachea is spared. The etiology is not clearly understood, but may relate with chronic infection, inflammation, and trauma. In some case studies, it has also been reported to be accompanied by other chronic diseases such as atrophic rhinitis and amyloidosis. However, Coexistence of TO and tuberculosis has rarely been reported, and has never been reported in Korea. Here, we report a case of a 70-year-old male patient who complained of hemoptysis and whose case was diagnosed as TO and pulmonary tuberculosis through bronchoscopy with bronchial washing and biopsy.

Customized Alar Stent Fabrication for Atrophic Rhinitis Patient: A Non-invasive Technique.

Atrophic Rhinitis is a form of chronic rhinitis in which the nasal mucosa atrophies and hardens; eventually causing the nasal passages to dilate and dry out. Other prominent findings include foul smelling crusts and bleeding. Despite various local, medical and surgical methods suggested for the treatment of this slowly progressing disease, the problem with respect to the proper maintenance of the nasal valve area remains unsolved. The alar stent prevents the narrowing of the nostrils and helps in maintaining the airway patency. This article describes a simplified, non-invasive technique for the fabrication of a heat polymerized clear acrylic resin alar stent for treating the atrophic rhinitis patient.

Evaluation of the immunogenicity of Bordetella bronchiseptica, a vaccine antigen / 대한수의학회지

Bordetella (B.) bronchiseptica is a causative agent of swine atrophic rhinitis that promotes colonization of the mucous membrane of the swine nasal cavity by Pasteurella (P.) multocida. Mixed infection with B. bronchiseptica and P. multocida leads to growth inhibition of pigs, resulting in significant economic loss. There are many commercial vaccines for atrophic rhinitis, including B. bronchiseptica as a killed vaccine antigen (Ag). However, the immunogenicity of killed B. bronchiseptica Ag has not yet been elucidated; therefore, this study was conducted to investigate the immunogenicity of killed B. bronchiseptica Ag and the type of immune response it induces. In vitro assays using mouse spleen cells and flow cytometry revealed that B. bronchiseptica Ag induced high proliferation capability of lymphocytes, especially B lymphocytes, and the proliferating cells showed a significant response to interleukin (IL)-2. B. bronchiseptica Ag also enhanced the production of IL-12, a representative cytokine for cell-mediated immunity. In vivo experiments using mice showed that the injection of B. bronchiseptica Ag markedly induced Ag-specific antibody. Taken together, these results indicate that B. bronchiseptica Ag has high immunogenicity by itself.

Two Cases of the Inverted Papilloma in the Maxillary Sinus Treated by Modified Transnasal Endoscopic Medial Maxillectomy / 대한이비인후과학회지

Although inverted papilloma (IP) of the nose and paranasal sinus is a benign neoplasm, it is associated with frequent recurrence and malignant transformation. Various surgical techniques have been employed for resection of this tumor. Transnasal endoscopic medial maxillectomy (TEMM) is an effective surgical management of IP originating from the maxillary sinus. It usually removes the inferior turbinate, lateral wall of the nasal cavity, and nasolacrimal duct, and may cause adverse effects such as atrophic rhinitis, empty nose syndrome, impairment of nasal physiological function, and epiphora. Recently, however, a modified TEMM, which preserves the inferior turbinate, lateral wall of the nasal cavity, and nasolacrimal duct has been introduced. We present two cases of IP successfully treated by the modified TEMM.

Extranodal NK/T Cell Lymphoma, Nasal Type that Occurred in Patients with Atrophic Rhinitis / 대한이비인후과학회지

Extranodal NK/T cell lymphoma, nasal type, is a rare non-Hodgkin lymphoma originating in the nasal cavity or in the paranasal sinuses. Atrophic rhinitis is a debilitating chronic nasal mucosal disease of unknown etiology. However, there have not been any reports on the occurrence of nasal NK/T cell lymphoma in patients with atrophic rhinitis. We experienced a case of the extranodal NK/T cell lymphoma in the left nasal cavity, which had been misdiagnosed as atrophic rhinitis in a 39-year-old female. Thus, we report this rare case with a review of the literature.

Rinitis atrófica / Atrophic rhinitis

La rinitis atrófica es una enfermedad crónica y progresiva de etiología desconocida. Se caracteriza por atrofia de la mucosa nasal y hueso subyacente, dilatación anormal de las cavidades nasales, obstrucción nasal paradójica, y formación de secreciones viscosas y costras secas; produciendo fetidez. Sus manifestaciones clínicas más frecuentes son obstrucción nasal, secreción purulenta, costras nasales y mal olor nasal. Se ha separado en dos entidades: primaria y secundaria. El tratamiento es principalmente conservador, y se han propuesto diversas terapias farmacológicas y quirúrgicas. La rinitis atrófica unilateral es una condición infrecuente, con escasos reportes en la literatura científica. Se puede asociar a la desviación septal, por lo que su corrección quirúrgica es una alternativa terapéutica disponible.

Atrophic rhinitis is a chronic disease of unknown etiology. This condition is characterized by progressive nasal mucosal and underlyng bone atrophy, abnormal widening of the nasal cavities, paradoxical nasal congestion and formation of viscid secretions and dried crusts, leading to a characteristic fetor (ozaena). The main clinical manifestations include nasal obstruction, purulent discharge, daily nasal crusting, nasal dryness and foul smell. It has been divided into two separate entities; primary and secondary. Treatment is mostly conservative, although pharmacological and surgical therapies have been proposed. Unilateral atrophic rhinitis is an uncommon condition, with few reports in the scientific literature. It is associated with septum deviation, so surgical correction is one of the therapeutic options available.

Primary Atrophic Rhinitis with Bilateral Turbinates Agenesis

In this paper, we report a case of bilateral inferior and middle turbinate agenesis, a rare anomaly. A 27-year-old woman presented with nasal obstruction, crust formation, anosmia, and foul odors. Anterior rhinoscopic examination revealed the absence of the middle and inferior turbinates on both sides. The patient had no history of nasal or sinus surgery. She denied over having expelled anything of significance from her nasal cavity. She had no history of infectious disease-including tuberculosis and syphilis, granuolomatous diseases, sarcoids, Wegener's disease, and radiation therapy. There have been few reports on bilateral turbinate agenesis.

Primary Atrophic Rhinitis with Bilateral Turbinates Agenesis

In this paper, we report a case of bilateral inferior and middle turbinate agenesis, a rare anomaly. A 27-year-old woman presented with nasal obstruction, crust formation, anosmia, and foul odors. Anterior rhinoscopic examination revealed the absence of the middle and inferior turbinates on both sides. The patient had no history of nasal or sinus surgery. She denied over having expelled anything of significance from her nasal cavity. She had no history of infectious disease-including tuberculosis and syphilis, granuolomatous diseases, sarcoids, Wegener's disease, and radiation therapy. There have been few reports on bilateral turbinate agenesis.

Management of Rhinitis: Allergic and Non-Allergic

Rhinitis is a global problem and is defined as the presence of at least one of the following: congestion, rhinorrhea, sneezing, nasal itching, and nasal obstruction. The two major classifications are allergic and nonallergic rhinitis (NAR). Allergic rhinitis occurs when an allergen is the trigger for the nasal symptoms. NAR is when obstruction and rhinorrhea occurs in relation to nonallergic, noninfectious triggers such as change in the weather, exposure to caustic odors or cigarette smoke, barometric pressure differences, etc. There is a lack of concomitant allergic disease, determined by negative skin prick test for relevant allergens and/or negative allergen-specific antibody tests. Both are highly prevalent diseases that have a significant economic burden on society and negative impact on patient quality of life. Treatment of allergic rhinitis includes allergen avoidance, antihistamines (oral and intranasal), intranasal corticosteroids, intranasal cromones, leukotriene receptor antagonists, and immunotherapy. Occasional systemic corticosteroids and decongestants (oral and topical) are also used. NAR has 8 major subtypes which includes nonallergic rhinopathy (previously known as vasomotor rhinitis), nonallergic rhinitis with eosinophilia, atrophic rhinitis, senile rhinitis, gustatory rhinitis, drug-induced rhinitis, hormonal-induced rhinitis, and cerebral spinal fluid leak. The mainstay of treatment for NAR are intranasal corticosteroids. Topical antihistamines have also been found to be efficacious. Topical anticholinergics such as ipratropium bromide (0.03%) nasal spray are effective in treating rhinorrhea symptoms. Adjunct therapy includes decongestants and nasal saline. Investigational therapies in the treatment of NAR discussed include capsaicin, silver nitrate, and acupuncture.

A Case of Tracheobronchopathia Osteochondroplastica Associated with Atrophic Rhinitis / 대한이비인후과학회지

Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease of trachea characterized by numerous osseocartilaginous nodules protruding into the tracheobronchial lumen. The etiology of TO is unknown; however, an association with upper respiratory diseases such as atrophic rhinitis has been suggested. The authors report a case of TO with atrophic rhinitis with related literatures.

Rinitis atrófica como causa del síndrome de nariz vacía: reporte de caso / Atrophic rhinitis as cause of the empty nose syndrome: case report

La rinitis atrófica es una de las causas del Síndrome de nariz vacía, la cual está relacionada con colonización por gérmenes, inflamación crónica y posterior atrofia progresiva de la mucosa nasal. Típicamente produce síntomas obstructivos nasales, rinorrea y costras fétidas. Se presenta el caso en imágenes endoscópicas, tomográficas y de cultivo en una paciente femenina en la cual por sus comorbilidades el manejo fue exclusivamente médico.

Atrophic rhinitis is one of the causes of the empty nose syndrome that is related to colonization by germs, chronic inflammation and subsequent progressive atrophy of the nasal mucosa. Typically produces nasal obstructive symptoms, runny nose and fetid crusts. Endoscopy, tomography and culture images of a female patient is presented in which by her co-morbidities associated the treatment was medical exclusively.

Modified surgical treatment of atrophic rhinitis

The aim of the study was to evaluate the role of alternate periods of surgical closure of the nostrils in treating patients with atrophic rhinitis. A descriptive study was conducted involving 11 patients clinically diagnosed as atrophic rhinitis who underwent surgical closure of the nostrils alternately. These patients were treated in the Department of ENT, Al-Jamhori Teaching Hospital, Mosul, Iraq during the period from April 1990 to December 2004. The parameters analyzed included age, sex, clinical presentation and residence. Moreover, evaluation of the result of alternative periodic surgical closure of the nostrils was evaluated. The study was conducted on 11 patients with atrophic rhinitis [10 females and 1 male]. The average age was 16.2 years with a range of 13.20 years. The peak age incidence was 18th year of life. The most frequent clinical presentation was nasal obstruction in spite of wide nasal cavities. There was improvement of symptoms with regeneration of the nasal mucosa in 10 [90.9%] patients. All of the patients accepted this operation as the other nostril was left open to allow for a relatively functional nasal airway. The results of this series suggest that this technique is useful in the treatment of atrophic rhinitis

A Case of Anhidrotic Ectodermal Dysplasia with Atrophic Rhinitis / 대한이비인후과학회지

Anhidrotic ectodermal dysplasia is a rare genetic disorder characterized by absence or diminished numbers of structures derived from the ectoderm, and it is reported to be inherited as an x-linked recessive trait. It is recognized clinically by anhidrosis, hypotrichosis, anodontia or reduced numbers of teeth with deformed shape and characteristic facial features. In addition, otolaryngological manifestations include atrophic rhinitis, sensorineural hearing loss, and conductive hearing loss and satyr ear, among others. Early diagnosis of anhidrotic ectodermal dysplasia can prevent fatal hyperpyrexia and appropriate genetic counseling can be followed to make a reasonable future plans for the pediatric patient. A 2-month-old infant was referred with symptoms of intermittent nasal obstruction and crust formation in both nasal cavities. The nasal endoscope demonstrated atrophic changes of nasal mucosa and radiologic study showed an unerupted conical shaped tooth. The diagnosis of anhidrotic ectodermal dysplasia was confirmed with the finger impression test that revealed deficiency of sweat pores. We report a case of anhidrotic ectodermal dysplasia with a review of the literature.

The Clinical Effects of Topical Lanolin Ointment for the Treatment of Dry Nose

BACKGROUND AND OBJECTIVES: Many people experience problems with a dry nasal mucous membrane, often without wondering why. The cause of problem is known as rhinitis sicca, senile rhinitis, and atrophic rhinitis, etc. A common form of treatment for patients who have such symptoms has been to begin by rinsing the inside of the nose with saline solution, to drop peanut oil, to apply antibiotic-ointment and moisturizing agents. Lanolin has been know as a safe skin moisturizing agent and used to treat dry nose. The purpose of this study was to evaluate the effect of lanolin on a group of patients seeking treatment for dryness of the nose. MATERIAL AND METHODS: Ninety-three patients experiencing problems with dry nasal mucosa were selected from the out-patient clinic. Fifty-seven patients, average age 36.3 years old, were treated with 1:2 mixture of lanolin and vaseline ointment. Thirty-six patients, average age 32.0 years, were treated with vaseline ointment. Both ointments were applied three times a day for two weeks. The efficacy of treatment was determined with pre and post-treatment six symptoms on a visual analogue scale: nasal obstruction, crust formation, mucosal dryness, respiratory discomfort, sleep disturbance, and general discomfort. RESULTS: For subjects treated with lanolin, the average VAS value for nasal obstruction was 5.84+/-2.28 and it decreased to 2.89+/-1.29, while the corresponding values for subjects treated with vaseline were 4.39+/-1.77 decreasing to 3.11+/- 1.24 (p<0.05). Crust formation of lanolin treated subjects were 5.67+/-2.39 and it decreased to 2.09+/-1.46, while the vaseline treated subjects were 4.83+/-1.99 decreasing to 2.33+/-1.31 (p<0.05). Average total symptom improvement was 65.7% (from 27.95+/-9.30 to 9.86+/-4.58) in lanolin treated group, while it was 44.8% (from 20.9+/-76.59 to 11.64+/-4.18) in vaseline treated group. CONCLUSION: We found that the efficacy of lanolin was statistically signigicantly better than that of vaseline. During the study period, there was no local reactions have been reported, nor have any allergic reactions. The present study underlines the fact that the way to treat nasal mucosal dryness is to use lanolin ointment.

Nasal Myiasis

BACKGROUND: Nasal myiasis is very distressing condition of the nose that occurs among patients with atrophic rhinitis. This condition is frequently found among those belonging to the lower socioeconomic status suffering from bad nasal hygienic conditions. A retrospective study was done of 58 cases of patients admitted for nasal myiasis. All the patients belonged to the lower socio- economic class and suffered from poor hygienic condition. The majority of the patients were over the age of 60 years and male female ratio was 1 : 1.5 .The primary complaints of this condition were epistaxis, foul smelling nasal discharge, passage of worms from the nose and pain. The majority of the patients were suffering from primary atrophic rhinitis and a few from the secondary atrophic rhinitis due to syphilis and leprosy. TREATMENT: As a first step of treatment, the maggots were removed manually and endoscopically. All the patients became maggot free in 2-3 days time. Alkaline nasal douching was then started along with 25% glucose in glycerine nasal drop. Complications such as septal perforation, saddling nose, palatal perforation were observed in a few cases. The incomplete closure of nose (modified Young's operation) was performed in a few cases. CONCLUSION: Manual and endoscopic removal should be done repeatedly. Antimeningitis prophylaxis should be started at once. And, to prevent recurrence, mosquito net should be used while sleeping, and incomplete closure of both the nasal cavity (modified Young's operation) should be carried out.

Pre and post-treatment histopathological changes in atrophic rhinitis.

Atrophic rhinitis is a chronic debilitating nasal mucosal disease of unknown etiology. It is characterized by progressive nasal mucosal atrophy, crusting, fetor and enlargement of the nasal space with paradoxical congestion. The disease induces bilateral nasal obstruction and a persistent foul odour of which the patient and by-standers are painfully aware. Primary atrophic rhinitis has decreased markedly in incidence in the last century. However the prevalence still remains high in developing countries like India. Histopathological features allow this entity to be distinguished from chronic non-specific hypertrophic rhinitis, which may have a cell-mediated immune basis underlying its pathogenesis. Histopathological examination of primary atrophic rhinitis was performed on biopsy material from 30 patients. Mucosal atrophy, squamous metaplasia, and chronic inflammatory cell infiltrate were found to characterize this disease.

A Case of Surgical Treatment of Atrophic Rhinitis: Silastic Implant

The literature does not report a cure for atrophic rhinitis, but considerable relief of symptoms such as foul odor, crust formation and nasal stuffiness could be given to the patient by surgical treatment, which always involves a method of narrowing the nasal airway. In this report, a review of the surgical technique of silastic implantation, clinical results and follow up is presented. Forty three years old female patient who was diagnosed as primary atrophic rhinitis was treated surgically with silastic implantation. The result was excellent with complete resolution of the major symptoms. There was no complication such as extrusion of implant. We found that the silastic is a readily available and inexpensive material and the surgical procedureis relatively simple to perform and easily revised. We propose silastic implant as a treatment modality of atrophic rhinitis with a review of literatures.