Aeroallergens in West Crete, Greece: A five year (2010-2014) aerobiological study.

The objective of the analytic observational study was to present air-pollen counting program results for a 5-year period. Airborne pollens and fungi collection, from both urban and sub-urban areas, were obtained using a special Burkard pollen trap installed on the roof of Chania General Hospital. Aeroallergen concentration measurement was made in a standardized way with fixation of the material collected and then counting using an optical microscope. Annual and total circulating pollen and fungi counts for the study period are presented. In the year 2014, the highest total annual count was recorded, while 2013 was the year with the lowest one. Months with the highest average concentrations were June for the years 2010 and 2011 (1291 and 1114.6 grains/m(3), respectively) and May for the consecutive 3 years 2012-2014 (1120, 890 and 1353.1 g/m(3), respectively). Peak periods for circulating aeroallergens were April-June. Trees pollen accounted for the majority of circulating aeroallergens (615.9 and 677.1 g/m(3) during peak periods in the years 2012 and 2014), while fungi accounted for the majority of circulating aeroallergens (818.5, 729.4, 890.7 spores/m(3)), during the peak periods in the years 2010, 2011 and 2013. Variability in peak airborne allergen periods could be partly explained by the differences in climatic conditions during the study period.

Alternaria and Cladosporium calendar of Western Thrace: Relationship with allergic rhinitis symptoms.

OBJECTIVES/HYPOTHESIS: Alternaria and Cladosporium are the most important outdoor moulds. The aim of this study was to present fungal spore monitoring data, investigate the relationship of fungal counts with climate conditions, and to explore the clinical significance of Alternaria and Cladosporium species monitoring in allergic rhinitis (AR). STUDY DESIGN: Analytic observational study. METHODS: A 7-day volumetric trap was used to collect circulating Alternaria and Cladosporium fungi. Sixty-nine AR patients were studied and recorded their symptoms by Total 5 Symptoms Score (T5SS). Sensitization prevalence to fungi species was detected by skin prick tests. Monitoring data were correlated to climate conditions and patients symptoms score. RESULTS: Alternaria and Cladosporium were detected throughout the calendar year in ranges of 0 to 217 spores/m(3) and 6.5 to 1,600 spores/m(3) per day, respectively. Highest daily concentrations of both fungi were detected during the summer (73.9 ± 34.4 spores/m(3) for Alternaria and 595.8 ± 288.0 spores/m(3) for Cladosporium) and lowest during the winter (2.4 ± 3.0 spores/m(3) for Alternaria and 24.3 ± 15.7 spores/m(3) for Cladosporium). Both were positively correlated to mean daily temperature and negatively to relative humidity (all P < 0.001). Clinically, a strong significant correlation between T5SS and airborne fungi levels, both for Alternaria (r = 0.822, P = 0.001) and Cladosporium (r = 0.787, P = 0.002) species was observed. CONCLUSIONS: We found Cladosporium to be the most frequently detected airborne mould, whereas Alternaria was the most prevalent with regard to sensitization rate. Patients' symptoms score was significantly correlated to spore concentrations. Both fungi were clearly affected by climate factors, such as temperature and relative humidity. These findings are important in AR management. LEVEL OF EVIDENCE: N/A.

Seasonal variations of allergenic pollen in a Mediterranean region - Alexandroupolis, north-east Greece.

OBJECTIVES: The aim of this study was to describe the aerobiological characteristics of NE Greece, identify the most prevalent taxa, define the duration of the main pollen season and correlate allergen records with meteorological parameters. MATERIALS AND METHOD: A 7-day volumetric trap, running continuously throughout the year, was used to collect circulating pollen. Pollen taxa were characterized by standard protocols and counted as grains/m(3) . The main pollen season was deduced from these data and running means (10-day averages) were plotted against time. Correlations with climatic factors (temperature, rain, humidity, wind velocity) were assessed by single linear regression analysis. RESULTS: In total, 11 pollen families were identified, including 6 arboreal and 5 non-arboreal taxa. The 5 most prevalent taxa were Oleaceae, Fagaceae, Poaceae, Cupressaceae and Pinaceae. Peak pollen concentrations were detected in April and May, with daily averages exceeding 410 grains/m(3) . Compositeae had the longest pollen season of 135 days and Oleaceae the shortest, extending to only 27 days. Correlations with meteorological parameters showed variable associations among different taxa, with mean temperature (p<0.001), relative humidity (p=0.015), and wind speed (p=0.042) emerging as the most significant determinants as regards total pollen counts. CONCLUSIONS: Describing the aerobiological characteristics of NE Greece enabled the identification of allergenic risks that are specific for this region. Records generated in this study can be used to alert sensitized individuals of prevailing seasonal patterns, in order to take necessary precautions against imminent exposures. The monitoring system established here can serve as a reference guide for future epidemiological research focusing on allergic asthma and rhinitis.

The clinical significance of the pollen calendar of the Western Thrace/northeast Greece region in allergic rhinitis.

BACKGROUND: There are major differences in the clinical pattern of allergic rhinitis (AR) patients among countries, reflecting local aerobiological conditions. We analyzed the correlation between airborne pollen concentrations of the Western Thrace/northeast (NE) Greece region with symptoms scores in AR patients. The above data is the first provided for the Mediterranean climate of Greece and reflects the clinical significance of pollen calendar in everyday clinical practice. METHODS: An annual pollen calendar of the most important outdoor aeroallergens (grasses, trees, and weeds) was developed, using a Burkard volumetric spore trap. A total of 168 AR patients were studied and asked to evaluate their symptoms and main seasonal appearance. Sensitization prevalence to pollen species was detected by skin prick tests. Symptoms were evaluated by Total 5 Symptoms Score (T5SS) and correlated to aerobiological data. RESULTS: As far as the pollen calendar is concerned, the highest total percentages of pollens were recorded for olive (24.02% of total), oak (13.74%), grasses (9.08%), and cypress (7.63%). Regarding patients' sensitivities, the most prevalent ones were to grasses (56.0%), olive (43.5%), wall pellitory (24.4%), and cypress (16.7%) antigens. A strong significant correlation between total pollen counts and patients' T5SS (r = 0.874, p < 0.001) was observed. Moreover, strong significant correlations between T5SS and pollen counts were also found for the most prevalent species, including grasses, olive, and Parietaria allergens (r = 0.627, p = 0.029; r = 0.695, p = 0.012; and r = 0.656, p = 0.021, respectively). CONCLUSION: Patients' symptoms scores were found to be significantly correlated to pollen counts. Given data are important for the management of AR patients who live in similar Mediterranean climate conditions.

Predictors of quality of life improvement in allergic rhinitis patients after sublingual immunotherapy.

OBJECTIVES: Sublingual immunotherapy (SLIT) has been described as a significant intervention in the treatment of allergic rhinitis (AR). However, factors that may predict treatment outcomes with respect to quality of life (QoL) results and mainly the role of olfactory function are still being underestimated. In this study, we investigated determinants that best predict treatment outcomes for QoL, exploring mainly the role of olfaction. METHODS: One hundred forty-five patients following SLIT, 45 placebo-controls, and 48 healthy subjects were studied. Olfactory function was objectively evaluated using "Sniffin' Sticks" test pre- and post-cessation of SLIT. Three categories of validated QoL questionnaires were filled out by all subjects: questionnaire specific for olfaction (Questionnaire of Olfactory Deficits), questionnaires for assessing psychology (Beck Depression Inventory, Zung Depression Scale, State & Trait Anxiety Inventory), general Short Form-36 health survey. RESULTS: Statistically significant improvement of olfactory function by 11.1% and of all QoL questionnaires results (all P<.001) was observed on final evaluation. Anosmia, asthma history, and the severity of symptoms-expressed by the Total Symptoms Score-were proven independent determinants of clinically significant improvement in patients' QoL. CONCLUSIONS: Several factors were found that may predict QoL outcomes in AR patients following SLIT.

The effects of smoking on quality of life recovery after surgery for chronic rhinosinusitis.

BACKGROUND: The effects of smoking on quality of life (QoL) results in chronic rhinosinusitis (CRS) patients still remain a matter of debate. OBJECTIVE: To explore the impact of smoking on QoL and determine how quantity of daily smoking and duration affect QoL results after endoscopic sinus surgery (ESS). METHODOLOGY: Patients with CRS were prospectively asked to evaluate their QoL pre- and after ESS. All subjects' QoL was evaluated by means of validated questionnaires either specific (Questionnaire of Olfactory Deficits), for assessing psychology (Zung Anxiety Scale, State -Trait Anxiety Inventory, Zung Depression Scale and Beck Depression Inventory) or generic (Short-Form-36). Smoking habits were expressed in pack-years. RESULTS: No statistically significant differences were found in the pre-treatment scores in any of the questionnaires between smokers and non smokers. Post-operatively, all QoL questionnaires' results were significantly improved among both groups, although non smokers exhibited significantly greater improvement compared to smokers. There was a negative impact of the number of pack-years on the changes of QoL results; less improvement was observed as the number of pack-years was increasing. CONCLUSION: Although smoking did not improve preoperative QoL results and proved not to be a contra-indication factor for ESS regarding QoL, smokers presented worse treatment outcomes. Quantity and duration of smoking were significantly associated with worse postoperative results in all QoL questionnaires.

Demographic correlates of anxiety and depression symptoms in chronic sinonasal diseases.

OBJECTIVES: To explore mental health of patients with olfactory loss due to chronic sinonasal diseases and investigate the effects of age-, gender-, and socio-economic variables on anxiety and depression symptoms. METHODOLOGY: One hundred and eight patients (62 males; mean age: 39.78 ± 16.11 years), suffering from olfactory impairment due to chronic rhinosinusitis and allergic rhinitis and 30 healthy subjects (16 males; mean age, 37.03 ± 13.09 years) were studied. Olfactory function was evaluated using "Sniffin' Sticks" test. All patients completed four validated questionnaires specific for assessing anxiety and depression (Zung Anxiety Scale, State-Trait Anxiety Inventory-STAI, Zung Depression Scale, and Beck Depression Inventory-BDI). RESULTS: We found significantly more severe anxiety and depression symptoms in anosmic (all p < 0.001) and hyposmic patients compared to healthy controls. No significant differences were observed between normosmic patients and controls. Scores in all psychological measures were significantly higher in elderly and female patients as well as in low, compared to high, socio-economic status patients. No significant differences were found between low and medium socio-economic level. CONCLUSIONS: Olfactory loss in chronic sinonasal diseases was found to be associated with anxiety and depression symptoms. Moreover, anxiety was correlated with depression. With regard to patients' demographics, female gender and low socioeconomic status proved to be independently correlated with anxiety and depression levels.

Predictors of quality of life outcomes in chronic rhinosinusitis after sinus surgery.

The predictive value of olfaction for quality of life (QoL) recovery after endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) is still underestimated. The aim of this study was to explore the proportion of patients suffering from CRS who experience clinically significant QoL improvement after ESS and identify pre-operative clinical phenotypes that best predict surgical outcomes for QoL, focusing mainly on the role of patients' olfaction. One hundred eleven patients following ESS for CRS and 48 healthy subjects were studied. Olfactory function was expressed by the combined "Threshold Discrimination Identification" score using "Sniffin' sticks" test pre-treatment and 12 months after treatment. All subjects completed validated, widely used QoL questionnaires, specific for olfaction (Questionnaire of Olfactory Deficits: QOD), for assessing psychology (Beck Depression Inventory: BDI) and for general health (Short Form-36: SF-36). Statistically significant improvement of olfactory function by 41.8% and of all QoL questionnaires scores (all p < 0.001) was observed on the 12-month follow-up examination. Clinically significant improvement for QoL was measured in a proportion of 56.8% of patients on QOD, 64.9% on SF-36 and 49.5% on BDI scales results. Although olfactory dysfunction, nasal polyps, female gender, high socio-economic status and non-smoking habits were significantly associated with better QoL results, multivariate logistic regression analysis revealed that only olfactory dysfunction and nasal polyps were independent predictors significantly associated with higher likelihood of clinically significant improvement in all QoL questionnaire results. Olfactory dysfunction and nasal polyps were independent pre-operative predictors for surgical outcomes with regard to QoL results.

Inflammatory patterns in upper airway disease in the same geographical area may change over time.

BACKGROUND: Inflammatory patterns of nasal polyps (NPs) may vary. Changes over time have not been investigated so far. This study was designed to evaluate the inflammatory patterns of NPs in Thailand at two time points 12 years apart, explore differences in Staphylococcus aureus (SA) mucosal carriage rates over time, and the latter's relationship with the inflammatory patterns. METHODS: Formalin-fixed nasal tissue was obtained from 89 (47 in 1999 and 42 in 2011) patients suffering from chronic rhinosinusitis with NPs (CRSwNPs). Tissues were evaluated for eosinophils, neutrophils, IgE(+) cells, IgE and macrophage mannose receptors, interleukin (IL)-5 and IL-17 cytokine profile, and the presence of SA, using automated immunohistochemistry and peptide nucleic acid-fluorescence in situ hybridization. RESULTS: We found a significant increase in the absolute values of eosinophils and IgE(+) cells in the 2011 CRSwNP tissue series compared with 1999 and a significant but smaller increase in neutrophils. Semiquantitative evaluation revealed significantly higher mean values of positive cells for all studied inflammatory markers in the 2011 group of patients, except for the high-affinity IgE receptor. This "eosinophilic shift" of inflammation was accompanied by higher SA carriage, as well as higher frequencies of SA invasion (54.8% versus 10.6%; p < 0.001) in the 2011 compared with 1999 subjects. Patients with asthma were more likely to have higher SA carriage rates compared with nonasthmatic patients. CONCLUSION: There was a shift from predominantly neutrophilic to eosinophilic CRSwNPs in Thai patients within 12 years, with an increase in various inflammatory markers including IgE, which is associated with an increase in intramucosal presence of SA.

Olfactory dysfunction and asthma as risk factors for poor quality of life in upper airway diseases.

BACKGROUND: The study of olfaction/quality of life (QoL) interaction has not been adequately discussed and remains to be further explored. Determination of clinical predictors for poor QoL may support consultation of respective patients. This study explores QoL of patients with olfactory dysfunction and evaluates associated clinical risk factors for QoL prediction. METHODS: One hundred eight patients suffering from chronic rhinosinusitis (CRS) and allergic rhinitis (AR) and 30 healthy subjects were studied. Olfactory function was evaluated using objective olfactory test. All patients completed six validated questionnaires either specific for olfaction (Questionnaire of Olfactory Deficits [QOD]) and for assessing psychological state (Zung Anxiety Scale [ZAS], State-Trait Anxiety Inventory, Zung Depression Scale, and Beck Depression Inventory [BDI]) or a generic one (Short Form 36). RESULTS: Significantly poorer QoL and more severe anxiety and depression symptoms were observed in anosmic (all p < 0.001) and hyposmic patients compared with controls. Anosmic patients presented significantly worse results compared with hyposmic and normosmic patients. However, higher scores were observed in hyposmic compared with normosmic patients only in the QOD, ZAS, and BDI scale. Patients with CRS presented significantly poorer QoL than patients with AR only. The presence of nasal polyps or concomitant AR in patients with CRS did not show any differentiation in the results. Asthma was associated with significantly worse scores in all the psychometric questionnaires. CONCLUSION: Olfactory dysfunction was found to decrease QoL among patients. Anosmia, CRS disease, and asthma as clinical predictors were proved to be independently correlated with QoL, anxiety, and depression levels.

Improvement of olfactory function for quality of life recovery.

OBJECTIVES/HYPOTHESIS: To explore quality of life (QoL) improvement after treatment of patients with chronic olfactory disorders; and to correlate QoL with olfactory rehabilitation and evaluate olfactory improvement values over which QoL outcomes are significantly recovered. STUDY DESIGN: Prospective clinical study. METHODS: Eighty-nine patients following endoscopic sinus surgery for chronic rhinosinusitis (CRS) and immunotherapy for allergic rhinitis (AR) were studied. Olfactory function was evaluated using Sniffin' Sticks test pre-and 12 months after treatment. All patients completed six validated QoL questionnaires either specific for olfaction (Questionnaire of Olfactory Deficits-QOD) and for assessing mental health (Zung Anxiety Scale, State-Trait Anxiety Inventory, Zung Depression Scale, Beck Depression Inventory), or generic one (Short Form-36). RESULTS: Significant improvement (all P < 0.001) of olfactory function by 27.4% in total cohort (AR: 10.4%, P = 0.004; CRS: 39.9%, P < 0.001), expressed by the combined Threshold-Discrimination-Identification (TDI) score-and of all QoL questionnaires scores (all P < 0.01) as well, was observed after treatment. There was a positive correlation between olfactory recovery and improvement of patients' QoL. ROC analysis revealed that an increase in the TDI score by 3.50 points in AR and 4.75 points in CRS was necessary for a clinically significant improvement in all QoL questionnaires results. CONCLUSIONS: QoL and mental health of patients suffering from chronic sinonasal diseases are totally recovered after treatment, presenting a direct positive relationship with smell improvement. An increase of olfactory function by 3.50 points for AR and 4.75 points for CRS might be considered the cutoff point for patients' QoL significant recovery.

Involution of a large parotid hemangioma with oral propranolol: an illustrative report and review of the literature.

Propranolol has emerged as a new treatment option for infantile hemangiomas. We describe a 20-month-old boy with a large right parotid hemangioma diagnosed at the age of 37 days. Starting at the age of 2.5 months, he received oral propranolol for 6.5 months. Although the mass regressed, it recurred when propranolol was discontinued. He was successfully retreated at the age of 11 months with propranolol for another 5.5 months without further recurrences. Treatment was tolerated well. Our paper and a review of the literature demonstrate that propranolol appears to be safe and effective for symptomatic infantile parotid gland hemangiomas.

Olfaction-associated quality of life in chronic rhinosinusitis: adaptation and validation of an olfaction-specific questionnaire.

OBJECTIVES/HYPOTHESIS: To detect validity and reliability of the Questionnaire of Olfactory Disorders (QOD) compared to other quality-of-life (QoL) questionnaires, to explore its ability to reflect olfaction-related QoL changes, and to investigate age- and gender-related effects of olfactory changes on QOD results. STUDY DESIGN: Prospective clinical study. METHODS: One hundred two patients (56 males, 46 females; mean age, 41.15 ± 16.31 years), suffering from chronic rhinosinusitis, whose olfactory function was measured using Sniffin' Sticks test were studied. All patients completed three validated general health-related QoL questionnaires (Short Form-36 Health Survey [SF-36], Beck Depression Inventory [BDI], and Zung anxiety scale), and the olfaction-related QOD. RESULTS: Internal consistency and test-retest reliability for the QOD was high. Convergent validity assessment showed statistically significant negative correlations of the QOD and the QOD-negative statements (NS) with overall SF-36 score (P < .05 for all groups) and positive correlations of the same scores with BDI and Zung (P < .001). The QOD-positive statements (PS) was positively correlated to SF-36. Discriminative validity demonstrated statistically significant differences of the QOD and QOD-NS scores between all groups of patients (normosmics, hyposmics, anosmics; all pairwise comparisons, P < .001). The QOD-PS score was significantly higher in normosmics and hyposmics compared to anosmics. Patients' age was negatively correlated with the QOD-PS, whereas it was positively correlated with BDI (P < .001) and Zung (P = .007). Females presented significantly higher scores in the QOD, QOD-NS, BDI, and Zung (all P < .001) compared to males. CONCLUSIONS: The QOD proved to be a valid, reliable, and easy-to-use method of assessment of olfaction-related QoL with high specificity and sensitivity.

Clinical significance of Alternaria alternata sensitization in patients with allergic rhinitis.

PURPOSE: The aim of the study was to determine the epidemiologic profile of Alternaria alternata (AA)-sensitized patients with allergic rhinitis including coexistence of other atopic diseases, seasonal distribution of AA aeroallergens, age of onset of AA sensitization, and prevalence of sensitization to other allergens. MATERIALS AND METHODS: History, clinical examination, and skin prick tests were performed in 623 patients with allergic rhinitis from central Greece. Patients' age, cosensitization, place of living, seasonal distribution, and concomitant symptoms were the variables used to discriminate between AA-sensitized and non-AA-sensitized patients. Significant predictor variables for AA sensitization were determined. RESULTS: A alternata sensitization was associated with male sex, age younger than 18 years, living in new-built apartments in urban and semiurban areas by the sea, perennial distribution, and nonsmoking. A alternata-sensitized patients were affected more frequently by asthma than non-AA-sensitized patients. No significant differences were found in frequency of bronchitis, cough, conjunctivitis, urticaria, or eczema between patients sensitized or not to AA. Most (66.7%) of AA-sensitized patients were oligosensitized, 18.5% of patients were polysensitized, and 14.8% were monosensitized. Patients' age, cosensitization, place of living, and seasonal distribution were the significant predictor variables discriminating AA-sensitized from non-AA-sensitized patients. These variables correctly classified 79.7% of the patients. A alternata-sensitized patients were more frequently sensitized to grasses, cat epithelia, and flours-rye and less frequently sensitized to artemisia, Dermatophagoides pteronyssinus, D farinae, and chenopodium. CONCLUSIONS: Patients meeting the aforementioned epidemiologic criteria should be preferentially offered skin prick tests for AA sensitization.

Biometric predictive models for the evaluation of olfactory recovery after endoscopic sinus surgery in patients with nasal polyposis.

BACKGROUND: Determination of predictive factors and specific values of olfactory function after endoscopic sinus surgery (ESS) using objective diagnostic methods may support consultation of respective patients. This study was designed to assess the longitudinal olfactory functional outcome after ESS in patients with severe chronic rhinosinusitis (CRS) with nasal polyposis, to evaluate associated clinical factors and to provide statistical models for prediction of olfactory recovery. METHODS: One hundred sixteen patients with nasal polyposis refractory to medical treatment underwent ESS. Olfactory testing was performed preoperatively and 1, 3, and 6 months after surgery using "Sniffin' Sticks" (Burghardt, Wedel, Germany). Using multivariate linear and logistic regression analysis, statistical models were generated to predict (i) the 6th-month composite threshold-discrimination-identification (TDI) score and (ii) the probability of attaining normal olfaction at 6 months. RESULTS: A significant stepwise increment of all olfactory function indices was found over time. Factors influencing final olfactory recovery were patients' age, duration of olfactory deficit, previous paranasal sinus surgery, and aspirin-exacerbated respiratory disease. The first model explained 70% of the observed variation in postoperative TDI scores. The second model correctly classified 76% of the patients. CONCLUSION: A significant progressive improvement of olfaction for at least 6 months was observed after ESS. The statistical models developed may be useful for consultation of ESS candidates in clinical practice.

Inferior nasal turbinate wound healing after submucosal radiofrequency tissue ablation and monopolar electrocautery: histologic study in a sheep model.

OBJECTIVES/HYPOTHESIS: To study differences in inferior nasal turbinate (INT) mucosal and submucosal wound-healing histology after radiofrequency tissue ablation (RTA) and monopolar electrocautery (MEC). STUDY DESIGN: Randomized controlled trial. METHODS: Experimental study in sheep. Using hematoxylin- and eosin-stained sections, stromal fibrosis, submucosal interstitial space volume (ISV), mucosal epithelial cell necrosis, submucosal inflammation, and vascularization in inferior turbinate samples were compared after RTA and MEC. Twelve turbinate samples were studied for each technique after 1, 3, and 8 weeks postoperatively (four samples at each time point) and there were five samples of controls. A 4-point semiquantitative histologic grading scale (0 = absence, 1 = mild, 2 = medium, 3 = pronounced) was used to assess changes. Comparisons were performed using the Mann-Whitney test and the Kruskal-Wallis one-way analysis of variance (ANOVA). RESULTS: At postoperative week 8, the RTA group had more extensive fibrosis (P = .061) and ISV reduction (P = .127), less epithelial cell necrosis (P = .131), and significantly less submucosal inflammation (P = .036) and vascularization (P = .011) compared with the MEC group. Epithelial cell necrosis and submucosal inflammation at week 8 did not differ significantly between RTA and control group (P = 1.000 and P = .356, respectively). A significant decrease in submucosal layer vascularization in RTA-treated INTs has been observed (P = .003 compared with controls). CONCLUSIONS: RTA is more effective (although not significantly) and less invasive than MEC for INT volume reduction. Tissue damage and wound healing were dominated by inflammation and associated epithelial cell necrosis in MEC and by a disturbance in the INT submucosal microcirculation in RTA in the studied sheep model.

Ultrasound submucosal inferior nasal turbinate reduction technique: histological study of wound healing in a sheep model.

AIM OF THE STUDY: To describe histological changes after application of an ultrasound tissue reduction (UTR) technique in a newly introduced sheep model to study inferior nasal turbinate mucosal wound healing. MATERIALS AND METHODS: An experimental study in a sheep model. Stromal fibrosis, submucosal interstitial space volume (ISV), mucosal epithelial cell necrosis, mucosal inflammation and blood vessels' engorgement in inferior turbinate samples were assessed after application of UTR using hematoxylin/eosin staining in 12 turbinate samples after different time points. Histological grading was performed using a 4-point scale RESULTS: After one week, extensive development of fibrosis (p = 0.006) and significant reduced stromal ISV (p < 0.001) compared to controls were observed. The degree of fibrosis and the stromal ISV remained constant during the 8-week period. The extensive epithelial cell necrosis observed at week 1, diminished later, so that at 8 weeks no significant difference with controls in the necrosis extent was noted. Significant reduction of engorgement of blood vessels in the submucosal layer was noted after 8 weeks (p = 0.008, compared with baseline). Mucosal inflammation, while pronounced at week 1 (p = 0.005, compared with baseline), was normalized at week 8. CONCLUSION: Due to the rapid induction of extensive fibrosis, to the limited inflammation reaction, to the moderate degree of epithelial necrosis, to the reduction of subepithelial ISV and the persistence of these features till week 8 at least, UTR emerges as an effective minimally invasive technique for inferior nasal turbinate volume reduction.

Evaluation of prognostic factors for olfaction in nasal polyposis treated by endoscopic sinus surgery.

AIM: This prospective study aimed to assess treatment outcome on olfaction in patients undergoing Endoscopic Sinus Surgery (ESS) for nasal polyposis, and to evaluate the role of previous sinus surgery and the duration of olfactory deficit as prognostic factors for olfaction improvement. METHODS: In total, 116 patients with nasal polyposis who underwent ESS were studied. Olfactory testing was performed using the Sniffin' Sticks test, preoperatively and 1-, 3- and 6-month postoperatively. RESULTS: The values of the composite threshold discrimination identification score were significantly lower in patients with long duration of olfactory deficit and history of previous sinus surgery in all testing sessions. Adjustment for preoperative olfactory measures and all potential confounders revealed that both parameters remained strong independent predictors of normal olfactory function; a successful outcome was more frequent in patients with short duration of olfactory deficit and in patients who had not undergone previous sinus surgeries. However all patients achieved a significant stepwise increment of all indices of olfactory function over time, after ESS. CONCLUSIONS: Duration of olfactory deficit and previous sinus surgery presented highly significant predictive value for the short-term outcome of the olfactory function after ESS. However all patients suffering from nasal polyposis will probably improve olfaction significantly in a period up to six months after surgery.

Improvement of olfaction after endoscopic sinus surgery in smokers and nonsmokers.

OBJECTIVES: The aim of this prospective study was to examine the short-term benefit of endoscopic sinus surgery (ESS) on the olfactory function of patients operated on for nasal polyposis. We also studied the predictive value of smoking for the recovery of the olfactory function in these patients. METHODS: We studied 116 patients with nasal polyposis who underwent ESS. Olfactory testing was performed with the Sniffin' Sticks test before operation and 1, 3, and 6 months after operation. RESULTS: All patients achieved a statistically significant stepwise increment of all of the indices of olfactory function over time. The composite threshold-discrimination-identification score was lower in smokers than in nonsmokers in all testing sessions, but none of these differences reached statistical significance. After adjustment for preoperative olfactory measures and all other potential confounders, the effect of smoking on the 6-month postoperative measurement was not significant. However, we did find a statistically significant adverse effect of the quantity of smoking on the olfactory threshold scores. CONCLUSIONS: Both smokers and nonsmokers achieve a highly significant improvement on their olfactory function from ESS. Although smoking is not a major predictive factor for the short-term outcome of the olfactory function after ESS, a greater quantity of smoking may have an effect on the 6-month postoperative odor thresholds.