Assessment of taste functions in allergic rhinitis patients undergoing allergen-specific immunotherapy.

BACKGROUND: We evaluated taste functions of patients with perennial allergic rhinitis (AR) before and after allergen-specific immunotherapy (AIT). METHODS: The study was designed as a prospective clinical study in our tertiary care hospital. Patients (n = 21) who were diagnosed with perennial AR on the basis of physical examination, skin prick test of at least 3* for HDM allergen and treated with AIT were enrolled in this study. A control group (n = 21) was selected from patients who were given intranasal steroids (INS) for perennial AR. Both groups had self-reported hyposmia and subjective loss of the sense of taste before treatment. Taste strips (Burghart, Wedel, Germany) were used for the taste identification scores before and after 6 months treatment. RESULTS: A total of 42 subjects were included, with a mean age of 24.1 ± 7.9 years (range 15-43 years). Overall, the AIT group showed more of an improvement of taste function, observed in the total average test scores, compared to the INS group (p < 0.05), but no change was detected between the groups before treatment. No difference was found for the bitter taste scores between the study groups (p = 0.053). CONCLUSION: Subcutaneous allergen immunotherapy resulted in more of an improvement in taste function than intranasal steroids. Further studies are needed.

Radiofrequency treatment for inferior turbinate hypertrophy.

Radiofrequency ablation (RFA) is a technique which causes a reduction in tissue amount using ablation by high-frequency current. Beside other surgical tools, RFA has become quite popular over the past decade. Hypertrophy of the inferior turbinate is a common cause of chronic nasal obstruction. There is no agreement on how to deal with this problem. An ideal procedure for turbinate reduction should be performed with minimal discomfort or adverse reactions and should preserve the physiologic function of the turbinate, such as regulation of humidification and temperature of inspired air. All the current techniques have potential short and long-term complications such as bleeding and atrophic rhinitis. No technique is perfect, and the main goal of turbinate surgery should be the preservation of mucosal surfaces with reduction of submucosal tissue. The variety of surgical techniques available indicates the lack of consensus on the optimal technique. Radiofrequency tissue reduction is a surgical procedure that uses radiofrequency heating to induce submucosal tissue destruction, leading to the reduction of tissue volume. This energy induces ion agitation within the tissue, which increases the local temperature and causes a thermal lesion that should occur in the deep mucosa without damaging the surface. The healing process secondarily induces fibrosis with wound contraction, leading to tissue volume reduction. Radiofrequency ablation is an efficient, easily applicable technique, which does not lead to serious complications in the treatment of the nasal obstruction caused by inferior turbinate hypertrophy.

Lack of Chlamydophila pneumoniae and predominance of Alloiococcus otitidis in middle ear fluids of children with otitis media with effusion.

OBJECTIVE: To investigate the presence of Chlamydophila pneumoniae and other bacterial pathogens in middle ear effusion samples obtained from children with otitis media with effusion (OME). MATERIALS AND METHODS: Twenty-eight children (mean age 7.03; standard deviation 2.18) with OME unresponsive to medical therapy were included in the study. All of the children underwent ventilation tube insertion under general anesthesia. Eighteen patients were bilaterally affected whereas 10 children had unilateral disease. The middle ear fluids (46 samples in total) were collected during ventilation tube insertion, and were evaluated subsequently for the presence of C. pneumoniae and other bacterial pathogens using polymerase chain reaction (PCR). RESULTS: Although all samples were negative for C. pneumoniae, bacterial DNA was detected in 21 of 46 samples. Overall 40% of the patients (4/10) with unilateral involvement, and 61% of the patients (11/18) with bilateral involvement were positive for bacterial DNA. In 6 patients with bilateral OME bilateral samples were positive, whereas 5 patients with bilateral OME showed only unilateral positivity. According to the results of DNA sequencing analysis, all of the positive samples harbored only one bacterial species. In 12 of 46 samples Alloiococcus otitidis DNA (26%), in 7 Haemophilus influenzae DNA (15%), in one Streptococcus pneumoniae DNA (2%) and in one Moraxella catarrhalis DNA (2%) were present. CONCLUSIONS: Our findings support that C. pneumoniae does not seem to have a role in OME in children whereas A. otitidis was found to be more frequent than the other common pathogens. Further studies are required to elucidate the exact pathogenetic role of these microorganisms in OME.

Evaluation of nasal cytology in subjects with chronic rhinitis: a 7-year study.

BACKGROUND: No diagnostic test had been specifically developed to diagnose nonallergic rhinitis (NAR). Also a negative nasal smear for eosinophils does not rule out the diagnosis. There is a significant diagnostic problem in patients with NAR. How can we solve this problem? OBJECTIVES: Assessment of other cells than eosinophils present in the cytogram such as basophils, neutrophils, and goblet cells may help us to classify and management of diagnostic problem of rhinitis. We sought to characterize the cellular pattern of patients with allergic rhinitis (AR) and compare them with those of NAR. METHODS: According to the skin prick test positivity or negativity, individuals were divided into AR and NAR groups, respectively. Allergic rhinitis group was further divided into seasonal, perennial, and mixed subgroups. Nonallergic rhinitis group was also divided into the following 5 subgroups according to the nasal smear cytologic result: basophilic, neutrophilic, eosinophilic, mixed, and nonallergic noninfectious type. So the frequency rates of the subgroups were calculated and also smear cytologic results were compared. RESULTS: Frequency of AR was approximately equal to NAR in subjects with chronic rhinitis. Neutrophilic, eosinophilic, mixed, and nonallergic noninfectious types were the common types of NAR. An evident nasal eosinophilia was found in AR and eosinophilic NAR, whereas a higher percentage of goblet cells were determined in nonallergic noninfectious rhinitis. There is no significant difference between cytologic results from NAR and AR patients. CONCLUSION: In the patient with positive skin test result, the presence of nasal eosinophilia strongly supports the diagnosis of AR. No diagnostic test had been specifically developed to diagnose chronic NAR. Also, a negative nasal smear for eosinophils does not rule out the diagnosis. Assessment of other cells present in the cytogram such as basophils, neutrophils, and goblet cells may also provide valuable information for differential diagnosis and management of these conditions.

Use of nasal bivalve septal teflon splint for the treatment of recurrent epistaxis in patients undergoing anticoagulant therapy.

Management of recurrent epistaxis in patients on anticoagulant therapy is a challenging problem. In this article, we report our experience concerning the use of bivalve septal teflon splint (BSTS) for the treatment of recurrent mild epistaxis in a group of patients who underwent anticoagulant therapy after cardiac valve surgery. The study included 18 patients whose epistaxes recurred despite standard methods such as local pressure, vasoconstrictors, sedation, packing or cauterization. BSTS was sutured on the both sides of the nasal septum and held in place during one month. Epistaxis was controlled in all of the patients. We believe that the use of BSTS is an effective, easily applied, non-traumatic, well-tolerated additional method for the treatment of recurrent mild epistaxis in patients undergoing anticoagulant therapy, when other conventional treatments fail. Further controlled studies with larger groups are warranted in order to further evaluate this method.

Detection of HHV-8 and HPV in laryngeal carcinoma.

OBJECTIVE: In this study we aimed to investigate the presence of human herpesvirus 8 (HHV-8) and human papillomavirus (HPV) in laryngeal carcinoma. MATERIALS AND METHODS: Fifty patients operated on because of laryngeal carcinoma were included in the study. Forty-seven had squamous cell carcinoma (SCC) whereas three had verrucous carcinoma. Fresh tumoral tissues, or tumoral tissues obtained from archival paraffin-embedded blocks, were examined. HHV-8 DNA and HPV DNA were detected using polymerase chain reaction (PCR) and viral genotypes of HPV were determined via the hybrid capture method. The presence of HHV-8 DNA and HPV DNA were also investigated in normal appearing laryngeal tissue collected from 50 cadavers at autopsy. RESULTS: HPV DNA was detected in seven patients (7/50; 14%) (5 out of 47 patients with SCC (5/47; 10.6%) and two out of three patients with verrucous carcinoma). HHV-8 DNA was detected in five patients and they all had SCC (5/47; 10.6%). One case had both HHV-8 and HPV DNA. None of the control samples from cadavers harbored HHV-8 DNA, or HPV DNA. There was a statistically significant correlation between HHV-8 DNA and HPV DNA positivity and laryngeal SCC (Fisher exact test; p=0.023 for each). No statistically significant correlations were found between the presence of HHV-8 and/or HPV and age, gender, tumor stage, differentiation, the site of the tumor, smoking and alcohol use. CONCLUSIONS: The findings of the present study suggest that beside HPV, HHV-8 might have a role in laryngeal carcinogenesis. Further investigations are necessary to clarify the exact role of these viruses in laryngeal carcinoma.

Alveolar soft part sarcoma of the larynx.

Alveolar soft part sarcoma (ASPS) is a rare malignancy. It has generally a poor prognosis. Survival depends on the presence of metastases. Approximately, one-fourth of the cases are encountered in the head and neck region, mostly in the orbits and tongue. Surgery is accepted as the most effective treatment, radiotherapy and chemotherapy may be used as adjuvant treatments. Since it is a highly vascular tumor, profuse bleeding may occur during surgery. In this article, we report a case of ASPS occurring in the larynx, an extremely rare location for this rather unusual tumor. To our knowledge, only three cases of laryngeal ASPS have been previously reported in the English literature.

Nasal sound analysis: a new method for evaluating nasal obstruction in allergic rhinitis.

OBJECTIVE: Current measurements of nasal obstruction are unreliable and may be improved with the development of new techniques. The effectiveness of odiosoft-rhino (OR) in the evaluation of nasal obstruction was investigated in a blind comparison at a referral center, institutional practice. PATIENTS: Forty-eight patients with perennial allergic rhinitis and 52 healthy subjects were studied. Nasal endoscopic examination, acoustic rhinometry (AR), and OR were performed and symptom scores compared. MAIN OUTCOME MEASURE: Assessment of nasal blockage with OR method was the main outcome measure. RESULTS: Using the OR technique, significant differences were observed between the patient and control groups. OR data correlated with symptom scores and endoscopic examination. However, this was not observed with AR. A 15.5-dB cutoff point for the left side and 14.5 dB cutoff point for the right side at the 2,000 to 4,000 Hz frequency interval resulted in 93.8% sensitivity and 92.3% specificity and 72.9% sensitivity and 80.8% specificity, respectively. A 8.5-dB cutoff point for the left and right sides at the 4,000 to 6,000 Hz frequency interval resulted in 87.5% sensitivity and 80.8% specificity and 70.8% sensitivity and 78.8% specificity, respectively. CONCLUSION: OR is a simple, noninvasive test for assessing nasal obstruction. The OR technique can detect nasal obstruction with high sensitivity and specificity, and these findings correlate with symptoms and physical examination.