Pelargonium Extract EPs 7630 in the Treatment of Human Corona Virus-Associated Acute Respiratory Tract Infections - A Secondary Subgroup-Analysis of an Open-Label, Uncontrolled Clinical Trial.

Background: Experience in treating human coronavirus (HCoV) infections might help to identify effective compounds against novel coronaviruses. We therefore performed a secondary subgroup-analysis of data from an open-label, uncontrolled clinical trial published in 2015 investigating the proanthocyanidin-rich Pelargonium sidoides extract EPs 7630 in patients with the common cold. Methods: 120 patients with common cold and at least 2 out of 10 common cold symptoms received one film-coated 20 mg tablet EPs 7630 thrice daily for 10 days in an uncontrolled, interventional multicentre trial (ISRCTN65790556). At baseline, viral nucleic acids were detected by polymerase chain reaction. Common cold-associated symptoms and treatment satisfaction were evaluated after 5 days and at treatment end. Based on the data of patients with proof of viral nucleic acids, we compared the course of the disease in patients with or without HCoV infection. Results: In 61 patients, viral nucleic acids were detected. Of these, 23 (37.7%) were tested positive for at least one HCoV (HCoV subset) and 38 (62.3%) for other viruses only (non-HCoV subset). Patients of both subsets showed a significant improvement of common cold symptoms already after 5 days of treatment, although the observed change tended to be more pronounced in the HCoV subset. At treatment end, more than 80% of patients of both groups were completely recovered or majorly improved. In both subsets, less than 22% of patients took concomitant paracetamol for antipyresis. The mean number of patients' days off work or school/college was similar (0.9 ± 2.6 days in HCoV subset vs 1.3 ± 2.8 days in non-HCoV subset). In both groups, most patients were satisfied or very satisfied with EPs 7630 treatment. Conclusion: EPs 7630 treatment outcomes of common cold patients with confirmed HCoV infection were as favourable as in patients with other viral infections. As this trial was conducted before the pandemic, there is currently no evidence from clinical trials for the efficacy of EPs 7630 in patients with SARS-CoV-2 infection. Dedicated non-clinical studies and clinical trials are required to elucidate the potential of EPs 7630 in the early treatment of HCoV infections.

Secondary Hyperthyroidism due to an Ectopic Thyrotropin-Secreting Neuroendocrine Pituitary Tumor: A Case Report.

INTRODUCTION: The main differential diagnoses of secondary hyperthyroidism include thyrotropin-secreting neuroendocrine pituitary tumors (TSH-PitNETs) and resistance to thyroid hormone. As a rare cause of secondary hyperthyroidism, ectopic thyrotropin-producing neuroendocrine pituitary tumors must also be considered. CASE PRESENTATION: A 48-year-old female patient with overt hyperthyroidism and elevated thyrotropin was admitted to the endocrine outpatient clinic of a secondary care hospital in March 2018. The patient had an inconspicuous pituitary MRI and F18-F-DOPA PET-CT, but showed a tumor mass located at the pharyngeal roof. Most biochemical tests and an increased tracer uptake of the pharyngeal mass in a Ga68-DOTANOC PET-CT argued for the presence of an ectopic TSH-PitNET. After treatment with octreotide over 5 days and a consecutive normalization of free thyroxine and free triiodothyronine, the tumor was endoscopically resected. Histologically, the mass consisted of small partially spindle, partially polygonal monomorphic to mildly pleomorphic cells with immunoreactivity for thyrotropin and luteinizing hormone. Postoperatively, the patient required intermittent levothyroxine therapy. DISCUSSION AND CONCLUSIONS: Ectopic TSH-PitNETs represent an extremely rare cause for secondary hyperthyroidism. While the diagnostic process may be complicated by negative imaging studies of the pituitary gland, family history, biochemical tests, and functional imaging using gallium-labelled somatostatin analogues may be helpful in establishing the diagnosis.

Masking release with changing fundamental frequency: Electric acoustic stimulation resembles normal hearing subjects.

It has been shown that patients with electric acoustic stimulation (EAS) perform better in noisy environments than patients with a cochlear implant (CI). One reason for this could be the preserved access to acoustic low-frequency cues including the fundamental frequency (F0). Therefore, our primary aim was to investigate whether users of EAS experience a release from masking with increasing F0 difference between target talker and masking talker. The study comprised 29 patients and consisted of three groups of subjects: EAS users, CI users and normal-hearing listeners (NH). All CI and EAS users were implanted with a MED-EL cochlear implant and had at least 12 months of experience with the implant. Speech perception was assessed with the Oldenburg sentence test (OlSa) using one sentence from the test corpus as speech masker. The F0 in this masking sentence was shifted upwards by 4, 8, or 12 semitones. For each of these masker conditions the speech reception threshold (SRT) was assessed by adaptively varying the masker level while presenting the target sentences at a fixed level. A statistically significant improvement in speech perception was found for increasing difference in F0 between target sentence and masker sentence in EAS users (p = 0.038) and in NH listeners (p = 0.003). In CI users (classic CI or EAS users with electrical stimulation only) speech perception was independent from differences in F0 between target and masker. A release from masking with increasing difference in F0 between target and masking speech was only observed in listeners and configurations in which the low-frequency region was presented acoustically. Thus, the speech information contained in the low frequencies seems to be crucial for allowing listeners to separate multiple sources. By combining acoustic and electric information, EAS users even manage tasks as complicated as segregating the audio streams from multiple talkers. Preserving the natural code, like fine-structure cues in the low-frequency region, seems to be crucial to provide CI users with the best benefit.

A New Transcutaneous Bone Conduction Hearing Implant: Short-term Safety and Efficacy in Children.

OBJECTIVE: To investigate the safety and efficacy of a new bone conduction hearing implant in children, during a 3-month follow-up period. STUDY DESIGN: Prospective, single-subject repeated-measures design in which each subject serves as his/her own control. SETTING: Otolaryngology departments of four Austrian hospitals. PATIENTS: Twelve German-speaking children aged 5 to 17 suffering from conductive or mixed hearing loss, with an upper bone conduction threshold limit of 45 dB HL at frequencies between 500 and 4000 Hz. INTERVENTION: Implantation of the Bonebridge transcutaneous bone conduction hearing implant (tBCI). MAIN OUTCOME MEASURES: The subjects' audiometric thresholds (air conduction, bone conduction, and sound field at frequencies 500 Hz to 8 kHz) and speech perception (word recognition scores [WRS] and 50% word intelligibility in sentences [SRT50%]) were tested preoperatively and at 1 and 3 months postoperatively. The patients were also monitored for adverse events and they or their parents filled out questionnaires to analyze satisfaction levels. RESULTS: Speech perception as measured by WRS and SRT50% improved on average approximately 67.6% and 27.5 dB, respectively, 3 months after implantation. Aided thresholds also improved postoperatively, showing statistical significance at all tested frequencies. Air conduction and bone conduction thresholds showed no significant changes, confirming that subjects' residual unaided hearing was not damaged by the treatment. Only minor adverse events were reported and resolved by the end of the study. CONCLUSION: Safety and efficacy of the new bone conduction implant was demonstrated in children followed up to 3 months postoperatively.

Release of cyclooxygenase-2 and lipoxin A4 from blood leukocytes in aspirin-exacerbated respiratory disease.

BACKGROUND: The release of cyclooxygenase-2 (COX-2) and lipoxin A4 (LXA4) from blood mononuclear cells in patients with aspirin-exacerbated respiratory disease (AERD) is only partially understood. OBJECTIVE: To investigate the presence of COX-2 and LXA4 in peripheral blood mononuclear cells (PBMC) derived from patients with AERD and with nasal polyps (NP) (designated as the AERD-NP group), patients with NP without AERD (the NP group), and healthy controls without sinus disease (the control group). METHODS: Blood was taken from 14 patients in the AERD-NP group, 6 patients in the NP group, and 8 healthy subjects in the control group. After culturing of human PBMC, the presence of COX-2 protein and LXA4 (ELISA) was detected in the supernatant, and the results were compared among the groups. RESULTS: COX-2 and LXA4 were detectable after culturing of PBMC in all patients in the AERD-NP and NP groups and in the control subjects. COX-2 was highest in the patients in the AERD-NP group, but the difference was not significant compared with patients with non-AERD polyp and with the control subjects. LXA4 was also highest in the AERD-NP group, but the difference was also not significant compared with the patients who were non-AERD polyp and the control subjects. CONCLUSION: Neither the release of COX-2 or LXA4 was different between the patients with AERD and with NPs, the patients without AERD and with NPs, and the healthy control group. The release of these proteins in AERD needs further investigation.

Cyclooxygenase 2 and lipoxin A4 in nasal polyps in cystic fibrosis.

BACKGROUND: The etiology of nasal polyps (NPs) and sinusitis in cystic fibrosis (CF) patients is still unknown. This study investigates the presence of cyclooxygenase 2 (COX-2) and lipoxin A(4) (LXA(4)) in epithelial cultures derived from NPs and turbinates in patients with CF and without CF. METHODS: NPs and turbinates were evaluated from eight CF patients with obstructing NPs undergoing sinus surgery. NPs and tissue from the hypertrophic inferior turbinate from 14 patients without history of CF undergoing sinus surgery served as control specimens. After tissue culturing, the presence of COX-2 protein and LXA(4) (ELISA) was detected in CF polyps and turbinates and compared with that of the control group. RESULTS: COX-2 and LXA(4) were detectable in tissue specimens of all CF patients and control patients. COX-2 was highest in CF polyps, but the difference was not significant compared with CF turbinates or polyps and turbinates of patients not suffering from CF. LXA(4), however, was significantly higher in CF NPs compared with CF turbinate tissue. Compared with NPs of patients not having CF disease, CF polyps showed markedly higher concentrations of LXA(4). CONCLUSION: LXA(4) is significantly elevated in CF NPs, whereas COX-2 is only slightly increased. The present data support the concept that LXA(4) plays an important role in CF nasal polyposis. Chronic infection in nasal polyposis and, because of inflammation, induced COX-2 in CF NPs may be related to increased LXA(4). The suspected interaction of COX-2 and LXA(4) needs further investigation.

Endolaryngeal posterior mucosal flap for surgical repair of posterior glottic stenosis.

OBJECTIVE: We report our experience with an endolaryngeal surgical procedure for posterior glottic stenosis with review of the literature. METHODS: Four patients with posterior glottic stenosis underwent endoscopic reconstruction of the posterior glottis applying an endolaryngeal posterior mucosal flap. Laryngeal function (i.e., voice and airway patency) before and after surgery was assessed. RESULTS: One out of four patients has been tracheostomy-dependent prior to laryngeal surgery. After endolaryngeal surgery, no primary wound healing disorders could be observed in all patients. Aspiration problems occurred in none of the patients. In three of the four patients, the mucosal flap was completely successful. In one patient, the mucosal flap was only partially successful (improvement of voice, but no improvement of airway patency). CONCLUSION: We believe that the endolaryngeal posterior mucosal flap may offer an additional option in patients with mild to moderate posterior glottic stenosis.

Lipopolysaccharide induction of cyclooxygenase-2 in long-term nasal epithelial cultures in cystic fibrosis.

OBJECTIVE: To evaluate the lipopolysaccharide induction of cyclooxygenase-2 (COX-2) in long-term epithelial cultures from nasal polyp tissue of patients with cystic fibrosis (CF) and severe nasal polyposis. DESIGN: Experimental and histologic study. SETTING: Department of Otorhinolaryngology, University of Ulm, Ulm, Germany. PARTICIPANTS: Nasal polyp tissue was evaluated from 9 patients with CF and obstructing nasal polyps undergoing elective sinus surgery. Nasal mucosa from the hypertrophic inferior turbinate of 9 patients without a history of CF or aspirin intolerance undergoing nasal corrective surgery served as control specimens. INTERVENTIONS: Tissue culturing, Western blotting, and tissue staining with hematoxylin-eosin. MAIN OUTCOME MEASURES: The expression and lipopolysaccharide induction of COX-2 was detected and compared with those of the control group. Tissue was analyzed for the presence of inflammatory cells such as neutrophils, eosinophils, mast cells, plasma cells, lymphocytes, and monocytes. RESULTS: COX-2 was detectable in tissue specimens from all of the patients with CF and control subjects. In patients with CF, however, COX-2 expression was significantly lower in lipopolysaccharide-stimulated, long-term cultured epithelial cells compared with control tissue. Polyps from patients with CF contained markedly more neutrophils, macrophages, and plasma cells than did nasal mucosa from hypertrophic inferior turbinates of controls. CONCLUSIONS: COX-2 expression in lipopolysaccharide-stimulated, long-term cultured epithelial cells in patients with CF is decreased compared with that in hypertrophic turbinate mucosa. The estimated defect in lipopolysaccharide responsiveness and the reduced induction of COX-2 needs further investigation.

Numerical simulation and nasal air-conditioning.

Heating and humidification of the respiratory air are the main functions of the nasal airways in addition to cleansing and olfaction. Optimal nasal air conditioning is mandatory for an ideal pulmonary gas exchange in order to avoid desiccation and adhesion of the alveolar capillary bed. The complex three-dimensional anatomical structure of the nose makes it impossible to perform detailed in vivo studies on intranasal heating and humidification within the entire nasal airways applying various technical set-ups. The main problem of in vivo temperature and humidity measurements is a poor spatial and time resolution. Therefore, in vivo measurements are feasible only to a restricted extent, solely providing single temperature values as the complete nose is not entirely accessible. Therefore, data on the overall performance of the nose are only based on one single measurement within each nasal segment. In vivo measurements within the entire nose are not feasible. These serious technical issues concerning in vivo measurements led to a large number of numerical simulation projects in the last few years providing novel information about the complex functions of the nasal airways. In general, numerical simulations merely calculate predictions in a computational model, e.g. a realistic nose model, depending on the setting of the boundary conditions. Therefore, numerical simulations achieve only approximations of a possible real situation. The aim of this review is the synopsis of the technical expertise on the field of in vivo nasal air conditioning, the novel information of numerical simulations and the current state of knowledge on the influence of nasal and sinus surgery on nasal air conditioning.

Surgical treatment of hypopharyngeal diverticulum (Zenker's diverticulum).

The goal of this study was to evaluate the outcome of various modalities in the treatment of hypopharyngeal diverticulum (Zenker's diverticulum, HD) as performed in the ENT department, University of Ulm. A retrospective analysis of 40 consecutive patients with the diagnosis of a HD was conducted. The three different modalities of surgery applied had been endoscopic laser diverticulotomy (ELD), conventional endoscopic esophagodiverticulotomy (CEE) and transcervical open technique involving diverticulectomy and cricopharyngeal myotomy. Medical records had been reviewed to determine preoperative symptoms and diagnostic findings, operative time, length of hospital stay, time of oral intake, postoperative laboratory parameters, and postoperative complications. Significant differences (P < 0.05) could be observed between the three surgical groups concerning the postoperative time to oral intake, the length of the hospital stay, and the length of time with a nasogastric tube. Patients after ELD had statistically significantly less thoracic pain than patients after CEE. In conclusion, the comparison of three different surgical approaches in the treatment of HD showed that endoscopic techniques versus open-neck technique result in statistically significant shorter operative times and shorter hospital stays. Conventional endoscopic diverticulotomy is not safer than ELD or transcollar open technique.

Auricular keloids: treatment and results.

The aim of this study was to present long-term results in patients with auricular keloids after surgical excision and/or medical therapy by corticoid injection. A retrospective study at an academic tertiary referral centre is presented. Seventeen patients after excision, injection of corticoid, full skin grafting (single therapy or combination of interventions) for auricular keloids were followed up. The validated questionnaires SF-36 and patient outcomes of surgery-head/neck were applied to evaluate the quality of life and the patients' satisfaction after therapy. Photographs of the former keloid site were rated by an experienced facial plastic surgeon being unaware of treatment method and the patient's own estimation. The best results for retroauricular keloids were reached by excision, skin grafting and triamcinolone injection, and for earlobe keloids by excision, primary wound closure and triamcinolone injection. Both in rating by the patients and in grading by an investigator, the highest scores for aesthetics and satisfaction were found after triamcinolone injection together with or without excision or skin grafting. A size-related resection of keloids with defect reconstruction by full thickness skin grafting for retroauricular keloids and primary wound closure of ear lobe keloids with an additional steroid injection lead to good cosmetic results and high level of satisfaction among patients.

Nasal air conditioning in relation to acoustic rhinometry values.

BACKGROUND: Changes of nasal dimensions can influence the air-conditioning capacity of the nose because of alterations of airflow patterns. The goal of this study was to evaluate the correlation between intranasal temperature and humidity values and nasal dimensions, assessed by means of acoustic rhinometry. METHODS: Eighty healthy volunteers (40 men and 40 women; median age, 51 years; range, 20-84 years) were enrolled in the study. In total, 160 nasal cavities were examined. All volunteers underwent a standardized acoustic rhinometry. Additionally, intranasal air temperature and humidity measurements at defined intranasal detection sites within the anterior nasal segment were performed. RESULTS: There was no statistically significant difference between the right and left side of the nose regarding air temperature, absolute humidity, and acoustic rhinometric values. A negative correlation was established between the rhinometric nasal volumes/minimal cross-sectional areas and air temperature and absolute humidity values at the three intranasal detection sites. CONCLUSION: According to our results, nasal volumes and cross- sectional areas relevantly influence nasal air conditioning. A healthy nasal cavity with smaller volumes and cross-sectional areas seems to present a more effective air-conditioning function than a too "wide" open nose because of changes in airflow patterns. This observation should be considered as a limitation for overly extensive nasal surgery especially of the turbinates.

The impact of nasal surgery on air-conditioning of the nasal airways.

Air-conditioning in the nasal passageways is one of the most important functions of the upper airways. By means of in-vivo-measurements and numerical simulation, the air-conditioning function of the nose has been extensively investigated. Less well known is the effect of nasal surgery on the nasal climate. The following study presents a summary of the effect of various rhino-surgical operations, i.e. turbinoplasty, septoplasty, septorhinoplasty, repair of septal perforations, functional and radical sinus surgery, on the air-conditioning function of the nose. Nasal and sinonasal interventions have been demonstrated to be associated with increased nasal heating and humidification when the mucosal lining is preserved. Radical interventions with reduction of turbinate tissue cause reduced nasal warming and moistening within the nasal airway, with increased risk of nasal dryness and crusting. Although the impact of the nasal cycle and the airflow distribution within the nasal cavity on nasal temperature and humidity distribution is not fully understood yet, too much widening of the nasal cavity by sinunasal interventions has carefully to be avoided.

Dynamic nasal infrared thermography in patients with nasal septal perforations.

BACKGROUND: Nasal obstruction is a typical symptom in patients with nasal septal perforations. Rhinomanometry and acoustic rhinometry are not reliable in these cases because the perforations generate incorrect results. Infrared thermography camera (ITC) systems allow contact-free intranasal recordings of the nasal surface temperature and the semiquantification of nasal airflow. The aim of this study was to perform contact-free temperature measurements of the nasal vestibular surface by application of ITC systems in patients with septal perforations to investigate the disturbed intranasal heat exchange and nasal airflow. METHODS: The surface temperature profiles within the nasal vestibules of healthy volunteers (n=10) and patients with septal perforations (n=3) were recorded with an ITC during several breathing cycles. Thermal images were taken (60/s) displaying the surface temperature in degrees centigrade corresponding to a color scale. RESULTS: The temperature recordings showed a disturbed intranasal heat exchange during inspiration and expiration in patients with septal perforations in comparison with healthy subjects. A reduced and irregular inspiratory cooling of the entire surface within the nasal vestibules visualizes a reduced and disturbed airflow volume. CONCLUSION: The study was able to prove the feasibility of intranasal temperature recordings of the surface with an ITC system in patients with septal perforations. Contrary to rhinomanometry and acoustic rhinometry, thermography cameras can be applied to examine airflow in patients with septal perforations. The detected reduced cooling of the surface during inspiration might be a possible explanation for the patients' feelings of nasal obstruction.

Influence of the turbinate volumes as measured by magnetic resonance imaging on nasal air conditioning.

BACKGROUND: Changes in nasal airflow caused by varying intranasal volumes and cross-sectional areas affect the contact between air and surrounding mucosa entailing alterations in nasal air conditioning. This study evaluates the correlation between nasal air conditioning and the volumes of the inferior and middle turbinates as measured by magnetic resonance imaging (MRI). METHODS: Fourteen healthy volunteers were enrolled. Each volunteer had been examined by rhinomanometry, acoustic rhinometry, intranasal air temperature, and humidity measurements at defined intranasal sites as well as MRI of the nasal cavity and the paranasal sinuses. The volumetric data of the turbinates was based on the volumetric software Amira. RESULTS: Comparable results were obtained regarding absolute humidity values and temperature values within the nasal valve area and middle turbinate area for both the right and the left side of the nasal cavity. No statistically significant differences were found in the rhinomanometric values and the acoustic rhinometry results of both sides (p > 0.05). No statistical correlations were found between the volumes of the inferior (mean, 6.1 cm3) and middle turbinate (mean, 1.8 cm3) and the corresponding humidity and temperature values. Additionally, the air temperature and humidity values did not correlate with the rhinometrical endonasal volumes (0-20 mm and 20-50 mm from the nasal entrance). CONCLUSION: The normal range of volumes of the inferior and middle turbinate does not seem to have a significant impact on intranasal air conditioning in healthy subjects. The exact limits where alterations of the turbinate volume negatively affect nasal air conditioning are still unknown.

A controlled challenge study on di(2-ethylhexyl) phthalate (DEHP) in house dust and the immune response in human nasal mucosa of allergic subjects.

BACKGROUND: Few studies have yet addressed the effects of di(2-ethylhexyl) phthalate (DEHP) in house dust on human nasal mucosa. OBJECTIVES: We investigated the effects of house dust containing DEHP on nasal mucosa of healthy and house dust mite (HDM)-allergic subjects in a short-term exposure setting. METHODS: We challenged 16 healthy and 16 HDM-allergic subjects for 3 hr with house dust at a concentration of 300 microg/m(3) containing either low (0.41 mg/g) or high (2.09 mg/g) levels of DEHP. Exposure to filtered air served as control. After exposure, we measured proteins and performed a DNA microarray analysis. RESULTS: Nasal exposure to house dust with low or high DEHP had no effect on symptom scores. Healthy subjects had almost no response to inhaled dust, but HDM-allergic subjects showed varied responses: DEHP(low) house dust increased eosinophil cationic protein, granulocyte-colony-stimulating factor (G-CSF), interleukin (IL)-5, and IL-6, whereas DEHP(high) house dust decreased G-CSF and IL-6. Furthermore, in healthy subjects, DEHP concentration resulted in 10 differentially expressed genes, whereas 16 genes were differentially expressed in HDM-allergic subjects, among them anti-Müllerian hormone, which was significantly up-regulated after exposure to DEHP(high) house dust compared with exposure to DEHP(low) house dust, and fibroblast growth factor 9, IL-6, and transforming growth factor-beta1, which were down-regulated. CONCLUSIONS: Short-term exposure to house dust with high concentrations of DEHP has attenuating effects on human nasal immune response in HDM-allergic subjects, concerning both gene expression and cytokines.

Impact of external nasal strips on nasal geometry and intranasal air-conditioning.

BACKGROUND: The anterior nasal segment is the most effective part of the nasal airways when it comes to warming and humidification of the inhaled air. Any changes in nasal geometry in this segment modifying the airflow could therefore affect nasal air conditioning. The goal of this study was to examine if external nasal strips have an influence on intranasal geometry and air-conditioning. METHODS: Twenty healthy volunteers (mean age, 36 years) were enrolled in the study. All volunteers received active anterior rhinomanometry and acoustic rhinometry before and while wearing commercially available external nasal strips. In addition, in vivo air temperature and humidity were measured with and without nasal strips at the defined intranasal sites. RESULTS: No statistically significant changes in temperature, humidity, and rhinomanometric values were detected during the use of nasal strips (p > 0.05). The statistical analysis of the acoustic rhinometric results showed a significant increase (p < 0.05) in the minimal cross-sectional areas (MCA) 1 (0-2 cm) and MCA2 (2-5 cm) and the nasal volume (Vol) 1 (0-2 cm). On the other hand, the nasal strips did not significantly alter the nasal Vol2 (2-5 cm; p > 0.05). CONCLUSION: Changes in the nasal geometry of the anterior part of the nose by wearing nasal strips did not relevantly alter intranasal air-conditioning. The application of nasal strips entails an increase in MCAs but not in nasal airflow Vol.

Early influence of bilateral turbinoplasty combined with septoplasty on intranasal air conditioning.

BACKGROUND: Too extensive resection of the inferior turbinates (ITs) during nasal surgery leads to a severely disturbed intranasal air conditioning. Data comparing nasal air conditioning before and after turbinoplasty in nasal surgery are still lacking. The aim of this study was to determine the early effect of bilateral turbinoplasty combined with septoplasty on intranasal heating and humidification. METHODS: Twelve patients were included into this prospective study. In one-half of the patients a bilateral turbinoplasty of the IT during nasal surgery was performed, in the other half no surgery on the IT was performed. Intranasal air temperature and humidity were measured before and after surgery. A combined miniaturized thermocouple and a humidity sensor were used for simultaneous in vivo intranasal measurements. RESULTS: There were no statistically significant differences in temperature and humidity values between the two study groups before surgery (p > 0.05). In both groups, the postoperative temperature and humidity values were statistically significantly higher compared with the preoperative ones (p < 0.05). Regarding the two patient groups, the postoperative increase in temperature and humidity was even more pronounced in patients undergoing additional bilateral turbinoplasty. CONCLUSION: According to the results of this study, patients seemed to overall benefit from nasal surgery, with and without a preserving bilateral turbinoplasty, because intranasal air conditioning was improved after surgery. A carefully performed and conservative reduction of the IT in nasal surgery seems to even improve intranasal air conditioning.

Nasal-air conditioning in patients with chronic rhinosinusitis and nasal polyposis.

OBJECTIVES: To compare nasal-air conditioning in patients with chronic rhinosinusitis with nasal polyposis with healthy control subjects without nasal pathologic conditions, to investigate nasal-air conditioning after endoscopic sinus surgery with and without septoplasty and turbinoplasty 4 to 6 weeks after surgery, to examine the parameters of nasal patency and nasal geometry that possibly influence nasal-air conditioning before and after endonasal surgery, and to determine their relationship to nasal-air conditioning parameters. DESIGN: Prospective cohort study. SETTING: Tertiary referral center. PARTICIPANTS: Twenty-five patients (median age, 51 years; age range, 20-74 years) having a diagnosis of chronic rhinosinusitis with nasal polyposis refractory to medical treatment and 22 healthy control subjects (median age, 25 years; age range, 18-52 years). INTERVENTION: Patients underwent endoscopic sinus surgery with or without septoplasty and turbinoplasty during 6 months and were followed up 4 to 6 weeks after surgery. MAIN OUTCOME MEASURES: Nasal-air conditioning was measured and acoustic rhinometry and active anterior rhinomanometry were performed before and after nasal surgery. RESULTS: Nasal airflow and nasal volume were significantly higher postoperatively than preoperatively. The preoperative heat increase and water gradient were lower in the patients compared with the controls. The postoperative heat increase was significantly higher than the preoperative values. The water gradient did not change after endonasal surgery. Nasal patency and volume were positively correlated with nasal heating, whereas nasal humidification showed a significant negative correlation with nasal volume. CONCLUSIONS: Patients with chronic rhinosinusitis with nasal polyposis seem to benefit from endoscopic sinus surgery with or without septoplasty and turbinoplasty because nasal heating is improved postoperatively. Four to 6 weeks after endonasal surgery, nasal humidification is neither improved nor worsened compared with preoperative values.

Air-conditioning in the human nasal cavity.

Healthy humans normally breathe through their nose even though its complex geometry imposes a significantly higher resistance in comparison with mouth breathing. The major functional roles of nasal breathing are defense against infiltrating particles and conditioning of the inspired air to nearly alveolar conditions in order to maintain the internal milieu of the lung. The state-of-the-art of the existing knowledge on nasal air-conditioning will be discussed in this review, including in vivo measurements in humans and computational studies on nasal air-conditioning capacity. Areas where further studies will improve our understanding and may help medical diagnosis and intervention in pathological states will be introduced.