Clinical characteristics of 5 adult patients with rhinofacial entomophthoromycosis in Thailand.

Five patients [mean age: 36 years (range: 22-65)] were diagnosed with rhinofacial entomophthoromycosis at our center during the study period. All patients presented with painless cheek and nasal dorsum swelling with nasal obstruction. All pathology reports confirmed rhinofacial entomophthoromycosis, which is characterized by the Splendore-Hoeppli phenomenon. Conidiobolus coronatus was identified from fungal culture in all patients. All patients were successfully treated with various antifungals.

Nasal Cavity Length or Analyzed Nasal Segment of Acoustic Rhinometry in Thai Adults.

Background: Nasal cavity length (NCL) is important for determining analyzed nasal segment (ANS) of acoustic rhinometry (AR). AR is a technique for nasal airway assessment which nasal cross-sectional areas and nasal volume (NV) are obtained. NCL or ANS is the important parameter to determine NV measured by AR. The ANS used to calculate NV in previous literatures vary from 4 to 8 cm. However, there has not been any study regarding NCL of Asians which is probably different from that of Western countries. Objectives: To measure NCL in Thai adults using nasal telescope and compared NCL between left and right sides as well as male and female as well as among age groups. Design: Prospective study. Methods: This study was performed on patients, aged 18-95 years, who underwent nasal telescopy under local anesthesia at the Department of Otorhinolaryngology, Siriraj Hospital. Baseline characteristics (sex and age) of patients were collected. NCL (from anterior nasal spine to posterior edge of nasal septum) of both nasal cavities was measured using rigid nasal telescope of 0 degree. Mean NCL length of both nasal cavities was calculated. Results: There were 1277 patients, with 498 (39%) male and 779 (61%) female. The mean ± standard deviation (SD) of NCL of male was 6 ± 0.6 cm whereas that of female was 5.7 ± 0.5 cm. There were no significant differences in NCL between left and right sides as well as among age groups in each gender (p > 0.05 all). However, male had significantly longer NCL compared with that of female (p < 0.001). The mean ± SD of NCL of total population was 5.9 ± 0.6 cm. Conclusion: The NCL of Thais was approximately 6 cm. These data are useful to determine ANS used to calculate NV when AR is performed. Plain Language Summaries: The length of nasal cavity (LNC) is important variable for acoustic rhinometry (AR) which is the instrument to measure nasal volume (NV). We use AR in clinical researches to diagnose and monitor the results of treatment of nose and sinus diseasesThe LNC used to calculate NV in previous studies vary from 4 to 8 cm. However, there has not been any study of LNC of Asians which is probably different from that of Western countriesWe measured LNC in 1277 Thai adults, aged 18-95 years, with 498 (39%) male and 779 (61%) female using nasal rigid endoscope and compared LNC between male and female.The average of LNC was 5.9 cm. Male had longer LNC compared with that female. The LNC of Thais was approximately 6 cm. These data are useful for AR to calculate NV.

Local nasal immunotherapy for allergic rhinitis: A systematic review and meta-analysis.

INTRODUCTION: Local nasal immunotherapy (LNIT), an alternative noninjection immunotherapy method, is theoretically an efficient method for inducing immunotolerance directly in the affected organ. LNIT is more convenient and less invasive than injection immunotherapy, with fewer systemic reactions. The development of adjuvants to overcome LNIT's limitations raises the possibility of it being an alternative allergen immunotherapy. OBJECTIVES: To evaluate the clinical and immunological efficacy and safety of LNIT for patients with allergic rhinitis. METHODS: A systematic search for randomized controlled trials comparing LNIT and placebo was performed using OVID Medline and Embase. Outcomes were total nasal symptom score (TNSS), symptom-medication score (SMS), medication score, immunological assessment, and nasal provocation threshold. Data were pooled for meta-analysis. RESULTS: A total of 20 studies with 698 participants were included. The LNIT group had greater posttreatment improvement in TNSS, SMS, and medication score than control (TNSS: standardized mean difference [SMD], -1.37 [95% confidence interval [CI], -2.04 to -0.69]; SMS: SMD, -1.55 [95% CI, -2.83 to -0.28]; and medication score: SMD, -1.09 [95% CI, -1.35 to -0.83]). Immunological assessments showed no significant differences in serum-specific IgE (mean difference [MD], 6.35; 95% CI, -4.62 to 17.31), nasal IgE (MD, -0.59; 95% CI, -1.99 to 0.81), or nasal eosinophil cationic protein (MD, 7.63; 95% CI, -18.65 to 33.91). Only serum IgG significantly increased with LNIT (MD, 0.45; 95% CI, 0.20, 0.70). Posttreatment, nasal provocation threshold was higher with LNIT (MD, 27.30; 95% CI, 10.13-44.46). No significant adverse events were reported. CONCLUSIONS: LNIT is a safe alternative allergen immunotherapy route without significant adverse events. It improves clinical symptoms, reduces medication usage, and increases the nasal provocation threshold.

Prevalence of local allergic rhinitis to Dermatophagoides pteronyssinus in chronic rhinitis with negative skin prick test.

BACKGROUND: Local allergic rhinitis (LAR) is a localized nasal allergic response in the absence of systemic atopy that is characterized by local production of specific immunoglobulin E (sIgE), and a positive response to NAPT (nasal allergen provocation test). OBJECTIVE: The objective of this study is to investigate the prevalence of LAR in adults with chronic rhinitis (CR) and negative skin prick test to Dermatophagoides pteronyssinus (Dp), and to assess the clinical characteristics of LAR, comparing to non-allergic rhinitis (NAR). METHODS: Patients with history of CR with negative skin prick test (SPT) to Dp were recruited during January 2015-April 2016. Demographic and clinical data were obtained, and then a NAPT with Dp was performed. The immediate response to NAPT-Dp was assessed using clinical symptom score, visual analogue scale, peak nasal inspiratory flow, and acoustic rhinometry. Nasal lavage was evaluated for nasal sIgE and tryptase level. RESULTS: Sixty-two CR patients were recruited. NAPT-Dp was positive in 15/62 (24.2%) of CR patients. Most LAR patients were female (73.3%), and the mean age of all patients was 36.1 ± 10.4 years. Our evaluation of patient characteristics revealed sneezing to be the only evaluated factor to be statistically significantly different between groups [odds ratio (OR): 7.75, 95% confidence interval (CI): 1.91-31.48; p = 0.002]. CONCLUSIONS: The prevalence of LAR to Dp in Thai adults with CR and negative skin prick test was 24.2%. Most LAR patients had moderate-severe persistent severity. The clinical characteristics of LAR, sneezing was shown to be a significantly dominant symptom in LAR than in NAR.

The effect of steam inhalation on nasal obstruction in patients with allergic rhinitis.

BACKGROUND: Nasal obstruction is often impact on quality of life in allergic rhinitis (AR). The steam inhalation is one of widely used home remedies to soothe and open the nasal passages. Furthermore, steam inhalation may provide change in objective nasal airway assessment. OBJECTIVE: To compare the effect of steam inhalation on nasal obstruction between patients with AR and normal individuals, as well as the change in the cross-sectional area of the nasal cavity and in nasal airway resistance (NAR) between 2 groups. METHODS: A prospective comparative, parallel group study was conducted in AR and normal individuals. Steam with the temperature of 42-44°C was inhaled. Variables obtained before and after steam inhalation were compared. RESULTS: After steam inhalation, nasal symptom score, combined global symptoms, and Visual Analog scale (VAS) of combined global symptoms of AR patients showed statistically significant improvement. Whereas, normal individuals, there was statistically significant improvement only in sneezing and combined global symptoms. Meanwhile, the change of each measurement score, combined global symptoms, and VAS of the symptoms in those with AR were significantly higher than those of normal individuals. Total nasal airflow, NAR, volume, and mean minimal cross-sectional area of AR patients tended to better improve after steam inhalation. CONCLUSIONS: The steam inhalation significantly improved nasal obstruction in AR patients, but no statistical significant difference between both groups for any parameters. The different response between the 2 groups may be due to different nasal mucosa sensitivity to stimuli.

A multicenter survey on the effectiveness of nasal irrigation devices in rhinosinusitis patients.

BACKGROUND: Nasal irrigation is widely used as an adjunctive treatment for rhinosinusitis. However, there is little information available regarding the efficacy of the devices used in this procedure. The objective of this study was thus to evaluate the effectiveness of nasal irrigation devices based on the experiences of patients with rhinosinusitis. METHODS: We conducted a multicenter survey study between November 2017 and December 2019. The questionnaire was developed based on the available literature and expert opinion and submitted to the otolaryngology residents and staff of each center as well as those in their networks. RESULTS: Four hundred eighteen patients were enrolled in this study: 76 with acute viral rhinosinusitis (18%), 53 with acute bacterial rhinosinusitis (13%), 156 with chronic rhinosinusitis without nasal polyps (37%), and 133 with chronic rhinosinusitis with nasal polyps (32%). We found that high-volume devices were most effective in helping to clear secretion in patients with acute viral rhinosinusitis, chronic rhinosinusitis without nasal polyps, and acute bacterial rhinosinusitis (P = .017, .009, .002, respectively) and in reducing post-nasal drip in those with acute bacterial rhinosinusitis (P = .040). There were no statistically significant differences among devices in patients with chronic rhinosinusitis with nasal polyps. CONCLUSIONS: Nasal irrigation with high-volume devices was an effective treatment for rhinosinusitis and was more effective at clearing nasal secretion and reducing post-nasal drip than that with other types of devices. LEVEL OF EVIDENCE: 2C.

Chronic Rhinosinusitis and Allergy: Increased Allergen Sensitization Versus Real Allergic Rhinitis Multimorbidity: a Systematic Review.

PURPOSE OF REVIEW: The objective of this article is to provide a recent update of the association between allergic inflammation and chronic rhinosinusitis. The systematic approach of this review article critically evaluates the literature published over the past few years and summarizes the specific pathophysiologic pathway of chronic sinonasal inflammation that has been postulated. RECENT FINDINGS: From a systematic search of the Ovid Medline and Embase, 11 studies were included in a qualitative analysis of the association between systemic allergy and chronic rhinosinusitis (CRS). Of the 11 studies, four showed an association, three were inconclusive, and four did not show any association. From the systematic search, 50 studies suggested four possible pathophysiologic pathways that may explain the association of allergic inflammation and CRS, namely, (1) staphylococcal enterotoxin, (2) the innate immunity pathway, (3) mast cell-associated inflammation, and (4) dysbiosis of microbiota. The association of systematic allergy and CRS remains inconclusive. The recent advances in the study of the pathophysiologic pathway of CRS may lead to the possibility of a targeted treatment option for CRS.

Endotyping of Chronic Rhinosinusitis With and Without Polyp Using Transcription Factor Analysis.

Inflammation of the nose and paranasal sinus or rhinosinusitis (RS) is a significant global health problem that is both very common and very costly to treat. Previous reports reveal variability in histology and mechanism of inflammation in patients with chronic rhinosinusitis with and without polyp (CRScNP and CRSsNP, respectively). There are various methods and hypothesis that try to explain this variability. Accordingly, the aim of this study was to investigate the incidence of each type of sinonasal inflammation among patients diagnosed with CRScNP or CRSsNP using transcription factor analysis (TFA). This study included mucosa specimens from nose/paranasal sinuses from patients with chronic rhinitis (CR), CRSsNP, or CRScNP that were obtained at the Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during the June 2009 to May 2012 study period. TFA was employed to measure the following transcription factors: T-box transcription factor (T-bet) for Th1, GATA binding protein 3 (GATA-3) for Th2, retinoic acid-related orphan receptor C (RORC) for Th17, and forkhead box P3 (FOXP3) for Treg. Forty-one subjects (22 males, 19 females) were enrolled, with a mean age of 45.93 ± 13 years. Twenty-six patients were diagnosed with CRScNP, 7 with CRSsNP, and 8 with CR (controls). The majority of CRScNP specimens (76.9%) had eosinophil count greater than 100 cells/high-power field (HPF). Mean eosinophil count was 930.08 ± 1,399 cells/HPF (range: 17-5,570). Th2 transcription factor (GATA-3) was statistically significantly higher in the CRScNP group than in the CRS and control groups (p < 0.001); whereas, Treg transcription factor (FOXP3) was statistically significantly lower in the CRScNP group than in the CRSsNP and control groups (p < 0.001). The transcription factors for Th1 and Th17 (T-bet and RORC, respectively) were not significantly different among the three groups. The result of transcription factor analysis revealed hyperfunction of Th2 in patients with CRScNP, which might result in hypereosinophilic infliltration in the polyps. One explanation for this finding is the decreased activity of Treg. Although environment-host interaction is the most probable hypothesis, the etiology of aberrant adaptive immunity needs to be elucidated.