Stepwise approach towards adoption of allergen immunotherapy for allergic rhinitis and asthma patients in daily practice in Belgium: a BelSACI-Abeforcal-EUFOREA statement.

Allergic rhinitis (AR) affects 23-30% of the European population with equal prevalence reported in Belgium. Despite guidelines on the correct use of effective treatment, up to 40% of AR patients remain uncontrolled. Allergen immunotherapy (AIT) has been shown to improve the level of control up to 84% of patients being controlled by AIT. Recently, new guidelines for AIT have been published, supporting the clinical evidence for effectiveness of various subcutaneous and sublingual products for AIT in patients who are allergic to airborne allergens. AIT in AR patients not only reduces nasal and/or ocular symptoms but also induces tolerance and has preventive potential. Adoption of AIT into daily clinical practice in Belgium and other European countries is hampered primarily by reimbursement issues of each of the single products but also by several patient- and physician-related factors. Patients need to be better informed about the effectiveness of AIT and the different routes of administration of AIT. Physicians dealing with AR patients should inform patients on tolerance-inducing effects of AIT and are in the need of a harmonized and practical guide that supports them in selecting eligible patients for AIT, in choosing evidence-based AIT products and in following treatment protocols with proven efficacy. Therefore, a stepwise and holistic approach is needed for better adoption of AIT in the real-life setting in Belgium.

Long-term Complications after facial trauma: literature review.

Long-term complications after facial trauma: literature review. PROBLEMS/OBJECTIVES: In facial trauma medicine, many articles deal with necessary treatment in an acute setting to achieve the best possible functional and aesthetic outcome for the patient. It is difficult, if not impossible, to ensure long-term follow-up with these patients. Often the long-term outcome is not reported and, if so, most data are retrospective. The goal of this article is to present an overview of known data concerning complications after the initial healing processes are completed. METHODOLOGY: Literature review Results: An overview of complications is presented and discussed. Comparison of results is not possible due to the large number of factors influencing outcome (age, multiple injuries, severity of trauma, etc.). Post-trauma complications are inevitable, but it is agreed that, in any case, the initial treatment of trauma is important in determining optimal functional and aesthetic outcomes. Close collaboration between different specialisms is essential to achieve good patient management, control and follow-up. CONCLUSIONS: Long-term post-trauma complications are inevitable, but it is important to be aware of these complications so as to provide the best possible treatment.

Critical evaluation of different objective techniques of nasal airway assessment: a clinical review.

Objective tests for the nasal volume flow are needed for the assessment of nasal patency for diagnosis, documentation and medicolegal purposes. Three main techniques are nowadays established: active anterior rhinomanometry (AAR), 4-phase rhinomanometry (4PR) and acoustic rhinometry (AR). Several guidelines and consensus reports and the International Committee on Standardization have clarified the field of interest and the limitations of this technology. In the meantime, technical progress and the development of seemingly new methods have brought up many new facts which necessitate the re-evaluation of the test available. From our method of critical analysis we can conclude that AAR can be still considered as the standard technique for the objective assessment of the nasal airway. AR is a valid technique with limitations and cannot replace AAR because it measures different parameters thus forming a complementary technique. 4PR might provide supplementary information although not yet all open technical and mathematical inconsistencies conjoint with this technique have been clarified. Still the individual subjective sensations of the patient do not always match the objective measurements. In conclusion, a combination of information given by the patient, the rhinoscopic findings and the carefully interpreted results of AAR and AR will increase considerably the success of surgical interventions and the feeling of satisfaction by the patient after surgery, when matched thoughtfully.

Cushing's disease: diagnosis through the nose. A case report.

In Cushing's disease clinical symptoms are usually related to the ACTH hypersecretion. On diagnosis these secreting tumours tend to be small due to their ability to reach clinical detection early. However, symptoms may also be caused by mass-related effects such as the depression of secretion of other pituitary hormones. Furthermore growth related symptoms may occur due to the invasion of the suprasellar region with compression of the visual system. As we illustrate in a case report, when spreading of pituitary adenoma occurs to the infrasellar region, Cushing disease may manifest itself by rather atypical initial symptoms that are more related to ear-nose-throat (ENT) complaints. In these invasive macro adenomas multimodal therapy is usually required to achieve control of hypersecretion and mass related symptoms.

Epiglottitis and related complications in adults. Case reports and review of the literature.

Since the introduction of Haemophilus influenza type b (Hib) vaccinations in child immunisation programmes, a significant decline in the incidence of epiglottitis has been observed among children. However, recent studies show an increase in the incidence of adult epiglottitis without any identifiable predominant causative pathogen. Adult disease is known to have a slightly more protracted course. Vigilance is nevertheless indicated due to the risk of a rapidly evolving airway obstruction. In this paper, we discuss three recent cases of adult epiglottitis in a tertiary care unit, and review of the current literature. In two of these cases frank abscess formation was already present at the initial evaluation. In spite of very close monitoring, with securing of the airway, administration of intravenous antibiotics and drainage of the abscess, the eldest patient died. The other patients recovered completely.

Craniofacial embryology and postnatal development of relevant parts of the upper respiratory system.

OBJECTIVES: To compare historical and current knowledge relating to the development of the paranasal sinuses, the nose and face, the Eustachian tube and temporal bones, particularly with respect to chronic inflammation during childhood. METHODOLOGY: Traditional literature data, mainly emanating from text books, were supplemented with information based on a non-structured PubMed search covering the last two decades. RESULTS: Historical knowledge has most often been confirmed, sometimes supplemented and only rarely challenged by present-day studies. Recent studies focus mainly on the clinical application of modern imaging techniques. CONCLUSIONS: Interest in the development of relevant parts of the upper respiratory system remains as lively as ever. Imaging techniques with low or absent radiation exposure may give rise to a novel field of research, especially with respect to paediatric rhinosinusitis.

Biological conditions affecting chronic inflammation in upper airways in children.

PROBLEMS/OBJECTIVES: A child's immune system cannot depend on a memory-type immune response and it also induces cytokine responses less efficiently. Biological conditions like allergy or cystic fibrosis, immune deficiency or gastrooesophageal reflux can induce and maintain background inflammation in children's upper airways, making newborns and children more susceptible to upper airway infections and inflammations. This paper will describe in brief how allergy, cystic fibrosis, immune deficiency, nasal and paranasal anatomical variants, and gastro-oesophageal reflux (GOR) can affect the immune and inflammatory responses in upper airways and how they could interfere with immunity development and maturation in children. METHODOLOGY: Literature review. RESULTS: Chronic inflammation induced by infection, allergy, cystic fibrosis or immune deficiency is multifactorial in origin and is strongly influenced by physiological, immunological, anatomical, environmental and, above all, genetic parameters. Finally, the direct role played by nasal and paranasal anatomical variants and GOR is also discussed. CONCLUSIONS: These conditions should be screened systematically in all children presenting chronic clinical features of upper airway inflammation.

Clinical aspects of chronic ENT inflammation in children.

In children, all ENT cavities are particularly prone to the development of chronic inflammation. This is due to many predisposing factors, of which the most common are unfavourable anatomy, absence of nasal blowing, day care attendance, allergy, immature immunity, gastro-oesophageal reflux and tobacco smoke exposure. The aim of this paper is to outline the most specific paediatric clinical aspects of chronic pharyngo-tonsillitis, rhinosinusitis, otitis media, adenoiditis and laryngotracheitis and the important influence that some of these pathologies exert on the others.

A review of nasal dorsal hump reduction techniques, with a particular emphasis on a comparison of component and composite removal.

Nasal dorsal hump reduction is a frequently performed and basic step in non-functional rhinoplasty. The literature has described multiple techniques for nasal hump removal. However, most of the descriptions consider new or modified techniques. No papers have been published comparing any of these different surgical interventions. The aim of this paper is to review several techniques in common use, looking at their inherent advantages and disadvantages in the light of the authors' personal experiences. Particular attention is devoted to a comparison of component and composite hump reduction. The latest trends in hump removal techniques aim for predictable and realistic results with pleasing aesthetic outcomes based on precise resection techniques and the optimal preservation of nasal anatomy and function.

Microbiology of the middle meatus: a comparison between normal adults and children.

Middle meatal samples were obtained from 52 carefully selected healthy adults. In 75 per cent of the test subjects bacterial organisms were cultured. However, growth was often poor and the predominant species suggest a commensal flora: coagulase-negative staphylococci were retrieved from 35 per cent, Corynebacterium sp. from 23 per cent and Staphyloccus aureus from eight per cent of the adults. These data are very different from those previously obtained among children where--even in the absence of obvious ENT pathology--the most frequently cultured organisms were typical sinusitis pathogens: Haemophilus influenzae present in 40 per cent, Moraxella catarrhalis in 34 per cent and Streptococcus pneumoniae in 50 per cent of children. Furthermore, Streptococcus viridans and Neisseria sp., both organisms that might be able to inhibit colonization by some of the pathogens and found commonly among children, are virtually absent in healthy adults.