[Biological therapy in the inflammatory disorders of the upper airway: the endotype-driven treatment of chronic rhinosinusitis]. / Biológiai terápia a felso légúti gyulladásos betegségekben: az endotípus-alapú megközelítés a krónikus rhinosinusitis kezelésében.

Patients with difficult-to-treat chronic bilateral rhinosinusitis with nasal polyps - a type 2 inflammatory endotype - who are resistant to conventional medical and surgical therapy exhibit prolonged and not controlled symptoms. Quality of life, daily activities and sleeping are severely affected. Symptomatic, etiopathologic, surgical and general antiinflammatory (systemic steroid) therapeutic options of the past decades have not been sufficient enough in the treatment of refractory chronic rhinosinusitis. The new therapy with humanized monoclonal antibodies directed against the most relevant mediators and effector cells resulted in outstanding impovements in this field. Other type 2 manifestations may also be effectively treated at the same time, which improves the quality of life and is considered cost-effective as well. The author summarizes the actual etiopathogenic and clinical implications, the approved and available biologics, the related evidences and the preliminary clinical experiences. Orv Hetil. 2023; 164(18): 694-701.

Endoscopic removal of a dental implant displaced into the maxillary sinus: A case presentation and a review of the literature / Arcüregbe diszlokált fogimplantátum eltávolítása endoszkópos ellenorzéssel: Esetismertetés a szakirodalom tükrében

Összefoglaló. Az utóbbi idoben egyre gyakoribbá vált fogászati implantáció egyik nem kívánt szövodménye az arcüregbe került implantátum, amely a maxilla molaris, esetenként praemolaris régiójának implantációjakor fordulhat elo. Ennek oka lehet a kúpsugaras komputertomográfia nélküli, azaz nem megfelelo tervezés, fennálló arcüreggyulladás és -ventilációs probléma, kevés, puha csont, a fúrási vagy implantátumbehelyezési sebészi gyakorlat hiánya, észre nem vett membránperforáció arcüreg-csontfeltöltés esetén. Esetünkben implantáció elott a beteg szájsebész orvosa kúpsugaras komputertomográfia alapján sinusventilációs zavart és arcüreggyulladást véleményezett. Az arcüreggyulladás funkcionális endoszkópos sinussebészeti mutéttel történo kezelését és gyógyulását követoen két lépésben, eloször arcüreg-csontfeltöltést, majd 6 hónappal késobb implantációt végeztek. 4 hónap panasz- és tünetmentes gyógyulást követoen az implantátumfeltárás elott derült fény az arcüregbe került implantátumra, amelyet funkcionális endoszkópos sinussebészeti eljárással, transnasalis (Lothrop) és intraoralis behatolás kombinációjával távolítottunk el. Az implantátumok arcüregbe kerülésének gyakorisága továbbra is ismeretlen, a szakirodalomban kb. 70 közölt esetrol tudunk; a leggyakrabban egy-egy implantátummal kapcsolatban születnek cikkek, ami az összes beültetett implantátum számához képest elenyészo. Az arcüregben lévo szabad implantátum arcüreggyulladást okoz, eltávolítása szükséges, kötelezo. A sinus hátsó részében elhelyezkedo implantátum esetén elsosorban funkcionális endoszkópos sinussebészeti eljárás javasolt. Az elso recessusban lévo implantátum eltávolítására a legjobbnak a praelacrimalis recessusból végzett korszeru behatolás tunik. Tradicionális transoralis/Luc-Caldwell-féle behatolást a friss sinuslift utáni gyulladt csontexcochleatio esetén javasolunk, illetve ha fennálló oroantralis fistulát is zárnunk kell. Orv Hetil. 2022; 163(13): 527-531. Summary. Accidental implant displacement into the maxillary sinus is often due to inappropriate surgical planning or technique, unrecognised sinus disease, failure to recognise low residual bone quality and quantity during implant-supported maxillary molars and premolars rehabilitation. Secondary implant migration can be attributed to the risk of failing osteointegration due to unnoticed sinus membrane rupture during surgery, incomplete soft tissue closure over the implant's site, preexistent sinus ventilation problems. In this study, we present the case of a patient with a symptomless preexistent sinus infection, which had been treated with functional endoscopic sinus surgery. After the healing period, the following two-stage procedures were performed: 1) maxillary sinus bone augmentation, 2) 6 months later dental implant placement, based on a routine orthopantomogram. At the end of the 4-month planned healing period, the implant displacement was noticed in the sinus cavity. The implant was removed with a combination of endoscopic surgery, transnasal and transoral Luc-Caldwell approach. The possible reasons for displaced implant into the sinus cavity, the treatment decision tree and lessons we learned, updated by the international literature, are discussed. Our recommendation for displaced implant removal is primarily transnasal under general anaesthesia. In the case of the implant in the anterior recess of the maxillary sinus, the functional endoscopic sinus surgery through the prelacrimal recess approach seems to be the preferred approach. A transoral approach should be the chosen method in the case of present oro-anthral fistulae or recent sinus bone graft, when the infected graft should also be removed. Orv Hetil. 2022; 163(13): 527-533.

Prevalence of Asthma and Its Associating Environmental Factors among 6-12-Year-Old Schoolchildren in a Metropolitan Environment-A Cross-Sectional, Questionnaire-Based Study.

We aimed to evaluate the prevalence of asthma and its associating environmental factors within a 6-12-year-old population. A cross-sectional, questionnaire-based study was conducted in primary schools located in the capital of Hungary; 3836 eligible parent-reported questionnaires were evaluated. Besides the International Study of Asthma and Allergies in Childhood (ISAAC) phase three core questions for asthma, the survey also assessed various potential risk factors. We introduced the umbrella term cumulative asthma as the union of physician-diagnosed asthma and current wheezing to estimate the lifetime prevalence of asthma. Current wheezing and physician-diagnosed asthma showed a frequency of 9.5% and 6.3%, respectively. They contributed to a cumulative asthma prevalence of 12.6% among the sampled population, with a girl-boy percentage of 37.4% to 62.6%. Air-pollution and weedy areas were associated with greater risk for asthma, while a suburban residence showed lesser odds. Indoor smoking, visible mold, and keeping a dog were defined as risk factors for asthma, while the presence of plants in the bedroom and pet rodents were associated with lower odds ratios. The consumption of fast food, beverages containing additives and margarine were significantly higher in asthmatics, while we found frequent sport activity and cereal intake associated with lower odds ratios for asthma. In this urban environment, we identified an increased asthma prevalence compared to some previously published studies, but the cross-sectional design and the different methodology did not permit us to draw timeframe-dependent conclusions.

Prevalence of allergic rhinitis, related comorbidities and risk factors in schoolchildren.

BACKGROUND: The study aimed to determine the prevalence and risk factors of allergic rhinitis and related comorbidities in school-age children in Budapest, capital of Hungary. Data and epidemiological studies on this disease are still limited. METHODS: A cross sectional study was conducted in 21 representative and randomly selected primary schools in 2019. International Study of Asthma and Allergies in Childhood-based questionnaires (n = 6869) inquiring about prevalence and related risk factors of allergic rhinitis were distributed to all parents. The data were characterised with standard descriptive statistics: frequencies (percentages) and means for categorical and quantitative data, respectively. RESULTS: 3836 of the questionnaires (1857 M/1979F) were completed. The prevalence of current allergic rhinitis was 29.3% (1043), physician-diagnosed allergic rhinitis was 9.7% (373), cumulative allergic rhinitis was 36.2% (1289) and current allergic rhinoconjunctivitis was 16.2% (577). The presence of physician diagnosed atopic disease-asthma (p < 0.0001, OR = 4.398, 95% CI 3.356-5.807), food allergy (p < 0.0001, OR = 2.594, 95% CI 1.995-3.378), and eczema (p < 0.0001, OR = 1.899, 95% CI 1.568-2.300)-were significantly related to an increased risk of cumulative allergic rhinitis. Significant factors associated with allergic rhinitis include male gender (p < 0.0001), family history of atopy (p < 0.0001), frequent upper respiratory tract infections (p < 0.0001), tonsillectomy (p = 0.0054), antibiotics given in the first year of life (p < 0.0001), paracetamol given in the first year of life (p = 0.0038), long-lasting common infections caused by viruses and/or bacteria before the appearance of the allergy (p < 0.0001), consumption of drinks containing preservatives or colourants (p = 0.0023), duration of living in Budapest (p = 0.0386), smoking at home (p = 0.0218), smoking at home in the first year of life (p = 0.0048), birds at home (p = 0.0119), birds at home in the first year of life (p = 0.0052), visible mould in the bedroom (p = 0.0139), featherbedding (p = 0.0126), frequent or constant heavy-vehicle traffic (p = 0.0039), living in a weedy area (p < 0.0001) and living in the vicinity of an air-polluting factory or mine (p = 0.0128). CONCLUSIONS: The prevalence of allergic rhinoconjunctivitis in 6-12-year-old children in Budapest is higher than reported for most of the surrounding European countries. While asthma (OR = 4.398) is the most significant comorbidity, environmental factors such as birds at home in the first year of life (OR = 2.394) and living in a weedy area (OR = 1.640) seem to be the most important factors associated with AR. Strategies for preventive measures should be implemented. TRIAL REGISTRATION NUMBER: KUT-19/2019. The study was approved by the Ethics Committee at Heim Pál National Pediatric Institute.

Hungarian adaptation and launch of the 2019 ARIA care pathways of allergic rhinitis in Hungary / A 2019. évi ARIA kezelési irányelvek magyar adaptációja és a hazai alkalmazás lehetoségei allergiás rhinitisben.

Összefoglaló. Az allergiás betegségekben szenvedo emberek száma világszerte, köztük Magyarországon is növekszik. Az egészségügyi ellátórendszerek azon dolgoznak, hogy minél hatékonyabban tudják felhasználni a rendelkezésre álló forrásokat. Az Allergic Rhinitis and its Impact on Asthma (ARIA) szervezet célja az allergiás náthában szenvedo betegek ellátásának javítása, szakmai ajánlások készítése, aktualizálása. Ennek egyik módja integrált betegellátási utak kidolgozása. Célunk ezek hazai elérhetové tétele, az ajánlások széles köru elterjesztése az Európai Unió (EU) többi tagállamához hasonlóan Magyarországon is. Az ARIA más nemzetközi innovatív szervezetek bevonásával olyan integrált betegellátási utakat fejlesztett ki, amelyek allergiás nátha, esetleg társbetegsége, az asztma esetén támogatják a kezelést. Ezeket újgenerációs irányelvek kidolgozása útján alkották, amelyekhez felhasználták a mobiltechnológiából és pollenkamra-vizsgálatokból származó valós evidenciákat is. A gyógyszeres terápia optimalizálásához a vizuális analóg skálán alapuló, úgynevezett Mobil Légúti Figyelo Hálózat algoritmusát digitalizálták, és valós evidenciák felhasználásával tovább finomították. Allergén immunterápiára az ARIA a világon elsoként dolgozott ki integrált betegellátási utakat 2019-ben. A kezelési irányelvekhez való adherenciaszint alacsony, a betegek a tüneteik erossége alapján módosítják a kezelést. A flutikazon-propionát-azelasztin kombináció hatása erosebb az intranasalis kortikoszteroidokénál, míg az utóbbi hatásosabb az oralis H1-antihisztaminoknál. A mobiltelefonokban tárolt elektronikus napló vagy más 'mobile health' (mHealth) eszközök használata segíti a betegek kiválasztását allergén immunterápiára. Az ARIA által javasolt algoritmus megfelelonek mutatkozott az allergiás rhinitis kezelésére, ezért ezek az irányelvek bekerülnek integrált betegellátási utakba, és részét fogják képezni az EU Egészségügyi és Élelmiszer-biztonsági Foigazgatósága digitalizált, személyközpontú gondozási anyagainak. Az allergén immunterápia hatékony az inhalatív allergének által okozott allergiás betegségekben, alkalmazását azonban korlátozni kell gondosan válogatott betegekre. Orv Hetil. 2020; 161(49): 2059-2071. Summary. The number of allergic patients is increasing all over the world, also in Hungary. Delivering effective and cost-effective health care is essential for all health care systems. ARIA (Allergic Rhinitis and its Impact on Asthma) aims to improve the care of patients who suffer from allergic rhinitis by setting up guidelines and updating them. Development of ICPs (integrated care pathways) can play an essential role in attaining this goal. Our aim is to make ICP-s developed by ARIA available also in Hungary, as is already the case in other countries of the European Union (EU). Together with other international initiatives, ARIA has worked out digitally-enabled ICPs to support care in allergic rhinitis and comorbid asthma. ICPs are based on new-generation guidelines using RWE (real-world evidence) from chamber studies and mobile technology. The MASK (Mobile Airways Sentinel NetworK) algorithm - based on visual analogue scale - was digitalized to support pharmacotherapy, and was refined by using RWE. ARIA was the first to develop ICPs for allergen immunotherapy (AIT) in 2019. Based on MASK data, patients did not follow guidelines and their adherence to treatment was poor. Patients would modify their treatments, depending on the disease control. The effect of fluticasone propionate-azelastine combination is superior to intranasal corticosteroids which are superior to oral H1-antihistamines. Electronic diaries obtained from cell phones and other 'mobile health' (mHealth) devices help select patients for AIT. The ARIA algorithm for AR was found appropriate and no change is necessary. These guidelines will inform ICPs and will be included in the DG Santé digitally-enabled, person-centred care system. AIT is an effective treatment for allergic diseases caused by inhaled allergens. Its use should, however, be restricted to carefully selected patients. Orv Hetil. 2020; 161(49): 2059-2071.

[Otosclerosis. 2nd part. Diagnosis]. / Otosclerosis. 2. rész. Diagnózis.

Otosclerosis is a bone remodeling disorder affecting exclusively the human temporal bone which causes small bony lesions in the otic capsule. The symptoms depend on the location and the extent of the otosclerotic foci. Hence, clinically the most relevant sign is the conductive hearing loss due to the stapedial otosclerosis with fixation of the stapes footplate. In many cases, the specific anamnestic features, the age of presentation and usually the absence of tympanic membrane pathology can provide a strong clinical suspicion for otosclerosis. Although audiometric and imaging examinations and VEMP testing can confirm our preoperative diagnosis, the histolopathologic examination of the removed stapes footplate is the most accurate way to determine the diagnosis. Orv Hetil. 2019; 160(51): 2007-2011.

[Endoscopic removal of middle ear haemangioma and review of the literature]. / Középfül-haemangioma endoszkópos mutéti megoldása és irodalmi áttekintése.

The endoscopic middle ear surgery as a new technique has been introduced during the past few years in our country and it is available in only a few hospitals. Beyond the lack of external incision, endoscopic transcanal approach provides wide field of view to previously hidden middle ear spaces compared to the traditional microscopic technique. In this case report, we present an endoscopic surgery of middle ear capillary haemangioma that is a rare entity in tympanic cavity, therefore little has been published in the literature. Generally, these kind of vascular tumours occur in the internal auditory canal or in the perigeniculate ganglion area while this lesion originated from the inner surface of the inferior part of the bony tympanic ring. We discuss the difficulties in differential diagnosis and imaging tests then the treatment options. Orv Hetil. 2019; 160(41): 1639-1643.

[Otosclerosis. 1st part: pathogenesis]. / Otosclerosis. 1. rész: patogenezis.

Otosclerosis can be found exclusively in the human otic capsule of the temporal bone. Its etiology is still unknown. In the past decades, several potential etiopathogenetic factors have been revealed, however, most studies were based on otosclerotic patients diagnosed by clinical symptoms only. The current experience indicates that one third of this group suffer from non-otosclerotic stapes fixation. In our experimental series, we have diagnosed and classified otosclerotic patients based on histologic examination, and analyzed also the pathogenetic factors. Recent data demonstrate that measles virus and rs1800472 SNP of transforming growth factor beta 1 (TGFß1) gene are marked obvious etiologic factors, which have no therapeutic consequences so far. Furthermore, we summarize the genetic and environmental factors to be found in the literature, which may play a fundamental role in the pathogenesis of otosclerosis. Orv Hetil. 2018; 159(30): 1215-1220.

[Orbital compartment syndrome. The most frequent cause of blindness following facial trauma]. / Orbitakompartment-szindróma. Arcot ért trauma következtében leggyakrabban vakságot okozó állapot.

INTRODUCTION: Although orbital compartment syndrome is a rare condition, it is still the most common cause of blindness following simple or complicated facial fractures. Its pathomechanism is similar to the compartment syndrome in the limb. Little extra fluid (blood, oedema, brain, foreign body) in a non-space yielding space results with increasingly higher pressures within a short period of time. Unless urgent surgical intervention is performed the blocked circulation of the central retinal artery will result irreversible ophthalmic nerve damage and blindness. Aim, material and method: A retrospective analysis of ten years, 2007-2017, in our hospital among those patients referred to us with facial-head trauma combined with blindness. RESULTS: 571 patients had fractures involving the orbit. 23 patients become blind from different reasons. The most common cause was orbital compartment syndrome in 17 patients; all had retrobulbar haematomas as well. 6 patients with retrobulbar haematoma did not develop compartment syndrome. Compartment syndrome was found among patient with extensive and minimal fractures such as with large and minimal haematomas. Early lateral canthotomy and decompression saved 7 patients from blindness. CONCLUSION: We can not predict and do not know why some patients develop orbital compartment syndrome. Compartment syndrome seems independent from fracture mechanism, comminution, dislocation, amount of orbital bleeding. All patients are in potential risk with midface fractures. We have a high suspicion that orbital compartment syndrome has been somehow missed out in the recommended textbooks of our medical universities and in the postgraduate trainings. Thus compartment syndrome is not recognized. Teaching, training and early surgical decompression is the only solution to save the blind eye. Orv Hetil. 2017; 158(36): 1410-1420.

Different activations of toll-like receptors and antimicrobial peptides in chronic rhinosinusitis with or without nasal polyposis.

Both up- and down-regulation of the Toll-like receptors (TLRs) and antimicrobial peptides (AMPs) of the sinonasal mucosa have already been associated with the pathogenesis of chronic rhinosinusitis with (CRSwNP) or without (CRSsNP) nasal polyps. The objective of this study was to determine the expression of all known TLR and several AMP genes and some selected proteins in association with allergy, asthma and aspirin intolerance (ASA) in CRS subgroups. RT-PCR was applied to measure the mRNA expressions of 10 TLRs, four defensins, lysozyme, cathelicidin and lactoferrin (LTF) in sinonasal samples from patients with CRSsNP (n = 19), CRSwNP [ASA(-): 17; ASA(+): 7] and in control subjects (n = 12). Protein expressions were detected with immunohistochemistry (n = 10). Statistical analysis was done with the Kruskal-Wallis ANOVA, Mann-Whitney U, and Student t test. TLR2, TLR5, TLR6, TLR7, TLR8, TLR9, ß-defensins 1 and 4, cathelicidin and LTF mRNA expressions were significantly (p < 0.05) increased in CRSwNP, whereas only TLR2 and LTF were up-regulated in CRSsNP compared to controls. There was no statistical difference in respect of allergy, aspirin intolerance and smoking between CRSsNP, ASA(-) and ASA(+) CRSwNP patients. TLR2, TLR3, TLR4, LTF, ß defensin 2 and lysozyme protein expressions were found to be elevated in macrophages of CRSwNP samples (p < 0.05). Gene expression analysis showed markedly different expressions in CRSwNP (6 out of 10 TLR and 4 out of 7 AMP genes were up-regulated) compared to CRSsNP (1/10, 1/7). The distinct activation of the innate immunity may support the concept that CRSsNP and CRSwNP are different subtypes of CRS. These findings were found to be independent from allergy, asthma, smoking, aspirin intolerance and systemic steroid application.

Treatment of acute rhinitis with a nasal spray containing tramazoline and essential oils: a multicenter, uncontrolled, observational trial.

BACKGROUND: In this observational trial, data were collected on the effectiveness and tolerability/safety of a nasal spray containing tramazoline and essential oils (trade name Rhinospray(®) Plus) used for symptomatic treatment of acute rhinitis due to common cold. METHODS: The trial was performed in 300 children, adolescents and adults, who were to be treated with Rhinospray(®) Plus for up to 4 times per day for up to 10 days. Primary endpoints were the change from baseline to final visit in the mean of three single symptom scores (blocked nose, sneezing, and runny nose) and the mean improvement in two quality-of-life parameters (ability to perform normal daytime activities and quality of sleep). RESULTS: A total of 108 children, 30 adolescents and 162 adults were treated with Rhinospray(®) Plus. No patient discontinued prematurely. There was a mean reduction of 2.0 ± 0.6 (standard deviation) in nasal symptom scores from baseline to final visit; 297 of 300 of patients (99.0 %) reported an improvement. The mean value for improvement in quality-of-life parameters was 1.3 ± 0.5. Improvement in daytime activities was reported by all 300 patients (100.0 %) and in quality of sleep by 292 patients (97.4 %). Effectiveness and tolerability were rated as 'very good' or 'good' by 95.4 % and 97.4 % of patients, respectively; the investigators rated effectiveness and tolerability as 'very good' or 'good' for 97.4 % and 100.0 % of patients, respectively. No adverse events were reported. CONCLUSIONS: Community-based patients reported a relief in acute rhinitis symptoms and improvement in quality of life as a result of treatment with Rhinospray(®) Plus. Treatment was well-tolerated.

A conserved linkage group on chromosome 6, the 8.1 ancestral haplotype, is a predisposing factor of chronic rhinosinusitis associated with nasal polyposis in aspirin-sensitive Hungarians.

Inflammation plays a central role in the pathogenesis of chronic rhinosinusitis (CRS), and TNFα is a key pro-inflammatory cytokine in the pathogenesis of this disease. In our previous studies, we showed that the TNFA -308A allele is a genetic predisposition factor in a subgroup of aspirin-sensitive (ASA+) CRS patients suffering from nasal polyps (NP) in the Hungarian population. To determine whether the TNF -308A allele or the presence of a complex, extended ancestral haplotype (8.1AH) located on chromosome 6 is responsible for the previously observed genetic effect, we performed a case-control study for examining the frequency of 8.1AH carriers in controls and in subgroups of CRS patients. Our novel observations demonstrate that the presence of the 8.1AH may be responsible for the development of severe forms of CRS (CRSwNP, ASA+) and strengthen the clinical observation that CRS patients can be classified into clinically and genetically different subgroups.

The -308 G>A SNP of TNFA is a factor predisposing to chronic rhinosinusitis associated with nasal polyposis in aspirin-sensitive Hungarian individuals: conclusions of a genetic study with multiple stratifications.

Single nucleotide polymorphisms (SNPs) of the tumour necrosis factor alpha (TNFα) gene (TNFA) have been extensively studied and shown to be associated with an increased risk of the development of various chronic inflammatory diseases. Inflammation has been demonstrated to play a central role in the pathogenesis of chronic rhinosinusitis (CRS), and TNFα is a key pro-inflammatory cytokine with important functions in these processes. In order to determine whether the well-known TNFA -308 G>A SNP has a role in a genetic predisposition to CRS in the Hungarian population, we analyzed our genomic collection containing control and CRS patient samples in a case-control study, and compared the genotype and allele frequencies. There was no significant difference in the observed genotype or allele frequencies between the controls and the total CRS group. However, after careful stratification of the patient group on the basis of the observed clinical symptoms, we found a significantly higher carriage rate of the rare A allele-containing genotypes among the CRS patients with nasal polyposis (NP) who also exhibited sensitivity to aspirin (acetylsalicylic acid, ASA(+)). It is concluded that genetic variants of the TNFA gene may affect the risk of CRS in a clinically well-defined group of CRSNP(+)ASA(+) patients in the Hungarian population. Our results also emphasize that the group of CRS patients is not homogenous in that patients exhibiting different clinical symptoms exist. Their carried genetic predisposing factors, and as a result, the exact molecular events leading to the development of various forms of CRS, may also differ.

Prevalence and risk factors for allergic rhinitis in primary schoolchildren in Budapest.

OBJECTIVE: There is growing evidence that the prevalence of allergic diseases is increasing, especially among children. The aim of this study was to evaluate the incidence and risk factors of allergic rhinitis in 6-12-year-old schoolchildren in Budapest. METHODS: A total of 6335 children aged between 6 and 12 years attending 21 randomly selected primary schools in Budapest were surveyed in September 2007 by using a questionnaire consisting in part of questions compiled by the International Study of Asthma and Allergies in Childhood and in part of questions based on our own experience. RESULTS: 3933 of the questionnaires (1976 M/1957 F) were appropriately completed by the parents. The prevalence of current allergic rhinitis was 14.9% (n=530), that of physician-diagnosed allergic rhinitis was 11.6% (n=413), and that of cumulative allergic rhinitis was 26.5% (n=943). Male gender (p<0.001), family history of atopy (p<0.001), eczema (p<0.001), urticaria (p<0.001), itchy-watery eyes (p<0.001), coughing (p<0.001), wheezing (p<0.001), a hearing impairment (p<0.001), itching of the palate (p<0.001), frequent upper airway infection (p<0.001), frequent rhinosinusitis (p<0.001), a history of tonsillectomy (p<0.01), a history of adenoidectomy (p<0.001), antibiotics given in the first year of life (p<0.001), paracetamol given in the first year of life (p<0.001), living in a green area (p<0.001), the consumption of soft drinks containing preservatives or colourants (p<0.04), feather bedding (p<0.01), living in a house made of concrete (p<0.001), living not far from an air-polluting factory or mine (p<0.001), and long-lasting disease before the appearance of the allergy (p<0.001) were all significant factors involving an increased risk of allergic rhinitis symptoms. The frequent consumption of tomatoes, nuts, margarine and butter significantly affected the cumulative allergic rhinitis prevalence. RESULTS: Overall, the 12-month prevalence of allergic rhinitis in these 6-12-year-old children in Budapest was 14.9%, which is higher than reported from other European countries. Our findings differ from those on other cohorts in that exposure to ragweed and to indoor environmental factors in concrete housing estates in Budapest may be of particular importance as concerns allergic sensitization.

Histamine H4 receptor expression is elevated in human nasal polyp tissue.

Altered histamine metabolism is thought to be involved in the pathomechanism of nasal polyposis characterized by local eosinophil infiltration. The present study was performed to determine whether histamine receptors play a role in the effect of histamine in nasal polyp tissue. The findings suggest that the expression of H1 and H4 receptors is elevated in polyp tissue (p=0.045; p<0.001), while the level of H2 and H3 receptors is not increased significantly. The elevation of H1 and H4 receptors' expression may indicate that the histamine related mechanisms are preferentially mediated through H1 and H4 histamine receptors in the polyp tissue. Simultaneously with increased H4 receptor expression, the concentration of eosinophil cationic protein (ECP) was increased significantly in polyp tissue (p=0.002). One may speculate that the H4 receptor mediated histamine effects have a role in eosinophil accumulation and activation in inflammatory diseases of the nasal and paranasal sinus mucosa, such as nasal polyposis.

Adaptation of nasometry to Hungarian language and experiences with its clinical application.

OBJECTIVES: (1) To adopt the nasometry for the Hungarian language and to obtain normative nasalance scores. (2) To compare our results with the data of other languages and to evaluate the correlation between nasalance scores and perceptual ratings of nasality. (3) To use the nasometry in various fields of the otolaryngological, phoniatric, and logopedic diagnostics, therapy and documentation. METHODS: (1) To determine the normative nasalance scores regarding the Hungarian language, we included 30 children aged 5-7 years and 45 adults in the 20-25 years age group. In the latter group 15 subjects were speech therapists and 30 phonetically untrained people-15 males and 15 females. STUDY DESIGN: phonation of isolated vowels, articulation of spirants, cyclical repetition of affricates, pronunciation of various (oral, nasal, mixed type) sentences and evaluation of the nasalance score in continuous speech. (2) Thirty-six persons (12 speech pathologists, 12 logopedic students, 12 phonetically uneducated individuals) evaluated the children's physiological and nasal speech recordings with a 3-point scale. (3) Two hundred and forty-eight children of kindergarten age were examined, 20 infants and 6 adult singers in the following fields: evaluation of hypernasality due to cleft palate or velopharyngeal insufficiency (VPI), and of the success of the therapy; examination of hyponasality in cases of enlarged adenoid and allergic rhinitis; evaluation of the speech of hard-of-hearing people; differentiation between nasal sigmatism and hyperrhinophony; testing of the resonance in professional singers; examination of infant cry; application of nasometry in the therapy. RESULTS: The mean value of the nasalance score using the oral sentence: "Zsuzsi kutyája ugat" is 11-13%, in the nasal sentence ("A majom banánt enne") 56%, while that of the mixed sentence representing the Hungarian language ("Jó napot kívánok!") falls in the 30-40% range. The resonance grows with aging and there is no significant difference between genders. The nasalance score is greater with phonetically trained people. Our data correlate with the values of other languages. The correlation is significant between the nasalance scores and perceived nasality (r=0.901). Practical results: Values above 40% in cases of VPI using mixed sentences may support the indication of velopharyngoplasty, together with the subjective evaluation of nasality and other tests. In cases with rhinitis and adenoid vegetation the nasalance score remains below 20%. The nasality value is increased in sensorineural hearing loss, and is decreased in cases with conducting hearing impairment. In nasal sigmatism not the vowels' but the nasality of consonants grow. The difference between the nasalance score of the cry in clefted and non-cleft infants is significant (26% versus 36%): this observation could give possibility in the future to screen babies with congenital hearing problems or hidden VPI. Alterations in nasalance can be documented with nasometry in professional singers when they increase the nasal resonance to grow the power capacity of their voice. The nasometry procedure is a significant help also in speech therapy through the real time visual and auditive control. CONCLUSIONS: The otolaryngological, phoniatric and logopedic diagnostics and therapy is significantly widened with nasometry which is a quick, non-invasive and objective procedure, measuring the nasal resonance of the speech.

The pathogenesis of nasal polyposis by immunoglobulin E and interleukin-5 is completed by transforming growth factor-beta1.

OBJECTIVES/HYPOTHESIS: Nasal polyps are benign mucosal protrusions into the nasal cavity of multifactorial origin and are characterized by chronic mucosal inflammation. The suggested multifactorial pathological mechanisms comprise several factors including cytokines and immunoglobulin E (IgE). The study was designed to examine the suggested roles of IgE, interleukin-5 (IL-5), and transforming growth factor-beta1 (TGF-beta1) in the pathogenesis of nasal polyposis. METHODS: Nasal polyps (n = 34) and healthy nasal mucosa samples (n = 9) were taken during routine endonasal surgeries. Immunoglobulin E (n = 13), IL-5 (n = 22), and TGF-beta1 (n = 27) concentrations were measured with enzyme-linked immunosorbent assay technique in homogenized polyp tissue and in control mucosa. Atopic and nonatopic groups were selected and compared. Histomorphological examination and immunohistochemical analysis to detect IL-5 and TGF-beta1 were performed in five specimens. RESULTS: The level of tissue-bound IgE was significantly higher in polyps compared with control specimens and in atopic compared with nonatopic polyps, but between nonatopic polyps and control specimens the difference was not significant. However, significant correlation was found between tissue and serum IgE in the complete polyp (P =.001) and atopic polyps group (P =.05). Tissue IL-5 concentration was significantly higher in polyps compared with control specimens, in which it was below the limit (15 pg/mL), and there was no difference between atopic and nonatopic polyps. In atopic polyps there was significant correlation between tissue IgE and IL-5. Transforming growth factor-beta1 concentration proved to be significantly higher in control mucosa than in polyps, with no difference between atopic and nonatopic polyps. Immunohistochemical analysis revealed numerous IL-5-positive eosinophil cells and TGF-beta1 positivity in the lamina propria of polyp samples, but none in control specimens. CONCLUSIONS: High tissue TGF-beta1 quantity in healthy nasal mucosa without its active form on the cell surface and its low quantity in polyps may reflect its essential role in the inhibitory mechanisms of nasal polyposis. Interleukin-5 plays a key role in the eosinophil recruitment and activation, and both atopic and nonatopic pathways might activate this process. The main sources of IL-5 and TGF-beta1 are the eosinophils and macrophages. Immediate hypersensitivity, besides other mechanisms, might be related to atopic polyps, but the involvement of other, local allergic mechanisms in IgE production of nonatopic polyp tissue cannot be excluded.

Rhinomanometry: an update.

Rhinomanometry has been widely accepted and used as an objective method to assess nasal patency for more than two decades. Much knowledge was obtained with its application in nasal pathophysiology and measuring techniques are still an issue for continuous improvement. Background, concept and current techniques, past, present and future, reliability, indications and contraindications are discussed in details. Special attention is paid to problems of definition, correlation between rhinomanometric data and subjective sensation of nasal patency and calibration. It is concluded that rhinomanometry applied together with acoustic rhinometry gives the most reliable objective information on nasal patency in an authentic rhinologic laboratory.