Impact of isotonic and hypertonic saline solutions on mucociliary activity in various nasal pathologies: clinical study.

OBJECTIVE: To investigate the impact of nasal irrigation with isotonic or hypertonic sodium chloride solution on mucociliary clearance time in patients with allergic rhinitis, acute sinusitis and chronic sinusitis. PATIENTS AND METHODS: Mucociliary clearance time was measured using the saccharine clearance test on 132 adults before and after 10 days' application of intranasal isotonic or hypertonic saline. Patient numbers were as follows: controls, 45; allergic rhinitis, 21; acute sinusitis, 24; and chronic sinusitis, 42. The results before and after irrigation were compared using the Wilcoxon t-test. RESULTS: Before application of saline solutions, mucociliary clearance times in the three patient treatment groups were found to be significantly delayed, compared with the control group. Irrigation with hypertonic saline restored impaired mucociliary clearance in chronic sinusitis patients (p < 0.05), while isotonic saline improved mucociliary clearance times significantly in allergic rhinitis and acute sinusitis patients (p < 0.05). CONCLUSION: Nasal irrigation with isotonic or hypertonic saline can improve mucociliary clearance time in various nasal pathologies. However, these solutions should be selectively prescribed rather than used based on anecdotal evidence. Further studies should be conducted to develop a protocol for standardised use of saline solution irrigation in various nasal pathologies.

Interleukin-4, interleukin-8 and E-selectin levels in intranasal polyposis patients with and without allergy: a comparative study.

Intranasal polyposis is a chronic inflammatory upper airway disease with unknown aetiology. Interleukin (IL)-4 and IL-8 play very significant roles in allergic events and infectious inflammation, respectively. In contrast, E-selectin is important in the initiation and organization of inflammation. In this study, levels of IL-4, IL-8 and E-selectin were measured in nasal mucosa specimens of intranasal polyposis patients with and without allergic rhinitis, and healthy controls. Healthy controls had significantly higher IL-4 levels than allergic patients and non-allergic patients; IL-4 levels were similar in allergic and non-allergic patients. Allergic and non-allergic patients had significantly higher IL-8 levels than healthy controls; IL-8 levels were comparable in allergic and non-allergic patients. E-selectin levels were similar in all groups. The infection-based theory, represented by IL-8, seems to be more likely than the allergy-based theory, represented by IL-4, for the pathogenesis of nasal polyposis.

Scanning electron microscopy of hydroxylated polyvinyl acetal and conventional gauze strip nasal packing materials.

The application of nasal packing is one of the most commonly performed procedures in rhinology. Various materials have been used as nasal packing, including conventional gauze strips and hydroxylated polyvinyl acetal. Complications related to nasal packing may cause problems that lead to increased morbidity. Among those complications, infectious ones range from localized infection in the nasal cavity to toxic shock syndrome. The purpose of this study was to evaluate conventional gauze strips and hydroxylated polyvinyl acetal nasal packing materials by scanning electron microscopy, to reveal their surface characteristics that would promote or prevent the development of infectious complications. The two types of materials were examined before and after application into the nasal cavity. Scanning electron microscopy demonstrated that hydroxylated polyvinyl acetal material had a smooth surface, whereas conventional gauze strips had an irregular surface with fibers projecting, thus increasing the surface area for bacterial adherence and allowing possible evasion of bacteria from the elements of the immune system within this fibrillar structure.

A histopathologic evaluation of mucosa obtained from mastoidectomy cavity by mastoidoscopy.

Despite the routine application of intact canal wall mastoidectomy for chronic suppurative otitis media, the outcome of mucosa within the mastoidectomy cavity is not wellknown. The purpose of this was to evaluate the mastoidectomy cavity and obtain mucosal study specimens from the mastoidectomy cavities in order to reveal any residual pathology. Mastoidoscopy under local anaesthesia was performed to evaluate the mastoidectomy cavity and obtain mucosal specimens from the mastoid antrum. The procedure was carried out in 12 patients. Four (33%) patients had wide cavities, 6 (50%) had their cavities narrowed down to the antrum, and 2 (17%) patients had obliterated cavities. Mucosal specimens examined with transmission electron microscopy revealed findings like swelling of some of the mitochondria, decrease in the number of organelles, intracellular oedema, changes in the nuclei, decrease in cilia and fibrosis. In conclusion, even if there may be some pathology at a microscopic level, this does not necessarily lead to any clinical problem.

Submandibular accessory salivary gland causing Warthin's duct obstruction.

BACKGROUND: Submandibular masses are mostly secondary to sialolithiasis. Salivary gland tumors should be considered in the differential diagnosis. In this case report, an unusual cause of Warthin's duct obstruction caused by an accessory salivary gland tissue is presented. METHODS: Sialography revealed the submandibular accessory salivary gland. RESULTS: Submandibular gland excision was performed and histopathologic investigation showed the accessory salivary tissue, which was narrowing the Warthin's duct. CONCLUSIONS: In cases of a symptomatic submandibular accessory gland, excision extirpation of the submandibular gland and accessory salivary tissue should be undertaken.

Accessory nerve function after modified radical and lateral neck dissections.

OBJECTIVES: Evaluate preoperative and postoperative electrophysiological changes related to the accessory nerve with reference to dissection technique, modified radical neck dissection, and lateral neck dissection. STUDY DESIGN: Prospective electrophysiological analysis of accessory nerve function in a total of 20 laryngeal carcinoma patients after neck dissection, 12 being lateral neck dissection (4 bilateral) and 8 being modified radical neck dissection. METHODS: Distal latencies, compound muscle action potentials, and electromyography findings were investigated before surgery and, in early and late postoperative periods in 20 laryngeal carcinoma patients. Results were evaluated by Student t test and chi2 test for intragroup and intergroup differences. RESULTS: In the lateral neck dissection group, postoperative distal latencies were longer, without statistical significance, whereas in the modified radical neck dissection group postoperative latencies were statistically longer. Postoperative compound muscle action potentials were significantly lower in both groups. Electromyographic work-up showed deterioration in early postoperative periods and improvement in late postoperative periods. When intergroup differences were compared, both postoperative compound muscle action potential and electromyographic findings were worse in the lateral neck dissection group. CONCLUSIONS: The accessory nerve function after modified radical neck dissection is better than function after lateral neck dissection because of increased stress applied to the nerve during retraction of the sternocleidomastoid muscle for achievement of a better exposed surgical field in lateral neck dissection.

Clinical presentation of a sphenochoanal polyp.

Although choanal polyps frequently arise from the maxillary sinus, a choanal polyp originating from the sphenoid sinus is a rare entity. In this report, an unusual case of a large choanal polyp taking origin from the sphenoid sinus is presented. The reasons for its development and methods of management are discussed.

Clinical importance of the Korner's septum.

OBJECTIVE: To evaluate the clinical importance of the petrosquamosal lamina (Korner's septum [KS]), which is not only a bony plate dividing the mastoid cells at the level of antrum, but is also a lamina starting from the posterior aspect of the glenoid fossa that extends above the middle ear cavity and courses in an inferior direction lateral to the facial canal and proceeds to the mastoid apex. STUDY DESIGN AND SETTING: A retrospective review of 688 mastoidectomies performed in University Hospital from 1987 to 1992. PATIENTS: The study group consisted of 389 males and 299 females (mean age 30.85 +/- 12.80, the youngest being 8 and the oldest being 67 years of age). MAIN OUTCOME MEASURES: The main outcome measures were the prevalence of KS encountered during mastoidectomies and comparison of prevalence of retraction pockets (RPs) or retraction and/or adhesion of the whole tympanic membrane (R/A-TM) between ears with KS and without KS. RESULTS: The prevalence of KS was 30.4% among the ears with RP or R/A-TM, 6.58% in normal ears, and 17.4% in ears with chronic otitis media without RP or R/A-TM. CONCLUSIONS: KS is an important anatomic handicap predisposing the individual to chronic otitis media, particularly when it is characterized by attic retraction pockets and cholesteatoma, and adhesive otitis media, because KS contributes to attic blockage. This statement is in accordance with the original articles written by Cheatle (1910, 1923) and Williams (1966), and recently published data related to supratubal recess and the cog (Tono et al., 1996).