Eosinophilic mucin rhinosinusitis.
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Diagnosis, Differential↗
Biomedical subjects
E B Kern
Publications and source records attributed to E B Kern.
Pathologic quiz case 1. Tumefactive fibroinflammatory lesion of the nasal cavity.
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Aged↗
The diagnosis and incidence of allergic fungal sinusitis.
OBJECTIVE: To reevaluate the current criteria for diagnosing allergic fungal sinusitis (AFS) and determine the incidence of AFS in patients with chronic rhinosinusitis (CRS). METHODS: This prospective study evaluated the incidence of AFS in 210 consecutive patients with CRS with or without polyposis, of whom 101 were treated surgically. Collecting and culturing fungi from nasal mucus require special handling, and novel methods are described. Surgical specimen handling emphasizes histologic examination to visualize fungi and eosinophils in the mucin. The value of allergy testing in the diagnosis of AFS is examined. RESULTS: Fungal cultures of nasal secretions were positive in 202 (96%) of 210 consecutive CRS patients. Allergic mucin was found in 97 (96%) of 101 consecutive surgical cases of CRS. Allergic fungal sinusitis was diagnosed in 94 (93%) of 101 consecutive surgical cases with CRS, based on histopathologic findings and culture results. Immunoglobulin E-mediated hypersensitivity to fungal allergens was not evident in the majority of AFS patients. CONCLUSION: The data presented indicate that the diagnostic criteria for AFS are present in the majority of patients with CRS with or without polyposis. Since the presence of eosinophils in the allergic mucin, and not a type I hypersensitivity, is likely the common denominator in the pathophysiology of AFS, we propose a change in terminology from AFS to eosinophilic fungal rhinosinusitis.
Diagnosis, Differential↗
The role of outfracture in correcting post-rhinoplasty nasal obstruction.
Post-rhinoplasty nasal osbtruction is often related to narrowing in the region of the nasal valve. Correction of this obstruction can include inferior turbinectomy, septoplasty spreader grafts and nasal valvuloplasty. The authors have seen cases of severe valve stenosis related to infracture after osteotomy which did not respond to any of the aforementioned procedures. These patients were treated with revision osteotomy with outfracture. We discuss patient selection and surgical technique for revision osteotomy with outfracture as well as a cadaver dissection demonstrating the effects of infracture and outfracture on valve area. The clinical results, based on patient satisfaction and pre- and postoperative photographs, are presented. Revision osteotomy with outfracture should be included in the surgeon's armamentarium for the treatment of post-rhinoplasty nasal obstruction.
Adult↗
Psychological complications of septo-rhinoplasty.
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Anesthesia, General↗
Effects of Aspergillus fumigatus and Alternaria alternata on human ciliated epithelium in vitro.
Fungi represent the etiologic agent in a large number of patients with chronic sinusitis. Despite this, no study has examined the effects of fungi on ciliated epithelium. This study evaluates the effects of cultures and filtrates of Aspergillus fumigatus and Alternaria alternata on ciliary beat frequency (CBF) in vitro. CBF was recorded after exposure to either a control or experimental solution. A statistical comparison of control and experimental values was performed to determine significance at P < 0.05. A statistically significant inhibition of CBF in cultures and filtrates of A fumigatus and A alternata was demonstrated. We conclude that a soluble metabolite produced by clinical isolates of both A fumigatus and A alternata causes inhibition of CBF and may represent one virulence factor involved in the development of fungal sinusitis.
Adult↗
Nasofrontal duct reconstruction with silicone rubber sheeting for inflammatory frontal sinus disease: analysis of 164 cases.
The authors reviewed their experience in reconstructing the nasofrontal duct with thin silicone rubber sheeting in patients who had chronic inflammatory frontal sinus disease. The 164 patients were divided into four groups. The patients in group 1 had the traditional modified Lynch procedure, while those in group 2 had certain technical variations of the modified Lynch operation. The patients in the other two groups had major technical variations: those in group 3 had a primary osteoplastic flap approach and those in group 4 had revisions of failed osteoplastic flap with fat obliteration operations. Surgical indications included mucopyocele (87 patients), chronic frontal sinusitis (71 patients), osteomyelitis (2 patients), acute sinusitis (2 patients), and subacute sinusitis (2 patients). Follow-up averaged 47 months. At their last clinic visit, 157 patients (96%) were asymptomatic. Forty-six revision procedures were performed in 30 patients (18% of initial cases). There were no major complications. Nasofrontal duct reconstruction using thin silicone rubber sheeting is technically straightforward, safe, and effective.
Adolescent↗
Reconstruction of caudal end of septum. A case for transplantation.
OBJECTIVE: To examine the results of complete removal and reconstruction of the caudal end of the septum with emphasis on long term success. DESIGN: A case series reviewing the surgical outcome of 45 consecutive cases of transplantations for severely deformed of absent caudal ends of the septum. After at least 18 months, all 45 patients were given a postoperative evaluation. SETTING: All procedures were performed at Mayo Clinic, Rochester, Minn. PATIENTS: Forty-five patients (36 male and nine females) ranged in age from 7 to 78 years, with a mean age of 38 years. Twenty-seven patients had severe caudal end deformities, and 18 patients had absent or flaccid caudal end. OUTCOME MEASURES: Subjective assessment included the opinion of the patient, rhinologic examination, and photographic analysis. Anterior mask rhinomanometry was performed to measure nasal resistance. Clinically noted complications were documented when present. RESULTS: Subjectively, 36 (80%) of the 45 patients reported "normal" nasal breathing, and seven patients (15.6%) reported improved nasal breathing. Objective preoperative and postoperative rhinomanometry data, available in 28 cases, was related to the subjective findings. The longevity of the caudal end transplant was confirmed by reviewing the data from the 33 patients who were followed up more than 1 year. Ninety percent of the patients were free of complications. CONCLUSION: Objective and subjective results showed excellent long-term results. The caudal end of the nasal septum can be removed safely and reconstructed.
Adolescent↗
Rhinoscleroma: a growing concern in the United States? Mayo Clinic experience.
Rhinoscleroma is a chronic, progressive, granulomatous infection of the upper airways caused by the bacterium Klebsiella rhinoscleromatis. Although most cases occur in developing countries, recent immigration patterns have led to an increasing number of patients with rhinoscleroma in the United States. Rhinoscleroma may mimic various inflammatory and neoplastic processes, including leprosy, paracoccidioidomycosis, sarcoidosis, basal cell carcinoma, and Wegener's granulomatosis. Current therapy consists of a combination of surgical débridement and prolonged antimicrobial therapy. Rhinoscleroma should be added to the list of opportunistic infections that can occur in patients with human immunodeficiency virus.
Adult↗
Inflammatory diseases of the sinuses:physiology. Clinical applications.
Physiologic principles form the foundation upon which rational medical and surgical decisions are based. Over the years, a growing understanding of the physiology of the nose and sinuses has evolved, allowing us to better treat our patients with sinonasal disease. As clinicians, we are challenged to keep abreast not only of advances in therapeutic options but also of advances in physiology. In this manner, we may employ the new therapies with both skill and intelligence.
Female↗
Classical intranasal ethmoidectomy: does the endoscope have a role?
The major advantage of intranasal endoscopy is that it allows a magnified view of the osteomeatal region and the frontal recess. Performing intranasal ethmoidectomy with nasal endoscopes may be hazardous, particularly in the hands of inexperienced surgeons. The use of 2-power loops for performing intranasal ethmoidectomy has several advantages, including direct binocular vision and visualization of external anatomic landmarks. The use of loops does not preclude the use of endoscopes.
Endoscopy↗
Nasal influences on snoring and obstructive sleep apnea.
Although the relationship between nasal obstruction and sleep disturbance is variable, either partial or total obstruction of the nasal passages can cause snoring, obstructive sleep apnea, and the sequelae of alveolar hypoventilation. In addition, nasal obstruction can cause sleep fragmentation, sleep deprivation, and the known sequelae of disturbed sleep architecture, including associated daytime tiredness and alterations in normal behavior patterns. Nasal obstruction may produce greater physiologic effects during sleep than during the awake state. A complete examination of the upper respiratory tract should be done in all patients with obstructive sleep apnea and snoring. The degree of nasal obstruction is not directly correlated with the severity of symptoms and findings.
Humans↗
Effect of Klebsiella ozaenae on ciliary activity in vitro: implications in the pathogenesis of atrophic rhinitis.
Klebsiella ozaenae is a gram-negative rod that has been isolated with relative frequency from patients with atrophic rhinitis. The relationship of this bacterium to the pathogenesis of atrophic rhinitis is not understood, and whether this bacterium is simply an opportunistic colonizer of the injured nose or the etiologic agent of the disease is unclear. This study was designed to investigate a potential role for bacterially produced cilioinhibition as a mechanism for the pathogenesis of atrophic rhinitis.
Cilia↗
Measurement of human nasal ciliary motility using computerized microphotometry.
A new computerized technique for the assessment of human nasal ciliary beat frequency is described. Thirty normal volunteers underwent nasal cytologic brushing to obtain ciliary samples. In each subject, 150 ciliary beats were analyzed from each of 50 separate ciliated cell clusters. The ciliary beat frequency for each area was determined with fast Fourier transformation. The results were plotted on a histogram to determine the ciliary beat distribution. The mean frequency for these samples was 11.29 Hz, with a standard deviation of 0.96 Hz. The median frequency for these samples was 11.25 Hz. These results show a marked improvement over hand-counting microphotometry techniques because of the much larger sampling size and elimination of much human error. We believe this method of ciliary analysis represents a significant advancement in the evaluation of ciliary function and should assist in the diagnosis of patients with congenital and acquired forms of ciliary dysmotility.
Body Temperature↗
Rhinolift operation in the treatment of the aging nose.
Disturbance of the normal relationship between the caudal border of the upper lateral cartilage and the cephalic margin of the lobular cartilage--the so-called "cul-de-sac" area--can result in alar collapse and nasal airway obstruction. This may be caused by either the aging process or trauma, both surgical and nonsurgical. Rhinolift is a surgical procedure that was developed for the treatment of the aging ptotic nasal tip. We have applied this technique to patients with nasal airway obstruction resulting from alar collapse. Elevation of the cephalic margin of the lobular cartilage to a position superficial to the upper lateral cartilage restores the normal relationship between these two structures. The upper lateral cartilage then assists in stenting the vestibule open, and thereby improves nasal breathing. Over the past 10 years, 20 patients have had rhinolifts at our institution for the relief of nasal airway obstruction. Concomitant surgery included nasal septal reconstruction in 12 patients, polypectomy in one patient, and placement of a silicone rubber septal prosthesis for closure of a large septal perforation in three patients. Rhinolift was the sole procedure used for the correction of valvular pathology in 10 patients. The other 10 patients had modifications made in their upper lateral cartilage along with the rhinolift. Five patients described restoration of normal nasal breathing, while 14 patients showed partial symptomatic improvement. One patient reported no improvement in nasal breathing. Rhinolift is a safe effective surgical technique for functional improvement of nasal breathing in patients with alar collapse resulting from inadequate cartilaginous support.
Adult↗
Third place--Resident Clinical Science Award 1990. The in vivo and in vitro effect of phenylephrine (Neo Synephrine) on nasal ciliary beat frequency and mucociliary transport.
Twenty volunteers with normal noses were studied to determine the effect of phenylephrine on nasal ciliary function. In vivo study of this drug was performed in 15 patients and revealed a significant increase in their ciliary beat frequency from a control of 11 Hz to 12.03 Hz (p = 0.001). Mucociliary transit times in these volunteers were also studied, revealing a mean of 9.9 minutes prestimulation and 10.2 minutes poststimulation, which was not statistically significant (p = 0.77). Five additional subjects donated ciliated mucosal samples for in vitro analysis of varying concentrations of this agent that showed a significant ciliostimulatory effect at lower concentrations (0.01%), with a progressive cilioinhibitory effect at higher concentrations (0.25%, 0.5%). The 0.05% concentration showed no significant change in ciliary activity compared to control measurements. These data demonstrate that phenylephrine has a ciliostimulatory effect in vivo, as well as in appropriate concentrations in vitro, and should be safe and relatively nontoxic to the mucociliary apparatus for short-term use.
Awards and Prizes↗
Chronic sinusitis and dyspnea: could this be AIDS?
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Acquired Immunodeficiency Syndrome↗
Rhinomanometry for preoperative and postoperative assessment of nasal obstruction.
In this retrospective study we used active, anterior mask rhinomanometric methods to measure nasal resistance before and after surgery for nasal obstruction. The study group comprised 60 patients with nasal obstruction who had 63 preoperative and postoperative rhinomanograms and the control group contained 14 asymptomatic patients who underwent rhinomanometric studies before transnasal, transsphenoidal pituitary surgery. Before surgery the study group had significantly higher total and combined unilateral nasal resistances than either the control group before surgery (p less than 0.05 and p less than 0.01, respectively) or the study group after surgery (p less than 0.0001 for both comparisons). Surgery normalized the nasal resistances of the study group in relation to the control group. A total nasal resistance greater than 1 cm H2O/L/sec or a unilateral resistance greater than 3.5 cm H2O/L/sec suggests clinically significant nasal obstruction. Airway narrowing and obstructive symptoms correlated with airway resistance in the preoperative patient, but symptoms did not correlate well with postoperative resistance.
Adolescent↗