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PubMed1990

The increased number of epithelial mast cells in nasal polyps and adjacent turbinates is not allergy-dependent.

Respiratory epithelial mast cells are an expression of airway inflammatory processes. Nasal epithelial mast cells are known to be increased in allergic rhinitis and have now been examined in patients with nasal polyps. Metachromatic cell counts (mean +/- standard error) expressed as the sum of large mast cells, atypical mast cells and basophils in epithelial scrapings of the inferior turbinates, assessed after Carnoy's fixation and toluidine blue staining (pH 0.5), were 37.5 +/- 29 in non-allergic normal control subjects (n = 11), 435 +/- 130 in polyp patients who were allergic (n = 18), and 699 +/- 267 in polyp patients who were not allergic (n = 8). Metachromatic cell counts in epithelial scrapings obtained in vivo from nasal polyps of allergic patients (n = 8) were 1769 +/- 962, and 2308 +/- 1544 from polyps of non-allergic patients (n = 5); metachromatic counts were 2089 +/- 633 in epithelial scrapings from excised polyps of allergic patients (n = 14) and 2214 +/- 640 from polyps of non-allergic patients (n = 13). It is concluded that the number of metachromatic cells in the epithelium of nasal polyps and the adjacent nasal mucosa is elevated compared with normal nasal epithelium and the increased number does not depend upon allergy.

Humans↗
PubMed2004

Heterogeneity of human nasal vascular and sinusoidal endothelial cells from the inferior turbinate.

The vast heterogeneity of endothelial cells (EC) in various organs necessitates isolation of EC from the relevant organs when defining mechanisms of site-specific pathologies. We report a novel finding that describes the presence of two heterogeneous populations of human nasal microvascular EC isolated from the inferior turbinate. Light and electron microscopy, flow cytometric analysis, and immunocytochemistry analysis demonstrated that one EC population exhibited the classic vascular endothelial markers with cobblestone-like morphology, whereas the other was sinusoidal with fusiform morphology. The sinusoidal EC (SEC) lacked surface expression of the endothelial markers CD31 and E-selectin, were discontinuous, showed fenestrae and pinocytic vesicles, and did not form tight junctions. Gene expression analysis using microarray revealed significant but limited heterogeneity between the two cell types. Immunohistochemical staining of normal nasal biopsies confirmed the presence of two distinct populations of EC. We found that CD31 was exclusively expressed on vascular EC (VEC), whereas the molecule L-SIGN was mainly expressed on SEC. Both cell types formed capillary-like tubules in matrigel in vitro. The two heterogeneous EC populations provide a unique in vitro system to study the biology of nasal VEC and SEC in normal conditions and in inflammatory processes in various nasal disorders.

Cell Adhesion Molecules↗
PubMed2000

Inferior turbinectomy versus submucosal diathermy for inferior turbinate hypertrophy.

In order to compare and evaluate bilateral inferior turbinectomy (BIT) and submucosal diathermy (SMD), we retrospectively examined these two well-known techniques for treatment of nasal obstruction due to bilateral congestion of the inferior turbinates. One hundred patients with bilateral nasal obstruction were divided into 4 groups according to their nasal airflow patency. Forty-nine patients underwent BIT, and 51 patients underwent SMD. All 100 patients were followed for 2 months after surgery. Patients with difficult postoperative courses were followed up to 1 year after surgery, in order to decide on the necessity of operative revision. Postoperative improvement in nasal breathing after BIT was reported for 96% of patients 2 weeks after surgery, and for 88% 2 months after surgery. Only 1 BIT patient had to undergo revision operation. Diathermy showed good results in 78% of cases 2 weeks after surgery. The efficacy of the procedure was reduced to 76% 2 months after surgery. Twenty percent of SMD patients were advised to undergo operative revision. Postoperative bleeding occurred in 20% of BIT patients and in only 4% of SMD patients. We found that the extent of postoperative improvement does not depend on preoperative conditions; therefore, it is impossible to predict the extent of postoperative improvement on the basis of the results of preoperative assessment. Both procedures can be performed under local anesthesia, are relatively safe and effective, and do not need expensive instrumentation that may not be available in many medical centers.

Adolescent↗
PubMed2004

Immunohistochemical localization of histamine receptor subtypes in human inferior turbinates.

Histamine is an important chemical mediator in allergic rhinitis and plays an important role in eliciting the nasal symptoms of the disorder. However, the immunohistochemical localization of histamine receptor subtypes (H1R, H2R, H3R, and H4R) in human nasal mucosa is unknown. There are also no prior studies of H3R and H4R in human nasal mucosa. The objective of this study was to examine the distribution of histamine receptor subtypes in the human inferior turbinates by an immunohistochemical method. H1R was localized primarily in the epithelium, vessels, and nerves. H2R was localized primarily in the epithelium and the glands. H3R and H4R were clearly distributed on the nerves. In addition, H1R, H3R, and H4R were clearly localized on the same nerves. This result indicates that H1R, H3R, and H4R adjoin and regulate each other in the same nerves. All histamine receptor subtypes may play some role in patients with allergic rhinitis.

Adult↗
PubMedDate not supplied

Corticosteroid injections of the nasal turbinates: past experience and precautions.

Clinical experience with triamcinolone acetonide (Kenalog) injections into the nasal turbinates for allergic and vasomotor rhinitis is reported by two authors. Gratifying results have occurred in most of the over 60,000 patients treated, with no serious side effects. Two cases of intravascular injections of another corticosteroid reaching the retinal circulation are reported, and methods for preventing this complication are proposed.

Administration, Intranasal↗
PubMedDate not supplied

Long-term efficacy of our surgical approach to turbinate hypertrophy.

In our department, chronically enlarged inferior turbinates (not responding to adequate medical therapy) are treated with the CO2-laser or by partial inferior turbinoplasty. In this work, the latter technique is described and the short- and long-term results (up to 9 years of follow-up) are evaluated. Relief of nasal obstruction was reported by 93.5% of the patients. There was a good correlation between this success rate and the objective measurements of the nasal resistance by active anterior rhinomanometry. Rhinorrhea or postnasal drip was still present in 32.5%. Atrophic changes of the nasal mucosa were not observed in any of the patients. Early postoperative epistaxis was found in 6.5% of the patients. Late postoperative epistaxis did not occur.

Adolescent↗
PubMed1997

Histamine-induced calcium released from cultured human mucosal microvascular endothelial cells from nasal inferior turbinate.

Changes in cytosolic Ca2+ concentration ([Ca2+]i) in cultured human mucosal microvascular endothelial cells (HMMECs) from nasal inferior turbinate were measured using a fluorescent Ca(2+)-sensitive dye, fura-2, and photometric fluorescence microscopy. Histamine caused a transient increase in intracellular free Ca2+ in cell populations and in individual cells, followed by a decrease to a sustained elevation. Histamine (100 microM) elevated [Ca2+]i in HMMECs up to 563 +/- 20 nM from a resting level of 60 +/- 45 nM (means +/- SD, n = 31). Promethazine (a histamine H1 receptor antagonist) inhibited [Ca2+]i increase during histamine stimulation, whereas cimetidine (a H2 receptor antagonist) and thioperamide (a H3 receptor antagonist) showed no inhibition. These results suggest that the histamine increase [Ca2+]i in HMMECs induces both a Ca2+ release from stores and a Ca2+ influx through activation of the H1 receptor.

Calcium↗
PubMed1994

[Immunohistochemical study of inferior turbinate of nasal allergy with reference to eosinophils].

The number and distribution of EG1 positive cells, EG2 positive cells, MBP positive cells and EPO positive cells of the nasal mucosa were studied in nasal allergy. The correlation between the EG2 positive cells and subjective symptoms, the number of eosinophils in serum, the number of eosinophils in nasal secretion, the serum IgE level and the RAST score was studied. Subjects for EG2 were 13 males and 7 females ranging from 10 to 43 years of age, for EG1 they were 2 males and 3 females ranging from 18 to 43 years of age, and for MBP and EPO they were 3 males and 2 females ranging from 10 to 43 years of age. The specimens from inferior turbinates were frozen at -70 degrees C and sliced at a thickness of 4 microns by cryostat. Monoclonal antibodies and peroxidase-antiperoxidase staining (DAKO) were used to detect these cells. EG1 positive cells, EG2 positive cells, MBP positive cells and EPO positive cells were found mainly in the superficial layer, with some in the epithelial layer. However, damage to the epithelium was not related to the infiltration of EG2. No damage to the basement membrane was found. The number and distribution of EG1 positive cells and EG2 positive cells were almost the same. This means that eosinophils seen in the nasal mucosa have been activated. The number of EG2 positive cells was well correlated with the degree of nasal obstruction and serum IgE level. From the results, activated eosinophils were thought to be related to the late phase response of nasal allergy.

Adolescent↗
PubMed1999

[On the impact of surgery on mucosal vessels of the turbinates (10 years of submucosal vasotomy)].

The paper presents a detailed description of blood circulation in the mucosa of the turbinated bones (TB), cavernous plexuses of the conchae (CPC). The operation of submucous vasotomy is suggested basing on morphological features of CPC blood supply. The technique of the procedure is described. The results of this sparing surgery are available for 530 patients with hypertrophic and basomotor rhinitis.

Adolescent↗
PubMed1998

[Clinical observation and anatomical analysis of middle turbinate and ethmoidal internal wall moved to external side after microsurgery].

OBJECTIVE: To assess the effect of middle turbinate (MT) and ethmoidal internal wall(EIW) moved externally after microsurgery. METHODS: Twenty-four cases (45 sides) were followed-up endoscopically for (16.3 +/- 9.3) months. Thirteen cases (24 sides) were observed by CT scans. Three cadaver heads were measured for anatomical analysis. RESULTS: Forty-one (91%) of 45 sides obtained better olfactory function after operation. Twenty-two (91%) of 24 sides were found to have better CT changes in sinus ventilation as compared with preoperative CT scans. The gap between the MT and EIW to the orbital wall was (12.0 +/- 1.0) mm, while that between the ethmoidal bulla and processus uncinatus was only (2.3 +/- 0.6) mm as revealed in the autopsy. CONCLUSION: MT and EIW moderately moved suitably to externally had no bad effect on sinus ventilation, and it improved olfaction.

Adolescent↗
PubMed2002

[The application of argon plasma coagulation (APC) in surgical treatment of inferior turbinates].

For over 20 years, argon plasma coagulation (APC) has been used in open surgery, in laparoscopy and in thoracoscopy for the haemostasis of superficial haemorrhages and for the resection of parenchymatous tissue. This technique is based on the use of a high-frequency current that ionizes an inert gas, the argon; the emission of this latter generates a thermocoagulative effect that is selectively exerted on the superficial surfaces of the mucosa involved. In otorhinolaryngology, it may be seen as a valid alternative to traditional surgical techniques, to a mono- or bipolar electric surgical knife, and to laser surgery. From March to November 2000, 157 patients affected by "inferior turbinate hypertrophy non-responsive to ordinary medical therapy" underwent devitalizing APC surgery. In 20% of the cases (30 patients), the operation was performed under local anaesthesia. In no case was a nasal tampon employed. Twelve months after the operation, 87% of the patients treated (136 cases) had fully resumed normal nasal respiratory functionality, with marked improvement in the air flow and reduction of the unilateral nasal resistance during rhinomanometric evaluation. There were post-operative complications in 2% of the patients (3 cases), all of which were successfully handled through APC (2 cases of epistaxis on the 7th and 9th post-operative day, and 1 case of turbino-septal synechia). In the 13% of the patients (21 cases) in whom the results had been partial or unsatisfactory, the cause of the limited efficacy of the treatment was connected with an improper use of the instrumentation, lack of compliance on the part of the patient, or a concomitant psycofunctional pathology. The statistical study, accomplished via Student's t test, confirmed that the difference between the unilateral nasal resistance values present before the procedure and those measured during the 1-month follow-up were highly significant (t = 11.126, p < .001). The same significant correlation was ascertained between the pre-operative nasal resistance values and those ascertained post-operatively, respectively at 3, 6 and 12 months (p < .001).

Adult↗
PubMed2003

Aggressive psammomatoid ossifying fibroma of the inferior turbinate and lateral nasal wall.

OBJECTIVE: Fibroosseous lesions are rare entities of the nose and paranasal sinuses, the terminology and classification of which are still confusing. Psammomatoid or aggressive (juvenile) ossifying fibroma is a benign messenchymal tumor usually met in the young age (5-15 years), in the sinonasal tract, bearing distinctive histomorphologic features and a tendency towards locally aggressive behaviour. METHODOLOGY: We report here a rare case of an aggressive psammomatoid ossifying fibroma of the inferior turbinate and the lateral nasal wall, with obstruction of the nasolacrimal duct, in a 68-year-old woman. RESULTS: Diagnosis was based on physical examination, CT scan imaging and histopathological examination. Treatment consisted of endoscopic intranasal resection of the tumor accompanied by removal of the lateral nasal wall. CONCLUSIONS: Fibro-osseous tumors of the nose and paranasal sinuses require aggressive surgical approach in order to avoid recurrence. Complete surgical excision may not always be possible mainly due to the tumor's extent and location.

Aged↗
PubMed2003

Olfaction in patients with nasal polyposis: effects of systemic steroids and radical ethmoidectomy with middle turbinate resection (nasalization).

AIM: In this prospective study the effect of medical and surgical treatment on subjective olfaction was studied in patients with nasal polyposis (NPS). The effects on nasal obstruction, anterior and posterior rhinorrhea, sneezing and itching are reported in another article in this issue. PATIENTS AND METHODS: Protocol 1. Twenty-four patients with NPS who complained about anosmia were treated with a 7-days course of systemic steroids. Their subjective overall sense of smell was determined with a visual analog scale (VAS) before treatment, immediately after treatment, and two months later. Subsequently all patients underwent surgery bilaterally according to the nasalization principles. The sense of smell was re-evaluated at 1, 3, 6, 9, and 12 months postoperatively. Protocol 2. Thirty-two patients with NPS not responding to medical therapy who, for different reasons, did not receive oral steroid treatment, received surgery only and were followed up during one year after nasalization. Of these patients, 25 were anosmic and 7 normosmic. RESULTS: Protocol 1. Following the 7-day treatment with systemic steroids the olfactory score increased significantly. During the waiting time for surgery (64 +/- 39 days) this score deteriorated again in a significant way. One month after nasalization which included a depot injection of triamcinolone 80 mg the day after surgery, the olfactory score ameliorated again and remained stable at 3, 6, 9, and 12 months. None of the patients reported any intake of systemic steroids during the one-year of follow-up. Statistically, there was a trend suggesting that the 12 month post-nasalization score was better than the immediate post-oral steroid score. A good correlation between the improvement of the sense of smell after 7 days of systemic steroids and one year after nasalization was found. Protocol 2 One month after the nasalization protocol, olfaction in patients of the hypo-anosmic group had improved considerably. Scores at 3, 6, 9, and 12 remained very stable. The sense of smell in the normosmic group did not change after surgery and remained stable during the year of follow-up. In total, 49 patients with a severe loss of smell showed a significant improvement at 12 months after surgery. CONCLUSION: The present study shows that 1) long-lasting correction of olfactory dysfunction produced by nasal polyposis can be achieved through the combination of nasalization and low dose of nasal steroids, 2) middle turbinate resection does not alter the possibilities to restore the sense of smell.

Adolescent↗
PubMed2004

Inferior turbinate angiofibroma: an atypical presentation [correction of preservation].

Angiofibromas are nasopharyngeal tumours mostly seen in adolescent males. They usually present with nasal obstruction and epistaxis. They account for less than 0.5% of all head and neck tumours. Extranasopharyngeal angiofibromas although rare, have been reported (Ali et al., 1982). The most common extranasopharyngeal site is the maxillary sinus. We report a case of extranasopharyngeal angiofibroma arising from the inferior turbinate which had an unusual clinical presentation.

Adult↗
PubMed2004

Anosmia following superior turbinate resection.

Nasal polyposis is a chronic inflammatory disease of the sinus mucosa responsible for, among other symptoms, alteration of the sense of smell in a considerable percentage of patients. One of the aims of surgical treatment is the recuperation of the sense of smell, especially in patients with good preoperative indicators suggesting a possible favorable outcome. The purposes of this brief clinical report are to present the case of a patient with nasal polyposis who developed anosmia after a bilateral endoscopic functional ethmoidectomy with inadvertent resection of both superior turbinates, and to discuss briefly the possible physiopathological mechanisms that could explain it.

Adult↗
PubMedDate not supplied

Bipolar radiofrequency volumetric tissue reduction of inferior turbinate: does the number of treatment sessions influence the final outcome?

BACKGROUND: The aim of this study was to determine if the number of treatment sessions has an influence on the final intermediate term results of submucosal bipolar radiofrequency volumetric tissue reduction of the inferior turbinate. METHODS: One hundred two patients were enrolled in this study prospectively. The procedure was done using the Coblation (Arthrocare Corp., Sunnyvale, CA). The assessment was done using the 10-cm visual analog scale and acoustic rhinometry. Surgical procedures and pre- and postoperative assessments were done at the Faculty of Medicine, Cairo University. RESULTS: Eighty eight percent of our study population achieved final relief of their nasal obstruction, and at least three sessions were needed to maintain the favorable outcome at 1-year follow up. CONCLUSION: Increasing the number of bipolar radiofrequency volumetric tissue reduction treatment sessions was associated with better intermediate-term outcome. This was confirmed using subjective and objective methodology.

Catheter Ablation↗