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PubMed2003

[Expression of tenascin in human nasal polyp tissue and primary studies of its clinical significance].

OBJECTIVE: To explore the pathogenesis of nasal polyposis and the expression of tenascin in human nasal polyps. METHOD: Tenascin in nasal polyp tissues from twenty-four polyposis patients and tenascin in inferior turbinates tissues from fifteen chronic hypertrophic rhinitis patients were detected with immunohistochemistry (sp) method. The inferior turbinate mucosa of five healthy volunteers were selected as control. RESULT: Tenascin were expressed in the mucosa epithelial cells and serous cells from nasal polyps and inferior turbinates of chronic hypertrophic rhinitis; The level of tenascin in the mucosa epithelial cells from nasal polyps were significantly(P < 0.01); The level of tenascin in the serous cells from nasal polyps were significantly higher than that in inferior turbinates of chronic hypertrophic rhinitis(P < 0.01); Tenascin were hardly detected in nasal mucosa from healthy volunteers; The tenascin positivity in glandular cell was significantly higher in nasal polyps than in inferior turbinates of chronic hypertrophic rhinitis (P < 0.05). CONCLUSION: There is close relationship between tenascin and nasal polyps. Tenascin is strongly expressed in nasal polyps and its mucosa, where it could be produced by mucosa epithelial cells and serous cells.

Adolescent↗
PubMed1980

Experimental atrophic rhinitis in gnotobiotic pigs.

Twenty-nine caesarian derived colostrum deprived germfree pigs were reared in isolators in groups of three to four per isolator. At seven days of age each group was inoculated intranasally with one of four strains of Bordetella bronchiseptica (designated B, J, L and 55B), or Pseudomonas aeruginosa or a mucoid strain of Escherichia coli, all previously isolated from nasal mucus of pigs affected with clinical atrophic rhinitis. Another group was inoculated simultaneously with B. bronchiseptica B and Pasteurella multocida. The animals were observed for clinical signs of atrophic rhinitis and monitored bacteriologically at weekly intervals for seven weeks. Then they were bled for serology and killed and their respiratory organs examined for gross and histopathological lesions. All of the pigs inoculated with the Bordetellae had inflammation of the nasal mucosa and developed positive serum antibody titers against all four of the Bordetella strains used in this study. Strain J caused sneezing and turbinate atrophy in three of four pigs. One of the three pigs inoculated with strain L died in ten days from bronchopneumonia and pericarditis and had turbinate atrophy. Strains B and B55 caused no turbinate atrophy, but two out of three pigs inoculated with both B. bronchiseptica B and P. multocida had turbinate atrophy. No nasal lesions were observed in the pigs inoculated with E. coli or P. aeruginosa or in the noninoculated germfree controls. The results indicate a variation in the ability of different strains of B. bronchiseptica to cause turbinate atrophy in pigs and demonstrate that nasal infections by these organisms stimulate serum antibody response. Presence of P. multocida appears to increase the severity of the lesions. As the E. coli and Pseudomonas failed to produce atrophic rhinitis, they are probably of no significance as primary etiological agents in the atrophic rhinitis syndrome in swine.

Animals↗
PubMed1985

The role of turbinectomy in rhinoplasty.

Turbinectomy, in cases of inferior or middle turbinate hypertrophy, is one of the solutions for nasal breathing difficulties. For many decades, this procedure was controversial owing to the severe complications believed to occur after such an operation. Its performance was held to be within the responsibility of otolaryngologists. However, eventually most of these complications were found to be nonexistent, and the performance of turbinectomy became a simple surgical procedure. The turbinate hypertrophy, which often exists on the contralateral side of the deviated septum, blocks the correct reposition of the septum with the consequent nasal bone, and thus prevents the plastic surgeon from achieving a straight nose. Therefore, proper handling of both septal deviation and turbinate hypertrophy is an important aid for the plastic surgeon. This article is dealing with the various aspects of turbinate hypertrophy and its surgical handling.

Humans↗
PubMed1984

The pathogenesis of atrophic rhinitis in pigs induced by toxigenic Pasteurella multocida.

The pathogenesis of atrophic rhinitis was studied in an experiment in which piglets were infected with a toxigenic type D Pasteurella multocida strain in the right half of the nasal cavity. Two days before inoculation the nasal mucosa on the right side had been subjected to mild irritation by intranasal instillation of a weak solution of acetic acid. The untreated (left) half of the nasal cavity served as an intrinsic control. Macroscopically, changes in the turbinates were already appreciable at 3 days p.i., and pronounced turbinate atrophy was noted at 7 days p.i. At 14 days p.i. deviation of the snout and almost complete turbinate atrophy was observed. The turbinates in the untreated half of the nasal cavity developed normally. Histologically, the changes were initially characterized by bone resorption mediated by an increased number of osteoclasts. Later osteoclasts were sparse, and there was an apparent disruption of osteoid synthesis. Ultrastructurally, the osteoblasts showed nuclear indentations and dilatation of the endoplasmic reticulum. Since no inflammatory reaction was observed, the hypothesis is advanced that atrophic rhinitis in pigs is caused by a P. multocida-produced factor which will stimulate bone resorption and suppress osteoid synthesis.

Animals↗
PubMed1998

Acoustic rhinometric evaluation of nasal cavity and nasopharynx after adenoidectomy and tonsillectomy.

The occurrence of upper airway obstruction is frequently seen in patients with adenotonsillar hypertrophy. These patients usually also show hypertrophied inferior turbinates even without any other nasal or sinus disease. However, it is not known what the effect of adenoidectomy and tonsillectomy is on these hypertrophic turbinates. To determine the effect of these procedures on the nasal and nasopharyngeal geometry, we performed acoustic rhinometry previous to and 2 weeks following adenoidectomy and tonsillectomy, before and after spraying a decongestant in 31 children (19 males, 12 females; mean age, 8.03 years). After the adenoidectomy and tonsillectomy, there were increases in the cross-sectional area at the anterior end of the inferior turbinate (0.53+/-0.03 cm2 preoperatively, 0.65+/-0.21 cm2 postoperatively; P=0.01), the nasal volume (7.13+/-1.78 cm3 preoperatively, 9.38+/-1.65 cm3 postoperatively; P < 0.01), the cross-sectional area at the adenoid (0.80+/-0.53 cm2 preoperatively, 1.83+/-0.81 cm2 postoperatively; P < 0.01) before decongestion. However, 10 min after decongestion there was only a significant increase of the cross-sectional area at the adenoid (1.08+/-0.12 cm2 preoperatively, 1.80+/-0.20 cm2 postoperatively; P=0.01). We conclude that adenoidectomy and tonsillectomy reverse the congestion of the inferior turbinate which is observed in children with adenotonsillar hypertrophy and that acoustic rhinometry can be used to evaluate the effect of adenoidectomy and tonsillectomy on the nose and nasopharynx.

Acoustics↗
PubMed1996

Morphogenesis of the lateral nasal wall from 6 to 36 weeks.

This research describes the development of the lateral nasal wall, the description of which will allow a better comprehension of its anatomic complexity. One hundred embryos and fetuses from the sixth to thirty-sixth weeks of morphologic age were studied. The seventh week shows the first buds of the three turbinates. At the ninth week the precartilaginous nucleus of the inferior turbinate is observed. Likewise, at the tenth week the uncinate process appears, and the invagination of the epithelium begins the formation of the infundibulum and the maxillar sinus. At the fourteenth week the cartilaginous nasal capsule is present. The epithelium is invaginated, starting the formation of the ethmoid cells. During the seventeenth week of development the invagination of the mucus has invaded the maxillar bone, which constitutes the maxillar sinus. At the thirty-sixth week the lateral nasal wall is well developed. In 23 fetuses the supreme turbinate (fourth) was found. Although the length of the lower three turbinates increased progressively and proportionally in intrauterine life without differences between the sexes, the fourth remains invariably at an average length of 5 mm from the fourteenth to the thirty-sixth and was present in 65% of male fetuses.

Cartilage↗
PubMed2001

Methyl methacrylate toxicity in rat nasal epithelium: investigation of the time course of lesion development and recovery from short term vapour inhalation.

An investigation of the time course of development and recovery of the nasal lesion induced in rats by inhalation of methyl methacrylate (MMA) was conducted. Groups of 45 female F344 rats (five animals per time point) were exposed whole body for 6 hours per day to 0 (control), 110 or 400 ppm MMA for 1, 2, 5, 10 or 28 consecutive days. Additional animals were retained for a period of 4, 13, 24 or 36 weeks following exposure to assess reversibility of any nasal tissue effects. After inhalation of MMA there was damage to the olfactory epithelium at 110 and 400 ppm. This was apparent following the first day of exposure, but recovery/regeneration was evident during the subsequent days of the exposure phase of the study. The most severely affected section of the nasal passages was that which included the ethmoturbinates. Focal adhesions between the septum and turbinates and between the turbinates themselves were seen in some animals exposed to 400 ppm MMA at time points after 5 days of exposure. There were no lesions in the squamous, transitional or respiratory epithelia and none in control rats. Lesions that developed in rats exposed to 110 ppm MMA subsequently repaired during the exposure period. At 400 ppm, the majority of the olfactory epithelium had returned to normal within 13 weeks of the end of the exposure phase, but minimal respiratory metaplasia remained evident and there were some focal adhesions between the septum and turbinates and between the turbinates themselves.

Administration, Inhalation↗
PubMed1982

Characteristics and origin of the human olfactory organ.

The structure of human ethmoid bone may be characterized not only by the labyrinthine complexity, but also by asymmetry, numerous variations and deformity. Another important specificity is the co-existence of evoluted and nonevoluted structures. These characteristics are probably the result of encephalization and insufficient adaptation due to rapid evolution since man descended to the ground from his arborial life. Kyphosis of the cranial base, displacement of the lamina lateralis anterosuperiorly and rotating of both orbits antero-medialy, restricted the space where the numerous ethmotubinates were to grow. In quadrupeds and in lower primates, the lamina lateralis serves as the site of attachment for turbinates, exists in the antero-inferior part of the nasal cavity forming a medial wall of the sinus maxillaris. However, in human and in higher class primates also this lamina enters the orbit as the lamina orbitalis or lamina papyracea participating in the medial wall of the orbita. The lamina cribrosa, the other site of attachment of turbinates, displaces to antero-superior upon the nasal cavity. Thus, the course of the basal lamellae of turbinates are forced to bend from an antero-superior to a postero-inferior direction. Then, in human, who have more turbinates (Denker u. Kahler, 1925; Miller, 1964; Negus, 1958) than simiae (Ehara, 1974; Ishii, 1955), numerous basal lamellae with scrolls, compress each other with overlapping, fusion, displacement or deformities. With further compression by a deviated septum and the space-filling effect in its concave side, the ethmoid becomes increasingly complex. The complexity of the human ethmoid bone warrants further anthropological and biostatical study with regard to the pneumatisation theory.

Animals↗
PubMed1990

Inferior turbinectomy: comparison of four techniques.

As yet, there is not totally satisfactory means for treating hypertrophied turbinates and the proper management of turbinate dysfunction remains in question. In the present series, four of the widely practiced surgical procedures for the reduction of the size of the inferior turbinates were evaluated and compared. In all cases turbinectomy was performed as an isolated procedure. Eighty patients with chronic non-allergic rhinitis and hypertrophied inferior turbinates were selected, randomly divided into four groups, and followed up post-operatively for one year. Study of the results indicated that the beneficial effect of the operation is mainly mechanical by reduction of the resistance to nasal airflow. The post-operative improvement in smell acuity correlated positively with the increased patency of the nasal airway. None of the procedures had a deleterious effect on olfactory acuity. In contrast, the operation failed to enhance the mucociliary clearance rate or significantly decrease nasal drainage. Partial inferior turbinectomy and laser turbinectomy improved nasal breathing in 77 per cent of patients, and enhanced olfactory acuity in 78 per cent of patients who had pre-operative hyposmia. The results of turbinoplasty and cryoturbinectomy were less favourable. The surgical technique, advantages, and drawbacks of each of these procedures are discussed.

Adult↗
PubMed2003

Modulation of T-cell functions by laser surgery in patients with allergic rhinitis.

OBJECTIVE: Potassium-titanyl-phosphate (KTP) laser turbinectomy is an established treatment for hypertrophied inferior turbinates that do not respond to other medical treatments. KTP laser surgery is usually performed with the aim of reducing the size of hypertrophied inferior turbinates. We hypothesized that laser vaporation may also inhibit the allergic reaction in the nasal mucosa of inferior turbinates. MATERIAL AND METHODS: We examined the effect of KTP laser therapy on T-cell responses using peripheral blood mononuclear cells (PBMCs). RESULTS: Levels of T-cell proliferation after stimulation with Staphylococcus enterotoxin B (SEB) were higher in post- than pre-surgery patients. Levels of interferon-gamma and IL-2 produced by PBMCs after stimulation with SEB appeared to be higher in post- than pre-surgery patients. Serum levels of house dust-specific IgE were lower in post- than pre-surgery patients. These results indicate that KTP laser therapy modulates T-cell responses and probably tilts the Th1/Th2 balance towards the Th1-dominant state. CONCLUSION: KTP laser surgery eases or cures allergic rhinitis not only by reducing the volume of the inferior turbinates but also by modulating T-cell functions.

Adolescent↗
PubMed2006

Expression of acidic fibroblast growth factor and basic fibroblast growth factor in nasal polyps.

CONCLUSION: Up-regulated expression of acidic fibroblast growth factor (aFGF) and basic fibroblast growth factor (bFGF) in nasal polyps may be related to epithelial proliferation and neoangiogenesis associated with nasal polyp growth. BACKGROUND AND OBJECTIVES: aFGF and bFGF are polypeptides that effect mitogenesis, neoangiogenesis and tissue repair. The purpose of this study was to investigate the expression of aFGF and bFGF at both the mRNA and protein levels in nasal polyps. MATERIALS AND METHODS: Tissue samples of nasal polyp and inferior turbinate mucosae were obtained. Reverse transcriptase (RT)-PCR, in situ hybridization, and Western blotting for aFGF and bFGF were performed in nasal polyp and nasal inferior turbinate. RESULTS: RT-PCR showed 50% aFGF and 29% bFGF expression positivity in 14 nasal polyps; however, 13 turbinates revealed no PCR products. aFGF and bFGF expression was localized to some inflammatory cells of nasal polyps by in situ hybridization. Western blotting identified aFGF and bFGF molecular masses of 18 kDa and 24 kDa, respectively, in nasal polyps, and these levels were higher than those observed in nasal turbinates. aFGF and bFGF proteins were also localized in some inflammatory cells of nasal polyps by immunostaining.

Base Sequence↗
PubMed1999

Topical budesonide treatment reduces endothelial expression of intercellular adhesion molecules (vascular cell adhesion molecule-1 and P-selectin) and eosinophil infiltration in nasal polyps.

Infiltration of eosinophil granulocytes and endothelial expression of vascular cell adhesion molecule-1 (VCAM-1) and P-selectin was investigated in biopsies of polyps and inferior turbinates from 16 patients with nasal polyps, by the use of immunohistochemical staining and stereological quantification before, during and after topical treatment with budesonide (Rhinocort Turbuhaler). Before glucocorticoid treatment a higher density of eosinophil profiles (p < 0.005), making up a larger proportion of the total cellular infiltrate (p < 0.0005), was found in the polyps compared with the inferior turbinates. Endothelial VCAM-1 expression was higher in polyps than in inferior turbinates (p < 0.005), in contrast with the expression of P-selectin, which was more frequently expressed in the inferior turbinates (p < 0.05). Topical glucocorticoid treatment reduced the density of eosinophil profiles (p < 0.05) and the endothelial expression of VCAM-1 (p < 0.007) and P-selectin (p < 0.02) in polyps. Eosinophil counts and VCAM-1 expression returned to pre-treatment levels 8 weeks after discontinuation of budesonide treatment. The observed reduction in endothelial expression of cellular adhesion molecules may interfere with cellular recruitment in nasal polyps and thus contribute to the known anti-inflammatory effect of glucocorticoid in nasal polyposis.

Administration, Topical↗
PubMed1991

Effects of acute exposure to formaldehyde on surface morphology of nasal epithelia in rats.

This study investigated the distribution of epithelial cells over the turbinates in the rat nasal cavity and their injury following exposure to formaldehyde. Rats were exposed to either purified air or 10 ppm formaldehyde for a period of 4 h. The noses removed from these rats were decalcified, sectioned midsagittally along the septum to expose the internal turbinates, and processed for examination by scanning electron microscopy. The distribution of the various cell types present was documented in the control rats. Observations obtained from the formaldehyde-exposed rats were compared to those in rats exposed to purified air. Changes were seen in the various regions of the turbinates in the form of ciliary destruction and cell separation (especially in the naso- and moxilloturbinates), cellular swelling (throughout the turbinates), mucus release by the goblet cells (in the nasoturbinate), and in some cases pores on the cell surface or between adjacent cells (evident in the middle meatus). The data from this study indicate that the degree of deleterious effects of formaldehyde on the nasal epithelia of rats is dependent upon cell type and location. Histological studies supported the scanning electron microscopic observations by demonstrating increased goblet cell volume, cell sloughing, and damaged cilia.

Administration, Inhalation↗
PubMed1999

Transforming growth factor-alpha and rhinitis.

OBJECTIVES: Transforming growth factor-alpha (TGF-alpha) has been implicated in diverse physiologic and pathophysiologic functions including immunological, inflammatory, and neoplastic processes. TGF-alpha has been localized in the hyperproliferative, inflammatory environment of chronic otitis media, cholesteatoma, and asthmatic airways. TGF-beta1, which must be present with TGF-alpha to transform fibroblasts, has been found in rhinitic mucosa and in asthma in prior studies. The authors sought to identify whether TGF-alpha also played a role in the inflammatory cascade and fibrosis of rhinitis. STUDY DESIGN: A nonrandomized, prospective study was carried out in which samples of inferior turbinate and nasal polyps from rhinitic and nonrhinitic patients were subjected to immunohistochemistry and Western blotting to determine the presence of TGF-alpha. METHODS: Twenty-seven subjects undergoing surgery for rhinitis, obstructive sleep apnea, nasal fracture, and rhinoplasty were recruited for this study, the latter three groups acting as controls. Immunohistochemical and Western blotting techniques were employed to identify the presence of TGF-alpha in inferior-turbinate and nasal-polyp samples of rhinitic subjects. RESULTS: Immunohistochemistry demonstrated the selective staining of TGF-alpha in the basement membrane and extracellular matrix, including lymphatic, vascular, and glandular structures, in most turbinate samples and the absence of staining in corresponding controls. Further, TGF-alpha was isolated to a discrete 30-kD band in both inferior turbinate and polyp tissues by Western blotting without staining in the corresponding controls. CONCLUSIONS: These results suggest that TGF-alpha may play a role in the inflammatory derangement of rhinitis.

Adolescent↗
PubMed2000

Wedge turbinectomy: a new combined photocoagulative Nd:YAG laser technique.

OBJECTIVES: To demonstrate that Nd:YAG laser photocoagulation using a combination of interstitial and contact approaches in the surgical treatment of inferior turbinate hypertrophy yields improved results in terms of postoperative nasal patency, complications, and relapse. STUDY DESIGN: A group of 121 patients with symptoms of nasal obstruction due to hypertrophied inferior turbinates were treated between January 1994 and December 1997 at the Otolaryngology-Head and Neck Surgery Unit of the Main Military Hospital of Rome using the wedge turbinectomy, a new endonasal laser technique. METHODS: This is a combined photocoagulative procedure performed under local anesthesia. In the first surgical step we perform interstitial photocoagulation using Nd:YAG laser and in the second step we use a contact approach, making two strips of photocoagulated mucosa running side by side from the tail to the head of turbinate. RESULTS: At 1-year follow-up, the complication rate in all our patients treated with this laser technique was very low and we achieved a steady improvement in nasal patency in 104 patients (85.9%). The relapse rate was approximately 14%, but we observed that 65% of the patients who experienced long-term failure were affected by allergic rhinitis. CONCLUSIONS: An accurate preoperative evaluation of the cause of the turbinate hypertrophy is fundamental to achieving better results after laser turbinectomy and reducing the risk of relapse.

Adult↗
PubMed2006

Comparative study on the long-term effectiveness between coblation- and microdebrider-assisted partial turbinoplasty.

OBJECTIVES: Various surgical methods have been tried to relieve the symptoms of nasal obstruction in patients with inferior turbinate hypertrophy. Recently, coblation that uses the radiofrequency and microdebrider is being increasingly used in turbinate surgery. The aim of this study was to compare the long-term postoperative outcome between the coblation- and microdebrider-assisted partial turbinoplasty. METHODS: We selected 60 patients for this prospective study who had nasal obstruction and hypertrophied turbinate mucosa that was refractory to medical treatment. Thirty patients were treated with coblation (group 1) and 30 patients were treated with microdebrider (group 2). Postoperative changes in degree of nasal obstruction were evaluated prospectively at 3, 6, and 12 months after the procedure. A cross-sectional area of second notch and volume of nasal cavity were compared at 12 months after operation. Operation time, duration of crust formation, postnasal drip, and postoperative bleeding were also compared. RESULTS: Nasal obstruction was improved significantly in both groups at 3, 6, and 12 months after the procedure. However, when compared between two groups, symptom improvement was statistically significant in group 2 at 12 months after surgery. Acoustic rhinometry performed at 12 months demonstrated a significant increase of cross-sectional area of second notch and volume of nasal cavity in group 2 in comparison with group 1. There were no significant differences in degree of postnasal drip, operation time, or duration of crust formation between the two groups. CONCLUSION: This study suggests that microdebrider-assisted partial turbinoplasty is more effective and satisfactory in long-term relief of nasal obstruction and reduction in mucosal volume of anterior head of inferior turbinate.

Adolescent↗
PubMed1979

The infant rat as a model for assessment of the attenuation of human influenza viruses.

The intranasal infection of infant rats with Haemophilus influenzae type b can be considerably enhanced by prior infection of the rats with influenza virus. When influenza virus A/England/939/69 was used to infect the animals a minimum of 10(4-0) EID50 was required to enhance H. influenzae infection; infection with 4 x 10(6) H. influenzae bacteria was needed to reveal this enhancement and infant rats two days old at the time of virus inoculation had to be used. By this method, nine strains of influenza virus were assessed for their ability to enhance H. influenzae infection, and the results were compared with their known virulence for man. The results showed a close correlation in this respect for all of the viruses, except strain A/PR/8/34. The replication of these viruses in infant-rat turbinates and lungs was also studied; virus concentrations in turbinate tissues 48 h after infection showed a close correlation with virulence for man. Thus, three influenza virus strains known to be virulent for man reached concentrations in infant-rat turbinates ranging from 10(4-8) to 10(5-7) EBID50/0-05 ml at 48 h; the concentrations of six viruses known to be attenuated or non-infectious for man grew less well in infant rat turbinates, and reached concentrations at 48 h of 10(1-0) to 10(3-5) EBID50/0-05 ml. The results are discussed in relation to the use of the infant-rat model for assessment of the attenuation of candidate live influenza virus vaccine strains.

Animal Population Groups↗
PubMed1993

Laser treatment of rhinitis--1 year follow-up.

Laser cautery of the inferior turbinates for the treatment of rhinitis has been shown to be as effective as sub-mucosal diathermy in the short-term and to produce less morbidity. However, the long-term effects are unknown. A cohort of patients who were treated by either of these methods were reviewed 1 year after treatment. Subjective and objective measurements of airway obstruction were performed using a linear analogue scale and a nasal peak inspiratory flowmeter. The results obtained were compared with those recorded pre-operatively, 3 days post-operatively and 6 days post-operatively. In contrast to the results of sub-mucous diathermy of the inferior turbinates for the treatment of rhinitis, the reduction in subjective nasal airway obstruction obtained by laser cautery to the inferior turbinates is maintained 1 year after surgery. Neither method of turbinate reduction was associated with a sustained objective improvement in nasal airway patency as measured by peak nasal inspiratory flow rate determinations.

Adolescent↗