Sinonasal effects of external dacryocystorhinostomy

Objective External dacryocystorhinostomy is thought to cause mucociliary dysfunction by damaging the mucosa, in turn affecting ciliary activity and mucus quality. This study investigated the effect of external dacryocystorhinostomy on sinonasal function. Methods Patients scheduled for unilateral external dacryocystorhinostomy who underwent endoscopic nasal examination and paranasal sinus computed tomography were included in this study. A saccharine test was performed on the planned surgical side and the mucociliary clearance time was determined. The sinonasal quality of life was measured in all patients, pre-operatively and at six months post-operatively, using the Sino-Nasal Outcome Test-22. The Lund–Kennedy endoscopic score was also determined in all patients, both pre- and post-operatively. Results The study comprised 28 patients (22 females and 6 males). A statistically significant difference was found between the pre- and post-operative saccharine test results (p = 0.006), but not between the pre- and post-operative Sino-Nasal Outcome Test-22 scores (p > 0.05). Conclusion This study is one of only a few to investigate the effect of external dacryocystorhinostomy on sinonasal function. The results showed that external dacryocystorhinostomy impairs mucociliary clearance. The surgical procedure is well tolerated and does not significantly change nasal symptom scores.

The evaluation of nasal mucociliary clearance in patients with Helicobacter pylori infection

ObjectiveThis study aimed to examine nasal mucociliary clearance time in patients with Helicobacter pylori infection.MethodsFifty patients who were newly diagnosed with H pylori infection using gastric biopsy in the gastroenterology out-patient clinic, and 50 age- and gender-matched healthy adults who were admitted to the otorhinolaryngology out-patient clinic, were included in this study. After an otorhinolaryngological examination (anterior rhinoscopy and nasal endoscopic examination), the nasal mucociliary clearance time of each subject was calculated using the saccharine test.ResultsThe mean mucociliary clearance time was 06:29 ± 3:31 minutes (range, 00:55–15:19 minutes) in the control group and 10:12 ± 06:09 minutes (range, 01:28–32:00 minutes) in the study group. Comparisons of the two groups revealed a statistically significant difference (p = 0.002).ConclusionNasal mucociliary clearance time was significantly increased in patients with H pylori infection. The results suggest that H pylori infection may have an unfavourable effect on nasal mucociliary clearance.

Evaluation of the medical and surgical management of chronic rhinosinusitis with polyposis

<p class="abstract"><strong>Background:</strong> Chronic rhinosinusitis (CRS) is a group of disorders characterized by inflammation of the mucosa of the nose and paranasal sinuses of at least 12 consecutive weeks duration. Surgical intervention may be required if severe symptoms of obstruction and infection prove medical treatment to be ineffective. Little is known about the outcomes of patients electing to continue medical management or the comparative effectiveness of continued medical therapy with FESS.</p><p class="abstract"><strong>Methods:</strong> The study was conducted on 126 adult patients in the age group of 18-55 who fulfilled the CRS criteria with nasal polyposis. All patients were medically treated for the CRS, and observed after 3 weeks. In case the treatment was not effective; they were scheduled for FESS intervention and further observed after another 6 weeks. The improvement of the patients was measured by Visual analogue score, nasal endoscopy score and saccharine test. </p><p class="abstract"><strong>Results:</strong> Males between 41-50 were the most common patients with CRS. There was a significant improvement in the VAS score, nasal endoscopy score after 3 weeks of medical treatment. In 88% of patients the saccharine score was normal showing that this was not an effective measure for assessing the improvement.</p><p><strong>Conclusions:</strong> Medical treatment was found to be sufficient to treat most symptoms of CRS with nasal polyposis (grade 1 and 2). Surgery should only be done in refractory cases. Selection of those patients who will benefit from surgery should be based on the patient’s symptoms and not on the examiner’s polyp score. Quality of life is not proportional to polyp size (Upto grade 2).</p>

Atrophic Rhinitis and Its Surgical Management

ABSTRACT Objective Clinical evaluation of atrophic rhinitis and comparative study of its surgical treatments. Materials and methods This study was carried out in the Department of ORL-HNS, MLB Medical College and Hospital, Jhansi and Department of ORL-HNS, SRMS Institute of Medical Sciences, Bareilly, Uttar Pradesh, India from June 2006 to May 2011 including the cases of atrophic rhinitis. A total of 40 patients of atrophic rhinitis were included in this study. Thirty-two patients had modified Young's nostril closure and eight patients had dermofat graft obliteration of nasal cavity. Preoperative and postoperative assessment of nasal mucociliary flow rate were also assessed by saccharine test. Fifteen cases were kept in control group to compare the nasal mucociliary flow rate results. Results The results of both surgical modalities were compared at various intervals for 20 months. Conclusion The patients with history of nasal myiasis and septal perforation do better with partial nostril closure while patients, not having history of maggots and septal perforations, had best results with dermofat graft operation. It was seen that after surgical treatment of atrophic rhinitis, either by nostril closure or dermofat grafting, there was improvement in nasal mucociliary flow or, nearly, all patients were symptomatically improved.

Atrophic Rhinitis and Its Surgical Management

ABSTRACT Objective Clinical evaluation of atrophic rhinitis and comparative study of its surgical treatments. Materials and methods This study was carried out in the Department of ORL-HNS, MLB Medical College and Hospital, Jhansi and Department of ORL-HNS, SRMS Institute of Medical Sciences, Bareilly, Uttar Pradesh, India from June 2006 to May 2011 including the cases of atrophic rhinitis. A total of 40 patients of atrophic rhinitis were included in this study. Thirty-two patients had modified Young's nostril closure and eight patients had dermofat graft obliteration of nasal cavity. Preoperative and postoperative assessment of nasal mucociliary flow rate were also assessed by saccharine test. Fifteen cases were kept in control group to compare the nasal mucociliary flow rate results. Results The results of both surgical modalities were compared at various intervals for 20 months. Conclusion The patients with history of nasal myiasis and septal perforation do better with partial nostril closure while patients, not having history of maggots and septal perforations, had best results with dermofat graft operation. It was seen that after surgical treatment of atrophic rhinitis, either by nostril closure or dermofat grafting, there was improvement in nasal mucociliary flow or, nearly, all patients were symptomatically improved.

Effect of nasolacrimal duct obstruction on nasal mucociliary transport

Background:Most patients with nasolacrimal duct obstruction have dry, crusty nasal mucosa. Mucociliary clearance is modulated by the amount and biochemical composition of nasal mucus. Nasolacrimal duct obstruction disturbs the drainage of tears into the nasal cavity.Objective:We examined the effect of nasolacrimal duct obstruction on the mucociliary transport of nasal mucosa, by comparing saccharine test results for epiphora patients versus healthy volunteers.Study design:Prospective, randomised, clinical trial.Methods:Eight patients with bilateral epiphora and 10 patients with unilateral epiphora were included in the study group. Complete nasolacrimal duct obstruction was demonstrated by studying irrigation of the nasolacrimal system, and by fluorescein dye study. The control group comprised 20 healthy volunteers. Mucociliary transport was assessed by the saccharine test in both the study and control groups. The saccharine transit times of 26 impaired nasal cavities were compared with those of 20 healthy nasal cavities of controls. Also, the saccharine transit times of the healthy nasal cavities of the 10 patients with unilateral epiphora were compared with those of their diseased sides, and also with those of healthy volunteers.Results:The saccharine transit times of the epiphora patients were statistically significantly greater than those of the control group. Also, there was a statistically significant difference in saccharine transit times, comparing the healthy and impaired nasal cavities of patients with unilateral epiphora.Conclusion:Nasolacrimal duct obstruction has a negative effect on nasal mucociliary clearance. This may be related to changes in the amount and biochemical composition of nasal mucus.

Endonasal Sinus Surgery Improves Mucociliary Transport in Severe Chronic Sinusitis

A total of 22 patients with extensive chronic sinusitis were examined before and 7.2 ± 1.1 months after microscopic endonasal sinus surgery. Pre- and postoperative nasal mucociliary transport was measured using a modified saccharine test and ciliary beat frequency of nasal respiratory cells using video interference contrast microscopy. In patients suffering from chronic sinusitis, nasal ciliary beat frequency was significantly lower (8.0 ± 1.8 Hz) than in normals (9.5 ± 1.7 Hz, p < 0.02). Following endonasal sinus surgery, ciliary beat frequency in patients with chronic sinusitis remained reduced (8.3 ± 1.2 Hz). Nasal mucociliary transport time was significantly (p < 0.05) longer (20.9 ± 9.4 minutes) in patients with chronic sinusitis than in normals (14.9 ± 8.4 minutes). Nasal mucociliary transport improved significantly (p < 0.05) to 13.8 ± 8.4 minutes in 17 of 22 patients without recurrent sinusitis and remained prolonged (20.6 ± 7.7 minutes) in 5 of 22 patients with recurrent disease. These data suggest that ciliary beat frequency of nasal respiratory cells and nasal mucus transport are impaired in patients suffering from chronic sinusitis. After microscopic endonasal sinus surgery, impaired mucociliary transport is improved, and ciliary beat frequency remains lower than in normals.