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European Archives of... Dec 2016The auditory tube plays a fundamental role in regulating middle ear pressure. A "system" sensitive to a pressure gradient between the middle ear and the ambient...
The auditory tube plays a fundamental role in regulating middle ear pressure. A "system" sensitive to a pressure gradient between the middle ear and the ambient environment is necessary. The presence of mechanoreceptors in the middle ear and the tympanic membrane has been studied, but the presence of these receptors in the nasopharyngeal region remains unclear. The aim of this study is to confirm the presence of pressure sensitive corpuscles in the nasopharynx. An experimental study was conducted on five fresh and unembalded human cadavers. The pharyngeal ostium of the auditory tube and its periphery was removed in one piece by video-assisted endonasal endoscopy. Samples were fixed in formaldehyde solution, embedded in paraffin, and cut. Slides were analyzed by HES (Hematoxyline Eosine Safran) coloration, by S100 protein and neurofilament protein immunostaining. Encapsulated nerve endings were researched and identified by slides analysis. Eight samples were included in our study. On seven samples, Ruffini corpuscles were identified in the mucosa of the posterior area of the pharyngeal ostium, with a higher concentration in the pharyngeal recess and in the posterior nasopharyngeal wall. Our study identified nasopharyngeal mechanoreceptors that could detect the nasopharyngeal pressure and, by extension, the atmospheric pressure. These findings support the theory of the neuronal reflex arc of isobaric system of the middle ear, based on the existence of a "system" sensitive to a pressure gradient between the middle ear and the ambient environment. Understanding of this system has been helpful in the diagnosis and management of middle ear diseases.
Topics: Aged, 80 and over; Cadaver; Eustachian Tube; Female; Humans; Male; Mechanoreceptors; Microscopy; Mucous Membrane; Nasopharynx
PubMed: 27164946
DOI: 10.1007/s00405-016-4069-3 -
Vestnik Otorinolaringologii 2024Children's and adults' rhinosinusitis are two diseases that have both similarities and differences in anatomy, epidemiology, causes, pathogenesis, diagnosis and...
Children's and adults' rhinosinusitis are two diseases that have both similarities and differences in anatomy, epidemiology, causes, pathogenesis, diagnosis and treatment. At the same rhinosinusitis is one of the most common in otorhinolaryngology's practice, both in children and adults. The of adults paranasal sinuses (PNS) anatomy differs from children's PNS anatomy. Although ostiomeatal complex occlusion is recognized as a major cause of poor ventilation and drainage of the adult paranasal sinuses, it does not have a strong effect on pediatric rhinosinusitis, but adenoids play a key role. Adenoids are bacteria and biofilms reservoirs that cause chronic refractory rhinosinusitis regardless of pharyngeal tonsil size. The prevalence of chronic rhinosinusitis (CRS) is lower in children than in adults. Diagnosis of children's rhinosinusitis is more difficult because nasal cavity endoscopic examination is performed rarely due to the occasional need of general anesthesia during the procedure. Moreover, it's necessary to take into account prevailing etiological role of viruses in ARS at children's age and chronic adenoiditis often accompanies pediatric CRS, which requires attention prescribing medical therapy as the basis of rhinosinusitis treatment. The DysheLORz based on roots is highly effective and safe for children's and adults ARS and CRS treatment, both as monotherapy and in combination with topical steroids and antibiotics. This herbal medicine immunomodulatory effect is mediated mainly by stimulating the production of TNF-α, IL-1, IL-12 and IFN-γ. It activates macrophages and improves their phagocytic activity. IL-12, together with TNF-α, enhances NK and cytotoxic CD8 lymphocytes' activity against infected cells. IL-12 effect on Th1 lymphocytes maturation provides a link between innate and adaptive immunity. This is also increasing MCP-1, IP-10 and MIP-1β chemokines synthesis and decreasing MIP-1α, ENA-78, GROα and IL-8 production in PNS and nasal mucosa. This leads to decrease of neutrophils chemotaxis to the inflammation site, and decline of serine proteases concentration (neutrophils main enzymes), that increases mucous membrane epithelial barrier permeability, reducing bacterial infections risk. Additionally, increases epithelial cells beating cilia frequency and inhibits hemagglutinin and neuraminidase present on influenza virus surface. The drug increases antimicrobial peptides production as defensins, human neutrophil peptides (HNP) and bactericidal permeability-increasing protein (BPI), which is also important for rapid inflammation regression in rhinosinusitis. It causes bacterial adhesion to epithelial cells inhibition, phagocytosis stimulation, nitric oxide (NO) release and oxidative burst. The medicine had a direct effect on and . Based on these data, it is possible to explain the high effectiveness and safety of the drugs based on in ENT organs inflammation treatment, for both adults and children over 1 year old.
Topics: Adult; Humans; Child; Infant; Rhinitis; Rhinosinusitis; Tumor Necrosis Factor-alpha; Sinusitis; Nasal Mucosa; Inflammation; Interleukin-12; Chronic Disease
PubMed: 38506028
DOI: 10.17116/otorino20248901164 -
Nature Immunology Jan 2022Systemic immune cell dynamics during coronavirus disease 2019 (COVID-19) are extensively documented, but these are less well studied in the (upper) respiratory tract,... (Observational Study)
Observational Study
Systemic immune cell dynamics during coronavirus disease 2019 (COVID-19) are extensively documented, but these are less well studied in the (upper) respiratory tract, where severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replicates. Here, we characterized nasal and systemic immune cells in individuals with COVID-19 who were hospitalized or convalescent and compared the immune cells to those seen in healthy donors. We observed increased nasal granulocytes, monocytes, CD11c natural killer (NK) cells and CD4 T effector cells during acute COVID-19. The mucosal proinflammatory populations positively associated with peripheral blood human leukocyte antigen (HLA)-DR monocytes, CD38PD1CD4 T effector (T) cells and plasmablasts. However, there was no general lymphopenia in nasal mucosa, unlike in peripheral blood. Moreover, nasal neutrophils negatively associated with oxygen saturation levels in blood. Following convalescence, nasal immune cells mostly normalized, except for CD127 granulocytes and CD38CD8 tissue-resident memory T cells (T). SARS-CoV-2-specific CD8 T cells persisted at least 2 months after viral clearance in the nasal mucosa, indicating that COVID-19 has both transient and long-term effects on upper respiratory tract immune responses.
Topics: Antibodies, Viral; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; COVID-19; Granulocytes; HLA-DR Antigens; Humans; Killer Cells, Natural; Memory T Cells; Monocytes; Nasopharynx; Neutrophils; Nose; Prospective Studies; Respiratory Mucosa; SARS-CoV-2
PubMed: 34937933
DOI: 10.1038/s41590-021-01095-w -
Advances in Oto-rhino-laryngology 2016The tonsils are located at the entrance of the pharynx as a cardinal constituent of Waldeyer's ring, taking part not only in local immune responses, but also in systemic... (Review)
Review
The tonsils are located at the entrance of the pharynx as a cardinal constituent of Waldeyer's ring, taking part not only in local immune responses, but also in systemic immunity. Functional deficits of tonsils primarily underlie the pathogenesis of various characteristic disorders, including tonsillar focal infections such as palmoplantar pustulosis and IgA nephropathy, in addition to the highly prevalent sleep disorder called obstructive sleep apnea syndrome. Although the mechanisms underlying these disorders remain unknown, the tonsils have long been postulated as a unique and enigmatic immune organ. Lymphoid cells and tissues from surgically resected tonsils are often employed to analyze the human immune response from a retrospective view. This approach has provided much new fundamental evidence for understanding innate and acquired immune responses, thereby facilitating further studies in the fields of mucosal immunity and specific humoral immunity originating in the germinal center. Future studies of the tonsils in basic and clinical research are expected to reveal the mechanisms of tonsil-related disorders as well as the nature of human immunity. In this review, which is primarily based on our original research over the past 3 decades, we summarize our findings and discuss the future prospects of studies focusing on the tonsils.
Topics: Humans; Immunity, Mucosal; Palatine Tonsil; Respiratory Mucosa
PubMed: 27116026
DOI: 10.1159/000441902 -
Microbial Pathogenesis Feb 2020Studies on understanding the human microbiome continue to grow rapidly; nonetheless, reports on alterations in the microbiome post HIV infection are limited. Human...
Studies on understanding the human microbiome continue to grow rapidly; nonetheless, reports on alterations in the microbiome post HIV infection are limited. Human microbiome is an aggregate of bacteria, fungi, viruses and archaea that have co-evolved with humans. These microbes have important roles in immune modulation, vitamin synthesis, metabolism etc. The human pharyngeal microbiome, which resides in the junction between digestive and respiratory tracts, might have a key role in the prevention of respiratory tract infections, akin to the actions of the intestinal microbiome against enteric infections. The respiratory tract is constantly exposed to various environmental and endogenous microbes; however, unlike other similar mucosal surfaces, there has been limited investigation of the microbiome of the respiratory tract. HIV infection is associated with alterations in the respiratory microbiome. The aim of this study was to use next-generation sequencing to determine the composition of the oropharyngeal microbiome in a HIV-positive individual. The bacterial composition was determined by illumina sequencing using MiSeq of partial 16S rRNA genes (V3-V4). A total of 3, 57,926 reads were analyzed. Overall, the genera Proteus, Enterococcus, Bacteroides, Prevotella and Clostridium were most prevalent bacterial populations in the oropharynx of an HIV positive patient.
Topics: Bacteroides; Clostridium; DNA, Bacterial; Enterococcus; Gastrointestinal Microbiome; HIV Infections; High-Throughput Nucleotide Sequencing; Humans; Microbiota; Micrococcus; Oropharynx; Pharynx; Phylogeny; Prevotella; Proteus; RNA, Ribosomal, 16S; Respiratory System; Respiratory Tract Infections; Sequence Analysis, DNA
PubMed: 31790791
DOI: 10.1016/j.micpath.2019.103805 -
Frontiers in Immunology 2023HIV-infected patients are at higher risk of developing oral mucosal infection and Epstein-Barr virus (EBV)-associated B cell malignancies. However, the potential role of...
HIV-infected patients are at higher risk of developing oral mucosal infection and Epstein-Barr virus (EBV)-associated B cell malignancies. However, the potential role of oral immunity in the pathogenesis of oral lesions is unknown. Tonsils are oral-pharyngeal mucosal-associated lymphoid tissues that play an important role in oral mucosal immunity. In this study, we investigated the changes of innate and adaptive immune cells in macaque tonsils during chronic SIV infection. We found significantly higher frequencies of classical monocytes, CD3+CD56+ (NKT-like) cells, CD3CD4CD8 (DP), and CD161 CD4 T cells in tonsils from chronic infected compared to naïve animals. On the contrary, intermediate monocytes and CD3CD4CD8 (DN) cells were lower in chronic SIV-infected macaques. We further confirmed a recently described small B-cell subset, NKB cells, were higher during chronic infection. Furthermore, both adaptive and innate cells showed significantly higher TNF-α and cytotoxic marker CD107a, while IL-22 production was significantly reduced in innate and adaptive immune cells in chronic SIV-infected animals. A dramatic reduction of IFN-γ production by innate immune cells might indicate enhanced susceptibility to EBV infection and potential transformation of B cells in the tonsils. In summary, our observation shows that the SIV-associated immune responses are distinct in the tonsils compared to other mucosal tissues. Our data extends our understanding of the oral innate immune system during SIV infection and could aid future studies in evaluating the role of tonsillar immune cells during HIV-associated oral mucosal infections.
Topics: Animals; Persistent Infection; Epstein-Barr Virus Infections; Herpesvirus 4, Human; Mouth Mucosa; Palatine Tonsil
PubMed: 37671159
DOI: 10.3389/fimmu.2023.1201677 -
BMJ Supportive & Palliative Care Mar 2017To develop an evidence-based clinical practice guideline for the prevention of oral mucositis in children (0-18 years) receiving treatment for cancer or undergoing... (Review)
Review
PURPOSE
To develop an evidence-based clinical practice guideline for the prevention of oral mucositis in children (0-18 years) receiving treatment for cancer or undergoing haematopoietic stem cell transplantation (HSCT).
METHODS
The Mucositis Prevention Guideline Development Group was interdisciplinary and included internationally recognised experts in paediatric mucositis. For the evidence review, we included randomised controlled trials (RCTs) conducted in either children or adults evaluating the following interventions selected according to prespecified criteria: cryotherapy, low level light therapy (LLLT) and keratinocyte growth factor (KGF). We also examined RCTs of any intervention conducted in children. For all systematic reviews, we synthesised the occurrence of severe oral mucositis. The Grades of Recommendation, Assessment, Development and Evaluation approach was used to describe quality of evidence and strength of recommendations.
RESULTS
We suggest cryotherapy or LLLT may be offered to cooperative children receiving chemotherapy or HSCT conditioning with regimens associated with a high rate of mucositis. We also suggest KGF may be offered to children receiving HSCT conditioning with regimens associated with a high rate of severe mucositis. However, KGF use merits caution as there is a lack of efficacy and toxicity data in children, and a lack of long-term follow-up data in paediatric cancers. No other interventions were recommended for oral mucositis prevention in children.
CONCLUSIONS
All three specific interventions evaluated in this clinical practice guideline were associated with a weak recommendation for use. There may be important organisational and cost barriers to the adoption of LLLT and KGF. Considerations for implementation and key research gaps are highlighted.
Topics: Adolescent; Child; Child, Preschool; Cryotherapy; Fibroblast Growth Factor 7; Hematopoietic Stem Cell Transplantation; Humans; Infant; Mucositis; Neoplasms; Pharyngeal Diseases; Phototherapy; Practice Guidelines as Topic; Stomatitis
PubMed: 25818385
DOI: 10.1136/bmjspcare-2014-000804 -
Sleep & Breathing = Schlaf & Atmung Mar 2023Recently, the use of barbed pharyngoplasty (BP) has become widespread in snoring and obstructive sleep apnoea (OSA) palatal surgery, but there are no studies regarding... (Review)
Review
BACKGROUND
Recently, the use of barbed pharyngoplasty (BP) has become widespread in snoring and obstructive sleep apnoea (OSA) palatal surgery, but there are no studies regarding the short- and long-term complications resulting from these different techniques. This systematic review aimed to report the complications and side effects of different BP techniques.
METHODS
An electronic search was performed on PubMed/MEDLINE, Google Scholar, and Ovid databases. The PRISMA statement was followed. Databases were searched from inception through September 2, 2021.
RESULTS
We included 14 prospective clinical studies consisting of 769 patients aged 23 to 81 years. The associated intra-operative complications of BP were as follows: partial thread extrusion (2.9%), self-limited bleeding (2.9%), broken needle (1.0%), and suture rupture (1.0%). Short-term complications were as follows: thread/knot extrusion (12.4%), dysphagia (5.6%), bleeding (1.5%), velopharyngeal insufficiency (1.5%), anterior pharyngoplasty dehiscence (1.2%), tonsillar haemorrhage (1.0%), excessive postnasal discharge (1.0%), barbed suture failure (0.5%), acute infection (0.2%), mucosal granulomas (0.2%), chipped tooth caused by mouth gag displacement (0.2%), and fibrous scar (0.2%). Long-term complications were as follows: foreign body sensation (7.8%), sticky mucus in throat (5.9%), dysphagia (3.6%), rhinolalia (3.1%), throat phlegm (1.1%), nose regurgitation (0.8%), dry throat (0.6%), and throat lump (0.3%).
CONCLUSION
BP is a safe technique free of significant side effects and major complications. However, in this review, patients undergoing BP were very heterogeneous in terms of characteristics of patients chosen and severity of diseases, surgical technique used (myoresective vs non-myoresective), time of follow-up, and mono level vs multilevel surgery. More studies on a larger scale with long-term follow-up are needed to confirm these promising results.
Topics: Humans; Pharynx; Deglutition Disorders; Prospective Studies; Neck
PubMed: 35217931
DOI: 10.1007/s11325-022-02585-3 -
Journal of Applied Clinical Medical... Dec 2023Volumetric modulated arc therapy (VMAT) with cisplatin for head and neck cancer is often accompanied by symptoms of pharyngeal and oral mucositis. However, no standard...
Development of programs to predict the occurrence of mucositis from digital imaging and communications in medicine data by machine learning in head and neck volumetric modulated radiotherapy.
Volumetric modulated arc therapy (VMAT) with cisplatin for head and neck cancer is often accompanied by symptoms of pharyngeal and oral mucositis. However, no standard medical program exists for the prevention and treatment of mucositis, and the mechanisms of mucositis have not yet been fully proven. Therefore, adaptive radiotherapy (ART), which is a re-planning process, is administered when severe mucositis develops during the treatment period. We extracted the treatment plans of patients who developed severe mucositis from DICOM data and used machine learning to determine its quantitative features. This study aimed to develop a machine learning program that can predict the development of mucositis requiring ART. This study included 61 patients who received concurrent chemotherapy and radiotherapy (RT). For each patient, the equivalent square field size of each segmental irradiation field used for VMAT, dose per segment (Gy), clinical target volume high, and mean dose of the oral cavity (Gy) were calculated. Furthermore, 671 five-dimensional lists were generated from the acquired data. Support vector machine (SVM) and K-nearest neighbor (KNN) were used for machine learning. For the accuracy score, the test size was varied from 10% to 90%, and the random number of data extracted in each test size was further varied from 1 to 100 to calculate a mean accuracy score. The mean accuracy scores of SVM and KNN were 0.981 ± 0.020 and 0.972 ± 0.033, respectively. The presence or absence of ART for mucositis was classified with high accuracy. The classification of the five-dimensional list was implemented with high accuracy, and a program was constructed to predict the onset of mucositis requiring ART before treatment began. This study suggests that it may support preventive measures against mucositis and the completion of RT without having to re-plan.
Topics: Humans; Mucositis; Radiotherapy Planning, Computer-Assisted; Radiotherapy Dosage; Neck; Head and Neck Neoplasms; Radiotherapy, Intensity-Modulated; Machine Learning; Organs at Risk
PubMed: 37602786
DOI: 10.1002/acm2.14125 -
Archives of Oral Biology Dec 2018The goal of this study was to gain a better understanding of the potential functional specialization of palatine and pharyngeal tonsils, by comparing their cellular...
OBJECTIVE
The goal of this study was to gain a better understanding of the potential functional specialization of palatine and pharyngeal tonsils, by comparing their cellular composition in paired specimens from a large cohort of adenotonsillectomy patients.
DESIGN
Resident B cell, T cell, dendritic cell, and stromal cell subsets were characterized using multicolor flow cytometry in palatine and pharyngeal tonsil specimens from 27 patients, age 2-34 years.
RESULTS
Paired comparisons showed highly significant intra-individual differences in resident cell subsets of palatine and pharyngeal tonsils. Palatine tonsils harbored higher fractions of germinal center B cells/plasmablasts and IgD- CD27- double-negative B cells, and conversely lower fractions of IgD + CD38- resting naïve B cells compared to pharyngeal tonsils. Palatine tonsils also showed lower fractions of plasmacytoid dendritic cells, and higher percentages of two subsets of stromal cells - fibroblastic reticular cells and lymphatic endothelial cells - compared to pharyngeal tonsils from the same individual.
CONCLUSIONS
Despite their physical proximity and histological similarities, palatine and pharyngeal tonsils display marked intra-individual differences in their cellular composition with regard to functionally important immune and stromal subsets. These differences are likely to have immunologic, pathologic, and physiologic significance.
Topics: Adenoids; Adolescent; Adult; B-Lymphocytes; Child; Child, Preschool; Dendritic Cells; Endothelial Cells; Female; Flow Cytometry; Humans; Infant; Male; Palatine Tonsil; Pharynx
PubMed: 30195143
DOI: 10.1016/j.archoralbio.2018.08.020