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International Journal of Environmental... Mar 2021Surgical treatment of the inferior turbinates is required for hypertrophic inferior turbinates refractory to medical treatments. The main goal of surgical reduction of... (Review)
Review
Surgical treatment of the inferior turbinates is required for hypertrophic inferior turbinates refractory to medical treatments. The main goal of surgical reduction of the inferior turbinate is to relieve the obstruction while preserving the function of the turbinate. There have been a variety of surgical techniques described and performed over the years. Irrespective of the techniques and technologies employed, the surgical techniques are classified into two types, the mucosal-sparing and non-mucosal-sparing, based on the preservation of the medial mucosa of the inferior turbinates. Although effective in relieving nasal block, the non-mucosal-sparing techniques have been associated with postoperative complications such as excessive bleeding, crusting, pain, and prolonged recovery period. These complications are avoided in the mucosal-sparing approach, rendering it the preferred option. Although widely performed, there is significant confusion and detachment between current practices and their basic objectives. This conflict may be explained by misperception over the myriad of available surgical techniques and misconception of the rationale in performing the turbinate reduction. A comprehensive review of each surgical intervention is crucial to better define each procedure and improve understanding of the principle and mechanism involved.
Topics: Catheter Ablation; Humans; Hypertrophy; Nasal Obstruction; Treatment Outcome; Turbinates
PubMed: 33810309
DOI: 10.3390/ijerph18073441 -
European Annals of Otorhinolaryngology,... Apr 2012Empty nose syndrome (ENS) is a clinical entity without consensual definition; it is a rare complication of nose or sinus surgery, and of inferior turbinectomy in... (Review)
Review
Empty nose syndrome (ENS) is a clinical entity without consensual definition; it is a rare complication of nose or sinus surgery, and of inferior turbinectomy in particular. Physiopathology remains unclear, but probably involves disorder caused by excessive nasal permeability affecting neurosensitive receptors and inhaled air humidification and conditioning functions. Neuropsychological involvement is suspected. Symptomatology is variable and changeable, the most common sign being paradoxical nasal obstruction. Diagnosis is founded on: (1) a range of symptoms that need to be precisely collated; (2) broad post-surgical nasal permeability. Management is problematic, deploying the full range of simple nasal cavity hygiene and humidification techniques, with surgery reserved for the most severe cases; whatever the technique, surgery aims at partial filling of the nasal airway. Prevention is the most important strategy, and seeks (1) to check, before any surgery is envisaged, the reality of nasal dyspermeability resistant to medical treatment; and (2) to prefer the most conservative surgical techniques.
Topics: Humans; Nasal Obstruction; Nasal Surgical Procedures; Rhinitis; Syndrome; Turbinates
PubMed: 22513047
DOI: 10.1016/j.anorl.2012.02.001 -
JAMA Otolaryngology-- Head & Neck... Aug 2022To the authors' knowledge, no prior studies have examined the association between inferior turbinate hypertrophy (ITH) and extraesophageal reflux (EER). If EER were a...
IMPORTANCE
To the authors' knowledge, no prior studies have examined the association between inferior turbinate hypertrophy (ITH) and extraesophageal reflux (EER). If EER were a cause or cofactor of ITH, antireflux treatment can be considered prior to surgical intervention.
OBJECTIVE
To evaluate EER presence and severity in patients with different degrees of ITH.
DESIGN, SETTING, AND PARTICIPANTS
Prospective multicentric cohort study conducted at 3 referral centers treating patients with EER and certified for 24-hour monitoring of oropharyngeal pH. The monitoring was performed between October 2020 and October 2021. A total of 94 adult patients with EER symptoms were recruited, 90 of whom were analyzed.
INTERVENTIONS
Nasal endoscopy was performed to determine the degree of ITH, according to the Camacho classification. Presence and severity of EER were examined using 24-hour monitoring of oropharyngeal pH.
MAIN OUTCOMES AND MEASURES
Primary outcomes were presence of EER according to RYAN Score, total percentage of time below pH 5.5, and total numbers of EER events below pH 5.5.
RESULTS
Of the 90 analyzed patients (median [IQR] age, 46 [33-58] years; 36 [40%] male patients), 41 had a maximum of second-degree ITH (group 1), and 49 patients had at least third-degree ITH (group 2), according to the Camacho classification. On the basis of the RYAN Score, EER was diagnosed more often in group 2 (69.4%) than in group 1 (34.1%; difference, 35.3% [95% CI, 13.5%-56.9%]). Moreover, compared with group 1, group 2 exhibited higher median total percentage of time below pH 5.5 (median [IQR], group 1: 2.1% [0.0%-9.4%], group 2: 11.2% [1.5%-15.8%]; difference, 9.1% [95% CI, 4.1%-11.8%]) and higher median total number of EER events (median [IQR], group 1: 6 [1-14] events, group 2: 14 [4-26] events; difference, 8 [95% CI, 2-15] events). Patients with proven EER demonstrated no difference in the degree of ITH between the right and left nasal cavity (Cohen g, -0.17 [95% CI, -0.50 to 0.30]), or between the anterior and posterior parts of the nasal cavity (Cohen g, -0.21 [95% CI, -0.50 to 0.17]).
CONCLUSIONS AND RELEVANCE
In this cohort study, patients with a higher degree of ITH had more severe EER. A possible association between severe ITH and EER was demonstrated.
Topics: Adult; Cohort Studies; Female; Gastroesophageal Reflux; Humans; Hypertrophy; Male; Middle Aged; Paranasal Sinus Diseases; Prospective Studies; Turbinates
PubMed: 35771544
DOI: 10.1001/jamaoto.2022.1638 -
European Annals of Otorhinolaryngology,... Dec 2018The surgical technique of olfactory cleft dilatation consists in transmucosal lateral fracture-dislocation of the lateral wall of each olfactory cleft (i.e., of the...
The surgical technique of olfactory cleft dilatation consists in transmucosal lateral fracture-dislocation of the lateral wall of each olfactory cleft (i.e., of the turbinate wall of the ethmoid, composed, from anterior to posterior, of the middle, superior and supreme turbinates), in order to get access to the recess hosting the human olfactory mucosa and to the roof of the olfactory cleft (i.e., cribriform plate), with minimal trauma to the mucosa. Olfactory cleft dilatation is indicated for dysosmia secondary to constitutional stenosis of the olfactory clefts due to abnormal development of the ethmoid. Constitutional stenosis of the olfactory clefts should be differentiated from inflammatory obstruction and other diseases of the olfactory clefts, and especially from respiratory epithelial adenomatoid hamartoma, which enlarges the olfactory clefts and must be treated by resection. The technique of olfactory cleft dilatation is illustrated by three surgical cases. There was clear improvement in dysosmia in all three cases, without any complications. The place of constitutional olfactory cleft stenosis needs still to be defined in both diagnosis and treatment of dysosmia.
Topics: Adolescent; Adult; Constriction, Pathologic; Dilatation, Pathologic; Endoscopy; Ethmoid Bone; Female; Glucocorticoids; Humans; Nasal Obstruction; Nasal Septum; Olfaction Disorders; Tomography, X-Ray Computed; Turbinates; Young Adult
PubMed: 29934261
DOI: 10.1016/j.anorl.2018.05.008 -
Acta Otorhinolaryngologica Italica :... Oct 2022
Review
Topics: Humans; Treatment Outcome; Nasal Mucosa; Turbinates; Hypertrophy; Nasal Obstruction
PubMed: 36541379
DOI: 10.14639/0392-100X-N1896 -
Current Opinion in Allergy and Clinical... Feb 2020Immune system modulators have been under investigation to help elucidate the underlying pathophysiologies of chronic rhinosinusitis (CRS). Psoriasin (S100A7) and... (Review)
Review
PURPOSE OF REVIEW
Immune system modulators have been under investigation to help elucidate the underlying pathophysiologies of chronic rhinosinusitis (CRS). Psoriasin (S100A7) and calgranulins (S100A8, S100A9, and S100A12) are S100 proteins that have been studied for their immune-mediating responses to pathogens within the context of CRS. This review highlights the expression patterns and proposed roles of S100 proteins in CRS with (CRSwNP) and without (CRSsNP) nasal polyps.
RECENT FINDINGS
Elevated levels of S100A7 and S100A12 were measured in the sinonasal tissues of patients with CRSsNP compared with CRSwNP and controls. S100A12 expression in CRSsNP was significantly correlated to disease severity. Contrastingly, increased S100A8, S100A9, and S100A8/A9 levels were demonstrated in the nasal polyp tissues of patients with CRSwNP compared with those in inferior turbinate and uncinate tissues of patients with CRSsNP and controls.
SUMMARY
The reported differential expression patterns and activities of psoriasin and calgranulins suggest that S100 proteins exert unique and concerted roles in mediating immunity in different subtypes of CRS. These studies will enable further investigations focused on understanding the immune-modulating mechanisms of S100 proteins in different inflammatory signaling pathways and disease phenotypes of CRS toward the pursuit of identifying new biomarkers and targets for improved outcomes.
Topics: Biomarkers; Chronic Disease; Disease Progression; Gene Expression Regulation; Humans; Inflammation; Nasal Polyps; Rhinitis; S100 Proteins; Signal Transduction; Sinusitis; Turbinates
PubMed: 31644435
DOI: 10.1097/ACI.0000000000000595 -
Acta Bio-medica : Atenei Parmensis Aug 2022Allergic rhinitis (AR) and non-allergic rhinitis (NAR) belong to field of vasomotor rhinitis, characterized by nasal hyper-reactivity. Since AR and NAR are two separate...
BACKGROUND AND AIM
Allergic rhinitis (AR) and non-allergic rhinitis (NAR) belong to field of vasomotor rhinitis, characterized by nasal hyper-reactivity. Since AR and NAR are two separate nosological entities, these rhinopaties can coexist in the same patient in up to 15-20% of cases. Overlapped rhinitis (ORs) are associated with intense and persistent symptoms and are often misdiagnosed. Typically, when medical treatment fails, patients undergo turbinate surgery. We evaluated which rhinopaties are most at risk of undergoing turbinate surgery and established the percentage of ORs. Methods: The study included 120 patients undergoing turbinate surgery for turbinate hypertrophy. Anterior rhinoscopy, nasal endoscopy, nasal cytology, skin prick tests (SPT) and/or specific IgE serum assays (CAP-RAST) were performed preoperative on all patients.
RESULTS
Among patients with indication for turbinate surgery, 75% suffered from AR, whereas 25% of them had NAR. On closer analysis, only 7 (8%) of allergic patients presented a "pure" allergy. NAR with eosinophils and mast cells (NARESMA) represented the most common type of superimposed rhinitis (62.5%), while NAR with mast cells (NARMA) and with eosinophils (NARES) represented 25% and 12.5% of the superimposed forms, respectively.
CONCLUSION
Most of the patients undergoing turbinate surgery actually have complex forms of rhinitis. The non-allergic component of ORs often causes therapeutic failure. NARESMAs overlapping ARs are at most risk of undergoing turbinate surgery. Correctly framing a rhino-allergological patient is essential in order to guarantee the most adequate treatment. Hence the importance of introducing in clinical practice investigations, including allergy tests and nasal cytology.
Topics: Eosinophils; Humans; Rhinitis; Rhinitis, Allergic; Skin Tests; Turbinates
PubMed: 36043980
DOI: 10.23750/abm.v93i4.12200 -
European Annals of Otorhinolaryngology,... Jun 2015Angiosarcoma is a malignant tumour arising from endothelial cells that accounts for 1% of all sarcomas. The sinonasal site of angiosarcoma is exceptional.
INTRODUCTION
Angiosarcoma is a malignant tumour arising from endothelial cells that accounts for 1% of all sarcomas. The sinonasal site of angiosarcoma is exceptional.
CASE REPORT
The authors report a case of sinonasal angiosarcoma in a 53-year-old man. Despite wide resection by open surgery and postoperative chemoradiotherapy, several tumour recurrences were observed, requiring multiple operations.
DISCUSSION
Only histological examination with immunohistochemistry is able to confirm the diagnosis (factor VIII, CD34 and CD31 antigens). Standard treatment consists of surgery with wide resection followed by radiotherapy. The authors discuss the treatment modalities and prognosis of this tumour.
Topics: Chemoradiotherapy; Diabetes Mellitus, Type 2; Ethmoid Sinus; Fatal Outcome; Hemangiosarcoma; Humans; Hypertension; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Paranasal Sinus Neoplasms; Risk Factors; Turbinates
PubMed: 25698587
DOI: 10.1016/j.anorl.2015.01.006 -
Brazilian Journal of Otorhinolaryngology 2021Mechanical obstruction is the most common form of nasal obstruction. Among the types of mechanical obstructions, septum deviation and inferior turbinate hypertrophy are...
INTRODUCTION
Mechanical obstruction is the most common form of nasal obstruction. Among the types of mechanical obstructions, septum deviation and inferior turbinate hypertrophy are the most prevalent.
OBJECTIVE
This study evaluated the early clinical outcomes of inferior turbinate radiofrequency and inferior turbinate lateralization combined with septoplasty in the treatment of nasal obstruction symptoms.
METHODS
The research retrospectively evaluated data from 33 patients (24 male, nine female) undergoing septoplasty and inferior turbinate radiofrequency (RF group) and 32 patients (24 male, eight female) treated with septoplasty and inferior turbinate lateralization (LAT group), who were admitted, with complaints of nasal obstruction, to the University of Health Sciences, Department of Otorhinolaryngology, between January 1, 2017 and January 1, 2018. The patients' preoperative and 6-month postoperative symptoms were evaluated via the Nasal Obstruction Symptom Evaluation, the NOSE scale.
RESULTS
The mean preoperative NOSE scores were 10.3±4.2 in the RF group and 10.9±4.9 in the LAT group, and the mean six-month postoperative scores were 1.09±1.3 in the RF group and 1.2±1.3 in the LAT group. There was no significant difference in NOSE scores between the two groups (p>0.05).
CONCLUSION
The data obtained in this study show that both methods result in similar outcomes in terms of relieving nasal obstruction symptoms in patients requiring inferior turbinate intervention. Therefore, the researchers believe that, in each case, the intervention method should be selected at the discretion of the patient and surgeon(s).
Topics: Female; Humans; Hypertrophy; Male; Nasal Obstruction; Nasal Septum; Prospective Studies; Retrospective Studies; Rhinoplasty; Treatment Outcome; Turbinates
PubMed: 32888893
DOI: 10.1016/j.bjorl.2020.07.004 -
European Annals of Otorhinolaryngology,... Oct 2018Nasalisation is a surgical technique proposed for the treatment of nasal polyposis in 1995. The technique as initially described was based on large opening of the... (Review)
Review
Nasalisation is a surgical technique proposed for the treatment of nasal polyposis in 1995. The technique as initially described was based on large opening of the maxillary, sphenoidal and frontal ostia and resection of the middle turbinates, with the aim of resecting the mucosa of the lateral masses of the ethmoid as completely and safely as possible. Recent findings on the evolution and development of the nose and sinuses and sinus physiology allow both the concept and the technique of nasalisation to be updated. According to evo-devo theory, the ethmoid is not a paranasal sinus but the skull-base bone housing the olfactory mucosa. In humans, the olfactory mucosa can be distinguished as functional in the upper recess of both olfactory clefts and vestigial in the rest of the ethmoid bone. Nasal polyposis presents clinically as a specific disease of the vestigial olfactory mucosa of the human ethmoid (and not as a particular kind of chronic rhinosinusitis). The aim of surgery for nasal polyposis is thus maximal resection of the vestigial olfactory mucosa, conserving olfactory function as long as possible. By the production, storage and bolus release of nitric oxide thanks to the sphincter function of the paranasal (maxillary, sphenoidal and frontal) sinus ostia, the paranasal sinuses perform a respiratory function that should be conserved as much as possible. The nasalisation technique has been modified in order for the vestigial olfactory mucosa to be completely resected while sparing the sinus ostia. Middle turbinate surgery still needs to be evaluated: resection is a step toward maximal removal of vestigial olfactory mucosa, while conservation could ensure olfactory cleft integrity. Thus, updating the concept of nasalisation enables the nasalisation technique to be integrated in the evo-devo concept of rhinology.
Topics: Anatomic Landmarks; Humans; Nasal Polyps; Otorhinolaryngologic Surgical Procedures; Paranasal Sinuses; Smell; Turbinates
PubMed: 29887213
DOI: 10.1016/j.anorl.2018.05.006