Am J Otolaryngol. 2001 Jan-Feb;22(1):19-32.
Djupesland PG, Chatkin JM, Qian W, Haight JS.
University of Oslo, Norway.
The discovery that the gas nitric oxide (NO) is an important signaling molecule in the cardiovascular system earned its Nobel prize in 1998. NO has since been found to play important roles in a variety of physiologic and pathophysiologic processes in the body including vasoregulation, hemostasis, neurotransmission, immune defense, and respiration. The surprisingly high concentrations of NO in the nasal airway and paranasal sinuses has important implications for the field of otorhinolaryngology. NO provides a first-line defense against micro-organisms through its antiviral and antimicrobial activity and by its upregulation of ciliary motility. Nasal treatments such as polypectomy, sinus surgery, removal of hypertrophic adenoids and tonsils, and treatment of allergic rhinitis may alter NO output and, therefore, the microbial colonization of the upper airways. Nasal surgery aimed at relieving nasal obstruction may do the same but would also be expected to improve pulmonary function in patients with asthma and upper airway obstruction. NO output rises in a number of conditions associated with chronic airway inflammation, but not all of them. Concentrations are increased in asthma, allergic rhinitis, and viral respiratory infections, but reduced in sinusitis, cystic fibrosis, primary ciliary dysfunction, chronic cough, and after exposure to tobacco and alcohol. Therefore, NO, similar to several other inflammatory mediators, probably subserves different functions as local conditions dictate. At present, it seems that the measurement of NO in the upper airway may prove valuable as a simple, noninvasive diagnostic marker of airway pathologies. The objective of this review is to highlight some aspects of the origin, physiology, and functions of upper airway NO, and to discuss the particular methodological problems that result from the complex anatomy.
PMID: 11172211 [PubMed - indexed for MEDLINE]
Wednesday, January 20, 2010
Nitric oxide in health and disease from the point of view of the otorhinolaryngologist.
Curr Pharm Des. 2005;11(23):3051-60.
Selimoglu E.
Atatürk University, Department of Otorhinolaryngology, Erzurum, Turkey. erolselimoglu@hotmail.com
Nitric oxide (NO) plays role in a great range of important functions in the organism, such as vasodilatation, relaxation of muscles, neurotransmission, neuromediation, and host defense reactions. In the upper airways, nasal cavities and paranasal sinuses are the main sources of this biological mediator. Although the exact role of NO in nasal physiology remains poorly understood, the functions are thought to be host defense, ciliary motility and improved ventilation-perfusion ratio in the lungs by auto-inhalation. Low NO concentrations were reported in certain diseases such as primary ciliary dyskinesia, cystic fibrosis, and acute and chronic maxillary sinusitis whereas high concentrations were detected in upper airway infection, allergic rhinitis and nasal polyposis. Additionally this ubiquitous radical is being implicated in the regulation of cochlear blood flow, sensorineural hearing loss, middle ear effusions, and outer hair cell and vestibular functions. Solid tumors is another area where NO appears to have both tumor-promoting and tumor-inhibiting effects. The presence of NO with high levels within the nose and paranasal sinuses makes it reasonable to believe that this pluripotent gas is involved in a variety of physiological as well as pathophysiological events in the airways. Although NO has an ever-increasing role in various areas related to the practice of otolaryngology, further research is required to understand fully the role of NO in the upper airways.
PMID: 16178763 [PubMed - indexed for MEDLINE]
Selimoglu E.
Atatürk University, Department of Otorhinolaryngology, Erzurum, Turkey. erolselimoglu@hotmail.com
Nitric oxide (NO) plays role in a great range of important functions in the organism, such as vasodilatation, relaxation of muscles, neurotransmission, neuromediation, and host defense reactions. In the upper airways, nasal cavities and paranasal sinuses are the main sources of this biological mediator. Although the exact role of NO in nasal physiology remains poorly understood, the functions are thought to be host defense, ciliary motility and improved ventilation-perfusion ratio in the lungs by auto-inhalation. Low NO concentrations were reported in certain diseases such as primary ciliary dyskinesia, cystic fibrosis, and acute and chronic maxillary sinusitis whereas high concentrations were detected in upper airway infection, allergic rhinitis and nasal polyposis. Additionally this ubiquitous radical is being implicated in the regulation of cochlear blood flow, sensorineural hearing loss, middle ear effusions, and outer hair cell and vestibular functions. Solid tumors is another area where NO appears to have both tumor-promoting and tumor-inhibiting effects. The presence of NO with high levels within the nose and paranasal sinuses makes it reasonable to believe that this pluripotent gas is involved in a variety of physiological as well as pathophysiological events in the airways. Although NO has an ever-increasing role in various areas related to the practice of otolaryngology, further research is required to understand fully the role of NO in the upper airways.
PMID: 16178763 [PubMed - indexed for MEDLINE]
Nitric oxide and the paranasal sinuses.
Anat Rec (Hoboken). 2008 Nov;291(11):1479-84.
Lundberg JO.
Karolinska Institutet, Department of Physiology and Pharmacology, Stockholm, Sweden. Jon.Lundberg@ki.se
The discovery within the paranasal sinuses for the production of nitric oxide (NO) has altered the traditional explanations of sinus physiology. This review article reports the ongoing investigation of sinus physiology beginning with the discovery of NO gas production in the paranasal sinuses that occurred in 1995, and the impact that finding has had both in the basic science and clinical arenas. It was shown that healthy paranasal sinus epithelium expresses an inducible NO synthase that continuously generates large amounts of NO, a pluripotent gaseous messenger with potent vasodilating, and antimicrobial activity. This NO can be measured noninvasively in nasally exhaled breath. The role of NO in the sinuses is likely to enhance local host defense mechanisms via direct inhibition of pathogen growth and stimulation of mucociliary activity. The NO concentration in a healthy sinus exceeds those that are needed for antibacterial effects in vitro. In patients with primary ciliary dyskinesia (PCD) and in cystic fibrosis, nasal NO is extremely low. This defect NO generation likely contributes to the great susceptibility to chronic sinusitis in these patients. In addition, the low-nasal NO is of diagnostic value especially in PCD, where nasal NO is very low or absent. Intriguingly, NO gas from the nose and sinuses is inhaled with every breath and reaches the lungs in a more diluted form to enhance pulmonary oxygen uptake via local vasodilation. In this sense NO may be regarded as an "aerocrine" hormone that is produced in the nose and sinuses and transported to a distal site of action with every inhalation. Copyright 2008 Wiley-Liss, Inc.
PMID: 18951492 [PubMed - indexed for MEDLINE]
Lundberg JO.
Karolinska Institutet, Department of Physiology and Pharmacology, Stockholm, Sweden. Jon.Lundberg@ki.se
The discovery within the paranasal sinuses for the production of nitric oxide (NO) has altered the traditional explanations of sinus physiology. This review article reports the ongoing investigation of sinus physiology beginning with the discovery of NO gas production in the paranasal sinuses that occurred in 1995, and the impact that finding has had both in the basic science and clinical arenas. It was shown that healthy paranasal sinus epithelium expresses an inducible NO synthase that continuously generates large amounts of NO, a pluripotent gaseous messenger with potent vasodilating, and antimicrobial activity. This NO can be measured noninvasively in nasally exhaled breath. The role of NO in the sinuses is likely to enhance local host defense mechanisms via direct inhibition of pathogen growth and stimulation of mucociliary activity. The NO concentration in a healthy sinus exceeds those that are needed for antibacterial effects in vitro. In patients with primary ciliary dyskinesia (PCD) and in cystic fibrosis, nasal NO is extremely low. This defect NO generation likely contributes to the great susceptibility to chronic sinusitis in these patients. In addition, the low-nasal NO is of diagnostic value especially in PCD, where nasal NO is very low or absent. Intriguingly, NO gas from the nose and sinuses is inhaled with every breath and reaches the lungs in a more diluted form to enhance pulmonary oxygen uptake via local vasodilation. In this sense NO may be regarded as an "aerocrine" hormone that is produced in the nose and sinuses and transported to a distal site of action with every inhalation. Copyright 2008 Wiley-Liss, Inc.
PMID: 18951492 [PubMed - indexed for MEDLINE]
Tuesday, January 12, 2010
Significance of styloidectomy in Eagle’s syndrome: an analysis
Indian Journal of Otolaryngology and Head & Neck Surgery
Volume 61, Number 4 / December, 2009
Sanjeev Mohanty1 , N. S. Thirumaran1, M. Gopinath1, Gaurav Bambha1 and Shalini Balakrishnan1
(1) Department of ENT, Head and Neck surgery, Sri Ramachandra Medical College and Research Institute, Chennai, India
Abstract
Objectives/hypothesis: Reported here is a randomized retrospective analysis of 28 cases of elongated styloid process causing nagging cervicofacial pain, both unilateral and bilateral, and the effect of styloidectomy in these cases in relieving the symptom complex of the patient, in situations where conservative management failed in alleviating the symptoms.
Study design: Randomized retrospective analysis over a period of 25 months.
Conclusion: Elongated styloid process causing glossopharyn-geal neuralgia is beginning to be a frequently encountered clinical entity nowadays. Of the 28 cases of elongated styloid process who underwent unilateral/bilateral styloidectomy, 27 patients had total relief of symptoms. Hence, we advocate styloidectomy, following careful diagnosis of the entity with clinical and radiological correlation, if the patient does not respond to medical therapy. The psychological status of the patient would provide clue to the authenticity of the symptoms in unrelieved cases.
Volume 61, Number 4 / December, 2009
Sanjeev Mohanty1 , N. S. Thirumaran1, M. Gopinath1, Gaurav Bambha1 and Shalini Balakrishnan1
(1) Department of ENT, Head and Neck surgery, Sri Ramachandra Medical College and Research Institute, Chennai, India
Abstract
Objectives/hypothesis: Reported here is a randomized retrospective analysis of 28 cases of elongated styloid process causing nagging cervicofacial pain, both unilateral and bilateral, and the effect of styloidectomy in these cases in relieving the symptom complex of the patient, in situations where conservative management failed in alleviating the symptoms.
Study design: Randomized retrospective analysis over a period of 25 months.
Conclusion: Elongated styloid process causing glossopharyn-geal neuralgia is beginning to be a frequently encountered clinical entity nowadays. Of the 28 cases of elongated styloid process who underwent unilateral/bilateral styloidectomy, 27 patients had total relief of symptoms. Hence, we advocate styloidectomy, following careful diagnosis of the entity with clinical and radiological correlation, if the patient does not respond to medical therapy. The psychological status of the patient would provide clue to the authenticity of the symptoms in unrelieved cases.
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