The effects of natural pollen exposure on inflammatory cytokines and their relationship with nonspecific bronchial hyperresponsiveness in seasonal allergic rhinitis

Allergy and Asthma Proceedings, Volume 31, Number 2, March/April 2010 , pp. 126-131(6)

Authors: Kurt, Emel¹; Aktas, Ayse; Gulbas, Zafer; Erginel, Sinan; Arslan, Sertac

Publisher: OceanSide Publications, Inc

Abstract:
The exact mechanism of bronchial hyperresponsiveness (BHR) is not clear in allergic rhinitis (AR); an increase of BHR in pollen season suggests that natural pollen exposure causes airway inflammation in seasonal AR (SAR). 

This study was designed to investigate the effects of natural pollen exposure on inflammatory cytokines and their relationship with BHR. 

Sixty-six SAR patients with grass pollen sensitivity and 26 nonallergic rhinitis (NAR) patients were included. Peripheral blood samples for cytokine levels were taken and a nonspecific bronchial provocation test was performed during pollen season between May and August. The same measurements were repeated off-season between November and February. These measurements were done in NAR patients once. During the pollen season, SAR patients had significantly more increased levels of IL-13 than NAR patients (11.45 ± 12.54 versus 5.19 ± 4.02; p = 0.005). Blood eosinophil numbers were higher in those patients with BHR during pollen season than those without BHR (399.0 ± 255.8 versus 278.9 ± 193.2 mm⁻³; p = 0.046). Blood eosinophil numbers during off-season were not different in those with and without BHR (respectively, 261.4 ± 202.3 mm⁻³ versus 205.9 ± 116.9 mm⁻³; p = 0.53). IL-10 levels were higher in the patients without BHR (n = 28) than those patients with BHR (n = 22) during off-season (8.12 ± 13.1 versus 3.28 ± 0.37; p = 0.04). Having higher levels of IL-10 than threshold value was more frequent in SAR patients without BHR than those patients with BHR during off-season (7/28 versus 1/22; χ² = 4.34; p = 0.04). IL-10 has a role in the continuation of BHR during off-season in SAR patients.

Document Type: Research article
DOI: 10.2500/aap.2010.31.3325
Affiliations: 1: Department of Allergy, Faculty of Medicine, Eskisehir Osmangazi University, Turkey. dremelkurt@yahoo.com

Comprehensive review of olopatadine: The molecule and its clinical entities

Allergy and Asthma Proceedings, Volume 31, Number 2, March/April 2010 , pp. 112-119(8) Kaliner, Michael A.¹; Oppenheimer, John; Farrar, Judith R.


Abstract:
Olopatadine is a tricyclic compound with antihistaminic, mast cell-stabilizing, and anti-inflammatory properties. 

In the United States olopatadine is approved as a b.i.d. ophthalmic solution, Patanol (Alcon Laboratories, Inc., Fort Worth, TX) to treat all signs and symptoms of allergic conjunctivitis and as a q.d. formulation, Pataday (Alcon Laboratories, Inc.), to treat itching associated with allergic conjunctivitis. A nasal spray, Patanase (Alcon Laboratories, Inc.), was approved in 2008 for treatment of the symptoms of seasonal allergic rhinitis. 

 

The available data on olopatadine was assessed with regard to future uses through a comprehensive literature review and a Roundtable Discussion held at the 2009 meeting of the American Academy of Allergy Asthma and Immunology. 

 

The unique mechanisms of action of olopatadine still under study include mast cell stabilization, potent H₁-anthistaminic activity, and anti-inflammatory effects. 

 

Data support consideration of nasal olopatadine for as-needed use for episodic symptoms of allergic rhinitis, for treatment of nonallergic rhinitis, and for use in combination with topical steroids for patients with moderate-to-severe allergy symptoms. 

 

Document Type: Research article
DOI: 10.2500/aap.2010.31.3317
Affiliations: 1: Institute for Asthma and Allergy, Chevy Chase, Maryland, USA. makaliner@aol.com

Effects of type II thyroplasty on adductor spasmodic dysphonia.

Otolaryngol Head Neck Surg. 2010 Apr;142(4):540-6.

Sanuki T, Yumoto E, Minoda R, Kodama N.

Graduate School of Medicine, Kumamoto University, Department of Otolaryngology Head & Neck Surgery, Kumamoto, Japan. otostl0319@fc.kuh.kumamoto-u.ac.jp

Abstract

OBJECTIVES: Type II thyroplasty, or laryngeal framework surgery, is based on the hypothesis that the effect of adductor spasmodic dysphonia (AdSD) on the voice is due to excessively tight closure of the glottis, hampering phonation. Most of the previous, partially effective treatments have aimed to relieve this tight closure, including recurrent laryngeal nerve section or avulsion, extirpation of the adductor muscle, and botulinum toxin injection, which is currently the most popular. The aim of this study was to assess the effects of type II thyroplasty on aerodynamic and acoustic findings in patients with AdSD.

STUDY DESIGN: Case series.

SETTING: University hospital.

SUBJECTS AND METHODS: Ten patients with AdSD underwent type II thyroplasty between August 2006 and December 2008. Aerodynamic and acoustic analyses were performed prior to and six months after surgery. Mean flow rates (MFRs) and voice efficiency were evaluated with a phonation analyzer. Jitter, shimmer, the harmonics-to-noise ratio (HNR), standard deviation of the fundamental frequency (SDF0), and degree of voice breaks (DVB) were measured from each subject's longest sustained phonation sample of the vowel /a/.

RESULTS: Voice efficiency improved significantly after surgery. No significant difference was found in the MFRs between before and after surgery. Jitter, shimmer, HNR, SDF0, and DVB improved significantly after surgery.

CONCLUSIONS: Treatment of AdSD with type II thyroplasty significantly improved aerodynamic and acoustic findings. The results of this study suggest that type II thyroplasty provides relief from voice strangulation in patients with AdSD.

Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.

PMID: 20304275 [PubMed - indexed for MEDLINE]

Sutureless tympanoplasty using acellular dermis.

Am J Otolaryngol. 2010 Apr 12.

Raj A, Sayal A, Rathore PK, Meher R.

Department of Otolaryngology and Head, Neck Surgery, MAM College and Assoc. LN Hospital, New Delhi, India.

Abstract

OBJECTIVE: A prospective randomized unblinded controlled trial was conducted by comparing acellular dermis with temporalis fascia as graft materials in tympanoplasty (type 1) in terms of operative time, postoperative pain, graft success rate, and audiologic outcome.

STUDY DESIGN: Forty-two patients with (inactive) chronic suppurative otitis media of tubotympanic type were randomized, matched, and divided equally into 2 groups of 21 each. One group underwent tympanoplasty (type 1) via transcanal route using temporalis fascia graft and the other using acellular dermis. Both groups were compared for operative time, postoperative pain, graft success rate, and audiologic improvement in hearing.

RESULTS: There was a statistically significant reduction in operative time (P < .05) and postoperative pain (P < .05) in the acellular dermis group. However, there was no statistical difference in graft success rate (P > .05) and hearing improvement (P > .05) between both the groups.

CONCLUSION: Results of tympanoplasty using acellular dermis as graft material are comparable to that using temporalis fascia in terms of graft uptake and hearing improvement. However, tympanoplasty using acellular dermis has the advantage of shorter operative time and lesser postoperative pain. Copyright © 2010 Elsevier Inc. All rights reserved.

Impact on hearing of routine ear suctioning at the tympanic membrane.

Am J Otolaryngol. 2010 Apr 12. [Epub ahead of print]

Nelson JJ, Giraud A, Walsh R, Mortelliti AJ.

Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, NY, USA.

Abstract

OBJECTIVE: Patient and equipment safety has become increasingly scrutinized in today's medical care. Routine otolaryngologic evaluation often involves suctioning with Frazier-type suction devices in the ear canal for improved visualization, but data are limited on the potential acoustic trauma from ear canal suction devices. This study intends to document the objective and subjective effects of ear canal suctioning to identify any risk for hearing threshold shifts or other potential negative effects.

PATIENTS AND METHODS: Prospective study on 21 healthy volunteers enlisted for evaluation. Presuctioning tympanogram, audiogram, and otoacoustic emissions data were obtained. Spectrum analyses were recorded during ear canal suctioning with a probe microphone placed lateral to the tympanic membrane. Subjective data were recorded, and a follow-up audiogram and otoacoustic emissions were obtained to identify any temporary threshold shifts.

RESULTS: Spectrum analyses revealed a high degree of variability between subjects. A peak intensity of 111 dB sound pressure level was recorded. All patients tolerated suctioning, and none reported hearing loss. No threshold shifts were observed. Subjective data failed to correlate with the objective recorded intensities.

CONCLUSIONS: Clinicians and patients need to be acutely aware of potential risks and benefits from any medical intervention. Routine ear canal suctioning can be extremely loud and uncomfortable for patients. This study failed to document objective proof of hearing detriment from ear canal suctioning, although the possibility exists during office and surgical intervention. Further study and potential alternative suctioning methods deserve attention.

Copyright © 2010 Elsevier Inc. All rights reserved.

Impact of oseltamivir treatment on the incidence and course of acute otitis media in children with influenza

 

International Journal of Pediatric Otorhinolaryngology (Apr 2010)

 

Winther B, Block SL, Reisinger K, Dutkowski R

OBJECTIVE: Acute otitis media (AOM) is the most common complication of pediatric influenza, and imposes a substantial health care burden. We examined the influence of oseltamivir treatment on the incidence and course of AOM in children with influenza. 

METHODS: In the original study, 695 children 1-12 years who presented within 48h of the onset of influenza-like symptoms were randomized to oseltamivir (2mg/kg) or placebo given twice daily for 5 days. AOM was assessed at enrollment and days 3, 6 (+/-1), 10 (+/-2) and 28 (+/-7). AOM was clinically diagnosed by the participating primary care provider, supported by tympanometry when possible. We performed a retrospective analysis of those participants with laboratory-confirmed influenza (LCI). Assessments included the incidence and clinical course of new AOM cases. 

RESULTS: In all, 452 children had LCI; 217 received oseltamivir and 235 placebo. AOM was diagnosed on or after study day 3 at a significantly lower frequency in the oseltamivir versus placebo group (12.4% versus 21.7%; relative risk [RR]: 0.57 [95% CI: 0.37, 0.88], respectively). Treatment effects were greatest for children 1-2 years (RR=0.42 [95% CI: 0.20, 0.89]) and 3-5 years (RR=0.45 [95% CI: 0.19, 1.04]), in whom the incidence of AOM was highest. 

CONCLUSIONS: Oseltamivir treatment significantly reduces the emergence of new AOM infections in children with LCI; effects are most pronounced in those<5 years. Clinical trial number: WV15758.

Mucocutaneous leishmaniasis masquerading as Wegener granulomatosis

JCR: Journal of Clinical Rheumatology 16 (3), 125-8 (Apr 2010)

 

Brahn E, Pegues DA, Yao Q, Craft N;

 

A 43-year-old Brazilian female presented in 2001 with nasal stuffiness and sinusitis. A biopsy was consistent with limited Wegener's granulomatosis although antineutrophil cytoplasmic antibodies were negative. Her nasal inflammation progressed despite trials of prednisone, methotrexate, and azathioprine. A septal perforation developed and a repeat biopsy showed granulomatous inflammation. In 2006 the patient was referred to Division of Rheumatology, University of California, Los Angeles. 

The nose was grossly erythematous and a magnetic resonance imaging revealed nasal destruction and sinusitis. Palatine biopsies showed chronic inflammation. Cyclophosphamide at 150 mg/d resulted in markedly improved mucocutaneous lesions. The patient developed a leg and arm rash in 2007. A skin biopsy was positive for Leishmania braziliensis. The cyclophosphamide was discontinued and amphotericin B was initiated with transient benefit. Remission was achieved with pentavalent antimony. 

Despite multiple nasopharyngeal biopsies, for a 6-year span, mucocutaneous leishmaniasis masqueraded as Wegener's granulomatosis. Cyclophosphamide not only resulted in clinical improvement, due to reduced inflammatory response, but also allowed widespread cutaneous dissemination.

Routine clotting screen has no role in the management of epistaxis: reiterating the point

European Archives of Oto-Rhino-Laryngology (Apr 2010)

 

Shakeel M, Iddamalgoda T, Supriya M, Ah-See KW, Trinidade A;

Objective of the study is to investigate the role of clotting screen in adult patients presenting with epistaxis. The study is a prospective case series done in a teaching hospital in the Northeast of Scotland. Prospective data was collected for 100 consecutive patients with epistaxis admitted to the Department of Otolaryngology over 1 year (2006-2007 August). The demographics, co-morbidities, long-term medications and blood test results were noted for these patients. 

A retrospective audit of all patients attending the Emergency Department (ED) with epistaxis during the same study period was also performed. The following were measured: frequency of clotting screen performed in patients with epistaxis; the treatment modifying effect of clotting screen results. Of the 100 admitted patients, 45 were male and 55 were female. 

The majority of them had more than two co-morbidities such as hypertension, ischaemic heart disease and atrial fibrillation. Forty-seven patients were on aspirin, 19 on warfarin and 12 patients on clopidogrel. A clotting screen was done for 80 patients but only 2 patients (2.5%) had an abnormal INR. A total of 356 patients presented to the ED with epistaxis. Of 356 patients, 138 (39%) had their clotting screen checked. Of 138 patients, 42 (30%) were on warfarin. Only 7 patients (7/138 = 5%) had an abnormal result. Our data suggests that routine clotting screen check does not alter the epistaxis management in patients with no risk factors or with stable warfarin dosage. 

Therefore, routine clotting screen in patients with epistaxis without relevant risk factors is not an evidence-based practice.

Propranolol treatment for infantile hemangiomas.

Curr Opin Otolaryngol Head Neck Surg. 2009 Dec;17(6):458-9.
Buckmiller LM.

PURPOSE OF REVIEW: Infantile hemangiomas are the most common benign tumors of infancy and the majority of them occur in the head and neck. Recent literature has described propranolol for the treatment of these vascular tumors.

RECENT FINDINGS: Propranolol was serendipitously found to induce early involution in hemangiomas even during the proliferative phase of the hemangioma cycle. First reported in June 2008, and presented at the International Society for the Study of Vascular Anomalies meeting in Boston that same month, propranolol has stirred much interest in the physicians who treat these types of lesions. Early case report data are now appearing in the literature, and are verifying the findings of the initial studies as an effective treatment for hemangiomas. Our institution has the privilege of maintaining a high volume vascular center and we have begun treating patients with problematic hemangiomas with propranolol as well. The present article will briefly review the literature and give some of our preliminary experience with the drug.

SUMMARY: Research regarding propranolol is in its infancy but, should the initial results and safety record be borne out, it is likely to revolutionize how we manage infantile hemangiomas.

Fungal infection of the ear: A common problem in the north eastern part of Haryana.

Int J Pediatr Otorhinolaryngol. 2010 Mar 25. [Epub ahead of print]
Aneja KR, Sharma C, Joshi R.

Department of Microbiology, Kurukshetra University, Kurukshetra 136 119, Haryana, India.

OBJECTIVE: The aim of this study was to determine the prevalence of fungal agents, sex distribution and predisposing factors involved in otomycosis. METHODS: Samples from the 118 clinically suspected patients of otomycosis were collected between January 2008 and February 2009, with an age group of 6 and 75 years. Mycological examination of all the samples was done to isolate the fungal agents involved in otomycosis.

RESULTS: Mycological examination has revealed the confirmation of fungal otomycosis in 78% of the suspected patients. Pruritus has been found as the most common symptom. The major predisposing factors responsible for the otomycosis have been found as the wearing of traditional customary clothes followed by itching on other body parts and swimming. It has been found to be more prevalent in females than males in the age group of 31-40 years, higher incidence occurring in the rainy season. The fungi involved in otomycosis belonged to Aspergillus niger, A. flavus, A. fumigatus, A. luchuensis, A. terreus, Candida albicans and Penicillium sp. Of these, A. niger followed by A. flavus were the dominant fungi. Aspergillus luchuensis as the cause of otomycosis has been reported for the first time.

CONCLUSION: Finally we can say higher incidence of otomycosis may be due to high degree of humidity, warm and dusty environment. So, keeping in view the high prevalence of otomycosis in India, critical diagnosis of the causative agent by employing aseptic and proper culture techniques and susceptibility testing for proper treatment of this disease is the need of the hour. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Neurodevelopmental disorders in children with severe to profound sensorineural hearing loss: a clinical study

Developmental Medicine & Child Neurology (Mar 2010)
Chilosi AM, Comparini A, Scusa MF, Berrettini S, Forli F, Battini R, Cipriani P, Cioni G;

Aim: The effects of sensorineural hearing loss (SNHL) are often complicated by additional disabilities, but the epidemiology of associated disorders is not clearly defined. The aim of this study was to evaluate the frequency and type of additional neurodevelopmental disabilities in a sample of children with SNHL and to investigate the relation between these additional disabilities and the aetiology of deafness.

Method One hundred children with severe/profound SNHL (60 males, 40 females; mean age 5y 7mo, SD 3y 6mo, range 8mo-16y) were investigated using a diagnostic protocol including neurodevelopmental, genetic, neurometabolic, and brain magnetic resonance imaging (MRI) assessment.

Results Forty-eight per cent of the sample exhibited one or more additional disabilities, with cognitive, behavioural-emotional, and motor disorders being the most frequent. The risk of additional disabilities varied according to the type of aetiology. Thirty-seven out of 80 individuals with available MRIs showed signal abnormalities, in particular brain malformations (46%) and white matter abnormalities (54%). Frequency and type of disability were associated with aetiology (p=0.015) and MRI data (p<0.001).

Interpretation A multidimensional evaluation, including aetiological, neurodevelopmental, and MRI investigation, is needed for planning therapeutic intervention, such as cochlear implantation in children with severe to profound hearing impairment. The aetiology of deafness is a relevant risk indicator for the presence of an associated disorder.

Potentially malignant disorders of the oral and oropharyngeal mucosa; present concepts of management

Oral Oncology (Mar 2010)
van der Waal I

In spite of tremendous progress in the field of molecular biology there is yet no single marker that reliably predicts malignant transformation of a potentially malignant disorder of the oral mucosa. Therefore, it is recommended to excise or laser any oral of oropharyngeal leukoplakia/erythroplakia, if feasible, irrespective of the presence or absence of dysplasia. However, it is actually unknown whether such removal truly prevents the possible development of a squamous cell carcinoma. Therefore, lifelong follow-up is recommended at intervals of no more than 6months. At present, oral lichen planus is more or less accepted as being a potentially malignant disorder. There are no means to prevent such event. The efficacy of follow-up of oral lichen planus is questionable.

Cricothyroid Joint Abnormalities in Patients With Rheumatoid Arthritis

Journal of Voice (Mar 2010)
Berjawi G, Uthman I, Mahfoud L, Husseini ST, Nassar J, Kotobi A, Hamdan AL

The objective of this study was to assess structural and functional abnormalities of the cricothyroid joint (CTJ) in patients with advanced rheumatoid arthritis (RA). A total of 19 subjects-11 patients with advanced RA and eight normal controls-were considered. All subjects underwent laryngeal endoscopy, acoustic analysis, and high-resolution computerized tomography (HRCT). Vocal symptoms, such as hoarseness, loss of range, vocal fatigue, and dyspnea were inquired and acoustic parameters, mainly pitch range, fundamental frequency, habitual pitch, perturbation parameters, and noise-to-harmonic ratio (NHR) and voice turbulence index were measured. Frequencies and means were calculated for categorical and continuous variables. Cases and controls were compared with respect to acoustic analysis, HRCT findings and laryngeal symptoms using nonparametric tests, Mann-Whitney U test for continuous variables and Fishers exact test for categorical variables. Almost half of the patients with RA had loss range and two-thirds had vocal fatigue. Thirty-six percent experienced hoarseness compared with 25% in the control group. 9.1% had decrease in vocal fold mobility and 27% had moderate/severe edema of the vocal folds/arytenoids compared with none in the control group. HRCT showed narrowing in the CTJ in 81.8% and ankylosis in 9.1% compared with none in the control group. 45.5% had an increase in the CTJ density compared with 12.5% in the control group. Acoustic analysis revealed significant decrease in pitch range and maximum phonation time (MPT) and significant increase in perturbation parameters. CTJ is commonly affected in patients with RA. Functional disabilities are crucial especially in professional voice users. Proper awareness is important for early detection and intervention.

Is sensorineural hearing loss with chronic otitis media due to infection or aging in older patients?

Auris Nasus Larynx 37 (3), 402-6 (Jun 2010)
Yoshida H, Miyamoto I, Takahashi H

OBJECTIVE: To clarify true incidence of sensorineural hearing loss in ears with chronic otitis media (COM).

METHODS: Bone conduction (BC) hearing thresholds of 180 preoperative patients (207 ears) with COM and 226 normal individuals (289 ears)were measured by audiometry, and the percentage of ears with BC thresholds being higher than normal range was evaluated in the COM group. In the COM group, the size of the perforation on the eardrum (n = 196) and the cross-sectional area of the mastoid air cells based on the axial CT image (n = 103) were also measured and correlated with the results of BC threshold.

RESULTS: The percentage of ears with BC thresholds being higher than normal range calculated from comparison to the control group tended to increase with age, ranging from 4.5% in the 20s to 34.1% in the 60s with an average of 26.6%. The increase in the BC thresholds did not correlate with the size of eardrum perforation, but correlated well with the size of the mastoid air cells.

CONCLUSION: These results may suggest that all measures for early cure, including surgery, should be considered as early as possible for patients with COM.