Chronic Pharyngitis: Role of Atypical Organisms: A Case Control Study from South India

Otolaryngology - Head and Neck Surgery (Aug 2012)

Naina P, Anandan S, Mathews SS, Job A, Albert RR

Background: Bacteria including Chlamydophila pneumoniae, Mycoplasma pneumoniae, and anaerobic bacteria such as Fusobacterium necrophorum have been implicated as etiological agents of chronic pharyngitis in Western literature. Because there are no data regarding this from India, the authors undertook this study.

Study Design  Prospective case-control study.

Setting  Tertiary-level medical college and hospital.MethodIn total, 343 consecutive adults with persistent throat pain and/or irritation (duration ≥3 months) were screened for known causes of pharyngitis by a thorough clinical and endoscopic examination. In 71 patients, the evaluation performed was unable to determine any cause, and these were considered cases. An enzyme-linked immunosorbent assay test to detect IgA and IgG antibodies to C pneumoniae and M pneumoniae was performed on 66 of these cases and 62 controls. The posterior pharyngeal swabs taken from both the cases and controls were subjected to aerobic and anaerobic culture.

Results  Individuals with chronic pharyngitis had a 3.43 times odds of being seropositive for C pneumoniae as compared with controls (P = .001; odds ratio = 3.43). Aerobic organisms and M pneumoniae did not seem to be significant etiological agents for chronic pharyngitis. On the contrary, isolation of Fusobacterium spp was found to be significantly more in controls as compared with cases.

ConclusionThis study suggests an association between IgA antibodies to C pneumoniae and chronic pharyngitis. Further studies using more specific tests combined with long-term follow-up are needed to confirm these findings.

The Red Puffy Ear Sign - A Clinical Sign to Diagnose a Rare Cause of Meningoencephalitis

Fortschritte der Neurologie-Psychiatrie (Jul 2012)

Prinz S, Dafotakis M, Schneider RK, Mühlenbruch G, Stopschinski BE 

Tags: 

• azathioprine

We report on the case of a 63-year-old patient with a meningoencephalitis, presenting itself with headache and a general neuropsychological retardation. Additionally, a reddening and swelling of both auricles could be seen. Magnetic resonance imaging showed confluent, contrast-uptaking lesions. In the cerebrospinal fluid an aseptic lymphocytic pleocytosis was found. A biopsy of the ear revealed a chronic lymphoplasmacellular inflammatory reaction. We diagnosed a relapsing polychrondritis, an inflammatory disease of the cartilage, which can in rare cases affect the central nervous system. Typically, the patients complain about red swollen ears, the"red puffy ear sign". After initiation of steroid and azathioprin therapy the patient recovered fully.

Sexually transmitted infections of the oral cavity

 Der Hautarzt (Aug 2012)

Schöfer H

Various sexual practices like fellatio, cunnilingus, or anilingus (rimming) can cause both symptomatic and asymptomatic oral infections in both sexes. Clinically apparent lesions are found in primary, secondary, and tertiary syphilis, in acute HIV infection and the subsequent stage of immunodeficiency (opportunistic infections), as well as in herpes and human papilloma virus infections. Genital candidiasis also can be transmitted to the oral cavity. Depending on the infective agent transmitted, ulcerative, inflammatory or papillomatous lesions of the lips, tongue, mucous membranes and pharynx occur. Oropharyngeal infections with Neisseria gonorrhoeae or Chlamydia trachomatis (Serovar D-K) can cause pharyngitis and tonsillitis with sore throat, but are completely asymptomatic in most cases. Asymptomatic infections are an important, but frequently overlooked reservoir for new infections. Systemic treatment of oral STI's usually is the same as that for anogenital infections. It can be accompanied by symptomatic topical therapy. When the tonsils and other difficult to reach tissues are infected, higher doses and an antibiotic with good tissue penetration are recommended.

Human paranasal sinuses and selective brain cooling: A ventilation system activated by yawning?

Human paranasal sinuses and selective brain cooling: A ventilation system activated by yawning?
Medical Hypotheses
Volume 77, Issue 6 , Pages 970-973, December 2011

• Andrew C. Gallup

  AFFILIATIONS

  • Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544, United States
  • Corresponding author. Tel.: +1 518 727 2473; fax: +1 609 258 7892.
  
, 
• Gary D. Hack

Abstract 

The function of the paranasal sinuses has been a controversial subject since the time of Galen, with many different theories advanced about their biological significance. For one, the paranasal sinuses have been regarded as warmers of respiratory air, when in actuality these structures appear to function in cooling the blood. In fact, human paranasal sinuses have been shown to have higher volumes in individuals living in warmer climates, and thus may be considered radiators of the brain. The literature suggests that the transfer of cool venous blood from the paranasal sinuses to the dura mater may provide a mechanism for the convection process of cooling produced by the evaporation of mucus within human sinuses. In turn, the dura mater may transmit these temperature changes, initiated by the cool venous blood from the heat-dissipating surfaces of the sinuses, to the cerebrospinal fluid compartments. Furthermore, it has recently been demonstrated in cadaveric dissections that the thin bony posterior wall of the maxillary sinus serves as an origin for both medial and lateral pterygoid muscle segments, an anatomic finding that had been previously underappreciated in the literature. The present authors hypothesize that the thin posterior wall of the maxillary sinus may flex during yawning, operating like a bellows pump, actively ventilating the sinus system, and thus facilitating brain cooling. Such a powered ventilation system has not previously been described in humans, although an analogous system has been reported in birds.

Influence of lipoproteins and fibrinogen on pathogenesis of sudden sensorineural hearing loss

• The Journal of Laryngology & Otology (2011), 125: 258-261
• Copyright © JLO (1984) Limited 2010
• Z Oreskovic^a1, D Shejbal^a2, G Bicanic^a3 c1 and B Kekic^a4

^a1 Department of Anesthesiology and Intensive Care, Clinical Hospital Center Zagreb, Zagreb, Croatia

^a2 Department of Otorhinolaryngology, City Hospital Pakrac, Zagreb, Croatia

^a3 University Clinic for Orthopedic Surgery, Clinical Hospital Center Zagreb, Zagreb, Croatia

^a4 University Clinic for Otorhinolaryngology, Sestre Milosrdnice Clinical Hospital, Zagreb, Croatia

Abstract

Aim: To evaluate the relationship between lipoproteins, fibrinogen and sudden sensorineural hearing loss in a Croatian population. Since pathological derangement of lipoproteins and fibrinogen could be one of the causes of sudden sensorineural hearing loss, we hypothesised that patients with sudden sensorineural hearing loss would have more abnormal fibrinogen and lipoprotein concentrations, compared with subjects with normal hearing.

Methods: Plasma concentrations of cholesterol, fibrinogen and triglycerides in patients with sudden sensorineural hearing loss were compared with those in a control group (i.e. subjects with normal hearing function).

Results: Patients with sudden sensorineural hearing loss had significantly higher plasma concentrations of cholesterol and low density lipoprotein cholesterol, compared with controls.

Conclusion: Higher cholesterol and low density lipoprotein cholesterol concentrations were found in patients with sudden sensorineural hearing loss, within a Croatian population. Cholesterol and low density lipoprotein cholesterol concentrations may be important factors in the pathogenesis of sudden sensorineural hearing loss, and should be assessed during the investigation of patients with this condition.

(Accepted June 15 2010)

(Online publication November 05 2010)

Correspondence:

^c1 Address for correspondence: Dr Goran Bicanic, University Clinic for Orthopedic Surgery, Clinical Hospital Center Zagreb, Salata 6-7, 10000 Zagreb, Croatia Fax: +385 1 4818810 E-mail: gbic@mef.hr

Footnotes

Dr G Bicanic takes responsibility for the integrity of the content of the paper

Competing interests: None declared

Breakthrough In Allergic Asthma Treatments To Put Squeeze On Sneeze, UK

Breakthrough In Allergic Asthma Treatments To Put Squeeze On Sneeze, UK



A major breakthrough in creating effective new treatments for allergic asthma has been discovered by Asthma UK funded scientists at King's College London. 

The discovery is the culmination of over fifteen years of Asthma UK-funded research, and the findings are published today in the journal Nature Structural & Molecular Biology. 

The painstaking work conducted by a team of scientists led by Professor Brian Sutton at the MRC-Asthma UK Centre in Allergic Mechanisms of Asthma at King's College London, revealed the precise shape of an important molecule called IgE as it binds to receptor proteins on the surface of mast cells in the lungs. 

Scientists built up a picture of IgE's shape down to the location of each individual atom by firing X-rays at purified protein crystals and measuring how the rays were deflected. Using this technique they were also able to reveal how IgE moves and twists as it attaches to the receptor.

With further funding from Asthma UK, the team is now testing a library of small chemical compounds, looking for ones that have the potential to block the interaction between IgE and its receptor and prevent the development of asthma. 

There are hundreds of thousands of mast cells crawling through the lining of our lungs, each of which holds thousands of histamine-containing granules. In a person with allergic asthma, IgE molecules sit on the surface of these cells. Then, when the individual comes into contact with an allergen such as grass pollen, it sticks to the IgE, provoking the mast cells to release their granules. Histamine causes breathlessness, wheezing and other asthma symptoms by narrowing the airways and triggering inflammation. 

Although allergens from grass pollen, pets, house-dust mites and other sources all have different shapes, all of them trigger asthma and allergy symptoms by binding to IgE on mast cells. Hence, a drug that can prevent IgE from interacting with mast cells would help anyone with allergic asthma, no matter what triggers their allergy. 

The breakthrough is an essential step towards chemically-based drugs, such as those now being developed by Professor Sutton, which can be given in tablet form. 

Professor Brian Sutton from King's says: 'We are immensely proud of our achievement. Thousands of hours of work by my team, plus that of our collaborators, has brought us to an incredibly exciting point. 

'Armed with the precise structure of IgE bound to its receptor we stand a great chance of being able to create hugely effective new treatments for allergic asthma.' 

Dr Elaine Vickers, Research Relations Manager at Asthma UK, says: 'In the UK, 5.4 million people have asthma and almost 80% of them say they have allergies which affect their asthma control. 

'The impact of potential new treatments for allergic asthma resulting from this work could have an enormous impact on the quality of life of people across both the UK and the world.' 

Source: 
Asthma UK 

Omalizumab: Anti-IgE Therapy in Allergy

Current Allergy and Asthma Reports (Jan 2011)

 Kopp MV 

Omalizumab is a humanized, monoclonal anti-IgE antibody that binds specifically to circulating IgE molecules, thus interrupting the allergic cascade. Omalizumab has been shown to be highly effective in treating children and adults with moderate to severe allergic asthma. Beyond this indication, the mode of action itself suggests that omalizumab is not only an antiasthmatic drug but also a promising therapeutic option for various allergic conditions, including allergic rhinitis, food allergy, urticaria, allergic bronchopulmonary aspergillosis, insect hypersensitivity, and atopic dermatitis. However, data from double-blind, placebo-controlled clinical trials are only available for allergic rhinitis and moderate to severe bronchial asthma. The aim of this review is to discuss the current clinical data as well as possible further indications of omalizumab treatment

Vocal cord dysfunction: what do we know?

European Respiratory Journal 37 (1), 194-200 (Jan 2011)

Kenn K, Balkissoon R 

Vocal cord dysfunction (VCD) is a disorder caused by episodic unintentional paradoxical adduction of the vocal cords, which may induce acute severe dyspnoea attacks not responsive to conventional asthma therapy. The aetiology of VCD is complex and often multifactorial. The essential pathophysiology is that of a hyperfunctional laryngeal reflex to protect the lower airway as a result of any combination of post-nasal drip, gastro-oesophageal reflux, laryngopharyngeal reflux and/or psychological conditions. Laryngoscopic demonstration of the paradoxical motion while wheezing or stridorous is considered the diagnostic gold standard. Speech therapy, including the use of special relaxed-throat breathing patterns is effective for VCD that is purely of the functional nature. Knowledge of the clinical features of VCD and identifying factors that may be contributing to the development of VCD can provide adequate clues to the correct diagnosis and management.

Efficacy and safety of timothy grass allergy immunotherapy tablet treatment in North American adults

Journal of Allergy and Clinical Immunology (JACI) 127 (1), 72-80.e2 (Jan 2011)

Nelson HS, Nolte H, Creticos P, Maloney J, Wu J, Bernstein DI 

BACKGROUND Immunotherapy for allergic rhinoconjunctivitis (ARC) in North America is generally administered subcutaneously, but alternative formulations might be safer and more convenient. Trials of sublingual formulations in North America are needed to confirm European efficacy and safety data. 

OBJECTIVEWe sought to investigate the efficacy and safety of timothy grass allergy immunotherapy tablet (AIT) treatment in North American subjects with ARC. 

METHODS Four hundred thirty-nine adults with grass pollen-induced ARC with or without asthma were randomized to once-daily 2,800 bioequivalent allergen units of standardized grass AIT (oral lyophilisate, Phleum pratense, 75,000 standardized quality tablet, containing approximately 15 μg of Phl p 5) or placebo approximately 16 weeks before the 2009 grass pollen season (GPS). The primary end point was the average total combined score of the daily symptom score and the daily medication score during the GPS. Rhinoconjunctivitis Quality of Life Questionnaire with standardized activities (RQLQ[S]) scores, Phl p 5-specific IgG4 levels, and IgE-blocking factor levels were additional end points. Adverse events (AEs) were monitored for safety. 

RESULTS Relative to placebo, grass AIT treatment improved total combined scores by 20% (P = .005), daily symptom scores by 18% (P = .02), and RQLQ(S) scores by 17% (P = .02). Daily medication scores were improved by 26% and trended toward significance (P = .08). Phl p 5-specific IgG4 and IgE-blocking factor levels were higher after grass AIT treatment compared with those after placebo at the end of the GPS (P <.001). Grass AIT treatment was safe and well tolerated. The majority of AEs were transient mild local reactions with no investigator-diagnosed grass AIT-related serious AEs or reports of anaphylactic shock/respiratory compromise. In the grass AIT group, 1 subject received epinephrine after experiencing a possible grade 1 systemic reaction (local site reactions, chest discomfort, and rash). 

CONCLUSIONS Timothy grass AIT treatment (cross-reactive with related Pooideae grasses) was demonstrated to be effective, generally safe, and well tolerated in North American adults with grass pollen-induced ARC.

Effectiveness criteria for the topical application of glucocorticosteroids to the treatment of exudative otitis media associated with allergic rhinitis

Vestnik Otorinolaringologii (5), 32-34 (2010)

Poliakova SD, Popova EA 

We undertook comparative analysis of ciliotoxic effect of glucocorticosteroids frequently used for catheterization of the eustachian tube in patients presenting with exudative otitis media and concomitant allergic rhinitis. It was shown that the recovery of transport function of ciliary epithelium and appreciable clinical effect of the treatment were achieved by the application of mometasone furoate. Dexamethasone was next to mometasone in terms of efficiency whereas hydrocortisone produced much lower beneficial effect. It is concluded that, taking into account high bioavailability of dexametasone and hydrocortisone (>80%) and contraindications to their intranasal administration, the preference should be given to medications with lower bioavailability.

Neuromonics Tinnitus Treatment: Third Clinical Trial

Ear & Hearing: April 2007 - Volume 28 - Issue 2 - pp 242-259

doi: 10.1097/AUD.0b013e3180312619

Davis, Paul B.; Paki, Bardia; Hanley, Peter J.

Objectives: The Neuromonics Tinnitus Treatment combines the use of a novel approach to acoustic stimulation with a structured program of counseling and support by a clinician specifically trained in tinnitus rehabilitation. The distinctive acoustic component has been designed to provide stimulation to auditory pathways deprived by hearing loss, engage positively with the limbic system, and allow intermittent, momentary tinnitus perception within a pleasant and relaxing stimulus, thereby facilitating desensitization to the tinnitus signal. The purposes of this study were (1) to demonstrate the efficacy of the treatment, when enhanced with various modifications since previously reported trials and (2) to test the relative clinical effectiveness of two variations of the approach. In the first, intermittent tinnitus perception was facilitated throughout treatment through the use of a stimulus in which intensity peaks allowed the patients' tinnitus perception to be completely covered up, whereas in the intensity troughs their tinnitus was briefly discernible. In the second, subjects experienced little tinnitus perception while listening to the treatment for the first 2 mo, then experienced intermittent perception.

Design: Thirty-five subjects with a predominantly moderate to severe level of tinnitus-related distress before treatment were randomly allocated into one of two treatment groups, corresponding to the two stage-based variations of the Neuromonics Tinnitus Treatment. Participants were provided with a high-fidelity personal sound player with earphones and an acoustic stimulus that had been spectrally modified according to their individual audiometric profile. They were instructed to use the acoustic stimulus for at least 2 hr per day, particularly at those times when their tinnitus was usually disturbing. Each group had equal amounts of clinician time for education, monitoring, and support.

Results: At 2, 4, 6, and 12 mo after commencing treatment, both groups displayed clinically and statistically significant improvements in tinnitus distress, awareness, and minimum masking levels as well as loudness discomfort levels. Improvements increased with time over the first 6 mo of therapy, at which time 91% of all subjects across the two groups reported an improvement in tinnitus disturbance (as measured by the Tinnitus Reaction Questionnaire) of at least 40%, with a mean improvement of 65%. Also, 80% of subjects at 6 mo reported a level of tinnitus disturbance that was no longer clinically significant. There was some indication of a more consistent benefit over 12 mo for the group that was provided initially with a high level of tinnitus interaction; however, inter-group differences were not statistically significant. A relation between reported treatment usage (hours per day) and clinical outcomes was observed, suggesting that a dosage effect may apply with the stimulus provided.

Conclusions: This study found that the Neuromonics Tinnitus Treatment provides rapid and profound improvements to the severity of tinnitus symptoms and their effect on the subject's quality of life. This was a consistent effect, provided by a treatment that subjects reported as being pleasant to use. Both of the stage-based variations of the treatment that were tested in this study were shown to be successful in achieving these outcomes

Chronic cough and irritable larynx

Journal of Allergy and Clinical Immunology (JACI) (Dec 2010) 

Bucca CB, Bugiani M, Culla B, Guida G, Heffler E, Mietta S, Moretto A, Rolla G, Brussino L

BACKGROUND: Perennial rhinitis (PR), chronic rhinosinusitis (CRS), or both, asthma, and gastroesophageal reflux disease (GERD) are the most frequent triggers of chronic cough (CC). Extrathoracic airway receptors might be involved in all 3 conditions because asthma is often associated with PR/CRS and gastroesophageal refluxate might reach the upper airway. We previously found that most patients with rhinosinusitis, postnasal drip, and pharyngolaryngitis show laryngeal hyperresponsiveness (LHR; ie, vocal cord adduction on histamine challenge) that is consistent with an irritable larynx. 

OBJECTIVE: We sought to evaluate the role of LHR in patients with CC. 

METHODS: LHR and bronchial hyperresponsiveness (BHR) to histamine were assessed in 372 patients with CC and in 52 asthmatic control subjects without cough (asthma/CC-). In 172 patients the challenge was repeated after treatment for the underlying cause of cough. RESULTS: The primary trigger of CC was PR/CRS in 208 (56%) patients, asthma in 41 (11%) patients (asthma/CC+), GERD in 62 (17%) patients, and unexplained chronic cough (UNEX) in 61 (16%) patients. LHR prevalence was 76% in patients with PR/CRS, 77% in patients with GERD, 66% in patients with UNEX, 93% in asthma/CC+ patients, and 11% in asthma/CC- patients. Upper airway disease was found in most (95%) asthma/CC+ patients and in 6% of asthma/CC- patients. BHR discriminated asthmatic patients and atopy discriminated patients with PR/CRS from patients with GERD and UNEX. Absence of LHR discriminated asthmatic patients without cough. After treatment, LHR resolved in 63% of the patients and improved in 11%, and BHR resolved in 57% and improved in 18%. 

CONCLUSIONS: An irritable larynx is common in patients with CC and indicates upper airway involvement, whether from rhinitis/sinusitis, gastric reflux, or idiopathic sensory neuropathy.

The effects on cardiac functions and arterial blood gases of totally occluding nasal packs and nasal packs with airway

The Laryngoscope

Volume 120, Issue 11, pages 2325–2330, November 2010

1. Ehab Zeyyan MD¹, 
2. Münir Demir Bajin MD^2,*,
3. Kudret Aytemir MD², 
4. Taner Yılmaz MD¹

Article first published online: 22 OCT 2010

DOI: 10.1002/lary.21064

Abstract

Objective:

To evaluate the effects on cardiac functions and blood arterial gases of totally occluding nasal packs and nasal packs with airway.

Study Design:

Prospective, randomized trial.

Methods:

Thirty-nine adults without any comorbidities underwent septoplasty or septorhinoplasty and had nasal packs placed postoperatively; 19 nasal packs with airways and 20 totally occluding nasal packs. Twenty-four-hour Holter monitorization was done pre- and postoperatively. Arterial blood gas analysis was performed both before the operation and after application of nasal packs.

Results:

Application of packs with airway did not cause any significant changes in blood gas parameters. Packing with totally occluding nasal packs caused a significant decrease in HCO₃ and pCO₂, and insignificant changes in pO₂, O₂ saturation, and pH. No serious arrhythmias were observed in any patient. In both groups, nasal packing resulted in a significant increase in minimum heart rates, a significant decrease in maximum heart rates, and insignificant changes in the mean heart rates. Heart rate variability obtained from 24-hour Holter electrocardiography was analyzed by power spectral analysis. An increase in the high-frequency (HF) domain, a decrease in the low-frequency (LF) domain, and a decrease in the LF/HF ratio were observed after packing in both groups.

Conclusions:

Nasal pack-induced cardiac complications may occur due to increased vagal stimuli secondary to nasal mucosa compression rather than obstruction-related hypoxia. The use of nasal packs in the elderly patients with cardiopulmonary disease warrants close observation. Nasals packs with airways should be preferred in patients susceptible to hypoxia. Laryngoscope, 2010