Akira Shimomura

Endoscopic Sinus Surgery Improves Pulmonary Function in Patients with Asthma Associated with Chronic Sinusitis

We evaluated the clinical efficacy of endonasal endoscopic sinus surgery (ESS) in patients with asthma associated with chronic sinusitis. Twenty-one patients (13 men and 8 women) from 27 to 72 years old were enrolled in this study. All patients had had sinus-related symptoms for more than 3 months and had computed tomographic evidence of paranasal sinus opacification. Fifteen patients underwent bilateral endonasal ESS under local anesthesia, and 6 other patients without surgery were controls. The sinus-related symptoms of the preoperative and postoperative periods were assessed via a questionnaire. The period 6 months prior to surgery was compared with that 6 months postoperatively with regard to peak expiratory flow and total dosage of systemic glucocorticoids. Sinus-related symptoms in the ESS group were significantly improved 6 months postoperatively. The average peak expiratory flow 6 months following surgery was improved in the ESS patients, ranging from 40 to 190 L/min. Seven patients showed a reduction in the need for corticosteroids, whereas 2 patients were unchanged and 2 patients required larger dosages. The remaining 4 patients needed no corticosteroids before or after ESS. No significant changes in sinus-related symptoms or peak expiratory flow were obtained for the control group. Improvement of paranasal sinus disease by successful ESS can alleviate pulmonary dysfunction in asthma associated with chronic sinusitis. We believe that adequate and positive treatment for chronic sinusitis would reduce not only the nasal and sinus-related symptoms evoked by chronic sinusitis, but also some of the signs induced by asthma.

Mechanism of neutrophil recruitment induced by IL-8 in chronic sinusitis

BACKGROUND The mechanism of neutrophil recruitment in patients with chronic sinusitis is unclear. OBJECTIVE This study aims to elucidate the role of IL-8 in inducing neutrophil accumulation in the nasal discharge of patients with chronic sinusitis. METHODS Nasal discharge and mucosal specimens were obtained from two groups of patients, those with chronic sinusitis and those with allergic rhinitis. The samples were subjected to immunohistochemical examination and in situ hybridization. The IL-8 level in the nasal discharge was measured by enzyme immunoassay. RESULTS Immunoreactivity to IL-8 was observed in polymorphonuclear cells of nasal smear, in nasal gland duct cells, and in epithelial cells of the chronic sinusitis group; whereas those of the allergic rhinitis group mostly showed little or no reaction. Similar patterns of localization were shown by in situ hybridization for IL-8 messenger RNA. The IL-8 level in nasal discharge was significantly higher in the chronic sinusitis group than in the allergic rhinitis group. CONCLUSION These results suggest that chemotactic factors in sinus effusion, including IL-8 derived from nasal gland duct cells and epithelial cells, attract neutrophils out of mucosa, and the neutrophils that have emigrated into the sinus effusion secrete IL-8. This induces further neutrophil accumulation in the sinus effusion of patients with chronic sinusitis.

Inhibitory Effect of Macrolides on Interleukin-8 Secretion From Cultured Human Nasal Epithelial Cells

The mechanism of macrolide therapy in chronic sinusitis patients is unclear. The authors studied the effect of macrolides on interleukin (IL)‐8 secretion from cultured human nasal epithelial cells. Epithelial cells harvested from the nasal polyps of patients with chronic sinusitis were primary‐cultured, and secreted IL‐8 in culture media was measured by enzyme immunoassay. The cells secreted considerable amounts of IL‐8 constitutively and in response to lipopolysaccharide. The secretion was significantly inhibited by 10−5 M of erythromycin, clarithromycin, roxithromycin, and josamycin. 10−6 M erythromycin still showed the inhibitory effect, whereas the same concentration of josamycin did not. These results indicate that macrolide antibiotics may act as an immunomodulator to reduce IL‐8 in inflammatory sites and, at least partially, account for the clinically discrepant effects between 14‐ and 16‐membered ring macrolides in long‐term low‐dose therapy for chronic sinusitis.

Defibrinogenation Therapy for Idiopathic Sudden Sensorineural Hearing Loss in Comparison with High-dose Steroid Therapy

Objective--The efficacy of defibrinogenation therapy for idiopathic sudden sensorineural hearing loss was studied in comparison with high-dose steroid therapy. Material and methods--Eighty-eight consecutive patients with hearing levels >40 dB and who had suffered hearing loss for ≤30 days were enrolled: 40 patients for high-dose steroid therapy (PSL group) and 48 for defibrinogenation therapy (BX group). Hearing recovery was evaluated by grade assessment and by the improvement in hearing compared to the unaffected contralateral ear. Results--The overall hearing outcomes of the two groups were roughly equivalent. However, with regard to patients with initial hearing levels <80 dB, the hearing improvement rate of the BX group was significantly worse than that of the PSL group (61.2%±7.3% vs 88.7%±8.9%; p<0.05), whereas in patients with initial hearing levels ≥80 dB, the hearing outcomes did not differ between the 2 groups. Three patients in the PSL group manifested hyperglycemia while no serious side-effects were observed in the BX group. Conclusion--These results indicate that high-dose steroid therapy should be employed in preference to defibrinogenation therapy for patients with moderate hearing loss, whereas defibrinogenation therapy has an advantage for those with severe hearing loss, in view of its lower frequency of side-effects.

Subjective and Objective Evaluation in Endoscopic Sinus Surgery

Endoscopic sinus surgery (ESS) is the first modality for the surgical treatment of chronic sinusitis. We evaluated the outcome of ESS based on subjective and objective assessment. Subjective improvement was achieved in 98% of 54 patients chosen consecutively in the present study. The extent of disease revealed by computed tomographic (CT) scans was significantly ameliorated to an 82% improvement rate by ESS. However, no correlation of improvement rate between symptoms and CT scores was obtained. Both quantitative olfaction and anterior rhinomanometry were significantly improved following ESS. The present study provides objective evidence for clinical efficacy of ESS in the treatment of chronic sinusitis.

Functional inferior turbinosurgery (FITS) for the treatment of resistant chronic rhinitis.

Abstract Conclusions. Modified vidian neurectomy combined with inferior turbinoplasty provided an optimal surgical outcome as a treatment for intractable chronic rhinitis as evidenced by a relatively long-term follow-up. Objective. The study was designed to determine the efficacy of submucosal reduction of the inferior turbinate and resection of the posterior nasal nerve for the treatment of resistant chronic rhinitis. Patients and methods. Fifty-six consecutive patients (37 males and 19 females; mean ± SD age, 26 ± 11 years) with resistant allergic rhinitis or nonallergic rhinitis with eosinophilia syndrome despite medical treatment. Symptomatic improvement including nasal obstruction, nasal discharge, sneezing, smell perception, and quality of life and objective evaluation of nasal airway resistance and nasal provocation test before and after surgery were investigated. Results. The patients showed a remarkable improvement of ≥80%, with the exception of two patients who had an approximately 50% reduction of the total symptomatic scores. Four of eight patients with anosmia subjectively improved whereas the other four patients felt unchanged. All patients who underwent rhinomanometry (n = 15) and nasal provocation testing (n = 15) both before and after surgery showed a significant improvement. There were no intraoperative complications. Postoperative epistaxis occurred in one patient. One patient complained of a transient hypesthesia of the soft palate and dry eye. Nasal mucosal tears were observed in approximately 30% of the patients who otherwise showed no severe synechia or persistent crusting.

Endonasal Endoscopic Management in Fibrous Dysplasia of the Paranasal Sinuses

In fibrous dysplasia (FD) involving the paranasal sinuses, the initial clinical presentation is related to sinus obstruction, visual disturbance, facial asymmetry, and nasal obstruction. FD is characterized by changes of the normal bone to an isomorphous fibrous tissue and poorly formed woven b0ne.l Although clinical and radiographic features provide important information, the diagnosis of FD requires a biopsy to differentiate it from other fibro-osseous diseases.z-5 The treatment of FD is controversial and ranges from total and radical resection to conservative excision to alleviate and prevent symptoms.3,6-8 Total excisional surgery of the involved bone often accompanies secondary deformity, significant risks of morbidity, and probable mortality.3,g-12 Subtotal surgical resection of FD in advanced cases is recommended to alleviate or ameliorate symptoms. Endoscopic sinus surgery (ESS) is an established surgical treatment for chronic sinusitis.13 Expanded indications for ESS include repair of blow-out fractures, resection of inverted papilloma, and orbital decompression.14-16 An endoscopic approach provides a deep biopsy specimen with minimal surgical morbidity.2J7 We report three cases of FD treated successfully with ESS. ESS led to the establishment of

Methacholine Bronchial Hyperresponsiveness inChronic Sinusitis

The coexistence of chronic sinusitis (CS) may deteriorate the clinical condition of lower airway diseases such as bronchial asthma (BA) or chronic bronchitis (CB). However, the bronchial hyperresponsiveness (BH) in CS without any apparent lower airway disease is not fully understood nor are the effects of treatment. We examined lower airway hyperresponsiveness to methacholine (MCh) in 42 subjects with CS but without allergic rhinitis (AR) who had normal lung functions without any pulmonary symptoms, comparing it with that of 50 subjects with stable BA, 50 subjects with simple CB and 40 subjects with AR, and further examined the effect of endoscopic sinus surgery in 7 CS subjects with BH. The BH to MCh was measured in terms of the minimum dose (Dmin), defined as the cumulative dose at the point where respiratory conductance began to decrease. A Dmin <50 units was defined as BH. Seventy-one percent of CS subjects showed BH without relation to the severity or duration of CS, or atopic status. BH in CS subjects, which was less than that in BA subjects, was similar to that in simple CB or AR in both its prevalence and degree. After the surgical treatment of CS, BH significantly decreased (p < 0.01) with improvements in both nasal symptoms and sinus lesions. These findings suggest that CS itself induces BH to a degree similar to simple CB and AR without any relationship to the clinical background, and that adequate treatment of CS reduces BH.

Expression of Adhesion Molecules in Cultured Human Nasal Mucosal Microvascular Endothelial Cells Activated by Interleukin–1â or Tumor Necrosis Factor–·: Effects of Dexamethasone

Adhesion molecules of microvascular endothelial cells play a key role in the inflammatory processes involved in nonallergic sinusitis. We investigated the cytokine–regulated expression of intercellular adhesion molecule–1 (ICAM–1), E–selectin and vascular cell adhesion molecule–1 (VCAM–1), and the effect of dexamethasone on these expressions in cultured human nasal microvascular endothelial cells (HNMEC). ICAM–1 was enhanced, and E–selectin and VCAM–1 were induced in a dose–dependent fashion following stimulation with IL–1β or TNF–α. HNMEC differed from human umbilical vein endothelila cells in that (1) maximal upregulation of ICAM–1 expression induced by IL–1β or TNF–α required more time (2) TNF–α was more potent than IL–1β in VCAM–1 expression, and (3) dexamethasone inhibited the upregulation of E–selectin expression alone. These findings contribute to a better understanding of the characteristic features of leukocyte infiltration into inflamed tissue and the effect of glucocorticoid in nonallergic chronic sinusitis.

Laser-Assisted Uvulopalatoplasty for Habitual Snoring without Sleep Apnea: Outcome and Complications

Thirty patients suffering from habitual snoring were subjected to laser-assisted uvulopalatoplasty with a KTP/532 laser under local anesthesia. The patients selected for the present study had no complaints of severe sleep apnea. The surgical procedure included bilateral vertical incision through the palate at the base of the uvula with or without removal of the lower half of the uvula. Ninety-three percent of the patients showed apparent improvement of snoring following the operation. However, other sleep-related symptoms such as sleep quality and daytime sleepiness were not significantly improved. No major or critical complications such as massive bleeding and asphyxia occurred. Post-operative pain on deglutition disappeared in most patients 2 weeks after the operation. This procedure is safe, minimally invasive and effective for habitual snoring without apnea.