Anders Åkerlund

Prevalence of nasal polyps in adults: the Skövde population-based study.

Patients with nasal polyps present repeatedly in otorhinolaryngology practices, but the prevalence of nasal polyps in the general population is not known. Our objective was to investigate the prevalence of nasal polyps in an adult Swedish population in relation to age, gender, asthma, and aspirin intolerance. A random sample of 1,900 inhabitants over the age of 20 years, stratified for age and gender, was drawn from the municipal population register in Skövde, Sweden, in December 2000. The subjects were called to clinical visits that included questions about rhinitis, asthma, and aspirin intolerance and examination by nasal endoscopy. In total, 1,387 volunteers (73% of the sample) were investigated. The sample size was adequate, with a good fit to the whole population. The prevalence of nasal polyps was 2.7% (95% confidence interval, 1.9–3.5), and polyps were more frequent in men (2.2 to 1), the elderly (5% at ≥60 years of age), and asthmatics. Subjective symptoms of aspirin intolerance were not found to correlate with polyps. Nasal polyps were more common in adults than was stated by the a priori estimate. The Skövde population-based study is considered representative for the Swedish population.

Evaluation of Methods for Endoscopic Staging of Nasal Polyposis

Endoscopy is needed for reliable evaluation of the treatment of nasal polyposis. In this study, we compared the reproducibility of various score systems for staging nasal polyposis and the inter-individual variations between investigators. The mass of the polyps was assessed by five methods, three new techniques (numbers 1, 2 and 3) and two established ones (numbers 4 and 5). These were: 1, lateral imaging?projecting the extension of the polyps by drawing on a schematic picture of the lateral wall of each nasal cavity; 2, assessment of polyp obstruction?estimating the proportion of the total nasal cavity volume occupied by polyps; 3, nasal airway patency?determining the relationship between the patient?s patent airway lumen and an imaginary maximal nasal airway lumen; 4, a score system with four steps ad modum Lildholdt et al.?determining their relationship to fixed anatomical landmarks; and 5, a score system with three steps ad modum Lund and Mackay?determining their relationship to the middle meatus. High correlations were found between the first and the second assessments by a given investigator with all five methods used to score nasal polyposis. High correlations were also shown between the various methods. When three investigators examined a given patient, there were no significant differences between the investigators using score systems 1, 3 and 4. However, with score systems 2 and 5, there was insufficient agreement between the investigators. The patient?s symptom of nasal blockage was not a good indicator of the size of the polyps, especially as regards small polyps. Two of the best methods tested (1 and 4) were selected for further clinical studies regarding evaluation of the sensitivity of score systems to detect changes in polyp size during treatment.Endoscopy is needed for reliable evaluation of the treatment of nasal polyposis. In this study, we compared the reproducibility of various score systems for staging nasal polyposis and the inter-individual variations between investigators. The mass of the polyps was assessed by five methods, three new techniques (numbers 1, 2 and 3) and two established ones (numbers 4 and 5). These were: 1, lateral imaging projecting the extension of the polyps by drawing on a schematic picture of the lateral wall of each nasal cavity; 2, assessment of polyp obstruction estimating the proportion of the total nasal cavity volume occupied by polyps; 3, nasal airway patency--determining the relationship between the patients patent airway lumen and an imaginary maximal nasal airway lumen; 4, a score system with four steps ad modum Lildholdt et al.--determining their relationship to fixed anatomical landmarks; and 5, a score system with three steps ad modum Lund and Mackay--determining their relationship to the middle meatus. High correlations were found between the first and the second assessments by a given investigator with all five methods used to score nasal polyposis. High correlations were also shown between the various methods. When three investigators examined a given patient, there were no significant differences between the investigators using score systems 1, 3 and 4. However, with score systems 2 and 5, there was insufficient agreement between the investigators. The patients symptom of nasal blockage was not a good indicator of the size of the polyps, especially as regards small polyps. Two of the best methods tested (1 and 4) were selected for further clinical studies regarding evaluation of the sensitivity of score systems to detect changes in polyp size during treatment.

Mucosal Exudation of Fibrinogen in Coronavirus-induced Common Colds

We studied the mucosal exudation of plasma in relation to pathophysiological events during an induced common cold. Coronavirus 229E was inoculated nasally in 20 healthy volunteers under controlled conditions. Ten volunteers developed the common cold, determined by symptom scores and serology. The bulk plasma exudate was monitored, using fibrinogen (MW 340 kD) in nasal lavage fluids as an endogenous marker. Following inoculation, anterior rhinoscopy and objective registrations of nasal mucosal temperature, nasal discharge weight, and nasal blockage index by peak expiratory air flow, were followed twice daily for 6 days. Mucosal plasma exudation, as assessed by fibrinogen in lavage fluids, increased hundredfold after virus inoculation, concomitantly with the subjective symptoms and objective physiological changes. We propose that this exudation reflects the degree of subepithelial inflammation, and suggests that plasma bulk exudate, including all potent plasma protein systems may be involved in the resolution of acute viral rhinitis--common cold.

Changes in Human Nasal Mucosa during Experimental Coronavirus Common Colds

Twenty-four adult volunteers were inoculated with nasal drops containing a coronavirus of 229E serotype to determine the differences in the clinical and physiological reactions which occur between clinically infected, sub-clinically infected and non-infected individuals. Thirteen volunteers were clinically infected, 8 had sub-clinical infections and 3 were uninfected. Nasal airway resistance and the temperature of the nasal mucosa increased in all infected subjects both with and without symptoms: the core temperature increased also but to a lesser extent. Mucosal blood flow and nasal secretion increased only in those with symptoms. The albumin content of the nasal secretion increased in the clinically infected, suggesting that it was derived, partially at least, from the circulation. The nasal cycle of variation in airway resistance between the two sides of the nose was observed in all three groups but increased only in those clinically infected.

Sustained Use of Xylometazoline Nose Drops Aggravates Vasomotor Rhinitis

The effect of long-term treatment with nose drops on nasal obstruction was studied by measuring nasal airway resistance (NAR) in 12 patients with vasomotor rhinitis and in 10 healthy persons using anterior rhinomanometry. The dose-response effect on decongestion by xylometazoline was followed by decongestion induced by physical exercise. Measurements were performed before and after a 3-week treatment with nose drops containing xylometazoline. NAR at rest was significantly higher in the vasomotor rhinitis patient group than in the control group on the initial measurement, and the difference increased after the treatment period. No changes from before to after were found in the control group. Similar dose-response curves for xylometazoline were seen before and after the treatment period in both groups. Tolerance to xylometazoline apparently does not develop. Nose drops did not result in complete decongestion in patients with vasomotor rhinitis. These findings indicate that rebound congestion (rhinitis medicamentosa) develops in predisposed individuals, and interstitial edema of the nasal mucosa is a possible contributing pathophysiological mechanism.

Clinical relevance of nasal polyps in individuals recruited from a general population-based study

Objective To compare the clinical presentations of individuals with nasal polyps detected by endoscopy in a general population sample with those of patients with nasal polyp disease seeking medical attention. Material and Methods A total of 38 individuals with nasal polyps from a population-based sample were compared with 38 matched controls and a third group consisting of 44 patients who presented to an outpatient clinic with symptoms and diagnosed nasal polyps. Upper and lower airway symptoms were registered. Polyp size, peak nasal inspiratory flow (PNIF), olfactory function and health-related quality of life were measured. Results Compared with the individuals with nasal polyps in the population sample, patients actively seeking medical care for nasal polyposis experienced more symptoms of nasal blockage and an impaired sense of smell, and had more extensive polyps and reduced PNIF. There were equal frequencies of asthma symptoms in these two groups. Compared with the controls, the individuals with nasal polyps in the population sample had a greater frequency of asthma symptoms and aspirin intolerance and also experienced an impaired sense of smell. Conclusion Nasal polyps alone, as seen occasionally, are indicative of airway disease involving the upper and lower respiratory tracts.

Symptoms of persistent allergic rhinitis during a full calendar year in house dust mite-sensitive subjects

Background:  Little is known about the natural course of persistent rhinitis symptoms over a prolonged period.

Prevalence of upper and lower airway symptoms: the Skövde population-based study

Conclusion. This study was able to present representative data from Sweden as a whole and illuminates the epidemiological background of symptoms of the upper and lower airways. Current regular smokers, compared with non-smokers, had more problems with nasal blockage, cough and asthma. The relationship between the upper and lower airways was confirmed as regards airway symptoms. Background. Epidemiology of common respiratory symptoms is basic information in health care. This study has focused on the prevalence of upper and lower airway symptoms. Patients and methods. A random sample of 1900 age- and gender-stratified adults was recruited from a general population for this study, which included a structured interview about symptoms of nasal secretions and blockage, cough and asthma, and a clinical examination with nasal endoscopy, and peak nasal-inspiratory flow (PNIF). Smoking habits were evaluated by a questionnaire for current and previous smoking. Results. A response rate of 73% was achieved. The prevalence of various symptoms varied between age strata and gender. There was a statistically significant relationship between subjectively experienced nasal blockage and objectively observed nasal congestion. PNIF was negatively related to age and height and was increased in male gender. Smoking was most common among females and related to nasal blockage, cough and asthma, but not to nasal secretions. Significant relationships between the upper and lower airways were found.

Effect of oxymetazoline on nasal and sinus mucosal blood flow in the rabbit as measured with laser-Doppler flowmetry.

The effect of topical oxymetazoline hydrochloride on the blood flow of the nasal and sinus mucosa of the rabbit was measured by laser-Doppler flowmetry. Oxymetazoline, the active component in clinically used nose drops, induced a dose-dependent decrease of the nasal mucosal blood flow. This effect has previously been shown in humans and suggests the presence of α2–adrenoceptors in the nasal mucosa of the rabbit. Doses of oxymetazoline used clinically in humans induced a 50% reduction of blood flow in rabbits. Rhythmic variations in blood flow were seen in 30% of the rabbits after administration of oxymetazoline. Additionally, oxymetazoline induced a dose-dependent decrease of the mucosal blood flow in the maxillary sinus when the drug was applied in the nose. A vasoconstricting effect of oxymetazoline on the arteries penetrating the maxillary sinus ostium is a possible explanation. This can have positive as well as negative consequences on acute sinus infections.

Day-Night Differences in Mucosal Plasma Proteins in Common Cold

Aggravation of symptoms in inflammatory airway diseases is common in the early morning hours, but little is known about day-night differences in the occurrence of plasma exudate on the airway surface. We have therefore examined the plasma macromolecules on the nasal mucosa at different time points. The study comprised 20 subjects who had been inoculated (day 0) with coronavirus intranasally. Ten subjects remained healthy and 10 developed common cold with significant symptoms from day 2 to day 6. Starting on day 3 at 8.00 h and repeated at 4 h intervals until 4.00 h on day 4, nasal lavages were carried out by employment of a nasal pool-device which fills the entire unilateral nasal cavity and gently but effectively irrigates its surface. Lavage fluid levels of albumin (Mw 69,000 D) and fibrinogen (Mw 340,000 D) were determined. In the healthy subjects the levels of albumin and fibrinogen remained low throughout the experiment, however, with mean peak values of the two proteins occurring at 4.00 h (p < 0.05 compared to daytime nadir at 16.00 h). In subjects with common cold both albumin (p < 0.05) and fibrinogen (p < 0.01) exhibited marked variation with individual and mean peak levels recorded at 8.00 h day 3, and 4.00 h day 4. These mean peak values were 5-20 times higher (p < 0.01 - p < 0.05) than the mean levels recorded in these subjects at the other time periods. The present data indicate a marked day-night difference in the occurrence of plasma proteins on the airway surface in common cold, whereas in health the difference is much less. We conclude that different-sized plasma proteins may accumulate on the mucosa in healthy airways during late night hours and that in common cold this nocturnal accumulation may be considerably increased.