Bulent Mamikoglu

Acoustic rhinometry findings in patients with mild sleep apnea.

BACKGROUND: Nasal obstruction may contribute to the development of obstructive sleep apnea (OSA). Acoustic rhinometry (AR) measures nasal patency and congestion, which are useful parameters in objectively evaluating nasal obstruction. The nasal obstruction produced by allergic rhinitis may contribute to the development of OSA and can be easily assessed with AR. OBJECTIVE: This study was undertaken to assess the degree of nasal obstruction seen in allergic patients with and without OSA. STUDY DESIGN AND SETTING: This study was a retrospective data analysis from a tertiary referral center. The AR data from 10 patients with and 40 patients without mild OSA were compared. RESULTS: The mean congestion factors at the first cross-sectional area (CSA1) on the AR graph were found to be significantly higher in the OSA group than in the non-OSA group (P = 0.03). The classification of change in congestion factors demonstrated significant differences at CSA1, CSA2, and CSA3 and in volume (***t distributions <0.001, 0.0312, <0.001, and <0.001, respectively). The non-OSA patients noted a significant subjective improvement in nasal congestion after topical nasal decongestion, whereas the OSA patients did not (P < 0.0001 and 0.064, respectively). CONCLUSION: Although the role of nasal obstruction in OSA is controversial, our study lends evidence to the thought that the nasal obstruction associated with allergic rhinitis is associated with the presence of mild OSA. SIGNIFICANCE: Whether allergic rhinitis is a direct cause of OSA is debatable, but we have shown that greater nasal congestion is related to the presence of OSA in a population of patients with allergic rhinitis.

An interpretation method for objective assessment of nasal congestion with acoustic rhinometry

Objectives Acoustic rhinometry is a relatively new modality for evaluating the status of the nose. It assesses the geometry of the nasal cavity by analyzing reflected sound waves. Despite its expanding use, there is no established interpretation method. Our aims in the present descriptive study were to develop and test a protocol as a possible method to read these graphs for clinical use.

Acoustic rhinometry and computed tomography scans for the diagnosis of nasal septal deviation, with clinical correlation☆

OBJECTIVE: The aim in this study was to analyze the efficiency and reliability of acoustic rhinometry (AR) readings in recognition of nasal septal deviation. METHOD: We compared 24 patients AR readings with their sinus CT scans. The patient data were analyzed by comparison with normative data, area, and percentage differences between the two sides. Additionally, the data further analyzed by receiver operating characteristic curve and Spearman correlation of CT and AR in determining nasal septal deviation. RESULTS: The sensitivity of AR in detecting anterior septal deviations was found to be 54%, with a specificity of 70%. A very highly significant correlation (P ≤ 0.001) was found between minimal cross-sectional area (CSA) 1 values and CT results. DISCUSSION: In the interpretation of AR readings, comparison of each CSA value should be included, in addition to use of the total absolute CSA values. CONCLUSION: According to our findings the diagnosis of nasal septal deviation can be supported by AR readings. (Otolaryngol Head Neck Surg 2000; 123:61-8.)

Beef, Pork, and Milk Allergy (Cross Reactivity with Each Other and Pet Allergies)

OBJECTIVE: The purposes of this study were to examine milk allergic patients to determine concomitant reactivity between milk, beef, pork and cat and dog dander and other common inhalant allergens. METHODS: 19 patients were selected according to their Immuno-CAP results, which had increased Ig-E levels against milk, pork or beef. Patients were also tested against Johnson grass, short ragweed, cat/dog dander and d. farina. RESULTS: Pearsons test revealed strong correlation between beef and pork, beef and milk, pork and milk Ig-E counts (consecutively r2 = 0.89, r2 = 0.81, r2 = 0.60 and p < 0.01. All cat allergic patients also appeared to be allergic to either beef/pork meat or milk. The correlation between pork and dog dander Ig-E counts was also significant (r2 = 0.38, p < 0.01). No correlation detected between milk-meat-pet and grass-weed-dust allergies. DISCUSSION AND CONCLUSION: Patients who are known to have pet allergies may need to be screened for meat and milk allergy. Milk allergic patients may also need to avoid cows and pork meat.

Quality of life in treatment of acute rhinosinusitis with clarithromycin and amoxicillin/clavulanate.

Objectives: Clarithromycin and amoxicillin/clavulanate (A/C) are first line antibiotics used to treat uncomplicated acute rhinosinusitis (ARS). This study examined the efficacy of clarithromycin and A/C for the treatment of ARS relative to the patients quality of life (QOL).

Detection of the nasal cycle.

The nasal cycle is a fluctuation of nasal patency due to the stages of congestion and decongestion of the nasal mucosa on both the right and left nasal conchae. We compared the effectiveness of the rhinostereometer in detecting the presence of a nasal cycle with the acoustic rhinometer whose effectiveness we have demonstrated in previous studies. The rhinostereometer measures the horizontal range of the most anterior portion of the inferior turbinate. The acoustic rhinometer measures the volume and various cross-sectional areas of the nostril using a pulse emitted from a sound tube. Among some of the subjects tested, it was found that rhinostereometer and acoustic rhinometer measurements of nasal patency correlated reasonably well with r values up to 0.78. The overall correlation between rhinostereometry and acoustic rhinometry was not as strong at r = 0.36. Observed variations between rhinostereometry and acoustic rhinometry could be a result of certain confounding variables that may have altered the nasal cycle between measurements.

ImmunoCAP and HY•TEC enzyme immunoassays in the detection of allergen-specific IgE compared with serial skin end-point titration by receiver operating characteristic analysis:

OBJECTIVES In this study, we compared 2 different immunoassays, HY•TEC enzyme immunoassay (Hycor Biomedical Inc, Garden Grove, CA) and Pharmacia Upjohn ImmunoCAP (Pharmacia and Upjohn, Kalamazoo, MI) using skin end-point titration as a gold standard by receiver operating characteristic analysis. MATERIALS One hundred patients were enrolled in this study and were tested with the above 3 modalities. The results were analyzed by receiver operating characteristic analysis, in which the curves give a decision criterion for any diagnostic test relative to its sensitivity and specificity against an accepted gold standard test. Only inhalant allergens (Dermatophagoides pteronyssinus, Dermatophagoides farina, cat dander, giant ragweed, English plantain weed, timothy grass, Alternaria tenuis, Aspergillus fumigatus, meadow fescue, oak tree, white ash tree, and lambs-quarter weed) were studied. RESULTS The results obtained with both ImmunoCAP and HY•TEC showed a good correlation with skin end-point titration for D pteronyssinus, D farina, cat dander, giant ragweed, timothy grass, A tenuis, and meadow fescue, with sensitivities ranging from 71% to 88%. However, the sensitivity of both tests to English plantain weed, lambs-quarter weed, oak tree, and white ash tree was lower (66% down to 39%). Additionally, HY•TEC results were not satisfactory for detecting specific IgE to A fumigatus (30% sensitivity). The overall sensitivity for each test was 65.67% for the HY•TEC and 71.25% for the Immuno-CAP. CONCLUSION The 2 in vitro testing systems are comparable for most of the allergens, except for A fumigatus, English plantain, lambs-quarter, and white ash tree; ImmunoCAP and HY•TEC would benefit from improved technology for detecting these specific IgE antibodies. The HY•TEC assay did not give acceptable results for A fumigatus. The overall assay characteristics were good to excellent for each system tested. (Otolaryngol Head Neck Surg 2000;122:64–70.)

Clinical applications of acoustic rhinometry

Since its introduction to clinical diagnostic purposes in 1987, acoustic rhinometry has become a valuable tool for assessment of nasal function, for both clinical and research purposes. In this article, the authors review the recent literature regarding clinical applications of acoustic rhinometry. The first section of this review will update the readers about the definitions, testing accuracy, and repeatability of acoustic rhinometry; the second part will concentrate on the pros and cons of using acoustic rhinometry in clinical practice in the view of current literature.

Safety of antihistamine therapy

Management of the symptoms of allergic rhinitis greatly improved with the use of nonsedating antihistamines after the 1980s. The prevalence of allergic rhinitis ranges from 10% to 30%, and the estimated annual cost of over-the-counter and prescription antihistamines in the United States is close to

A comparison of skin endpoint titration and skin-prick testing in the diagnosis of allergic rhinitis.

1 billion. This paper reviews the recent literature on antihistamines, focusing especially on the mechanism of their adverse effects, drug-drug interactions, and the metabolism of currently available nonsedating or low-sedating antihistamines. The reader is directed to the original studies for more detailed information.