Kensei Naito

Nasal Resistance, Sensation of Obstruction, and Rhinoscopic Findings Compared

Nasal resistances were measured by posterior rhinomanometry with a head-out body plethysmograph in 101 adult patients referred to our nasal airflow laboratory and were compared with both the patients’ sensations of nasal stuffiness and with rhinoscopic findings. Symptomatic grading of nasal stuffiness, which is a subjective perception, did not reveal a significant correlation with nasal resistances or with rhinoscopic findings; however, ipsilateral rhinoscopic grading and resistance values were directly related (p < 0.05) and application of Ohms Law for parallel resistors to rhinoscopic grading also showed a direct relationship with measured total nasal resistance (p < 0.05). Pathologic conditions in the anterior nose and anterior septal deviation accompanied by a congested inferior turbinate were important determinants of obstruction.

Comparison of perceptional nasal obstruction with rhinomanometric and acoustic rhinometric assessment

Abstract Perception of nasal stuffiness, together with rhinomanometric and acoustic rhinometric assessments were evaluated before and after nasal and/or sinus surgery in ¶50 Japanese adult patients. Nasal resistance on both expiration and inspiration correlated well with the patients’ perceptions (P<0.05). Nasal volumes (0–4 cm and 0–7 cm) obtained from acoustic rhinometry measurements also correlated well with perception (P<0.05). No significant relationships were found between rhinomanometric and acoustic rhinometric results. Perceptional nasal obstruction, rhinomanometric and acoustic rhinometric results (except for the sectional areas at the I-notch) improved significantly after the operations. Rhinomanometry and acoustic rhinometry are valuable methods for assessing nasal stuffiness, but we must take account of the differences between the two methods.

Sclerosing mucoepidermoid carcinoma with eosinophilia of the salivary glands

We encountered two cases of low malignant mucoepidermoid carcinoma with scanty cellular atypism which originated in the parotid or submandibular gland and was characterized by marked fibrosis and eosinophilic infiltration within tumor tissue despite the predominance of the squamous component. Here we report these two cases and provide a review of the literature. We believe that clinically these two tumors with stromal fibrosis and eosinophilic infiltration have a low malignant potential, although histological examination revealed a scanty mucus-producing epithelial component. Therefore, we consider this type of tumor as a new subtype of mucoepidermoid carcinoma. A low-malignant mucoepidermoid carcinoma with stromal fibrosis and eosinophilic infiltration, as described in these two cases, may be misdiagnosed as a highly malignant mucoepidermoid carcinoma or squamous cell carcinoma because of its histologically scanty mucus-producing epithelial component. The objective of this study was to clarify their differences and to discuss the rendering of an accurate histological diagnosis, the degree of malignancy in relation to prognosis prediction, and the choice of therapy. In addition, we propose regarding this type of tumor as a new subtype of mucoepidermoid carcinoma.

Current advances in rhinomanometry

Current advances in rhinomanometry were reviewed in this paper. Active posterior rhinomanometry with a “head-out” body plethysmograph may be the least invasive method currently available for measuring nasal patency. In general, active anterior rhinomanometry with a face mask or a nasal nozzle has been employed in various studies throughout the world. Nasal resistance as calculated from the equationR = 0.78 (ΔP/V)1.33 at any points on a pressure/flow curve, or averaged nasal resistance may be the most suitable expression for nasal patency. Values for nasal resistance at ΔP 100 Pa in Japanese patients or ΔP 150 Pa in Caucasians have been widely employed as standard objective data for nasal obstruction, although rhinomanometric results sometimes do not agree with subjective evaluation of nasal obstruction. Nasal airflow acceleration or peak flow index during nasal breathing at rest can be applied as warranted to confirm an objective diagnosis of symptomatic nasal obstruction. Further, nationality and anthropological characteristics can be related to the severity and type of stuffiness.

Laryngeal symptoms in patients exposed to Japanese cedar pollen: allergic reactions and environmental pollution

Sirs: In Japan, the number of Japanese cedar (Cryptomeria japonica) pollinosis patients has been increasing, with more than 10% of the population now suffering from this seasonal nasal allergy [4]. Many of these patients complain about itching of the throat, persistent cough and feeling like there is a foreign body in the larynx. Additionally, ambient air pollutants probably promote sensitization of airway mucosa and exacerbate allergic respiratory disorders and their symptoms [1, 3, 6, 7]. In an attempt to determine both the existence of laryngeal allergy to cedar pollen and the effect of air pollutants, we undertook a clinical study and a series of animal experiments. To demonstrate laryngeal manifestations in Japanese cedar pollinosis patients, two hospitals in the Aichi prefecture were chosen. One hospital was situated in a planted cedar woodland region without heavy industry (Shinshiro) and the other in an urban, crowded, heavily industrial area (Nagoya). Between 1991 and 1995, clinical records of patients with Japanese cedar pollinosis attending the two hospitals were examined. The patients were diagnosed as suffering from Japanese cedar pollinosis by the presence of eosinophilia in nasal secresions and serum IgE antibody specific to Japanese cedar pollen. In Shinshiro (woodland region) a total of 276 patients were available for review, while 165 were seen in Nagoya (urban industrial area). No significant differences in age (unpaired t-test), sex (χ2-test) and serum level of specific IgE antibody (unpaired t-test) were found between the two groups in each year of the study. All patients were questioned as to symptoms of nasal stuffiness, itching of the eyes, soreness of the throat, cough, sputum, hoarseness and foreign body sensation in the larynx. U-tests were employed for statistical significance. Pollen counts in the woodland were 2–5 times higher than those in the urban industrial area (Fig.1). NO2 concentrations in the urban industrial area during the same periods were twice as high as those in the woodland (Fig.2). Also, SO2 and suspended particulate matter (SPM) levels of the ambient air in the urban area were 2–3 times higher. The severities of laryngeal symptoms varied directly with the cedar pollen counts, as did nasal and ophthalmic symptoms (Table 1). The large number of patients with Japanese cedar pollinosis who complained of laryngeal symptoms was beyond our expectation, with a foreign body sensation in the larynx being the most frequent complaint in the urban industrial area, and K. Naito · S. Iwata · N. Yokoyama

The Effect of L-Menthol Stimulation of the Major Palatine Nerve on Nasal Patency

Objective and subjective measurements of nasal patency were made before and after L-menthol stimulation of the palatal mucosa (supplied with the trigeminal nerve) in 15 normal adult subjects. The stimulation exerted indirect effect on the nasal cavity in that all subjects mentioned a cold sensation in their nose and a sensation of increased nasal patency, but no influence on nasal resistance to airflow was detected.

Efficacy of combined treatment with S-carboxymethylcysteine (carbocisteine) and clarithromycin in chronic rhinosinusitis patients without nasal polyp or with small nasal polyp

OBJECTIVE In Japan, fourteen-membered ring macrolides, antibacterial agents, and S-carboxymethylcysteine (SCMC; carbocisteine), a mucolytic, are commonly used to treat chronic rhinosinusitis (CRS), and they are also used in combination. However, no large-scale randomized study has examined the effects of these pharmacotherapies. The aim of this study is to evaluate the effect of combined administration of clarithromycin (CAM), a fourteen-membered ring macrolide, and SCMC, compared with CAM single therapy. METHODS Patients with CRS were centrally registered and randomly assigned to treatment with CAM (200mg/day) alone (monotherapy group) or CAM (200mg/day) in combination with SCMC (1500mg/day; combination group) for 12 weeks. We assessed the clinical efficacy of the treatments using measures of subjective symptoms and objective findings, health-related quality of life (HRQOL) determined by the 20-Item Sino-Nasal Outcome Test (SNOT-20) score and computed tomography (CT) score. RESULTS Four hundred twenty-five subjects were enrolled (combination group, 213; monotherapy group, 212). At week 12 of treatment, the rate of effectiveness was significantly higher in the combination group (64.2%) compared with the monotherapy group (45.6%; P=0.001). In addition, objective findings, including characteristics of nasal discharge (P=0.008) and post-nasal discharge (P=0.002) were significantly improved in the combination group. In both groups, SNOT-20 and CT scores were significantly improved from week 0 (P<0.001), and were not significantly different between groups. CONCLUSION The results indicated that long-term combination therapy with SCMC at a dose of 1500mg/day and CAM at a dose of 200mg/day is effective for improving subjective symptoms and objective findings in adult patients with CRS.

The effect of l-menthol stimulation of the major palatine nerve on subjective and objective nasal patency

To determine whether L-menthol stimulation of the major palatine nerve can affect nasal patency, we noted subjective and measured objective nasal patency before and after L-menthol stimulation of the palatal mucosa. L-Menthol stimulation of the palatal mucosa enhanced nasal sensation of airflow but nasal resistance was unaffected. By contrast, L-menthol stimulation after local anesthesia of the palatine nerve or of the nasal mucosa substantially diminished the subjective response of increased nasal patency but without affecting objective nasal patency. It is suggested that the effect of both direct stimulation by L-menthol of the major palatine nerve and its vapor action on the sensory nerve endings of the nasal mucosa produce an increase in the sensation of nasal patency without an increase in objective nasal patency.

Nasal Patency: Subjective and Objective

Nasal airflow resistances (cm H2O/L/sec), accelerations (L/sec2), alteration of transnasal differential pressure, duration (sec) of inspiration and expiration and peak flow index were measured in 31 adult patients referred to our nasal airflow laboratory. Measurements by posterior rhinomanometry using a head-out body plethysmograph were compared with symptomatic severity of nasal stuffiness. Symptomatic severity of nasal stuffiness, which is a subjective perception, did not reveal a significant correlation with nasal resistances and alteration of transnasal differential pressure on quiet breathing. Acceleration of inspiratory airflow through the nose showed a direct relationship with symptomatic severity of nasal stuffiness (p < 0.04) but acceleration of expiration was not related to obstructive symptoms. Peak flow indices on expiration in the patients who did not complain of nasal stuffiness were significantly less than those on inspiration; however, as symptoms of nasal stuffiness increased, the differences between inspiratory and expiratory indices decreased. Duration of the respiration cycle showed no particular relationship with severity of obstructive sensation. We think that acceleration of nasal airflow and peak flow index can be applied to complement the diagnosis of subjective nasal stuffiness.

A comparison of current expressions of nasal patency

SummaryRhinomanometry is well established as a useful clinical method for objective assessment of nasal patency, although several expressions of nasal patency have been reported and universal standardization has not been achieved. In this communication, nasal resistances were calculated from the equation R = ΔP/V (R; resistance; ΔP; transnasal differential pressure; V; nasal airflow) at ΔP 100 Pa and at peak flow. Time-averaged nasal resistances and integrated nasal patencies were measured in 350 adult patients by Rhinorheograph MPR-1100 and processed by a NI-101 computer program. The values from the equation R = ΔP/V at ΔP 100 Pa were slightly lower than those from the same equation at peak flow or those from the time-averaging method. Correlations between the values of nasal resistance at peak flow and the time averaging method were very close to the line of identity. No significant correlations were demonstrated between integrated nasal patency and the values from the other three expressions. The differences of the results from these expression are discussed.