Péter Clement

Correlations between complaints, inflammatory cells and mediator concentrations in nasal secretions after nasal allergen challenge and during natural allergen exposure

A quantitative determination of the inflammatory mediators was performed and correlated with complaints and the measurement of the inflammatory cells in nasal secretions of 18 seasonal allergic rhinitis patients (group 1) outside the pollen season and 40 symptomatic patients (group 2) with seasonal allergic rhinitis during the pollen season. Ten nonallergic subjects (group 3) were also studied as a normal control group. In group 1, 17 (94%) out of 18 patients had an immediate response of nasal symptoms accompanied by a significant increase of histamine, leukotriene C4 (LTC4), and tryptase 5 min after nasal allergen challenge (NAC). One hour later, a simultaneous increase was seen both in the percentage of the eosinophils and in the eosinophil cationic protein (ECP) concentration. The eosinophil count reached a peak 2 h after NAC with a duration of 8 h, while the highest ECP level was reached only after 24 h with no clear-cut plateau. In group 2, a high percentage of eosinophils was observed. Mostly one observed significantly (p < 0.01) higher concentrations of ECP, LTC4 and histamine but not of tryptase than the baseline values of group 1. The authors concluded that during the pollen season allergic rhinitis reflects mainly a chronic state of allergic inflammation of the nasal mucosa involving various inflammatory components induced by one or more episodes of early-phase type allergic reaction. Infiltration of eosinophils and consequently release of the various late-phase inflammatory mediators into the nasal secretions are certainly believed to be the predominant pathophysiologic condition in the patients.

Effect of cetirizine, levocetirizine, and dextrocetirizine on histamine-induced nasal response in healthy adult volunteers.

Background: Cetirizine, an effective H1‐receptor antagonist, is a racemate mixture of two enantiomers: levocetirizine (R enantiomer) and dextrocetirizine (S enantiomer).

Microbiology of the middle meatus: a comparison between normal adults and children

Middle meatal samples were obtained from 52 carefully selected healthy adults. In 75 per cent of the test subjects bacterial organisms were cultured. However, growth was often poor and the predominant species suggest a commensal flora: coagulase-negative staphylococci were retrieved from 35 per cent, Corynebacterium sp. from 23 per cent and Staphyloccus aureus from eight per cent of the adults. These data are very different from those previously obtained among children where--even in the absence of obvious ENT pathology--the most frequently cultured organisms were typical sinusitis pathogens: Haemophilus influenzae present in 40 per cent, Moraxella catarrhalis in 34 per cent and Streptococcus pneumoniae in 50 per cent of children. Furthermore, Streptococcus viridans and Neisseria sp., both organisms that might be able to inhibit colonization by some of the pathogens and found commonly among children, are virtually absent in healthy adults.

Once daily mometasone furoate aqueous nasal spray is as effective as twice daily beclomethasone dipropionate for treating perennial allergic rhinitis patients

BACKGROUND Perennial allergic rhinitis is chronic and persistent, may lead to a constellation of secondary complaints including sinusitis, mouth-breathing, and some symptoms resembling a permanent cold, and often requires constant medical intervention. Well-tolerated nasal corticosteroids, alone or in combination with antihistamines, have been found to be very effective in treating this condition. OBJECTIVE To compare the effectiveness and tolerability of mometasone furoate aqueous suspension, a new once daily nasal spray, to placebo vehicle and to beclomethasone dipropionate, administered twice daily, in patients with perennial allergic rhinitis. METHODS This was a randomized, double-blind, placebo-controlled, double-dummy, parallel group study, in 427 patients age 12 years and older at 24 centers in Canada and Europe. Patients allergic to at least one perennial allergen, confirmed by medical history, skin testing, and adequate symptomatology were eligible to receive one of the following regimens for 3 months: mometasone furoate, 200 micrograms only daily; beclomethasone dipropionate, 200 micrograms twice daily (400 micrograms total dose); or placebo vehicle control. The primary efficacy variable was the change from baseline in total AM plus PM diary nasal symptom score over the first 15 days of treatment. RESULTS Three hundred eighty-seven patients were valid for efficacy. For the primary efficacy variable, mometasone furoate was significantly (P < or = .01) more effective than placebo and was indistinguishable from beclomethasone dipropionate. Similar trends were seen among individual symptoms, physician symptom evaluations, and therapeutic response. There was no evidence of tachyphylaxis. All treatments were well tolerated. CONCLUSIONS Mometasone furoate nasal spray adequately controls symptoms of perennial allergic rhinitis, offers the advantage of once daily treatment, and is well tolerated.

Management of rhinosinusitis in children

The authors provide definitions for the different forms of pediatric rhinosinusitis, with an enumeration of the main symptoms and signs. They also provide the indications for CT scan examination and microbiological investigations. In addition, they emphasize the importance of concomitant systemic disease, such as allergy and immunological disorders. The adequate medical management, which is mandatory before any surgery, is considered and discussed, and the indications for surgery are provided.

Pathological changes of the lateral nasal wall in patients with cystic fibrosis (mucoviscidosis)

In a prospective clinical study, 84 patients aged 3 months to 34 years (mean age: 12 years; 53 males and 31 females), with cystic fibrosis systematically underwent an ENT examination, including rigid endoscopy of the anterior nasal cavity and lateral nasal wall. In 28 cases, CT-scan of the sinuses was performed. Mucopyosinusitis of the maxillary sinus with medial projection of the inter-naso-sinusal wall was present in 10 children (12%, mean age: 4 years; range: 3 months to 8 years). Nasal polyposis was present in 37 patients (45%) from the age of 5 years on (mean age: 15 years). Nasal obstruction was the main complaint when the condition was severe. The routine use of the endoscope makes it possible to diagnose early pathological changes of the lateral nasal wall. Local treatment could then help slow down progress evolution toward a more massive involvement.

Objective assessment of lower airway involvement in chronic rhinosinusitis.

Background When associated with lower airway involvement, the morbidity and the cost of chronic rhinosinusitis (CRS) can increase. The aim of this prospective study was to assess the clinical and radiological characteristics of the upper airways in CRS patients scheduled for functional endoscopic sinus surgery and to correlate these findings with the functional changes of the lower airways. Methods Twenty-five adult patients with CRS were subjected to clinical and endoscopic assessments, computed tomography scan, and allergic assessments using validated scoring systems. Lower airways were assessed by clinical history, pulmonary function test, histamine bronchial provocation test, and chest x rays. Results Sixty percent of CRS patients were shown to have associated lower airway involvement, i.e., 24% had asthma and 36% had small airway disease (SAD). Nasal congestion and nasal polyps were the most common clinical findings in both of these subgroups of patients. In addition, there was a negative correlation between computed tomography scan findings of the sinuses and the obstructive parameters on pulmonary function test in SAD but not in the asthma subgroup. Conclusion These results showed that different kinds of lower airway involvement frequently could be associated with CRS. Some are manifest such as asthma and some are hidden such as SAD and histamine bronchial hyperresponsiveness.

Acoustic rhinometry and Rhinomanometry in the evaluation of nasal patency of patients with nasal septal deviation

The aim of the present study was to assess the clinical utility of acoustic rhinometry (AR) compared with active anterior rhinomanometry (AAR) in the evaluation of nasal patency in subjects with nasal septal deviation. Fifty patients were divided into three groups based upon the part of the nasal cavity where the septal deviation was situated (anterior: up to 2.5 cm; middle: between 2.5 and 4.5 cm; posterior: between 4.5 and 8 cm measured from the columella). The control group consisted of 15 subjects with no nasal complaints and no history of nasal disease. Inspiratory and expiratory nasal airway resistance (NAR) at 75 Pa and at 150 Pa before and after decongestion were measured by AAR. Minimal Cross-sectional Area (MCA), distance of MCA, and nasal volume (Vol) were measured before and after decongestion by AR (Rhino 2000). Subjective nasal patency was assessed by Visual Analogue Score (VAS). In the statistical analysis the deviated unilateral nasal cavities were compared with the randomly chosen unilateral nasal cavities of normal subjects. Both techniques AR and AAR were sufficiently sensitive to reveal severe deviations in the anterior nasal cavity (MCA, Volant, NAR75, NAR150, p < 0.05). The techniques were less sensitive in cases of middle and posterior deviations (MCA, Volmid, Volpost, MCAmid, MCApost, NAR75, p > 0.05). The nondecongested inspiratory and expiratory NAR at 150 Pa were the only parameter that differed from normal in cases of posterior deviations. The VAS correlated better with NAR than with MCA. MCA correlated more frequently with expiratory than with inspiratory NAR.

Fiberoptic examination of the nasal cavity and nasopharynx in children

In this prospective study, a flexible fiberoptic nasolaryngoscope with color video camera was used to examine the nasal cavity and nasopharynx in 180 pediatric patients. The relative size of the adenoid tissue was judged by endoscopy, which lead to a classification into 3 types according to the distance from the vomer to the adenoid tissue. The condition of the nasopharyngeal orifice of the Eustachian tube was also described and differentiated into 3 types relating to the condition of adenoid tissue. Assessment was performed by correlating these measurements with the tympanogram, lateral X-ray and clinical complaints. The authors conclude that: (1) fiberoptic examination allows direct visualization of the size and condition of the adenoid tissue, as well as of the condition of the nasopharyngeal orifice of the Eustachian tube. (2) The size of the adenoid tissue correlates very well with the nasal obstruction complaints as well as with the type of tympanogram. (3) The condition of the nasopharyngeal orifice of the Eustachian tube significantly corresponds with the type of tympanogram. (4) For the indication of adenoidectomy, fiberscopy gives more accurate information than standard X-ray. (5) With a correct choice of premedication and local anesthesia, it is a minor invasive technique which is very well tolerated by children. It is possible in all cases, provided it is performed by a skilled endoscopist and preceded by careful explanation to the child. (6) Finally, thanks to the possibility of direct visualization of the fiberscopic image via a monitor, it allows a better explanation of the indication for adenoidectomy to the childs parents.

Prevalence of Sinusitis Signs in a Non-ENT Population

Relatively little is known about the prevalence of sinusitis in a general population. Patients with suspected intracranial neurological disease can be considered as representative of the general population. On magnetic resonance imaging nearly 60% of the sinuses were affected. If the most common lesion (a maxillary polyp or cyst) was excluded, still 40% of the sinuses were affected. Above all the maxillary sinuses are involved with 40% abnormal images followed by the anterior ethmoidal sinuses with 14%. The other sinuses are less likely to be affected with 2.5% of the sphenoidal, 2% of the frontal and 1.5% of the posterior ethmoidal sinuses.