Shigenobu Iwata

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.

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.

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.

SEASONAL VARIATIONS OF NASAL RESISTANCE IN ALLERGIC RHINITIS AND ENVIRONMENTAL POLLEN COUNTS II: EFFICACY OF PRESEASONAL THERAPY

We gave Mao-bushi-saishin-to, a Chinese blended medicine, and azelastine to an adult patient with hay fever due to Japanese cedar pollen and measured nasal resistance and ambient floating pollen counts throughout the time of Japanese cedar pollination in separated years. In the patient Mao-bushi-saishin-to was effective against preseasonal increases in nasal airway resistance but could not control severe episodes of allergic rhinitis caused by high dose exposure to Japanese cedar pollen and also perhaps caused by a priming effect. Azelastine inhibited both pre- and post-seasonal increases in nasal airway resistance but not only on high pollen counts days.

The Distribution of Eosinophil Cationic Protein Positive Eosinophils in the Nasal Mucosa of the Nasal Allergy Patients

The relationship between the distribution of eosinophils and epithelial damage of the nasal mucosa in nasal allergy was investigated by means of hematoxylin and eosin staining and a technique of immunohistochemistry using the anti-human EG2 mouse monoclonal antibody that reacts with the secreted form of eosinophil cationic protein (ECP). Nasal mucosa tissue of 26 adult nasal allergy patients and of 24 adult non-allergic rhinitis patients was removed surgically. Eosinophilia in the nasal mucosa of the allergy group was greater than that in the non-allergy group. A great number of ECP positive eosinophils accumulating in the nasal mucosa of the allergy group were mostly degranulated at the superficial layer of the lamina propria. Desquamation of the epithelium was observed mainly in the area of eosinophilia with degranulation of the secreted form of ECP in the nasal allergy group.

Intranasal aerodynamic aspects in patients with nasal septal perforations

SummaryIn an attempt to determine the influence of septal perforations on nasal airflow, nasal resistances were measured with active posterior rhinomanometry and compared before and after closure of asymptomatic septal perforations in five patients. No significant differences were found in the nasal resistances before and after closure of perforations either on inspiration or expiration. All patients were also unaware of any perceptive changes in nasal patencies after closure of the perforations.

Specific IgE and IgG4 antibodies to Japanese cedar pollen and total IgE antibody in lumbermen

Serum levels of specific IgE and IgG4 antibodies to Japanese cedar (Cryptomeria japonica) pollen and total IgE antibody in 75 lumbermen and in 53 male office workers at an urban establishment were measured by means of an enzyme linked immunosorbent assay (ELISA) and compared. No significant differences of specific IgE and IgG4 to cedar pollen and total IgE were found between the lumbermen and the office workers. There were no significant differences of incidence of cedar pollinosis and positive (greater than 100 FU/ml) rate of serum specific IgE between the two groups, though the lumbermen were exposed to dense concentrations of cedar pollen in their working area. In the lumbermen who showed positive values of specific IgE, the mean value of the specific antibody in Japanese cedar pollinosis lumbermen was significantly higher than that in symptom-free lumbermen, while no significant differences of serum level of specific IgG4 were found between the two groups.

Seasonal Variations of Nasal Resistance in Allergic Rhinitis and Environmental Pollen Counts

We made measurements of nasal airway resistance in a patient with Japanese cedar pollinosis and also measured the environmental pollen counts under different exposure conditions. In the season of high Japanese cedar pollen counts in Japan values of mean nasal airway resistance were significantly increased, remained elevated for 2 months after the season, and eventually decreased. In the season of low pollen counts, the mean values of nasal airway resistance measurements were increased during the season but decreased more rapidly after the season. In a year with no exposure to the environmental allergen because the subject lived out of Japan, the mean nasal airway resistances were relatively increased closely in phase with the Japanese cedar pollen season.