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Chronic rhinosinusitis is characterized by persistent inflammation of the nasal and paranasal mucosa with numerous emigrated leukocytes. L-selectin on leukocytes and its endothelial glycosylated ligands initiate organ-specific leukocyte infiltration into inflamed tissues.The purpose of this study was to evaluate the endothelial expression of functionally active endothelial L-selectin ligands, sulfated sialyl Lewis x, in maxillary sinus mucosa from patients with chronic rhinosinusitis and from normal control subjects.Maxillary sinus mucosa specimens (116) were obtained surgically and immunohistochemically stained with monoclonal antibodies detecting sialyl Lewis x or sulfated extended core 1 lactosamines. The severity of the inflammation was determined by intraoperative endoscopic findings, computed tomography scans, and histopathologic assessment of the specimens.The percentage of vessels expressing endothelial sulfated sialyl Lewis x epitopes increased during chronic rhinosinusitis compared with uninflamed control tissue, especially in patients with additional allergic rhinitis, and decreased in specimens from aspirin-intolerant patients with preoperative oral corticosteroid treatment. In addition, the expression level of endothelial sulfated sialyl Lewis x epitopes and the number of mucosal eosinophils correlated with the severity of the inflammation, and decreased in specimens taken 9 months postoperatively compared with intraoperative samples, especially in patients with intranasal corticosteroid treatment.Our results suggest that functionally active L-selectin ligands might guide leukocyte traffic into maxillary sinus mucosa preferentially in patients with severe findings of chronic maxillary rhinosinusitis, thus leading to aggravation of the inflammation.

The objectives of this prospective study were to clarify how well acoustic rhinometry (AR), computed tomography volumetry (CTV), rhinomanometry (RMM), and the visual analogue scale (VAS) identify changes in intranasal pathology after endoscopic sinus surgery in patients with chronic sinusitis. The measurements were performed in 44 nasal cavities of 11 patients pre- and postoperatively, 6 of whom underwent middle meatal antrostomy and 5 of whom underwent ethmoidectomy. The AR and RMM results were compared with those obtained with CTV and VAS. Furthermore, a favourable outcome in sinus surgery was obtained with all of the methods. The results showed clearly that endoscopic sinus surgery significantly changes the intranasal geometry and can be obtained reliably using rhinometric measurements. Both AR and CTV identified statistically significant (p < .05) volume changes in the nasal cavities. The AR and CTV results correlated generally well (r = .72) with each other, but wide differences were seen between the operative groups. Correlation in the ethmoidectomy group was very strong (r = .93) but weak in the middle meatal antrostomy group (r = .37). In the nasal function measurements, nasal obstruction decreased significantly (p < .05) after the surgery. The changes were clearly obtained using RMM and VAS (p < .05). Correlation between these methods was generally poor (r < .30), but a difference was again seen in the operative groups. In the ethmoidectomy group, correlation was moderately good (r = .55) but weak in the middle meatal antrostomy group (r = .29). We concluded that rhinometric methods are reliable tools for evaluation of operative outcome in endoscopic sinus surgery patients. Inspiratory resistance measured with RMM and nasal obstruction assessed with VAS appeared to measure separate parameters in nasal function.

The objective of this study was to determine how well different rhinometric measurement methods identify intranasal changes during acute viral rhinitis. A total of 69 patients acutely ill with the common cold were examined. Acoustic rhinometry (AR), rhinomanometry (RMM), nasal PEF (nPEF) and Visual Analogue Scale (VAS) recordings were performed before the subjects became ill and after the onset of the infection, on days 3 and 10. In AR the minimal cross-sectional area and nasal cavity volumes decreased in a statistically significant manner during the early stage of infection (20.0% vs. 20.4% lower than baselines), and at the end of the infection the values were normalizing towards the baseline values, although still 7.2% vs. 10.4% lower than baselines (p0.05). In RMM the total resistances during expiration and inspiration strongly increased, 39.7% vs. 41.6% higher than baselines on day 3. On day 10 the resistances were normalizing slowly but remained 34.1% and 41.5% higher than baselines (p0.05). In nPEF the decrease in rates was also seen on day 3 (25.0% lower than baseline) and recovery in rates on day 10 (only 3.1% lower than baseline, p0.05). The changes in VAS were similar to those seen in objective rhinometric measurements. Statistically and clinically significant correlations were calculated within AR parameters (r = 0.96) and RMM parameters (r = 0.98), other rhinometric parameters did not correlate in a clinically significant manner (r0.40). We concluded that these 4 rhinometric methods support each other very well in pathological noses, and the methods employed identify intranasal changes very sensitively during an intranasal mucosal pathology.

The most common rhinometric measurement methods used in modern rhinology are acoustic rhinometry, rhinomanometry, and nasal peak expiratory flow (PEF) rate. In this prospective study, we wanted to clarify whether the parameters given by these three methods in the same subject support each other and can be used simultaneously in clinical practice. We also wanted to define the dimensions of normal nasal geometry and function based on these three methods. The rhinometric measurements were done in 249 healthy white subjects consisting of 171 women and 78 men. The geometry was analyzed with regard to body mass index (BMI) and smoking habits. The result could be used as some kind of reference value for the same kind of patient cohort as when rhinological pathology is investigated. The measurements obtained by acoustic rhinometry showed only statistically significant correlations between the measured volume and minimal cross-sectional area in the nasal cavities (r = 0.959). Rhinomanometry showed only a statistically significant correlation between the measured resistance in expiration and inspiration (r = 0.977). Acoustic rhinometry, rhinomanometry, and nasal PEF did not show any correlations and the BMI did not have any effect on the results. Although the smoking group was relatively small in this cohort, the rhinometric methods showed smaller nasal cavity volume, higher resistance, and lower nasal PEF values. Based on these results, we recommend the use of these three rhinometric methods as independent instruments in rhinological examinations. However, in the pathological nose, e.g., smokers, the methods show equal changes in measurements. It is important to measure at least acoustic rhinometry and rhinomanometry at the same time in clinical practice to achieve good quality of examinations.

Lymphangiomas are benign, soft tumors that most often affect the head and neck area, usually causing marked cosmetic and functional problems. Treatment options include surgery and a large number of different sclerotherapy agents. Surgical treatment is challenging because of the need for complete excision. The risk of damage to surrounding structures or poor cosmetic results is high. Various sclerotherapy agents have been shown to have minimal effects on lymphangiomas. Their use has been associated with severe systemic, local and cosmetic side effects. OK-432 (Picibanil) is a new and promising form of sclerotherapy. An intracystic injection of OK-432 produces a local inflammatory reaction, which leads to resolution of the lesion. We have treated 11 pediatric lymphangioma patients with OK-432 with excellent results: complete regression in six, marked regression in four and no response in one case. Local swelling should be anticipated, especially when treating lesions near the upper airway. We found OK-432 injections to be safe and effective as a first line of treatment for lymphangiomas.

Maxillary sinus puncture is traditionally carried out through the lateral wall of the inferior nasal meatus under local anesthesia. One problem with it is that the insertion of a cotton-tipped applicator soaked in local anesthetic is painful. Patients also dislike waiting for the anesthetic effect with the metallic applicators in the nose. In this study, we present a new, well-tolerated method of topical anesthesia for maxillary sinus puncture via the inferior meatus of the nose. Twenty adult patients with maxillary sinus infection who were undergoing bilateral maxillary sinus puncture were studied. One side of each patient's nose was anesthetized with a cotton-tipped applicator moistened with a lidocaine-adrenaline solution (LA), and the other side was anesthetized with EMLA cream instilled with a suction needle and syringe; the sides were chosen randomly. The mean “application of anesthesia” pain score on a 100-mm visual analog scale was 39.2 for the LA side and 9.1 for the EMLA side (p

The objective of this study was to determine nasal cavity volumes and cross-sectional profiles from segmented coronal high-resolution computed tomography (HRCT) images. Pathological mucosal changes and congenital sinonasal variants were quantitated and three-dimensional (3D) images for determining sinonasal airway diseases evaluated by using the new semiautomatic segmentation software, Anatomatic. Anterior to posterior cross-sectional profiles of the sinonasal airway were obtained from acoustic rhinometry and segmented coronal HRCT images and compared in five patients having complaints of nasal obstruction and chronic sinusitis. Results showed that accurate volumes of air spaces in the nasal cavity and paranasal sinuses were obtained. When compared, the cross-sectional profiles of the nasal cavities obtained from acoustic rhinometry and the segmentation technique were similar in the anterior portion, but differed in the posterior portion. The results obtained by coronal HRCT and segmentation were more reliable than those produced with acoustic rhinometry. 3D images acquired from segmented images were found to help make a good pre-operative assessment of the whole sinonasal compartment. Segmentation and volumetric analysis using the Anatomatic technique also proved to be well suited to the evaluation of the nasal cavity and paranasal sinus geometry in patients with sinonasal diseases.

During the indoor cattle feeding season, dairy farmers are continuously exposed to allergenic bovine-derived materials for a long time every year. Limited information is available about the dynamics of exposed people's antibody responses under the influence of this kind of exposure. In this study, the level of antibodies to bovine epithelial antigen (BEA) was found to reflect the level of clinical allergy. On the other hand, the level of immunoglobulin (Ig)E, IgA and IgG antibodies to bovine urinary antigen (BUA) was lower in the group of bovine-allergic farmers than among other farmers. It was concluded that antibodies to different allergen extracts reflect different phenomena. Antibodies to BEA seem to be associated more with allergic symptoms, where as anti-BUA antibodies might reflect the level of bovine exposure. The indoor cattle feeding season did not cause any major changes in dairy farmers' humoral responses. The continued allergen exposure did not increase the level of sensitization as determined by antibody responses.

Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were used to study the ultrastructure of human respiratory cilia in 34 patients with chronic or recurrent respiratory infections and 11 control patients. Specimens of pathological mucosa were taken from 12 maxillary sinuses and 22 middle turbinates. Control tissues were taken from middle turbinates or from sphenoid sinuses during transsphenoidal pituitary surgery. Findings in control tissues or specimens with minimal amounts of pathological findings showed that TEM and SEM findings correlated well. TEM revealed axoneme structure better, while much larger populations of cilia could be studied three-dimensionally with SEM. SEM also was the better study when cilia orientations or lengths were evaluated. Optimal examination of ciliary ultrastructure required both TEM and SEM studies.

A 48-year-old man was examined because of anosmia. He was otherwise healthy except for mild arterial hypertension. He had stopped smoking 20 years ago. Previously he had been exposed to sulfuric acid gases for 3 years in his work. Clinical examination revealed no findings to explain his anosmia. The patient was fertile, indicating normal sperm/cilia motility. Nasal mucociliary function was examined by radioactive tracer and found to be markedly and constantly impaired. Ciliary ultrastructure in cross-sections was normal. However, in longitudinal sections the length of the cilia varied from 0.6 microns to 3.9 microns. The mean length of the cilia from the cell membrane to the tip was 2.5 +/- 0.9 microns, in contrast to normal ciliary length of 5-7 microns. These findings represent a new structural defect among the various known ciliary abnormalities.

Ciliary orientation was studied in 43 patients with the "immotile cilia" syndrome. Twenty-four of these patients had total situs inversus. One mucosal specimen was taken from uterine cervical epithelium, 2 were from bronchial mucosa and 40 from nasal mucosa. The orientation of the cilia was measured from micrographs using a semiautomatic image analyzer (IBAS I). The results from patients were compared with those of 10 control subjects. The mean standard deviation and its standard deviation of the angles of ciliary orientation was 39.7 degrees +/- 9.2 degrees in 43 patients and 27.4 degrees +/- 4.3 degrees in the control group. The difference between the groups is highly significant statistically (P less than or equal to 0.001). However, there were no statistically significant differences in the standard deviations of ciliary orientation between the fields sectioned near the cell membrane or near the ciliary tip. We were also unable to find any significant differences in the standard deviations of the ciliary angles in the specimens taken from brush biopsies and excisional biopsies. There were also no statistically significant differences between the standard deviations of the ciliary angles for the groups with or without situs inversus. If 35 degrees is considered to be the limit value for the mean standard deviation between normal and pathological specimens in our total material, this would give a specificity of 0.90 and a sensitivity of 0.72.

Ultrastructure of human respiratory cilia was studied in ultrathin serial sections and in random fields of sections. The apex of the cilium had dense gray material under the plasma membrane, where the "central" pair of tubules (often slightly eccentrically placed) and the single peripheral tubules ended. Thereafter the cilium thickened gradually about 1 micron below the apex and after that remained reasonably constant. At about 0.5 micron below the apex was a transformation zone (0.1 micron long), where both double and single peripheral tubules were seen. Dynein arms were not seen in the transformation zone but occurred approximately 0.1 micron below it. In a cilium, one peripheral double tubule was absent in the transformation zone but was seen about 0.2 micron below. This resulted in an artificial 8 + 2 pattern in a few sections. In cross sections at levels with peripheral double tubules the mean of the minor axes of the cilia was 0.198 +/- 0.009 micron (+/- SD) calculated from the serial sections of one patient. In 20 patients the variation was greater and the mean was higher: 0.210 +/- 0.042 micron (+/- SD).

The ciliary ultrastructure with different fixatives and buffer combinations and artifacts caused by handling the specimens was studied in samples from respiratory mucosa. After different standard fixatives the ciliary ultrastructure did not vary much. Glutaraldehyde in cacodylate gave the best result; the contrast was good and the cell membrane did not show undulation and so many blebs as with other fixatives. With old 4% formaldehyde + 1% glutaraldehyde inphosphate the cytoplasm was darker and the contrast was not as good as with a fresh fixative. Mechanical damage caused rupture of the cell membrane and sometimes changes in axonemal architecture. These findings are similar to those often seen in human samples. The axonemal architecture was always intact if the cell membrane was intact.