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Nitric oxide (NO) is a molecule that performs many functions in the human body. The entire respiratory tract can produce NO, but the highest production occurs in the upper respiratory tract, in the paranasal sinuses in particular. The aim of the present study was to assess a new nasal NO (nNO) measurement method using the Niox MINO Nasal® device (Aerocrine AB, Solna, Sweden) and a special procedure, in order to compare the nNO values obtained in 32 healthy subjects with the values found in the international literature. The measured normal nNO values were equal to 426.76±143.27 ppb, with a 95% confidence interval [160.22-733.30]. Males had an average nNO value equal to 446.76±133.63 [178.64 – 714.02], whereas in females the average value was 403.80±154.90 [94.00-713.60]. This study allows us to confirm that we have been able to establish the normal range of nitric oxide quantity produced in the nasal/sinus cavities of healthy individuals using the Niox MINO Nasal® device and tidal-breathing with velum-closure manoeuvre.

Allergic rhinitis (AR) is caused by an IgE-mediated inflammatory reaction. Non-allergic rhinitis (NAR) is characterized by a non-IgE-mediated pathogenesis. Frequently, patients have the two disorders associated: such as mixed rhinitis (MR). Hyaluronic acid (HA) is a fundamental component of the human connective tissue. HA may exert anti-inflammatory and immune-modulating activities. Recently, an intranasal HA formulation was proposed: a supramolecular system containing lysine hyaluronate, thymine and sodium chloride (T-LysYal®). This randomized study investigated whether intranasal T-LysYal® (rinoLysYal®, Farmigea, Italy) was able to reduce symptom severity, endoscopic features, and nasal cytology in 89 patients (48 males and 41 females, mean age 36.3±7.1 years) with AR, NAR, and MR. Patients were treated with intranasal T-LysYal® or isotonic saline solution as adjunctive therapy to nasal corticosteroid and oral antihistamine for 4 weeks. Patients were visited at baseline, after treatment and after 4-week follow-up. Intranasal T-LysYal® treatment significantly reduced the quote of patients with symptoms, endoscopic features, and inflammatory cells. In conclusion, the present study demonstrates that intranasal T-LysYal® is able, as ancillary therapy, to significantly improve patients with AR, NAR, and MR, and its effect is long lasting.

Functional Endoscopic Sinus Surgery (FESS) is a common day surgery technique for upper airway disorders. Hyaluronic acid (HA) is a fundamental component of the human connective tissue. HA may exert reparative, anti-inflammatory and immune-modulating activities. Recently, a new intranasal HA formulation has been proposed: a supramolecular system containing lysine hyaluronate, thymine and sodium chloride (T-LysYal®). This randomized study investigated whether intranasal T-LysYal® (RinoLysYal®, Farmigea, Italy) was able to reduce symptom severity, endoscopic features, and nasal cytology in 83 patients (49 males and 34 females mean age 45.4±6.2 years) treated with FESS. All patients were treated with isotonic saline solution for 4 weeks, and a sub-group (active group) was also treated with intranasal T-LysYal®. Patients were visited at baseline, after treatment, and after 4-week follow-up. Intranasal T-LysYal® treatment significantly reduced the quote of patients with symptoms, endoscopic features, and inflammatory cells in comparison to isotonic solution. In conclusion, the present study demonstrates that intranasal T-LysYal® is able to significantly improve patients after FESS and its effect is long lasting.

Nigroboletus is proposed as a novel genus in family Boletaceae, subfamily Boletoideae, to include N. roseonigrescens, a new boletoid species from tropical environment in south-eastern China. Detailed morphological description, color pictures of both fresh basidiomes in habitat and dried material along with photomicrographs and line drawings of the main anatomical features are provided, supported by a comprehensive phylogeny based on multigene molecular analysis (nrITS, nrLSU, rpb1, rpb2 and tef1-α datasets). Taxonomic placement and evolutionary relationships of Nigroboletus are investigated.

Background: Allergic rhinitis (AR) is characterized by typical symptoms that are dependent on inflammation. Poly-allergy is a frequent phenomenon. Phenotyping AR represents an up-to-date issue., Objective: The aim of this study was to evaluate whether the number of allergies is able to define different phenotypes in patients with AR., Methods: 83 patients (43 males, mean age 34.7 years) suffering from AR were evaluated. Sensitization, VAS for nasal symptoms perception, and nasal cytology were evaluated., Results: Poly-allergic patients perceived more severe nasal obstruction than mono-allergic ones (p = 0.0006) as well as they had more frequent sneezing (p < 0.0001). Moreover, poly-allergic patients had a more intense inflammatory infiltrate, concerning both eosinophils (p = 0.0005) and mast cells (p = 0.0001), than mono-allergic patients., Conclusions: The present study demonstrates that the presence of poly-allergy could define a distinct AR phenotype in comparison with mono-allergy. It could be clinically relevant as poly-allergic patients have more intense inflammation and more severe symptoms than mono-allergic ones.

Background: Allergic rhinitis affects up to 30% of the general population worldwide and is increasing in prevalence. Among several comorbidities, conjunctivitis is probably the most common and occurs so frequently with allergic rhinitis that the term allergic rhinoconjunctivitis (ARC) has been coined., Objectives: The cytological characteristics of conjunctival inflammation in patients with ARC were assessed and then correlated to clinical characteristics., Methods: Fifty-one patients with clinically diagnosed ARC (23 men; 32.4 ± 13.5 years old) underwent a detailed clinical history and standard diagnostic allergy workup as well as nasal and conjunctival scraping for cytological analysis. Patients were subdivided into 3 groups on the basis of cytological phenotype: (1) nasal and conjunctival inflammation, (2) nasal inflammation only, and (3) no mucosal inflammation., Results: Group 1 patients reported significantly higher eye itching scores (5.8 ± 2.9 on a 0-10 scale) than did patients in group 2 (3.8 ± 2.8; P = .06) or 3 (2.6 ± 2.9; P = .018) and were mostly men (81.8%). Male sex (odds ratio, 8.4; P = .005) and eye itching (odds ratio, 1.3; P = .019) significantly correlated with conjunctival inflammation. The odds of exhibiting conjunctival inflammation, at multivariate analysis, increased 13-fold for men and 1.5-fold for each point on the eye itching scale. A cutoff value of 3 or more for eye itching effectively identified patients with conjunctival inflammation., Conclusions: Our study demonstrates that some clinical manifestations of ARC correlate well with conjunctival inflammation., (Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

The number of people over 65 is increasing around the world. At present, between 5 and 10% of allergic diseases affect the elderly. In particular, rhinitis is increasing worldwide; the presence of high comorbidity makes the therapy of asthma even more complicated. With reference to dermatological allergies, the dryness of the skin favors the onset of allergic contact and atopic dermatitis, while the senescence of mucous membranes and the impaired secretion of polymeric IgA could be linked to food allergy. Overcoming the problem of adverse drug reaction is limited by the diagnostic difficulty in patients taking multiple drugs. In addition, some drugs, such as β-blockers, angiotensin-converting enzyme (ACE)-inhibitors and NSAIDs, are relevant factors of urticaria and anaphylaxis. The aim of this review is to provide updated diagnostic and therapeutic guidelines through a better understanding of the pathophysiologic mechanisms, preventive measures and adherence to therapy.

Alessioporus and Pulchroboletus are proposed as new monotypic genera to accommodate the thermo-xerophilic European species Xerocomus ichnusanus and X. roseoalbidus respectively. The present research focused on both morphological features and multigene molecular phylogeny (nrITS, nrLSU, tef-1α datasets) to elucidate the taxonomic status of these two rare Mediterranean boletes and delineate a natural classification within the family Boletaceae. Macro- and microscopic descriptions of the two species based on inclusive taxon sampling are provided and supported by line drawings of the main anatomical features. Phylogenetic relationships, ecology, geographical distribution and delimitation from the most closely allied taxa also are highlighted. In addition, epitype specimens are selected for both species., (© 2014 by The Mycological Society of America.)

Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear cavity behind an intact eardrum and is considered a multifactorial condition with Eustachian tube dysfunction as the underlying pathophysiologic condition. One of the most debated causes of OME is allergy, in particular allergic rhinitis. The aim of this paper is to review the role of rhinitis in the development of OME and in particular the role of both allergic (AR) and non-allergic rhinitis (NAR). Most of the recent literature confirms the role of AR in the development of OME, while there are few reports on the role of NAR. In non-allergic children affected by obstructive adenoid hypertrophy, the presence of mast cells in the nasal smear was associated with a high risk of developing a chronic OME.

Background: Rhinitis comprises several diseases with varying causes and different clinical manifestations and pathological features, but treated as a single clinical disorder. As heterogeneous disease, proper differential diagnosis is useful to delineate appropriate therapeutic intervention. Comparative proteomic investigation was aimed to provide information for specific differentially expressed proteins in rhino pathologic state, that could be used for diagnostic purpose and therapeutic monitoring., Methods: Proteins extracted from nasal mucosa cells of patients with different features of rhinitis and from control subjects, were separated by 2-DE. Proteins differentially expressed were identified by mass spectrometry (MS)., Results: Comparative proteomic analyses led to the identification of eighteen proteins differentially expressed in patients with rhinitis, mainly related to cell defense and innate and acquired immunity. From that, at least one protein can be a possible candidate as biomarker of disease.

Objective: The aim of the present study was to evaluate the role of the different forms of chronic rhinitis in the pathogenesis of otitis media with effusion in children affected by obstructive adenoid hypertrophy., Methods: 81 patients, aged between 4 and 15 years (mean age of 6.9 years), affected by obstructive adenoid hypertrophy were evaluated. All patients underwent accurate history taking, physical examination with endoscopy of the nasopharynx, skin prick test, nasal cytology and hearing evaluation., Results: Nasal citology showed that 21% of patients had a non-allergic rhinitis (NAR) subtype, 17.4% NAR overlapping with infectious rhinitis (IR), 29.6% IR, 4.9% allergic rhinitis (AR), 2.5% AR overlapping with IR and the remaining 24.6% a negative cytology. The presence of OME was positively correlated with neutrophils (p = 0.01) and mast cells (p = 0.022), while it was negatively correlated with the presence of eosinophils (p = 0.02) and bacteria (p = 0.02)., Conclusions: A chronic rhinitis was present in more than 70% of children with AH and 60% of them showed OME. Nasal cytology together with SPT showed that AR was rarely present in this group of children, while the mast-cells and neutrophils positively correlated with OME., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Adenotonsillar hypertrophy (ATH) is a frequent cause of upper airways obstructive syndromes associated to middle ear and paranasal sinuses disorders, swallowing and voice disorders, sleep quality disorders, and occasionally facial dysmorphisms. ATH treatment is essentially based on a number of medical-surgical aids including nasal irrigation with topical antibiotics and corticosteroids and/or treatment with systemic corticosteroids, immunoregulators, thermal treatments, adenotonsillectomy, etc., Objectives: The aim of the present study is to assess the efficacy of Aerosal halotherapy in the treatment of sub-obstructive adenotonsillar disease and correlated conditions compared to placebo treatment., Methods: A total of 45 patients with sub-obstructive adenotonsillar hypertrophy were randomized to receive either Aerosal halotherapy or placebo for 10 treatment sessions. The main outcome was a reduction greater than or equal to 25% from the baseline of the degree of adenoid and/or tonsillar hypertrophy., Results: In the intention-to-treat analysis, a reduction of the degree of adenoid and/or tonsillar hypertrophy ≥25% from baseline after 10 therapy sessions was found in 44.4% of the patients in the halotherapy arm and in 22.2% of the patients in the placebo arm (P=0.204). Among the secondary outcomes, the reduction of hearing loss after 10 treatment sessions in the halotherapy arm was higher than the placebo arm (P=0.018) as well as the time-dependent analysis showed significantly improved peak pressure in the Aerosal group (P=0.038). No side effects were reported during the trial. In addition, the therapy was well accepted by the young patients who considered it as a time for play rather than a therapy., Conclusions: Aerosal halotherapy can be considered a viable adjunct, albeit not a replacement, to conventional medical treatment of sub-obstructive adenotonsillar syndrome and related conditions. Further research is however needed to improve ATH treatment., (Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.)

Background: Rhinitis is an extremely common medical problem characterized by nasal congestion, clear rhinorrhea, sneezing, and itching. Hyaluronate is an endogenous compound that has an important role in mucociliary clearance by the epithelial surface of the nasal passages and in mucosal surface healing and repair. The objective of this work was to determine the effects of intranasal administration of sodium hyaluronate on nasal cytology in patients with allergic and nonallergic rhinitis., Methods: In a single-center, randomized, blinded trial, 78 patients received intranasal mometasone and oral desloratadine plus either intranasal sodium hyaluronate or saline for 1 month. Nasal cytology was performed and the change from baseline in the numbers of neutrophils, eosinophils, mast cells, lymphocytes, and infective species was determined. Other outcomes included changes in symptoms and the endoscopic appearance of the nasal mucosa, and tolerability., Results: Patients receiving sodium hyaluronate experienced a significant decrease in the median neutrophil count seen on nasal cytology compared with controls (p = 0.001). Sodium hyaluronate was associated with significant improvements in sneezing, rhinorrhea, and nasal congestion, and on exudate seen on endoscopy at 1 month compared with baseline. Intranasal sodium hyaluronate received better tolerability scores than saline over the 1-month treatment period., Conclusion: The addition of sodium hyaluronate to intranasal corticosteroid and systemic antihistamine reduced the neutrophil count seen on nasal cytology in patients with allergic and nonallergic rhinitis and improved several clinical and endoscopic parameters while being well tolerated. These data provide encouraging evidence of the efficacy of sodium hyaluronate in the treatment of this common disease., (© 2013 The Authors. International Forum of Allergy & Rhinology published by Wiley Periodicals, Inc., on behalf of ARS-AAOA, LLC.)

Background: Nasal hyperreactivity is the symptomatic expression of vasomotor rhinitis. This study describes a typical nasal reaction, represented by a "volley of sneezes" found in some patients during nasal endoscopy, and to assess the possible correlation between hyperreactivity and a particular clinical and cytological condition., Methods: We studied 671 rhinological subjects, 344 male, mean age 35.7 ± 13.76 standard deviation (SD) years. All were submitted to medical histories and clinical and instrumental investigations (skin prick test, nasal endoscopy, and nasal cytology). While performing endoscopy, particular attention was paid to the possible signs of nasal hyperreactivity, in particular "volley of sneezes" both during and immediately after the diagnostic procedure., Results: Out of 671 endoscopies performed, 130 (17.1%) patients presented signs of hyperreactivity during and/or immediately after nasal endoscopy. The ratio of positive vasomotor reaction was 10.6% in the nasal polyposis (NP) group, 19% in the allergic rhinitis (AR) group, 70.6% (p < 0.01) in nonallergic rhinitis with mast cells (NARMA), 76% (p < 0.01) in nonallergic rhinitis with eosinophils and mast cells (NARESMA), and 83% (p < 0.01) in nonallergic rhinitis with eosinophils (NARES). In the AR subjects hyperreactivity was more frequent during the pollen season, compared to the period of absence of pollen (87.5% vs 12%)., Conclusion: The onset of hyperreactivity (sneezing) can be considered an important "sign" in nasal symptomatology, whose sensitivity and specificity for nonallergic "cellular" rhinitis are 79% and 93%, respectively., (© 2013 ARS-AAOA, LLC.)

Background: To determine the effect of intranasal sodium hyaluronate on mucociliary clearance time following functional endoscopic sinus surgery in patients with nasal polyposis., Study Design: Randomized, controlled, blinded study., Methods: Thirty-six patients with grade II nasal polyposis undergoing functional endoscopic sinus surgery received intranasal sodium hyaluronate 9 mg twice daily or saline for 30 days commencing on the second day after surgery. Ciliary mucous transport time was assessed using charcoal powder and saccharin administered during rhinoscopy. Other outcomes included changes in symptoms, endoscopic appearance of the nasal mucosa, and tolerability., Results: Patients receiving sodium hyaluronate had a significantly faster mucociliary clearance time at 1 month compared with controls (14.3 +/- 2.5 vs. 23.6 +/- 3.3 minutes; p = 0.000). Furthermore, sodium hyaluronate recipients experienced a lower incidence of rhinorrhea, less nasal obstruction and a lower incidence of exudate on endoscopy than control subjects at 1 month (all p < 0.05). Sodium hyaluronate was well tolerated in patients following functional endoscopic sinus surgery., Conclusion: The use of intranasal sodium hyaluronate in patients undergoing functional endoscopic sinus surgery for nasal polyposis augmented the improvement in mucociliary clearance observed following this procedure and improved several clinical and endoscopic parameters. These data provide encouraging evidence of the beneficial effects of sodium hyaluronate in the care of patients undergoing functional endoscopic sinus surgery with which to continue the development of the product for this indication.

Background: Recently, it has been reported that nasal cytology in light microscopy can identify biofilms, which appear as cyan-stained "Infectious Spots". We assessed by the same method and in the same population, the presence of biofilms in different nasal disorders, and estimated if a correlation with the functional grade of obstruction existed., Methods: Subjects suffering from different nasal disorders, after a detailed clinical history and ENT examination, underwent nasal fibroendoscopy, skin prick test, rhinomanometry and nasal cytology. The presence of biofilm was linked to the type ofdisease and to the grade of obstruction., Results: Among 1,410 subjects previously studied, the infectious spot was found in 107 patients (7.6%), and this percentage reached 55.4% in subjects with cytologic signs of infectious rhinitis (presence of bacteria/fungi). Biofilms were largely more frequent in patients with adenoid hypertrophy (57.4%), followed by nasal polyposis (24%), chronic rhinosinusitis (9.5%) and non-allergic rhinitis (7.6%). Nasal cytology was normal in the remaining patients, where no infectious spot was detectable. Statistical analysis showed that nasal resistances were significantly higher in presence of biofilms in patients with adenoid hypertrophy (p = 0.003), nasal polyposis (p < 0.001), chronic rhinosinusitis (p = 0.018) and septal deviation (p = 0.001)., Conclusion: The results demonstrate that biofilm is present not only in infectious rhinitis, but also in inflammatory and/or immune-mediated diseases. The presence of biofilms significantly correlates with the degree of nasal obstruction as assessed by rhinomanometry.

Nasal cytology is a very useful diagnostic tool in nasal disorders, being able to detect both the cellular modifications of the nasal epithelium caused by either allergen exposure or irritative stimuli (that may be physical or chemical, acute or chronic), or inflammation. Over these past few years, nasal cytology has allowed to identify new disorders, such as the non-allergic rhinitis with eosinophils (NARES), the non-allergic rhinitis with mast cells (NARMA), the non-allergic rhinitis with neutrophils (NARNE), and the non-allergic rhinitis with eosinophils and mast cells (NARESMA). The rhinocytogram is actually able to distinguish the different forms of allergic rhinitis and to suggest the appropriate treatment, such as antinflammatory drugs or allergen immunotherapy. The technique is easy to perform and nasal cytology is therefore particularly suitable even for children. Such a consideration suggests the utility of a systematic use of nasal cytology in the diagnostic work-up of nasal disorders in children, in order to reach a proper defined diagnosis and to set a rational therapeutic approach: in facts, these two elements are fundamental in order to prevent from complications and to improve the patient's quality of life.

Objectives: To analyze nasal inflammation in a group of patients with obstructive sleep apnea syndrome (OSAS) by means of nasal cytology and to describe the changes induced by continuous positive air pressure (CPAP) treatment., Subjects and Methods: Thirty-two consecutive patients affected by OSAS (mean age 46.9 years) and 13 control subjects (mean age 49.1 years) were enrolled. Detailed clinical, laboratory, and polysomnographic studies were obtained in all participants and, in particular, nasal cytology was performed; inflammatory cells (neutrophils, eosinophils, mast cells, lymphocytes), bacteria, and spores were counted. A subgroup of 19 OSAS patients underwent regular nasal CPAP for eight weeks while the remaining 13 were noncompliant. Nasal cytology was repeated after eight weeks in all patients and controls., Results: All patients with OSAS were affected by some form of rhinopathy, mostly subclinical, which was not found to influence compliance to CPAP. Regular CPAP treatment induced a significant reduction of cell infiltration (neutrophils, eosinophils, lymphocytes, and muciparous cells), which was not seen in nontreated patients., Conclusion: Nasal inflammation/infection is a very frequent finding in OSAS and can be reverted by the regular use of CPAP., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Determination of time since death is one of the most difficult and crucial issue in forensic medicine. Apart from body cooling, which is commonly used in the early postmortem interval (PMI), supravital reactions are the most interesting postmortem changes for time of death estimation. Nasal ciliary motility has been occasionally observed in postmortem period although no studies have focused on this phenomenon for forensic purposes. We aimed to evaluate the diagnostic usefulness of ciliary motility as a potential tool in estimating the time of death. Specimens of ciliated epithelium from 100 consecutive cadavers were obtained by scraping the nasal mucosa at three different postmortem intervals. The samples were then smeared on a slide, and an in vitro evaluation of ciliary movement was analyzed by phase-contrast microscopy. A postmortem nasal ciliary motility was observed, and a statistically significant relationship between decreasing ciliary movements and increasing postmortem interval was detected even in presence of putrefactive changes of nasal ultrastructure integrity. Some peculiar causes of death seem to influence ciliary motility in the early PMI, while no significant correlations with sex or age were observed. According to the results of this study, postmortem evaluation of nasal ciliary motility may be a bona fide and a feasible option for estimating the time of death.

Background: Vasomotor rhinitis (VR) seems to be related to an imbalance between cholinergic and adrenergic activity in the autonomic nervous system. The nerve fibers of the sympathetic and parasympathetic nervous systems reach the nose through the posterior nasal nerve, which, after crossing the sphenopalatine foramen, distributes to the mucosa following the branches of the sphenopalatine vessels. This study was designed to evaluate the effect of sphenopalatine artery ligation on nasal function and nasal cytology in patients with VR., Methods: Thirty patients with VR and bilateral inferior turbinate hypertrophy (ITH) were randomly assigned to receive endoscopic inferior turbinoplasty either with or without sphenopalatine artery ligation. Pre- (baseline) and postsurgical (1-year follow-up) assessment included fiber endoscopy, active anterior rhinomanometry, measurement of mucociliary transport time (MTt), and nasal cytology examination., Results: At 1-year follow-up there was a statistically significant improvement in nasal resistances in both groups but not on intergroup comparison; MTt significantly decreased in both groups (p < 0.01) and was significantly better (p < 0.05) in the group that had undergone sphenopalatine artery ligation. Among the patients in this group, significantly fewer were found to have altered ciliated cells (p < 0.005) or a hyperchromatic supranuclear stria (p < 0.005) on nasal cytology; the differences were statistically significant also on intergroup comparison (p < 0.005 and p < 0.001, respectively)., Conclusion: In patients with vasomotor rhinopathy and ITH, improvement in symptoms, nasal resistance, ciliated cell trophism, and MTt was observed after sphenopalatine artery ligation.

Introduction: A number of medical conditions, some of them recently reported, are associated with an increased production of eosinophils. We report the first case of eosinophilic parotitis in the literature., Case Presentation: The patient was an eight-year-old Caucasian boy who presented with a two-year history of recurring acute parotitis with no fever. He had had a total of five episodes with no response to antibiotics, but remission had been achieved with oral corticosteroid therapy. We performed allergy tests for inhalant and food allergens and for haptens, but the results were all negative. The results of echography ruled out sialodochitis. Instead, a swab from the parotid duct led to the detection of a high number of eosinophils., Conclusions: This report is first in the literature to describe a case of eosinophilic parotitis, and we suggest that a cytological assessment, which is quite simple yet rarely used by physicians, be performed when patients with parotitis of uncertain origin are under evaluation.

This longitudinal and prospective study aimed at investigating the influence of some parameters,including nasal cytology and clinical findings (such as asthma, atopy, acetylsalicylic acid (ASA) sensitivity, ASA associated with asthma), as risk factor of post-surgical relapse of nasal-sinus polyps. One hundred sixty-one consecutive patients (92 males and 69 females, mean age 47 years), affected by bilateral nasal polyposis and who had undergone surgical nasal polypectomy (endoscopic FESS), were examined post-surgically at least every 6 months for a period of 10 years. Endoscopic exam and nasal cytology exam were carried out on all patients and their case histories were carefully examined. The association eosinophilic-mast cell cellularity and the contemporary presence of asthma + ASA sensitivity showed the highest level of relapse (OR 4.5). In conclusion, cytological data in association with certain clinical parameters can predict a high risk prognosis of relapse.

Background: In clinical practice it can be observed that some patients with seasonal allergic rhinitis (AR) continue to have symptoms even when the exposure to allergens is expected to be low or absent. We studied the clinical and cytological characteristics of these atypical forms of (AR) in a large population of patients., Methods: Consecutive patients with symptoms of rhinitis and with positive skin test to pollens only were interviewed for the duration of symptoms, correlation with sensitization pattern, and presence of reactivity to nonspecific stimuli. All underwent rhinoscopy and nasal scraping for cytology., Results: Five hundred nineteen patients with AR were studied. Of these 519 patients 60 (11.5%) had an atypical or mixed form of rhinitis, with symptoms independent of the exposure and also elicited by nonspecific stimuli. These patients clearly differed from typical forms, especially for the nasal inflammation. They had a greater number of eosinophils and mast cells out of season (p < 0.05). Moreover, these atypical forms had, more frequently, asthma and eosinophilic polyps., Conclusion: In approximately 12% of patients with AR, other mechanisms of inflammation seem to intervene. Nasal cytology can be helpful in discriminating these atypical forms.

A wide variety of nasal irrigation systems are currently available for improving nasal symptoms, but few studies have compared their effectiveness with respect to patient age and type of nasal disease. This pilot study aims to compare the efficacy of two irrigation systems in 20 patients (12 males and 8 females; age range, 19-54 years; mean age, 36) with acute rhinosinusitis and treated only with antibiotic (levofloxacin 500 mg/day for 10 days) and topical nasal decongestant (naphazoline 2 puffs in each nostril twice daily for 7 days). Patients were randomly assigned to the treatments, using either a nasal syringe (10 mL saline solution, 3 times daily for 14 days) (Group 1) or the recently available Lavonase system (250 mL saline solution sac, twice daily for 14 days) (Group 2). Work-up included history, evaluation of signs and symptoms (nasal obstruction, rhinorrhea), nasal endoscopy, and anterior rhinomanometry. Nasal irrigation with the Lavonase system was found to be more effective in reducing symptoms, as all significantly diminished (p<0.05). In addition, the Lavonase system significantly decreased nasal resistances (p<0.05). This preliminary study shows that the ancillary treatment of acute rhinosinusitis with Lavonase may be useful.

Background and Aim: Nasal polyposis (NP) occurs in about 1-4% of the worldwide population. Increased plasma concentrations of different pro-inflammatory cytokines have been observed in NP, and might be related to the pathogenesis of this syndrome. The present study was designed to investigate IL-6 and IL-4 concentrations in nasal and oral exhaled breath condensate of patients with early and advanced NP, and following polypectomy., Methods: Ten individuals with polyposis in early status, twenty-three patients affected by advanced status of NP and ten healthy controls were enrolled into the study. Exhaled breath condensate was collected by all individuals, according to a previous standardised method. An immunoassay kit was used to measure IL-6 and IL-4 levels., Results: Concentrations of oral and nasal exhaled IL-6 and IL-4 were significantly higher in patients with early nasal polyposis and advanced nasal polyposis, compared to healthy controls. A statistically significant decrease of nasally but not of orally exhaled IL-6 (p < 0.001) and IL-4 (p < 0.05) was observed after polypectomy., Conclusions: We consider oral and nasal exhaled condensate of IL-6 and IL-4 as valid inflammatory and oxidative stress marker in patients with nasal polyposis.

Three main types of inflammatory Non-Allergic Rhinitis (NAR) have been defined: NAR infiltrated by eosinophils (NARES), by mast cells (NARMA), and by neutrophils (NARNE). In the absence of studies that investigated the Quality of Life (QoL) in NAR, the present work is aimed at evaluating the Quality of Life of patients with NARES, NARMA, and NARNE. One hundred thirty one (131) NAR patients were prospectively and consecutively evaluated: 54 patients with NARES, 38 with NARMA, and 39 with NARNE. Their history, nasal infiltration and rhinomanometry were characterized, and Quality of Life (using 2 instruments) was evaluated, and associated to clinical and histological features. Quality of Life was significantly different in the 3 groups (p less than 0.001); NARES patients had the worst Quality of Life. Nasal resistances were significantly higher in the NARES group. Significant associations were shown in NARES patients between Quality of Life and nasal function. This study provides the first evidence that Quality of Life is impaired in NAR as well as in allergic rhinitis. Furthermore, Quality of Life impairment differs among the various forms of NAR, and there is a correlation with the cellular infiltrating type.

Background: Primary ciliary dyskinesia (PCD) is a congenital, clinically and ultrastructurally heterogeneous disease caused by abnormal structure and/or function of cilia. Kartagener's syndrome is one subgroup of PCD. Acquired ciliary dyskinesia is frequent, generally being associated with or following respiratory tract infections., Methods: From January 2003 to April 2006, nasal mucociliary transport time was measured in 64 patients and specimens obtained by nasal scraping were examined by transmission electron microscope (TEM)., Results: The 64 nasal scrapings led to the diagnosis of 11 (17.2%) cases of PCD and 51 (79.7%) cases of secondary ciliary disorder. In two cases (3.1%) no clear diagnosis was possible., Conclusion: Nasal scraping is an easy, cheap, and efficient tool for detecting ciliary abnormalities by TEM and for distinguishing acquired and congenital modifications.

Background: Interleukin (IL)-4 and IL-6, respectively, markers of neutrophilic and eosinophilic inflammation, were analyzed in nasal and oral exhaled breath condensate to understand the inflammation of upper and lower airways in subjects with aspirin-induced asthma (AIA) syndrome, evaluating possible differences between AIA and the single pathological conditions included in AIA syndrome., Methods: Twelve patients with AIA, 17 patients with mild asthma (MA), 12 patients with nasal polyposis (NP), 11 patients with mild asthma + nasal polyposis (MA + NP), and 10 healthy subjects (HSs) were enrolled. Nasal and oral exhaled IL-4 and IL-6 were measured by enzyme immunoassay kit., Results: Higher levels of nasal and oral exhaled IL-4 and IL-6 were observed in AIA compared with MA, NP, MA + NP, and HSs. Moreover, a positive correlation was identified between nasal exhaled IL-4 and IL-6 and, respectively, the number of neutrophils and eosinophils and in nasal scraping., Conclusion: The concentration of eosinophilic and neutrophilic markers in upper and lower airways of subjects with AIA syndrome is higher compared with HS and subjects with MA, NP, and MA + NP.

Unlabelled: Acoustic Pharyngometry is a modern diagnostic method based on physical principle of acoustic reflection. It is useful for volume analysis of oro-pharyngo-laryngeal spaces., Aim: To evaluate variations of pharyngometric parameters in patients with sleep disorders and to establish a correlation between morpho-volumetric variations of oro-pharyngo-laryngeal spaces and the presence and severity of disease., Study Design: a clinical and experimental study., Material and Method: 110 patients, of which 70 with sleep disorders and 40 healthy patients as a control group, were analysed between June 2004 and June 2005. All patients underwent acoustic pharyngometry to evaluate the mouth and hypopharynx based on an explanatory chart., Results: A significant difference in parameters was observed between sleep disorder patients and the control group, especially in the amplitude of the I wave (significantly lower in patients with macroglossia), the extension of the O-F segment, and the amplitude of the O-F segment and hypopharyngeal area., Conclusion: Although not a standardized test, acoustic pharyngometry was proved to be a useful method both in the diagnosis and severity of obstructive sleep apnea, and in post-operative monitoring of upper airway surgery in patients with sleep disorders.

To assess the increasing sensitivity to cypress, we evaluated a group of allergic subjects living in Apulia who had been referred for respiratory symptoms to the Section for Allergic and Immunological Diseases (SAID) of Bari University Hospital in the period between January and March 2006, and compared them with a group evaluated during the same months of 2003. We submitted all patients to Skin Prick Tests (SPT) and Radio-Allergo-Sorbent Tests (RAST). Our data show that the percentage of people sensitised to cypress has increased from 28.6 percent (2003) to 65.5 percent (2006). By contrast, we observed no variations in sensitisation to other substances. Since according to data furnished by the Italian Association of Areobiology (AIA), Monitoring Center of Brindisi 1, there was a variation in the quantity of pollen grains in 2006 as compared to 2003, it seems conceivable that an increase in the amount of pollen grains, together with other factors may influence the increasing sensitization, like the volume and the brittleness of the grain. In addition, other allergo-immunologic parameters are evaluated in order to better evaluate this allergic phlogosis.

Objective: This study aims at defining the incidence of rhino-bronchial syndrome (RBS) in children in order both to verify the influence of nasal obstructions on the disease and to determine therapeutic strategies which may cure the syndrome effectively at its early stage., Methods: The investigation includes 128 non-allergic children with obstructive disorders (adenoid hypertrophy, septal deviation, etc.) and rhino-sinus inflammations associated with bronchopulmonary diseases (asthma, chronic cough, bronchopulmonary infections). Medical and/or surgical treatment was chosen in consideration of the type and entity of the patients' main nasal pathology. At least 1 year follow-up was provided for each case to establish the improvement in the disorders affecting both the lower and upper airways. The results were statistically assessed., Results: Medical and mainly surgical treatment always cured the upper airways disorders in patients with chronic nasal obstruction and rhino-sinus inflammation. Improvement of bronchopulmonary disease was reported in about half of the patients (49.4%). Statistically significant results were obtained only in the group with recurrent bronchopulmonary infections (80.9%, p<0.05)., Conclusions: The study confirms that RBS may be quite frequent in childhood. This disorder has a multifactorial pathogenesis prevalently due to nasal obstruction and rhino-sinus infections. In the population studied, among the lower airways disorders, only infective bronchopulmonary inflammation showed a significant correlation in the assessment between lower and upper airways disorders. In order to prevent the progression of the syndrome to serious pathologic events of the lower airways, a prompt and effective treatment of children's nasal disorders is thus recommended.

Unlabelled: A 21-year-old man presented with nasal obstruction of the right nasal fossa of 1 year duration. Nasal endoscopy revealed in the right inferior turbinate head a rounded neoplasm about 1 cm in diameter. Cytologic study of a nasal scraping specimen disclosed numerous clusters containing columnar cells with cytomegaly, prominent multinucleation, markedly sparse shortened cilia; the cytoplasm contained an acidophil area and a small round area that stained poorly; cells with a large intracytoplasmic vacuole that was acidophil and PAS+. Serology tests using the nested polymer chain reaction (PCR) technique on serum, nasal and pharyngeal smears revealed an Epstein-Barr virus (EBV) infection that was confirmed at electron microscopy. The clinical and cytological features resolved 19 months after the initial evaluation., Conclusion: The authors advise carrying out clinical (endoscopy, serology, etc.) evaluation of all endonasal neoplasms and to routinely perform cytological study on nasal scraping specimens. When samples test positive for EBV, nasal and nasopharyngeal endoscopy should be performed regularly to detect possible evidence for nasopharyngeal carcinoma (NPC).

Background: Allergic rhinitis is characterized by inflammatory cell infiltrate and increased nasal airflow resistance., Objective: The aim of this study was to evaluate the relationship between sensitization type, inflammatory cell pattern, and nasal airflow resistance in a group of rhinitics with monosensitization., Methods: Seventy-seven subjects (40 males and 37 females, with a mean age of 33 +/- 4.4 years) suffering from allergic rhinitis were studied. Skin prick test, nasal cytology and electronic rhinomanometry were assessed in all subjects., Results: The number of subjects monosensitized to house dust mites was 23, to grasses 20, to cypress 17, to Parietaria 11, and to olive tree 6. Significant differences were observed between each type of allergen sensitization concerning both the nasal airflow resistance (p = 0.002) and the nasal cytology pattern: eosinophils (p = 0.004), degranulated eosinophils (p = 0.002), mast cells (p = 0.006) and degranulated mast cells (p = 0.008). Furthermore, goblet cells were higher in house dust mite-sensitized subjects compared with the pollen-sensitized group (p = 0.018), in which a prevalence of eosinophils, degranulated eosinophils, mast cells and degranulated mast cells was observed (p = 0.049, p < 0.001, p = 0.022 and p = 0.007, respectively). Nasal resistances were higher in the pollen group (p = 0.001)., Conclusions: This study provides evidence that inflammatory cell pattern and nasal resistance depend on the type of allergen sensitization.

Objective: A grading into four classes of hypertrophied adenoid rhinopharyngeal obstructions in children on the basis of fiberendoscopic findings to outline an effective therapeutic program according to this classification., Methods: Ninety-eight children with chronic nasal obstruction and oral respiration were examined by anterior rhinoscopy, and fiberendoscopy. During the investigation, the fiberendoscopic images of the choanal openings were divided into four segments from the upper choanal border to the nasal floor. In view of clinical findings, 78 patients also underwent active anterior rhinomanometry., Results: In eight patients (8.2%), the fiberendoscopic imaging revealed that the adenoid tissue occupied only the upper segment in the rhinopharyngeal cavity (< 25%). Therefore, choanal openings were free (first degree obstructions). In 20 patients (20.4%), the adenoid tissue was confined to the upper half (< 50%) of the rhinopharyngeal cavity (second degree obstructions) and in 63 patients (64.3%) the tissue extended over the rhinopharynx (< 75%) with obstruction of choanal openings and partial closure of tube ostium (third degree obstructions). Only in seven cases (7.14%), the obstruction was almost total. As a consequence, both the tube ostium and the lower choanal border could not be observed (fourth degree obstructions)., Conclusions: In the first two classes of obstructions, characterized by moderate or discrete adenoid hypertrophy, adenoidectomy should not be performed. In these conditions, the causes of possible nasal obstructions are usually due to either dysmorphic, allergic or phlogistic pathologies. For the fourth degree adenoid obstructions, surgery is always recommended. The most important therapeutic problems occur in the third degree obstructions which include most patients who suffered from hypertrophied adenoids. Moreover, the therapeutic strategy can be conditioned not only by nasal respiratory difficulties but also by frequent concomitant complications such as otitis, sinusitis, sleep apnea, etc. These disorders may be caused by both nasal obstruction and/or phlogistic problems (adenoiditis).

Background: The aim of this study was to describe a particular intracellular hyperchromatic formation located over the nucleus of normal nasal ciliated cells. This finding, never described in literature, very rarely occurs in pathological conditions., Methods: A nasal cytological test and mucociliary transport test were performed in a group of 24 subjects with rhinologic diseases and in a control group of 10 healthy subjects., Results: The "hyperchromatic supranuclear stria" (SNS) was observed in a high percentage of normal cells (90.3%); SNS was present in very few pathological subjects (in only 6.26% of pathologic cells)., Conclusion: We interpreted SNS as a specific marker for the anatomic and functional integrity of the ciliated cell. Therefore, the absence of SNS is considered an abnormal finding in the nasal mucosa and therefore could be useful as a "prognostic sign" of the disorders themselves and as an indication of the "therapeutic efficacy" of pharmacologic treatments, both topical and systemic.