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Background: Allergic rhinitis may be associated with asthma. Forced expiratory flow between 25 and 75% of vital capacity (FEF2575) is a measure of small airways narrowing. The aim of this study was to evaluate whether patients with seasonal allergic rhinitis (SAR) without symptoms of asthma might, nevertheless, have airways obstruction both in and out of the pollen season., Methods: Fifty patients (mean age, 23.7+/-4.9 years) with SAR were evaluated both during and outside the pollen season. All of them had moderate-severe grade of nasal obstruction. Total symptom score, rhinomanometry, nasal lavage, nasal scraping, spirometry, and methacholine (MCH) bronchial challenge were assessed in all subjects., Results: Although data on forced vital capacity and response to MCH were similar in and out of the pollen season, all other parameters were markedly different. The major finding of the study was that FEF25-75 was significantly associated with nearly all of the parameters considered, including bronchial hyperreactivity, with Pearson R ranging from 31 to 75% and differences in mean FEF25-75 ranging between 14.5 and 16.5% of predicted. The more significant association was with nasal airflow in the pollen season (R = 82.8%; p < 0.001). A significant association persisted for all parameters while controlling for season., Conclusion: This study highlights the link between upper and lower airways and the role of FEF25-75 as an early marker of bronchial impairment in those patients with SAR alone.

Background: The small airways may play an important role in the clinical manifestations of asthma. Forced expiratory flow between 25% and 75% (FEF25%-75%) has been proposed as an approximate measure of the caliber of distal airways. Bronchial hyperreactivity (BHR) is a feature of asthma., Objective: To evaluate the possible role of FEF25%-75% as a predictor of BHR in allergic patients with asthma and rhinitis., Methods: A total of 726 patients (mean +/- SD age, 24.7 +/- 6.3 years) were evaluated. Spirometry and methacholine bronchial challenge were evaluated in all the participants., Results: A difference between forced expiratory volume in 1 second and FEF25%-75% greater than 20 or a ratio between these variables greater than 1.24 discriminates between patients with no response to a mild response to methacholine vs patients with a moderate-to-severe response with high sensitivity (P < .001)., Conclusion: This study highlights the possible role of FEF25%-75% in predicting BHR in allergic individuals with airway disorders.

Background: Rhinomanometry measures nasal airflow that is frequently impaired in allergic rhinitis. Decongestion tests consist of spraying an intranasal vasoconstrictor drug to evaluate the reversibility of nasal airflow limitation. The aim of this study was to evaluate the decongestion test in patients with seasonal allergic rhinitis (SAR) caused by pollen sensitization, perennial allergic rhinitis (PAR) caused by sensitization to perennial allergens only, or mixed allergic rhinitis (MAR) caused by sensitization to both allergens., Methods: One hundred twenty-three subjects (112 men and 11 women, mean age, 22.9 +/- 5.7 years) were studied; 40 subjects had PAR, 43 subjects had MAR, and 40 subjects had SAR. Total symptom score (including: nasal itching, sneezing, rhinorrhea, and nasal obstruction) was assessed. Rhinomanometry and decongestion tests were performed in all subjects., Results: Nasal symptom severity was superimposable in the three groups (p was not significant). After decongestion tests, an increase of nasal airflow and a decrease of nasal resistance was shown in PAR (p < 0.01), MAR (p < 0.001), and SAR subjects (p < 0.001). The intergroup analysis showed that SAR patients had less reversibility than PAR (p < 0.01)., Conclusion: This study provides the first evidence of the different response to decongestion tests, taking into consideration the causal allergens.

There is a clear connection between upper and lower airways. Allergic rhinitis may affect asthma by worsening natural history. Airways share similarities and differences such as: epidemiology, anatomy, physiology, immunopathology, and treatment. In asthmatic patients non-responder to conventional treatment, therapeutic success may be achieved only by recognizing and treating co-existent upper airways disorders. New therapeutical strategies should be based on a rational (i.e. considering the pathophysiology of the single patient) use of: antihistamines, antileukotrienes, and corticosteroids.

Background: Chronic rhinosinusitis is frequently associated with asthma. A Th2 cytokine pattern has been recently reported in chronic rhinosinusitis in asthmatic children., Objective: To evaluate the effects of treating concomitant chronic rhinosinusitis on respiratory symptoms and function and immunopathological parameters in asthmatic children., Methods: Eighteen children with moderate asthma (age range, 5 to 12 years) poorly controlled by high doses of inhaled corticosteroids and chronic rhinosinusitis were evaluated for symptoms, spirometry, and inflammation at baseline, after treatment, and 1 month after suspension of treatment. All of the children were treated with a combination of amoxicillin and clavulanate (20 mg/kg twice daily) and fluticasone propionate aqueous nasal spray (100 microg/d) for 14 days. A short course of oral corticosteroids was also prescribed (deflazacort, 1 mg/kg daily for 2 days, 0.5 mg/kg daily for 4 days, and 0.25 mg/kg daily for 4 days). Rhinosinusal lavage for cytokine measurements and a nasal scraping for cytologic analysis were performed in all patients before and after medical treatment., Results: A negative endoscopy result was demonstrated in 15 children after treatment. Symptoms and respiratory function significantly improved after treatment and 1 month later; 8 children had intermittent asthma and 10 had mild asthma. A significant reduction of inflammatory cell numbers was detected in all asthmatic children. Interleukin 4 levels significantly decreased (P < 0.001), whereas interferon-y levels increased (P < 0.001)., Conclusion: Treatment of chronic rhinosinusitis is able to improve symptoms and respiratory function in asthmatic children, reducing inflammatory cells and reversing the cytokine pattern from a Th2 toward a Th1 profile.

A Th2 cytokine pattern has recently been reported both in allergic and nonallergic chronic rhinosinusitis in asthmatic children. The aim of the study was to evaluate the cytokine pattern in chronic rhinosinusitis in allergic and nonallergic asthmatic children before and after medical treatment. Thirty asthmatic children were evaluated, 18 males and 12 females (mean age 9.1 years). Sixteen were allergic and 14 were nonallergic. All children were asthmatic and suffered from chronic rhinosinusitis, whose diagnosis was confirmed by endoscopy. All of them were treated with amoxicilline-clavulanate (20 mg/kg b.i.d.) and fluticasone propionate aqueous nasal spray (100 microg daily) for 14 days; a short course of oral corticosteroid was also prescribed (deflazacort 1 mg/kg daily for 2 days, 0.5 mg/kg daily for 4 days and 0.25 mg/kg daily for 4 days). Rhinosinusal lavage and nasal cytology were performed in all subjects before and after medical treatment. IL4 and IFNgamma were measured by immunoassay and inflammatory cells were counted by conventional staining. Thirteen allergic children and 12 nonallergic children showed a negative endoscopy after the treatment. Allergic subjects showed a significant decrease of IL4 (p = 0.0002) and a significant increase of IFNgamma (p = 0.03) after the treatment. Nonallergic children showed a significant decrease of IL4 (p = 0.0007) and a nonsignificant increase of IFNgamma. A significant reduction of the inflammatory infiltrate was detected in all asthmatic children (p < 0.05). This study confirms a Th2 polarization in chronic rhinosinusitis both in allergic and nonallergic asthmatic children. Moreover, the medical treatment of chronic rhinosinusitis reversed the cytokine pattern from a Th2 towards a Th1 profile both in allergic and nonallergic children.

Objective: The aim of this double-blind, randomized, multicenter study was to compare the efficacy of betahistine dihydrochloride (BH) and flunarizine (FL) using the Dizziness Handicap Inventory (DHI), a validated self-assessment questionnaire that has not previously been used in a clinical trial to evaluate antivertigo drugs., Material and Methods: Patients with recurrent vertigo of peripheral vestibular origin and who were severely handicapped by vertigo were randomized to an 8-week course of treatment with oral BH 48 mg daily or oral FL 10 mg daily. The efficacy endpoints were the total DHI score and the physical, functional and emotional subscores., Results: Fifty-two patients completed the study. After 8 weeks of treatment the mean total DHI score and the physical subscore were significantly lower in the BH group compared to the FL group (7.5 and 3.6 points, respectively). The mean total DHI score as well as the three subscores decreased significantly after 4 and 8 weeks in both treatment groups., Conclusion: This study showed that at 8 weeks BH is significantly more effective than FL in terms of improving the total DHI score and the physical subscore. It was also established that the DHI is a useful and reliable method for evaluating the efficacy of antivertigo drugs.

Lyophilized bacterial lysates, which actively stimulate the immune response, are widely used as vaccines or 'biological response modifiers' in subjects with recurrent bacterial respiratory infections. Since vaccines are indicated in the absence or in the presence of a weak constitutive immune response activity, a better knowledge on the 'naturally' occurring antibacterial immune response at the oropharingeal level should be helpful. A study was, therefore, designed to quantify the presence of salivary IgA directed against surface antigens bacteria frequently involved in the pathogenesis of upper respiratory tract infections: Klebsiella pneumoniae (KP), Staphylococcus aureus (SA), Streptococcus pyogenes (SPy), Morraxella catarrhalis (MC), Haemophylus influenzae (HI), and Streptococcus pnumoniae (SPn). In 34 volunteers (21 adults and 13 children), salivary fluid was collected and the presence of microorganism-specific IgA antibodies evaluated by a novel enzyme immuno-assay. In the whole population only 29 and 24% of subjects had IgA directed, respectively, to KP and SA, while the immune-response against other microbes was detectable in a small population ranging from 12 to 15% of all subjects studied. We found higher proportions of individuals with strain specific salivary IgA in the adult than in the pediatric population for all the microorganism evaluated. In addition, in children, the only strain inducing a significant production of specific IgA at oropharingeal level was KP. Interestingly, only ten out of 21 adults and two out 13 children have at least one significantly high antibody titer against one of the bacteria evaluated. Nevertheless, when a group of healthy donors was treated with a polyvalent mechanical bacterial lysate (Ismigen t.), the large majority developed a specific immune-response in the salivary fluid. These results are thus consistent with the good features of the novel enzyme-immunoassay and with a poor frequency of naturally induced specific anti-microbe antibodies in children and in adults despite the presence on recurrent respiratory infections in their clinical history.

Alternating chemoradiotherapy was shown by our institution to be superior to standard radiation in patients with nonsurgical squamous cell carcinoma of the head and neck (SCC-HN). Gemcitabine has shown in vitro and in vivo radiosensitizing properties, synergistic activity with cisplatin, and cytotoxic activity against SCC-HN. Thus, the authors tested the feasibility and antitumoral activity of a modified alternating chemoradiotherapy program that includes gemcitabine. Fourteen patients with stage IV (nine patients) or relapsed after surgery (five patients) unresectable SCC-HN were enrolled. None had previously received chemotherapy or radiotherapy. The treatment plan consisted of cisplatin, 20 mg/m2/day, days 1 to 5, weeks 1 and 5, and gemcitabine 800 mg/m2, day 5, weeks 1, 2, 3, and 5, 6, 7. Radiation was administered during weeks 2, 3, and 4 and 6, 7, and 8 with conventional fractionation up to 60 Gy. At the end of the combined therapy, patients had to receive two additional courses of cisplatin, 20 mg/m2/day, and fluorouracil, 200 mg/m2/day, for 5 days every 21 days. All the patients are evaluable for toxicity and 11 for response. Main grade III-IV toxicities and frequencies were: neutropenia (79%), neutropenia with fever (50%), thrombocytopenia (57%), anemia (35%), mucositis (100%), and cutaneous toxicity (14%). Ten patients (71%) had a weight loss greater than 10%. All but two patients needed hospitalization and tube feeding or parenteral nutrition. The median relative dose intensity of gemcitabine actually delivered was 83%. Two patients died 1 month after the end of treatment before the final evaluation. One patient died of sepsis during the additional cisplatin and fluorouracil courses before response assessment. Ten patients reached a complete response (intention to treat: 71%), and 1 patient had a partial response (9%). At a median follow-up of 34 months, the actuarial 3-year progression-free survival and overall survival are 41% and 63%, respectively. The estimated 3-year locoregional control is 70%. Considering the expected poor prognosis of the enrolled patients, this combined regimen showed an impressive antitumoral activity, but the severity of acute local and hematologic toxicity correlated makes the exportation of this regimen unproposable. However, the activity observed warrants the exploration of different, less toxic, chemo-radiotherapy programs including gemcitabine.

Neurologic manifestations of human immunodeficiency virus (HIV) infection, rather than being a late complication of the disease, are principally correlated with the early central nervous system (CNS) localization of HIV. The CNS may be infected in the early stages of acquired immunodeficiency syndrome (AIDS) without evidence of neurologic disorders. Evoked potentials (visual, auditory, and somatosensory) and electronystagmographic test batteries have proven to be very sensitive in showing subclinical CNS disorders due to HIV. In this study, auditory brain stem response (ABR) and electronystagmographic test battery findings (smooth pursuit, saccades, caloric test) were performed in 29 neurologically asymptomatic, HIV-positive subjects at different stages of the disease. Compared to results of a control group, the ABR latencies of waves V, I, and III and interpeaks I-V and III-V were significantly increased in HIV patients. The same parameters did not differ significantly among the stages of the disease. In HIV-positive subjects, the accuracy of saccades was significantly reduced, while latency was normal. The velocity and the gain of pursuit were significantly reduced in HIV-positive patients, and 15 of 29 patients showed corrective saccades. Caloric tests revealed qualitative nystagmus abnormalities in 82% of HIV patients, while quantitative parameters were normal. The present results confirm that CNS involvement by HIV occurs early in the course of the disease. In particular, HIV does not seem to affect the labyrinth or the eighth cranial nerve, as demonstrated by the normality of the I-III value of the ABR and of the quantitative parameters of the caloric responses, but it does appear to involve the brain stem acoustic pathways, pontocerebellar pathways, and supratentorial areas.

Wegener's and Stewart's diseases are two rare pathologies of unknown origin; both can cause disruptive facial lesions. Wegener's disease is a systemic pathology and generally involves the kidneys and lungs. Granulomatosis lesions are characterized by the necrotizing vasculitis involving the small vessels. From a diagnostic point of view the systemic features of Wegener's disease and the specific immunological findings (i.e. IgG autoantibodies vs. monocyte and neutrophil cytoplasm) make it possible to diagnose the disease precisely. Stewart's disease can be differentiated from Wegener's disease by the absence of any systemic lesions and the lack of necrotizing vasculitis. Pathogenesis of the disease is still unknown although immunohistochemical findings indicate that it is related to extranodal Tcell lymphomas. Stewart's disease is very aggressive with massive destruction of the midface tissues and prognosis is very poor (from a few months to 23 years). Surgery is generally ineffective in such disorders. The treatment for Wegener's disease includes the use of systemic steroids, immunosuppressive drugs and the sulfametoxazole-thrimethoprime association while radiotherapy associated with chemotherapy appears most effective in Stewart's disease. The authors describe a case of Stewart's disease prevalently involving the nasal cavities, ethmoid and paranasal sinuses. Diagnosis was made on the basis of immunohistochemical, histomorphological and immunological data. Treatment--based initially on systemic steroids with the association thrimethoprimsulfometoxazole--induced significant disease remission. Subsequent use of cytostatic drugs has made it possible to control the disease progression to date.

The present study was carried out to assess the indications and to evaluate the functional and oncological results of the supracricoid laryngectomy with crico-hyoid-pexy proposed by J. Labayle. This technique consists of a sub-total laryngectomy where the cricoid cartilage, the hyoid bone and at least one of the arytenoids are spared. These structures can then be reassembled into a "neo-larynx", thus preserving respiration and phonation. The present paper deals with 23 laryngeal carcinomas: 13 glottic (2 T1bN0, 6 T2N0, 1 T2N1, 1 T2N1, 3 T3N0) and 10 supraglottic (4 T2N0, 3 T2N1, 3 T2N2). The follow-up shows a 5-year overall actuarial survival rate of 80.65%. The authors agree that when performed under very precise indications the crico-hyoid-pexy is a useful alternative to both radiotherapy and the extended-partial or total laryngectomy in the treatment of laryngeal carcinoma. It also appears useful in treating selected cases of post-surgical or post-radiotherapy recurrences.

Fhar's disease is a rare idiopathic CNS pathology characterized by widespread calcifications of the basal ganglia, cerebellar nuclei and endocranial vessels. The origin of this disease is unknown and a lack of thyroid and parathyroid pathologies is the main statement. From the clinical point of view, extrapyramidal manifestations are common while vertigo and equilibrium disorders are rare. In the present case vertigo and disequilibrium were the main symptoms. Fhar's disease was diagnosed by CT and MRI showing calcification of the basal ganglia without any metabolism disorders or thyroid and parathyroid pathology. A battery of neurotological tests showed alterations of VOR and ocular movement. In particular the saccades movements showed significant hypometria while the smooth-pursuit showed gain diminution and corrective saccades. These anomalies imply dysfunction of sub-cortical centers regulating and modulating ocular movement. VOR alterations included both qualitative anomalies of nystagmus (i.e. dysrhythmia, square waves) and quantitative alterations (i.e. bilateral deficit response to caloric and rotatory stimuli). These alterations could be due to the impairment of cerebellum-vestibular and vestibular-thalamic pathways. Acoustic evoked potentials (ABR, MLR) ruled out central acoustic pathway dysfunction.

Pleomorphic adenoma is a tumor which most often originates from one of the major salivary glands; it is rarely located in the lacrymal glands and it is highly exceptional in the nasal cavity. Cases of pleomorphic adenoma in the nasal cavity have been described by Spiro (40 cases), Compagno and Wong (40 cases) and Suzuki et al. (41 cases). This type of tumor generally originates from the septal mucosa even though the seromucosal glands are mostly located in the lateral nasal wall. This pathology is more frequently found in females. The clinical signs of this tumor are non specific, slow unilateral nasal occlusion, rhinorrhea and, at times, epistaxis. Evolution is generally local although locoregional and distant metastases have been described in the literature. This sort of tumor has no specific appearance and thus diagnosis is based on histology. Indeed, microscopically nasal pleomorphic adenoma differs from salivary gland adenoma for the predominance of the cellular component over the connective component. The epithelial cells are small, oval-shaped and often arranged in cordons; they are sometimes organized in small acinous structures. The connective component can be mixoid, condroid or collagenous; follicles with squamous metaplasia and mitosis are rare. Histologically differentiating this disorder from olfactory esthesione-uroblastoma can prove difficult; the lack of extra cellular neurifibrillar structures, neurotubules and neurosecretory granules in nasal pleomorphic adenoma are the main distinguishing criteria. The present work reports a case of a 45-year-old man who had suffered of an increasing unilateral nasal obstruction from 1 year. Endoscopic examination showed a smooth surface neoplasm involving the entire nasal cavity. CT scan showed the deformation of the medial bone wall of the maxillary sinus and of the ethmoid although without any osteolysis. Median maxillectomy surgical exeresis of the neoplasm was performed with the facial degloving technique. Histology revealed a 5 cm pleomorphic adenoma originating from the lateral nasal wall. This origin is extremely rare because this tumor generally originates in the nasal septum. Immunohistochemical stains proved positive for epithelial membrane antigen (MNF 116), for myoepithelial cells (PS100) and for stromal cells (Vimentine) with the epithelial elements predominating. After 9 months of follow-up the patient is still disease free.

Cellular Infiltrate as well as class I and II HLA molecule expression, on 22 nasal polyps and on 12 samples of corresponding hypsilateral mucous membrane were studied by means of immuno-histological methods. These nasal polyps were classified according to their histopathological structure. Five polyps, with a fibrous connective core infiltrated by cells of the monocyte-macrophage lineage, were classified mixed. The remaining seventeen polyps were characterized by the presence of central oedematous connective tissue infiltrated almost exclusively by eosinophils and either contained (glandular type) or did not contain (oedematous type) glands. A comparative study of different types of nasal polyps and corresponding hypsilateral nasal mucous membranes was carried out on atopic and non-atopic patients. No correlation between atopic status and polyp presence or polyp typology was found. On the other hand, different polyp types appear to have a structural correlation with the corresponding hypsilateral mucous membrane regarding infiltrate cell type, oedematous or fibrous connective tissue presence and expression of on HLA antigen positivity pattern. The characteristic histological structure of hypsilateral mucous membranes in patients with different types of polyps appeared to be brought about by a multifactorial etiology involving mucosal hyperreactivity. Lastly, both polyps and parapolypal nasal mucous membranes were found to be infiltrated mainly in the peripheral subepithelial connective tissue by lymphocytes (55%) as well as by other leukocyte types. The presence of growth factors capable of enhancing an increase of fibroblasts, endothelial cells, together with focal distrupture on the basal membrane, might well be a general mechanism responsible for polyp sprouting.

Taste disorders can a rise from lesions of peripheral receptors, taste control pathways or cortical area involvement. Among peripheral lesions, trauma of the tongue and oropharynx are the most common. Iatrogenic lesions of facial and glossopharingeal nerves are very important in Forensic Medicine, while there are different opinions about taste alterations due to head injuries; hypogeusia associated to smell disorders are found in 0.4-0.5% of patient after head trauma with good prognosis (90% healing) while qualitative disorders are more common (30%). The Authors describe clinical methodologies for taste evaluation and their application in Forensic Medicine. Forensic estimation of taste disorders con be classified by two main groups: study of cause relation between the occurrence and damage and quantitative valuation of the damage in three different juridical ambits: Penal, Civil, Insurance and foresight. In Penal Right taste damages could be classified among personal lesion crimes and can be classified as serious (permanent injury of taste) ore very serious (complete lost of taste function). Italian Legislation equipare the 5 sense organs. In Civil Right evaluation the so-called "biologic damage" and working ability are considered; this means very different evaluations. In the most recent baremes, generic damage is estimated by different Authors from 0 to 10% while with regard to specific working capacity, common evaluation criteria does not exist. In Insurance taste disorders evaluation is based only on working ability and not on biologic damage. In the previdenzial ambit, taste disorders are not even included in the most recent tables of permanent invalidity estimation. The Authors propose new and more efficacious valutation criteria for taste disorders in all ambits, hoping for more interest in the Forensic aspects of taste, a too often forgotten sensory function.

In the last years nasal polyps have been studied by several authors with different methodologies; however, their etiology is still unclear. In this paper we have analyzed in four nasal polyps of fibrous type, the HLA class II (HLA-DR, DP, DQ) molecule expression by means of immunohistochemical techniques (immunoperoxidase and immunophosphatase). A strong inflammatory cell infiltration, a percentage increase of both HLA-DR+ and HLA-DQ+ cells (normal nasal mucous membrane stroma infiltrating cells: DR+ < 40%, DP+ < 2%, DQ+ < 3%; fibrous polyps infiltrating cells: DR+ = 68%, DP+ < 2, DQ+ = 7%) as well as a clear positivity for DR expression of both surface and glandular epithelia were observed in all polyps. Furthermore, in the stalk area of one of the studied polyps DR+DQ+ cells with macrophagic features and having tight. connections with the vessels were observed. The scanty vascularization with the presence of activated mononuclear and mast cells might be responsible for polyp growth by locally producing an anomalous concentration of growth factors.

Nasal polyps constitute a common pathology, but their etiology is not yet clear. In the present report, by means of immunohistochemical methods, both cell infiltrate and HLA-DR molecule expression were analysed in nasal mucous membrane fragments biopsied in the vicinity of fibrous polyps. Both surface and gland epithelia were positive for HLA-DR antigens in all sample whereas the epithelium of control nasal mucous membranes appeared to be negative. In addition only little delimited portions of the basement lamina seemed disrupted by an intense traffic of infiltrating cells. The poor venous drainage, the presence of activated mononuclear and mast cells capable of releasing soluble growth factors, together with basal lamina interruptions, might be factors for polyp sprouting.

Although in the last few years histopathological, immunohistochemical and immunological studies on nasal polyps have been carried out by several Authors, the etiology of these formations still remains unknown. Nasal polyps have a very characteristic structure and have been classified in three histologic types: edematous, glandular and fibrous. In the present report, 11 nasal polyps of edematous type, representing 61% of total number of collected polyps, were studied employing immunohistochemical methods. All the examined polyps were similar in histology and positivity pattern for HLA molecule expression. The edematous core appeared infiltrated (149 cells/mm.2) mainly by eosinophils (> 90%), whereas the peripheral subepithelial connective tissue contained cellular clusters (416 cells/mm2.) made up of different subsets of hematic cells (30.8% were monocytes-macrophages and 48.6% were lymphocytes largely represented by CD4+ cells). On the contrary, mast cells were quite rare (on the average 1.7 cells/mm2.) and located near T cell clusters. The epithelial positivity for HLA-DR and HLA-A,B,C molecules showed a characteristic discontinuous pattern. In the same patient, controlateral nasal mucosa showed a histological structure very similar to that of polyps. The above data suggest that the presence of polyps is the result of an inflammatory process brought about by a complex array of cellular and humoral components.

ORL inflammations present particular pathogenetic and clinical characteristics due to the close anatomic and physiological connection among them and to their particular anatomic characteristics. The ear communicates with the rhinopharynx through the Eustachian tube, and this relationship explains how bacterial infections of the upper respiratory tract can cause otitis and how tubal dysfunctions are often responsible for chronic ORL infections, also favoured by the microcavity structure of the middle ear and the mastoid bone. Also the macro- and microcavity anatomic structure of the paranasal sinuses favours chronic infectious diseases, and their adjacency with the endocranial and facial structures justifies the secondary complications of these infections. The palatine tonsil and other structures of the Waldeyer's lymphatic ring play an important immune role in the first respiratory and digestive tract, and infections occurring in these structures (for example, streptococcal infection) can cause pathologies such as rheumatic disease. Other ORL infections are connected to immunodeficiency or atopy.

The ever-increasing use of magnetic resonance tomography (MR) as an investigation mean has created a new interest in the biological effects of magnetic fields (MF) and in finding protective measures to be taken in their event. At the moment, use of MR is contraindicated in the presence of pacemakers, vascular clips, liquoral shunts and orthopedic prostheses, all of which may be dislocated by the MF created by MR or may interact with the MF itself creating distorted or falsified images. The aim of our study was to verify if metallic stapedectomy prostheses are dislocated by the MF and if they produce enough interference to falsify MR images. Five types of metallic stapedial prostheses exposed to a MF of 0.5T were studied. We may conclude from our results that MR does not create any otological risks for patients with these prostheses in that none of them were dislocated during exposure. However, all the prostheses studied did instead bring about alterations in the MF and the MR image to varying degrees. In some cases (Robinson) there was notable image distortion, while in others (Schuknecht wire teflon and platinum piston) the distortion was practically negligible. It is our opinion, however, that even if the image distortion does not interfere with routine MR, use of prostheses made of materials not affected by MF are advisable in view of an eventual development of visualization of the labyrinth and intratemporal facial nerve portion with MR.

In this study fibrous nasal polyps, obtained from four patients, were analyzed by means of immunocytochemical methods for the presence of interstitial hematic cell infiltrate and HLA-DR molecule expression. This histologic type accounted for 36.4% of nasal polyps studied. Our results demonstrated that cells belonging to monocyte-macrophage lineage were mainly detected within fibrous and edematous zones (greater than 50%), whereas T cells were found within the subepithelial peripheral connective tissue (greater than 60%). Surface and gland epithelial cells appeared to be more intensely stained for HLA-DR molecules than nasal epithelium of normal subjects, thus indicating that the intensity of HLA-DR molecule expression correlated with the presence of a hematic cell infiltrate. Nasal polyps are a frequent pathology whose etiology has not yet been completely clarified. The present study provides additional information about the fibrous polyp structure and can support some speculations on the nasal polyp etiology.