Do citation classics in rhinology reflect utility rather than quality?

Citation rates have been suggested to be more of an indicator of utility than quality. The aim of this study was to apply measures of utility and quality to articles identified as citation classics in rhinology/anterior skull base surgery. There were 14 articles analysed in the study. The assessment of quality was performed by combining factors from previous publications on quality assessment and the various elements were categorised into four groups; quality of written article and publication, quality of research, quality of evidence-based methodology and quality of outcome. This study revealed that citation classics in rhinology/anterior skull base surgery were well-written and satisfied peer review in reputable journals in the specialty. Quality is satisfied by clarity of exposition and patient numbers. The research was generally asking an important question and the methodology overall was adequate and appropriate for the type of study performed. A good quality of research and outcome was demonstrated with a definite historical importance, and reports that stimulated further research and enquiry. Quality is not satisfied by the lack of randomised controlled trials, appropriate statistical analysis or patient criteria. In conclusion citation rates when considered as an individual measure, reflect utility rather than quality.

Health related quality of life in sinonasal disease

Objective measurements of sinonasal disease have proved difficult to standardise and correlate poorly with the severity of symptoms. Quality of life, which has been defined as the gap between expectation and experience allows the impact of disease to be quantified thus enabling comparison of different diseases and enabling examination of therapeutic response. A range of generic and disease specific questionnaires have been developed of varying complexity. These have been applied to a range of sinonasal conditions including allergy, infection and neoplasia. With increasing refinement they may become the main primary outcome measures in both clinical trials and practice.

Effects of ammonia inhalation and acetic acid pretreatment on colonization kinetics of toxigenic Pasteurella multocida within upper respiratory tracts of swine

Pigs reared in intensive production systems are continuously exposed to ammonia released by the microbial degradation of their excrement. Exposure to this gas has been shown to increase the severity of the disease progressive atrophic rhinitis by facilitating colonization of the pig's upper respiratory tract by Pasteurella multocida. The etiological mechanism responsible for this synergy was investigated by studying the colonization kinetics of P. multocida enhanced by ammonia and comparing them with those evoked by an established disease model. Three-week-old Large White piglets were weaned and allocated to five experimental groups (groups A to E). Pigs in groups A and B were exposed continuously to ammonia at 20 ppm for the first 2 weeks of the study. Pigs in group C were pretreated with 0.5 ml of 1% acetic acid per nostril on days -2 and -1 of the study. On day 0 all the pigs in groups A, C, and D were inoculated with 1.4 x 10(8) toxigenic P. multocida organisms given by the intranasal route. The kinetics of P. multocida colonization were established by testing samples obtained at weekly intervals throughout the study. The study was terminated on day 37, and the extent of turbinate atrophy was determined by using a morphometric index. The results of the study showed that exposure to aerial ammonia for a limited period had a marked effect on the colonization of toxigenic P. multocida in the nasal cavities of pigs, which resulted in the almost total exclusion of commensal flora. In contrast, ammonia had only a limited effect on P. multocida colonization at the tonsil. The exacerbation of P. multocida colonization by ammonia was restricted to the period of ammonia exposure, and the number of P. multocida organisms colonizing the upper respiratory tract declined rapidly upon the cessation of exposure to ammonia. During the exposure period, the ammonia levels in mucus recovered from the nasal cavity and tonsil were found to be 7- and 3.5-fold higher, respectively, than the levels in samples taken from unexposed controls. Acetic acid pretreatment also induced marked colonization of the nasal cavity which, in contrast to that induced by ammonia, persisted throughout the time course of the study. Furthermore, acetic acid pretreatment induced marked but transient colonization of the tonsil. These findings suggest that the synergistic effect of ammonia acts through an etiological mechanism different from that evoked by acetic acid pretreatment. A strong correlation was found between the numbers of P. multocida organisms isolated from the nasal cavity and the severity of clinical lesions, as determined by using a morphometric index. The data presented in the paper highlight the potential importance of ammonia as an exacerbating factor in respiratory disease of intensively reared livestock.