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Taş BM, Bekin Sarıkaya PZ, Şencan Z, Cömert E, Bayar Muluk N. Radiological Evaluation of the Effect of Laryngopharyngeal Reflux on the Thickness of Inferior Turbinate, Maxillary Sinus Mucosa and Nasal Septal Body. Indian J Otolaryngol Head Neck Surg 2024; 76:530-535. [PMID: 38440497 PMCID: PMC10908712 DOI: 10.1007/s12070-023-04204-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/28/2023] [Indexed: 03/06/2024] Open
Abstract
Background We investigated the relationship between Laryngopharyngeal Reflux (LPR) and maxillary sinus mucosal thickness (MSMT), inferior turbinate mucosal thickness (ITMT), inferior turbinate width (ITW) and nasal septal body thickness (NSBT), which can be signs of chronic rhinosinusitis and allergic rhinitis. Methods The study, which included 87 patients, was designed as two groups. While 42 of the patients were included in the Laryngopharyngeal Reflux group, 45 were included in the control group. Age and gender information of the patients were noted. MSMT, ITMT, ITW and NSBT values were measured in patients who had Paranasal Sinus Computed Tomography. MSMT, ITMT and ITW were measured as right and left. Both groups were evaluated in terms of these values. Results Right ITMT, bilateral ITW and MSMT values were found to be significantly higher in the LPR group than in the control group (p < 0.05). MSMT values were higher in males (p < 0.05). The left-ITT and NSBT values were not significantly different between the LPR group and the control group, but both values were higher in the LPR group than in the control group (p > 0.05). In the LPR group, there were positive correlations between ITMT and ITW values of the right side; and left side separately (p < 0.05). Conclusion It has been shown that Laryngopharyngeal Reflux increases maxillary sinus mucosal thickness, inferior turbinate thickness and width, and nasal septal body thickness, which can be signs of chronic rhinosinusitis and allergic rhinitis. The negative effects of LPR on nasal and paranasal mucosa and structures were demonstrated in this study.
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Affiliation(s)
- Burak Mustafa Taş
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | | | - Ziya Şencan
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | - Ela Cömert
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
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Ramkumar SP, Brar T, Marks L, Marino MJ, Lal D. Biological sex as a modulator in rhinologic anatomy, physiology, and pathology: A scoping review. Int Forum Allergy Rhinol 2023; 13:1783-1800. [PMID: 36688669 DOI: 10.1002/alr.23135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/06/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Biological sex is increasingly recognized as a critical variable in health care. The authors reviewed the current literature regarding sex-based differences in rhinology to summarize the data and identify critical knowledge gaps. METHODS A scoping review was conducted. Publications reporting sex-based differences in anatomy, physiology, and pathology focusing on disease prevalence, disease burden, and outcomes in rhinology were identified. RESULTS Seventy-five relevant manuscripts were identified. While paranasal sinuses are of similar size at birth, they become larger in males leading to differences in ostium location. Females outperform males in olfactory identification but only in the 18- to 50-year age group. Estrogen and progesterone administration can impact muscarinic and α1 -adrenergic nasal mucosa receptor density. Chronic rhinosinusitis (CRS) and CRS without nasal polyps are more prevalent in females while CRS with nasal polyps is more prevalent in males. CRS symptom burden is higher in females before and after endoscopic sinus surgery; however, no difference in endoscopic sinus surgery utilization was found based on sex. Allergic rhinitis is more common in males before puberty and in females after puberty. Epistaxis is more prevalent in males and postmenopausal females compared with premenopausal females, perhaps from differences in sex-hormonal and hypertension status. In nasopharyngeal carcinoma, the incidence of sinus abnormalities was higher in males than females. CONCLUSIONS Although many sex-based differences exist in rhinology, further research is necessary to offer evidence-based treatment guidelines. Gonadal hormones should be studied as a therapeutic in rhinologic pathology as baseline physiologic differences exist such as those found in nasal mucosa receptor density.
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Affiliation(s)
- Shreya P Ramkumar
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
- Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Tripti Brar
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Lisa Marks
- Division of Education, Department of Library Services, Mayo Clinic, Phoenix, Arizona, USA
| | - Michael J Marino
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Devyani Lal
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA
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Pshennikov DS, Angotoeva IB. [The septal tubercle: the state of the problem]. Vestn Otorinolaringol 2022; 87:51-56. [PMID: 35605272 DOI: 10.17116/otorino20228702151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The septal tubercle is considered to be a thickened area of the nasal septum, which is located above the lower nasal concha and in front of the middle nasal concha. Taking into account its histological structure and location in the distal segment of the internal nasal valve, it is located and structured for secretory function and vasoactive regulation of the respiratory air flow. These histologically rich tissues with glandular elements are well adapted to the possible dryness that occurs under the influence of intense air flow during breathing, and the existence of a certain number of venous sinusoids of the blood confirms the connection with part of the extensive vascular tissues in the nasal cavity. It is believed that the tubercle of the nasal septum is more pronounced in patients with chronic inflammation of the sinonasal region, for example, with chronic allergic rhinitis or chronic rhinosinusitis. There is currently no consensus on the issue of surgery of the nasal septum body. Due to the lack of consensus among practitioners, many surgeons do not routinely perform operations on this structure and consider the surgical intervention too aggressive, and the effect on nasal obstruction is insignificant. However, according to the presented studies, the results of surgical reduction of soft tissues of the enlarged septal tubercle in the treatment of nasal obstruction using radiofrequency ablation, coblation or microdebrider seem promising, which requires additional study of this issue during long-term follow-up.
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Affiliation(s)
- D S Pshennikov
- Ryazan State Medical University, Ryazan, Russia.,Semashko Regional Clinical Hospital, Ryazan, Russia
| | - I B Angotoeva
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
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Liu J, Qian Z, Yan Z, Yang X, Wang N. Asymmetry of inferior turbinate in patients with nasal septum deviation and its significance for nasal ventilation surgery. Eur Arch Otorhinolaryngol 2021; 279:2423-2431. [PMID: 34302496 DOI: 10.1007/s00405-021-07012-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 07/20/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate the asymmetry of the inferior turbinate (IT) in patients with nasal septum deviation (NSD). METHODS The paranasal sinus computed tomography (CT) of 100 patients with NSD were retrospectively investigated from February 2018 to December 2019. The thickness of IT, IT mucosa and IT bone, the distance between the IT and the midline were measured on both the concave and convex sides, and which correlation with NSD was analyzed. RESULTS The widths of the IT, IT bone and IT medial mucosa on the concave side were larger than those on the convex side (all P < 0.05). The distance from the IT and IT bone to the midline on the concave side was smaller than those on the convex side (P < 0.05, respectively). The degree of NSD had a negative correlation with the widths of the IT and IT bone on the convex side, and the distance between the IT and the midline on the concave side; and a positive correlation with the distance from IT and IT bone to the midline on the convex side, and IT mucosa thickness on the concave side (all P < 0.05). CONCLUSION The asymmetric IT width is mainly caused by both hypertrophies of the IT mucosa on the concave side and atrophy of the IT bone on the convex side. Therefore, during the surgery of nasal ventilation reconstruction, the IT on the convex side are suggested to be protected from intervention. In contrast, it is necessary to lateralize the IT bone and reduce the IT submucosal tissue on the concave side. However, routine excision of the IT bone is not recommended.
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Affiliation(s)
- Jinfeng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China.
| | - Zhuoming Qian
- Department of Otorhinolaryngology, Beijing Huairou Hospital of University of Chinese Academy of Sciences, Beijing, 101400, China
| | - Zhanfeng Yan
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China.,Department of Otorhinolaryngology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xuwen Yang
- 7 Medical Students of Long Schooling Class 3, The Third Clinical Medical School, Capital Medical University, Beijing, 100020, China
| | - Ningyu Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
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Hajem H, Botter C, Al Omani M, Sounthakith V, de Bressieux E, Benkhatar H. Pyriform Aperture Enlargement for Internal Nasal Valve Obstruction in Adults: Systematic Review and Surgical Classification. Otolaryngol Head Neck Surg 2021; 165:745-750. [PMID: 33648407 DOI: 10.1177/0194599821994739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Pyriform aperture enlargement or "pyriplasty" is an uncommonly used procedure for internal nasal valve obstruction in adults besides functional rhinoplasty, inferior turbinate reduction, and septoplasty. A systematic review of the literature was performed to analyze current surgical techniques, their suggested indications, and their related outcome in terms of success and complications. DATA SOURCES The search was performed on PubMed, EMBASE, SCOPUS, and Cochrane databases. REVIEW METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies on congenital, traumatic, tumoral, or infectious internal nasal valve obstruction were excluded. RESULTS Eight articles were finally included. Three types of pyriplasty have been described according to the level of bone resection: low-level pyriplasty through the sublabial approach, mid-level pyriplasty through endonasal approach, and extended pyriplasty through either approach. Indications included (1) clinically or radiologically narrow pyriform aperture, (2) previously unsuccessful internal nasal valve surgery, (3) lateral nasal wall collapse, and (4) inferior turbinate's head hypertrophy. Subjective improvement of nasal obstruction was reported in these 4 indications. No major complication was encountered. CONCLUSION Pyriplasty for nasal obstruction is a simple and safe procedure that could be effective in selected cases. However, level of evidence is currently low, and success rate may vary with indications and pyriplasty techniques. Moreover, there is no clear definition of normal pyriform aperture dimensions to date. Further prospective studies are thereby necessary and should include radiological analysis of pyriform aperture and validated nasal obstruction measurement tools.
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Affiliation(s)
- Humoud Hajem
- Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
| | - Charles Botter
- Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
| | - Mohammad Al Omani
- Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
| | - Vincent Sounthakith
- Centre Hospitalier de Versailles, Service de Stomatologie et Chirurgie maxillo-faciale, Le Chesnay, France
| | - Eléonore de Bressieux
- Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
| | - Hakim Benkhatar
- Centre Hospitalier de Versailles, Service d'ORL et chirurgie cervico-faciale, Le Chesnay, France
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