[The study about the role of laryngopharyngeal reflux for the hemorrhage after tonsillectomy]

Objective:To assess the role of LPR in the development of complications, such as hemorrhage, following tonsillectomy in adult patients. We want to provide a guidence for future clinical practice.Method:Totally 70 adult patients who had indication of tonsillectomy were recruited and divided into two groups, the laryngopharyngeal reflux (LPR) group and the control group, which were identified by the results of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). We observed and compared the postoperative complications of the two groups and analyzed the role of LPR.Result:All the patients complained pain after surgery. The duration of the pain in LPR group was much longer than that of control group. The mean body temperature in both groups was not significantly different (P＞0.05). There were six cases of bleeding in the LPR group, while only one case of bleeding occurred in the control group. The difference was statistically significant (P<0.05). There were no cases of infection or pulmonary complications in both groups. All patients were discharged successfully.Conclusion:LPR is closely related to the complications following tonsillectomy.

[Impact of blood eosinophils on clinical effect of endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps]

Objective: To investigate the effect of blood eosinophils on clinical effect of endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: From March 2011 to March 2016, 72 cases with CRSwNP were treated by endoscopic sinus surgery in Department of Otorhinolaryngology Head and Neck Surgery, Peking University People's Hospital. The clinical records were retrospectively reviewed, and the cases were divided into eosinophilia elevated and non-elevated group according to blood eosinophils, and nasal polyps were evaluated for histopathology eosinophil count. Statistical analysis was performed to compare two groups' pre- and post-operative symptoms of VAS score, sinus computed tomography (CT) scans scores according to the Lund-Mackay system and the outcome of surgery. Both groups' factors that might have affected their outcome were analyzed by t-test, Chi square, Pearson Correlation Coefficient and Willcoxon rank sum test. Results: Seventy two cases were followed up from 24 to 78 months.The average follow-up time was 56 months. The VAS score in the eosinophilia elevated group (n=16) was higher than that in the non-elevated group(n=56), and the difference was statistically significant (11.44±7.13 vs 4.98±5.64, t=3.726, P<0.05). The control of symptoms in the peripheral blood eosinophilia elevated group was less than that in the non-elevated group, and the difference was statistically significant (Z=-1.979, P<0.05). There was a positive correlation between eosinophil counts in peripheral blood and tissues of 72 cases (r=0.429, P<0.05). Conclusion: There is a significant correlation between tissue and blood eosinophil counts, and eosinophilia group has poorer outcomes.

[Rosenmüller valve during endoscopic dacryocystorhinostomy in treating refractory nasolacrimal duct obstruction]

OBJECTIVE

The objective of this study was to assess the efficacy of exposing Rosenmüller valve during endonasal endoscopic dacryocystorhinostomy (EES-DCR) in treating refractory nasolacrimal duct obstruction.

METHODS

Thirty six patients (47 eyes) with refractory nasolacrimal duct obstruction were entered into this study, including 13 patients (15 eyes) underwent nasal lacrimal duct intubation before, 18 patients (26 eyes) with small lacrimal sac, 2 patients underwent DCR before, 1 patient with functional nasal lacrimal duct obstruction, 1 patient with lacrimal mucocele, 1 patient with nasal trauma. During the DCR, the bone window was enlarged as wide as possible and the valve of Rosenmüller was exposed. The intubation of the lacrimal apparatus was performed if the lacrimal sac was very small and the Rosenmüller valve was tight. Functional endoscopic sinus surgery and septoplasty were performed simultaneously if necessary. Postoperatively, each patient was assessed by the symptom and nasal endoscopy.

RESULTS

The postoperative follow-up period ranged from 3 to 36 months. Thirty two patients(89.4%, 42/47 eyes) were cured, which presented as the disappearance of symptoms, the patency of the lacrimal ostium and the lacrimal duct irrigation was clear. One patient (2.1%, 1/47 eyes) was improved, which presented as the improvement of symptoms, a few hypertrophic scar around the lacrimal ostium and the lacrimal duct irrigation was clear. Four cases failed (8.5%, 4/47), which presented as symptomatic and obstruction of the lacrimal ostium. The total effective rate reached to 91.5%. No serious postoperative complications were found in all cases.

CONCLUSIONS

To expose Rosenmüller valve during endoscopic DCR in treating patients with refractory nasolacrimal duct obstruction could obviously increase the operative success rate, fewer complications, with no facial surgical scar. It is an ideal way to treat the refractory nasolacrimal duct obstruction.

[Type 2 innate lymphoid cells and chronic rhinosinusitis]

Type 2 innate lymphoid cells (ILC2) is a new group of the innate lymphoid cells which has been recently discovered. These cells can produce type 2 cytokines such as interleukin-5 (IL-5) and interleukin-13 (IL-13) on response to interleukin-33 (IL-33), interleukin-25(IL-25) and thymic stromal lymphopoietin (TSLP) to initiate and maintain the type 2 inflammation in human. Nasal polyps from patients with chronic rhinosinusitis (CRS) show enrichment for ILC2, which suggests ILC2 could have a critical role in the occurrence/development of nasal polyps. This review focuses on discovery of ILC2, immunological properties of ILC2 and ILC2 in CRS.