PURPOSE: Nitric oxide (NO) is an important endogenous mediator in both upper and lower respiratory systems. The purpose of the present study was to extract nasal NO (nNO) normal range of Chinese adults and the internal influencing factors. The differences in nNO levels between rhinitis and asymptomatic atopic subjects, and the diagnostic value of nNO in allergic rhinitis (AR) were further investigated. METHODS: One thousand adults were recruited from the general public. Participants were divided into different subgroups according to the questionnaires and skin prick tests. In all of these subjects, nNO, fractional exhaled NO (FeNO) and nasal airflow resistance were measured. The normal ranges of nNO and FeNO, the differences between subgroups, and the correlations between NO (nNO and FeNO) and other internal factors were analyzed. RESULTS: Both nNO and FeNO levels were significantly higher in AR patients than in healthy and asymptomatic atopic subjects. The nNO levels were significantly lower in asymptomatic atopic subjects than in normal adults. FeNO levels were significantly higher in non-AR patients than in the healthy and asymptomatic atopic adults. The cutoff value of nNO for the diagnosis of AR was 117.5 ppb (sensitivity, 50.9%; specificity, 63.9%). The nNO levels were correlated with FeNO levels, total nasal resistance measured at 75Pa, nasal volume within 0–7 cm from the anterior nares (V0–7cm) and nasal symptom visual analogue scale (VAS) scores, while the FeNO levels were correlated with age, height, weight, body surface area, nasal volume of V0–7cm and the nasal symptom VAS score. CONCLUSIONS: The nNO level can be significantly different between healthy and AR patients and may be significantly correlated with nasal symptoms and nasal patency of rhinitis patients. However, the clinical value of nNO is still in the exploration stage.
Adult ; Asian Continental Ancestry Group ; Body Weight ; Diagnosis ; Humans ; Nasal Obstruction ; Nitric Oxide ; Reference Values ; Respiratory System ; Rhinitis ; Rhinitis, Allergic ; Sensitivity and Specificity ; Skin

Woakes' syndrome is a group of disease which include recurrent nasal polyps resulting in the broadening of the nasal pyramid, the onset of hypoplasia of frontal sinus and bronchiectasis, as well as the production of mucous discharge. Children and young adults are mostly susceptible to Woakes' syndrome due to the plasticity of the bone. Even though the exact etiology is unknown, genetic factor is thought to be influential because it is often diagnosed in siblings. Otolaryngologically, the mainstream method of removing nasal polyp by endoscopic sinus surgery as well as topical or systemic treatment can be helpful. We report two siblings who visited our clinic both complaining of nasal obstruction. The patients presented with recurrent nasal polyps and showed signs of bronchiectasis, which led to the diagnosis of Woakes' syndrome. These rare cases are presented here with a review of related literature.
Bronchiectasis ; Child ; Diagnosis ; Fibrinogen ; Frontal Sinus ; Humans ; Methods ; Nasal Obstruction ; Nasal Polyps ; Plastics ; Siblings ; Young Adult

A nasal septal abscess results from the collection of purulent fluid between the cartilage of bony septum and overlying mucoperichondrium or mucoperiosteum. Unless early diagnosis and surgical treatment are performed, serious complications such as cavernous sinus thrombophlebitis, sepsis, and saddle nose may occur. We report a case of septal abscess and sphenoid sinusitis that occurred after dental implant. A 74-year-old female with diabetes and liver cirrhosis was referred to the hospital for management of rapidly aggravated perinasal pain, nasal obstruction, and headache. The patient had undergone dental implant in the right upper incisor area 6 days ago. A CT revealed septal abscess and bilateral sphenoid sinusitis. The patient was operated upon to drain septal abscess, and both sphenoid sinuses were opened widely.
Abscess ; Aged ; Cartilage ; Cavernous Sinus Thrombosis ; Dental Implants ; Early Diagnosis ; Female ; Headache ; Humans ; Immunocompromised Host ; Incisor ; Liver Cirrhosis ; Nasal Obstruction ; Nasal Septum ; Nose ; Sepsis ; Sphenoid Sinus ; Sphenoid Sinusitis

Nasal airway obstruction is one of the most frequent causes of revision rhinoplasty despite the golden rule that nasal function should not be sacrificed because of cosmetic reason. Nasal function is jeopardized due to diverse reasons including inaccurate diagnosis or inadequate surgical technique. Detailed and thorough evaluation of the nose with review of previous operative technique is necessary to find out exact causes of obstruction. Septum, middle vault, tip, nostril, and nasal mucosa are common anatomic areas of obstruction after rhinoplasty. They are often weakened, damaged, or even destroyed losing their original shape, strength, or position. Changes in these anatomic structures are strongly related to static and/or dynamic obstruction. In this article, authors reviewed the common locations, anatomic causes, and treatment strategies of nasal obstruction after rhinoplasty.
Diagnosis ; Nasal Mucosa ; Nasal Obstruction* ; Nose ; Rhinoplasty*

Sinonasal intestinal-type adenocarcinoma is a rare neoplasm which can be diagnosed by pathologic report. Nasal obstruction, epistaxis, and rhinorrhea are common symptoms, but presenting with a benign-looking palpable mass is also possible. This is a report of our experience in diagnosing and treating a sinonasal intestinal-type low grade adenocarcinoma. A 63-year-old man initially presented with a rapidly growing palpable mass in the glabella region for 4 months. A malignancy of sinus origin was suspected on imaging studies. We performed further preoperative evaluations for cancer staging, and curative surgery was planned. Radical resection and immediate reconstruction with free anterolateral thigh flap were performed. The pathology findings confirmed a diagnosis of sinonasal intestinal-type adenocarcinoma.
Adenocarcinoma* ; Diagnosis ; Epistaxis ; Frontal Sinus* ; Humans ; Middle Aged ; Nasal Obstruction ; Neoplasm Staging ; Pathology ; Thigh

Malignant lymphoma is tumor of the immune system. It is mainly found in the lymph node but it can also originate from extranodal organs such as gastrointestinal tract, sinonasal tract, and etc. We experienced a case of 18-year-old female patient with a huge nasopharyngeal mass. The patient visited our clinic with complaints of nasal obstruction and mouth breathing without general symptoms. After extirpation and biopsy of the nasopharyngeal mass, lesion was diagnosed as malignant lymphoma. In immunohistochemistry, CD 20, Bcl-2, Bcl-6 were positive. Final diagnosis was diffused large B cell lymphoma, for which she received chemotherapy (Rituximab, Cyclophosp, Ahamide, Adriamycin, Vincristine, Prednisone). We report a case of huge malignant lymphoma that occurred in the nasopharynx with a brief review of literature.
Adolescent* ; Biopsy ; Diagnosis ; Doxorubicin ; Drug Therapy ; Female* ; Gastrointestinal Tract ; Humans ; Immune System ; Immunohistochemistry ; Lymph Nodes ; Lymphoma ; Lymphoma, B-Cell* ; Mouth Breathing ; Nasal Obstruction ; Nasopharynx ; Vincristine

BACKGROUND AND OBJECTIVES: Chronic rhinitis is divided into allergic rhinitis (AR) and nonallergic rhinitis (NAR), both of which have similar symptoms but differ in treatment approaches. For the diagnosis of AR, allergen-specific immunoglobulin E (IgE) tests along with characteristic symptoms are required. However, these tests are costly and not always practicable. The purpose of this study was to investigate how symptoms respond differently to different allergen sensitization or sensitized allergen. SUBJECTS AND METHOD: We retrospectively reviewed 1661 patients who underwent multiple allergen simultaneous test (MAST) for chronic rhinitis symptoms. The total nasal symptom (TNS) scores of these patients from 2006 to 2014 were assessed for rhinorrhea, nasal obstruction, itching, and sneezing. Patients were classified as AR and NAR according to the results of MAST and their association with symptoms. RESULTS: There were 1021 patients designated to the AR group and 640 patients to the NAR. The AR group had lower age, higher TNS, and higher serum IgE levels than the NAR group. In addition, sneezing and itching were more common in the AR group. Furthermore, sneezing was a positive predictor for seasonal allergen sensitization. On the other hand, itching was a positive predictor for perennial allergen sensitization. CONCLUSION: AR and NAR patients showed different demographic characteristics and symptoms. These results may be helpful in classifying and treating patients with chronic rhinitis, especially when the allergen specific IgE test cannot be performed.
Diagnosis ; Hand ; Humans ; Immunoglobulin E ; Immunoglobulins ; Methods ; Nasal Obstruction ; Pruritus ; Retrospective Studies ; Rhinitis ; Rhinitis, Allergic ; Seasons ; Sneezing ; Urbanization

PURPOSE: Nasal cytology is important in the diagnosis and treatment of nasal inflammatory diseases. Treatment of allergic rhinitis (AR) according to nasal cytology has not been fully studied. We plan to explore the individualized treatment of AR according to nasal cytology. METHODS: Nasal cytology from 468 AR patients was examined for inflammatory cell quantity (grade 0–5) and the percentage of neutrophils and eosinophils. Results were subdivided into the following categories: AR(Eos), eosinophil ≥50% of the whole inflammatory cells; AR(Neu), neutrophils ≥90%; AR(Eos/Neu), 10%≤ eosinophil <50%; AR(Low), grade 0/1 inflammatory cell quantity. Nasal cytology-guided treatment was implemented: all AR(Eos) patients (n=22) and half of the AR(Neu) patients (AR[Neu1], n=22) were treated with mometasone furoate spray and oral loratadine. Another half of the AR(Neu) patients (AR[Neu2], n=22) were treated with oral clarithromycin. Visual analog scale (VAS), symptom scores, and nasal cytology were evaluated 2 weeks before and after treatment. RESULTS: There were 224/468 (47.86%) AR(Eos), 67/468 (14.32%) AR(Neu), 112/468 (23.93%) AR(Eos/Neu), and 65/468 (13.89%) AR(Low) of the AR patients studied. There were no significant differences in clinical characteristics among these subgroups, except that the nasal blockage score was higher in AR(Eos) patients than in AR(Neu) patients (1.99 vs. 1.50, P=0.02). Comparing AR(Eos) patients with AR(Neu1) patients 2 weeks after treatment, nasal symptoms and VAS were significantly lower in AR(Eos) patients, except for nasal blockage symptoms (P<0.05 of nasal itching and sneezing; P<0.01 for nasal secretion, total scores, and VAS). Comparing AR(Neu1) with AR(Neu2) patients, nasal symptoms, and VAS were significantly lower in AR(Neu2), except for nasal blockage and nasal itching symptoms (P<0.05 for nasal secretions, sneezing, total score, and VAS). CONCLUSIONS: Nasal cytology may have important value in subtyping AR and optimizing AR treatment. Treating neutrophils is very important in AR patients with locally predominant neutrophils.
Clarithromycin ; Diagnosis ; Eosinophils ; Humans ; Loratadine ; Mometasone Furoate ; Nasal Obstruction ; Neutrophils ; Pruritus ; Rhinitis, Allergic* ; Sneezing ; Visual Analog Scale

BACKGROUND AND OBJECTIVES: The skin prick test is a widely used test that uses three methods (allergen/histamine ratio method, erythema size method, and wheal size method) to interpret the results. However, there has been no comparison of these methods. The aim of this study is to compare the three different interpretation methods and define the relationship among them. SUBJECTS AND METHOD: A total of 139 patients who visited our allergy clinic complaining of nasal symptoms were enrolled. Three interpretation methods were used for defining positivity in the skin prick test, and their results were compared. The validity of each interpretation method was evaluated by total nasal symptom score. RESULTS: Positivity in the skin prick test was reported in 48.2% of patients according to the allergen/histamine ratio method and in 64.0% of patients according to the wheal size method and erythema size method. The proportion of subjects who showed a negative result with the allergen/histamine ratio method but positive results with the wheal size method or erythema size method was 15.8%. This group had a significantly higher total nasal symptom score, especially rhinorrhea and nasal obstruction, than subjects who showed negative results on all three methods. CONCLUSION: When diagnosing allergic rhinitis patients using the skin prick test, the wheal size method and erythema size method should be considered rather than the allergen/histamine ratio method.
Diagnosis ; Erythema ; Humans ; Hypersensitivity ; Methods* ; Nasal Obstruction ; Rhinitis, Allergic ; Skin Tests* ; Skin*

Sarcoidosis is a chronic granulomatous disease, involving multisystem, confirmed by the presence of non-caseating granulomas. Sinonasal involvement in sarcoidosis is rare and difficult to diagnose since the symptoms of nasal obstruction and rhinitis are nonspecific. The diagnosis of sarcoidosis begins with clinical suspicion, followed by with imaging, and finally confirmed with tissue biopsy. In this study, we report a case of sarcoidosis of the nasal septum, which was early confirmed by a biopsy of the nasal septum and hilar lymph node.
Biopsy ; Diagnosis ; Granuloma ; Granulomatous Disease, Chronic ; Lymph Nodes ; Nasal Obstruction ; Nasal Septum* ; Rhinitis ; Sarcoidosis*