OBJECTIVE: Non-allergic rhinitis is a heterogeneous disease whose etiology is largely unknown. Nasal cytology only allows us to recognize different non-allergic rhinitis forms on the basis of the prevalent inflammatory cell infiltrate: non-allergic rhinitis with eosinophils, with neutrophils, with mast-cells and with both eosinophils and mast-cells. The aim of this study is to define the incidence, clinical features and comorbidity of the different types of cell-mediated non-allergic rhinitis in a pediatric age group. METHODS: One hundred and fourteen non-allergic children with chronic nasal obstruction and associated symptoms (rhinorrhea, sneezing and nasal itchiness) were retrospectively selected. All patients had been submitted to a clinical history, pediatric evaluation, anterior rhinoscopy and fiberendoscopy, rhinomanometry and nasal cytology. RESULTS: Non-allergic rhinitis with neutrophils was present in 46 (40.4%) children, non-allergic rhinitis with eosinophils in 53 (46.5%), non-allergic rhinitis with mast-cells in 12 (10.5%) and non-allergic rhinitis with both eosinophils and mast-cells in 3 (2.6%). Nasal obstruction was prevalent in non-allergic rhinitis with eosinophils and in non-allergic rhinitis with mast-cells patients (P<0.001) whereas rhinorrea and sneezing only in the form with eosinophils (P<0.0001). Nasal itching on the other hand was prevalent in the form with mast-cells (P<0.0003). Non-allergic rhinitis with eosinophils group showed a higher probability of asthma (P<0.02) and respiratory sleep disorders (P<0.04). CONCLUSIONS: In the pediatric age group the most frequent forms of non-allergic rhinitis are those with eosinophils or with neutrophils. A diagnosis of non-allergic rhinitis with eosinophils in children presumes more severe symptoms and a higher incidence of pulmonary disease and roncopathy.

Purpose To assess the efficacy, tolerability and cytological alterations of nasal mucosa with various materials for nasal packing. Materials and methods One hundred and five patients, submitted to a nasal surgery and post-operative packing with four different materials (Clauden®, Merocel®, two-fingered glove pack with gauzes inside and Lyofoam™) were prospectively enrolled in the study. All patients were submitted to a questionnaire of 12 questions which required the patients to refer to the tolerability of packing. Finally a nasal cytological test was performed after removal of packing and 10 days after, to evidence the alterations of ciliated cells and reduction of supranuclear stria. Results The questionnaire of tolerability of packing revealed a severe discomfort (grade III) in 13 patients (38.2%) with Clauden, 1 (2.4%) with Merocel, 7 (41.1%) with two-fingered glove packing and 6 (46.1%) with Lyofon. As regards cellular alterations, the two-fingered glove and the Merocel groups had the lowest percentage of cellular alterations which was particularly different from the Clauden group (p =.0014) The supranuclear stria was reduced in the Clauden group and the two-fingered glove packing group both after packing removal and after ten days with a statistical difference when compared to the other two groups (p <.001). Conclusions Merocel packing appears to be well tolerated by the patients with the lowest percentage of cytological alteration, of ciliated cells. Also finger glove packing shows scarce damage of nasal mucosa with a lower percentage of nasal bleeding but its tolerability is not so good.

BACKGROUND: Vasomotor rhinitis (VR) seems to be related to an imbalance between cholinergic and adrenergic activity in the autonomic nervous system. The nerve fibers of the sympathetic and parasympathetic nervous systems reach the nose through the posterior nasal nerve, which, after crossing the sphenopalatine foramen, distributes to the mucosa following the branches of the sphenopalatine vessels. This study was designed to evaluate the effect of sphenopalatine artery ligation on nasal function and nasal cytology in patients with VR. METHODS: Thirty patients with VR and bilateral inferior turbinate hypertrophy (ITH) were randomly assigned to receive endoscopic inferior turbinoplasty either with or without sphenopalatine artery ligation. Pre- (baseline) and postsurgical (1-year follow-up) assessment included fiber endoscopy, active anterior rhinomanometry, measurement of mucociliary transport time (MTt), and nasal cytology examination. RESULTS: At 1-year follow-up there was a statistically significant improvement in nasal resistances in both groups but not on intergroup comparison; MTt significantly decreased in both groups (p < 0.01) and was significantly better (p < 0.05) in the group that had undergone sphenopalatine artery ligation. Among the patients in this group, significantly fewer were found to have altered ciliated cells (p < 0.005) or a hyperchromatic supranuclear stria (p < 0.005) on nasal cytology; the differences were statistically significant also on intergroup comparison (p < 0.005 and p < 0.001, respectively). CONCLUSION: In patients with vasomotor rhinopathy and ITH, improvement in symptoms, nasal resistance, ciliated cell trophism, and MTt was observed after sphenopalatine artery ligation.

OBJECTIVE:The aim of this study is to report our new endoscopic technique for the repair of nasal septal perforations, called the "slide and patch" technique because it combines a mucoperiosteal free graft of the inferior turbinate with a mucosal rotational or advancement flap from the nasal septum. METHODS:Twenty-two patients with symptomatic septal nasal perforation of various sizes underwent our method of repair. RESULTS:At the last follow-up, 21 (95.4%) perforations were closed. There was a partial closure in only 1 patient with a large perforation (3.5 cm in diameter). After surgery, 19 (86.3%) patients were asymptomatic, 2 (9%) showed persistence of crusting, and 1 (4.5%) showed the appearance of nasal obstruction 1 month postoperatively. CONCLUSION:The method described herein has shown to be effective in nasal septal perforation repair and in nasal symptoms relief with the advantage of not requiring grafts from outside the nose.

PURPOSE: Extensive nasal polyposis could involve the middle turbinate inducing the surgeon to partially remove it. We initiated this retrospective study to evaluate the effect of a partial middle turbinectomy (PMT) on postoperative epistaxis and if sphenopalatine artery ligation (SPAL) could reduce the risk of bleeding in patients without nasal packing. MATERIAL AND METHODS: Twenty-seven patients with extended bilateral nasal polyposis and submitted to primary functional endoscopic sinus surgery (FESS) with PMT on 40 sides were retrospectively selected. Postoperative bleeding and other complications were evaluated and compared with those of a control group of 27 patients who underwent FESS with middle turbinate preservation on 40 sides. The study group was furthermore divided into 2 groups according to the execution of SPAL. The incidence of postoperative bleeding of both groups and of the 2 parts of the study group was compared using the Fisher exact test. RESULTS: A SPAL was necessary to stop intraoperative bleeding in 21 (52.5%) sides of the study group patients and in 7 (17.5%) of the control group patients. After surgery, epistaxis occurred in 8 cases (20%) in the PMT group (1 submitted to SPAL) and in 2 (5%) of the control group. The comparison with the Fisher exact test confirmed the major tendency of postoperative bleeding in the study group and in those not submitted to SPAL (P < .05). CONCLUSIONS: Partial middle turbinectomy causes a higher incidence of postoperative bleeding in patients who are not packed during the FESS operation. The execution of SPAL greatly reduces this risk.

La ricostruzione nasale primaria dopo un trauma del volto è spesso una problematica di difficile approccio. Infatti il naso per la sua prominenza e per la posizione centrale è spesso esposto a traumatismi di vario tipo e qualunque alterazione nel suo aspetto esteriore ha significativi effetti sullo stato psico-sociale del paziente. Nelle forme traumatiche, la ricostruzione nasale è importante non solo per migliorare l’estetica ma anche per evitare alterazioni della respirazione nasale. In questo articolo, riportiamo un caso inusuale di amputazione parziale del naso occorso a seguito di un incidente stradale con i dettagli di ricostruzione della struttura nasale. E’ stata utilizzata la cartilagine auricolare per preparare vari innesti che hanno consentito di ricostruire un supporto per la piramide nasale, evitando deformità a sella e alterazioni della valvola nasale. Il risultato della ricostruzione sulla piramide nasale è stato soddisfacente dal punto di vista estetico e funzionale.

AIM: This study was aimed to evaluate the effects of sleep apnea on attention parameters in children and the potential reversibility after adenotonsillectomy. METHODS: Twenty-eight children aged between 4 and 9 years with chronic adenoid and tonsils hypertrophy and a diagnosis of severe sleep apnoea were prospectively enrolled in the study. They were submitted to the “modified bells test” for the assessment of attention. The administration of the test requires the child seeking to tick the bells on a sheet in the shortest time possible, providing a score of accuracy, and a speed. The results are expressed in terms of percentiles compared to the average of the peers of equal months of age. RESULTS: The modified bells test evidenced in all children attention values lower than the normal for both areas assessed (speed: median 15th percentile; accuracy: median 12th percentile). The correlation between high levels of AHI and attention deficit was statistically significant, concerning both the rapidity (P=-0.524, P=0.01) and the accuracy (P=-0.583, P=0.01). At 3-month follow-up, the bells test values were significantly better reaching the 40th percentile for the parameter “speed” and the 42nd with respect to the “accuracy” (P<0.01). CONCLUSION: The child suffering from sleep apnea shows a severe attention deficit with regard both to the parameters of speed and to those of accuracy. This deficit, however, can be easily restored with surgical therapy with almost immediate attainment of normal levels.

In the literature, correlations between adenoids and middle ear disorders have been widely discussed over the years. Adenoids fundamentally influence inflammation/ infections of the middle ear through 3 factors: obstructive, inflammatory/infective, and immunologic. The authors carefully analyze each of these factors reviewing the opinion of the most important researches in the field. The important role of immunological (T cells and Ig), infective (microorganisms and bacterial biofilms) and allergic factors as predisposing factors for otitis media leads one to consider the importance of a medical treatment oriented to correction of the infective and immunological disorders in children with OM, without adenoids hypertrophy.

The effectiveness of sinus ventilation is due to a regular anatomy of inner nose structures such as the maxillary sinus ostium. With the aid of nose and sinus manometric measurements, it is possible to show that better functional results can be achieved using a conservative surgical technique. The present study compared 30 patients subdivided in two groups. Group A underwent conservative endoscopic sinus surgery whereas group B was operated on using non-conservative endoscopic sinus surgery. Thirty days later, both groups underwent a manometric survey of the maxillary sinus ostium by means of the digital manometry system. The pressure values obtained by nasal and sinus manometry in Group A or Group B patients were referred to those obtained in a Standard Group without nasal-sinus pathologies, calculating a percentage index of functional efficacy (maxillary sinus functional efficacy). The average percentage of the maxillary sinus functional efficacy was 98,35% for group-A patients, and 49,73% for group-B patients. Student t test revealed a statistical difference only between group B patients and standard group patients (p<0.4). Patients submitted to a more aggressive endoscopic approach showed inadequate sinus ventilation when compared to the standard reference group.

Inferior turbinate hypertrophy (ITH) is the main cause of nasal obstruction symptom. This study aimed at investigating whether a particular cellular pattern could be a predictive factor for failure of medical treatment for ITH in patients with rhinitis. Globally, 258 patients with chronic nasal obstruction due to ITH were evaluated by: visual analogue scale assessment of symptoms, skin prick tests, fiber-endoscopy, active anterior rhinomanometry, and nasal cytology. All patients were treated with drugs for 3 months and then re-evaluated. The symptom improvement depended on the different cellular pattern. There was improvement in: 54 (51.4%) patients with allergic rhinitis, 72 (69.2%) with non-allergic rhinitis with neutrophils (NARNE), 15 (42.8%) with non-allergic rhinitis with eosinophils (NARES), and 9 (64.3%) with non-allergic rhinitis with mast cells/non-allergic rhinitis with eosinophils and mast cells (NARMA/NARESMA). The non-responders (108; 41.9%) were therefore directed towards surgical treatment. Both patients with allergic rhinitis and patients affected by NARES had a higher failure rate to medical treatment compared with NARMA and NARESMA groups (p<0.01). In conclusion, elevated number of eosinophils, in the nasal secretion of both allergic (allergic rhinitis) and non-allergic (NARES) patients with ITH, can be associated to a higher medical treatment failure rate.