The risks of betel quid chewing with or without tobacco, alcohol drinking and cigarette smoking have been well explored in the oral cavity but not in the pharynx and larynx. We conducted a case-control study to investigate the association of these three risk factors to cancers of the pharynx and larynx in Taiwan. A total cases of 148 pharyngeal cancer, 128 laryngeal cancer and 255 hospital controls, all men, were recruited. Betel quid chewing was a significant independent risk factor (adjusted odds ratio [aOR] 5 7.7; 95% confidence interval [CI] 5 4.1-15.0) similar to that of alcohol drinking (aOR 5 6.6; 95% CI 5 3.5-13.0) for pharyngeal cancer, but not for laryngeal cancer (aOR 5 1.3; 95% CI 5 0.7-2.5) on which cigarette smoking (aOR 5 7.1) exerts a stronger significant independent risk than alcohol drinking (aOR 5 3.8). For pharyngeal cancers, chewers who consumed >20 quid/day, chewed with inflorescence in the quid or swallowed the betel quid juice were at higher risks; significant dose-response effects were found in daily quantity of drinking and chewing, and cumulative quantity of drinking. Synergistic effects from the 3 risk factors existed both on the pharynx (aOR 5 96.9) and the larynx (aOR 5 40.3), and attributed for 93.1% and 92.9% respectively. Our study is the first evidence to show that betel quid chewing without tobacco has different impact on the pharynx (digestive tract) and the larynx (airway), and supports the concept that exposure quantity and direct mucosal contact with the betel quid juice may contribute to carcinogenesis. Our results show an important insight into the impact of betel quid chewing on other sites of the digestive tract other than the oral cavity. ' 2005 Wiley-Liss, Inc.Key words: risk factors; areca; laryngeal neoplasms; pharyngeal neoplasms; betel; alcohol; cigarette Cigarette smoking and alcohol drinking are risk factors for cancers of the oral cavity, pharynx and larynx.1-6 Betel quid chewing with or without tobacco, a widespread habit in south and east Asian countries, is an important risk factor having both independent and synergistic effects with cigarette smoking and alcohol drinking for oral cancer.7-13 The risk of betel quid chewing without tobacco on the pharynx and larynx in humans has not been explored and is unknown.Betel nut (areca nut) is consumed by an estimated 400-600 million people worldwide, mainly IndoAsian, Chinese and Taiwanese. It has a long history of use and is deeply ingrained in many sociocultural and religious activities. 7,14 Betel nut is the seed of the fruit of the oriental palm, Areca catechu. It is seldom chewed alone but is usually consumed in the form of betel quid, which is most often prepared by adding different ingredients to the areca nut, for example, the betel fruit (unripe fruit, inflorescence of Piper betle), betel leaf (leaf of Piper betle), slaked lime, catechu and tobacco, mainly according to the local tradition and for the purpose of flavor enhancing. 11,14 In general, although chewers from different countries prepare betel quid ...

A significantly lower vitamin D level was found in a group of Taiwanese CRSwNP patients, which revealed an association with greater nasal polyp size. Serum vitamin D levels could be added to the routine workup of patients suffering from CRS and these data could be used to potentially help determine the disease severity.

Stimulation of the nasal sensory nerves leads to sensations of pain and stuffiness. Type C nociceptive nerve releases neuropeptides including substance P and calcitonin gene related peptides that increase plasma extravasation and glandular secretion. This axonal response acts as an immediate protective mucosal defense mechanism. Recruited parasympathetic reflexes cause submucosal gland secretion via acetylcholine and muscarinic M(3) receptors. Itching, sneezing, and other avoidance behaviors rapidly clear the offending agents from the upper airways and protect the lower airways. Dysfunction of these nerves may contribute to allergic rhinitis, infectious rhinitis, nasal hyperresponsiveness, and possibly sinusitis. Sympathetic arterial vasoconstriction reduces mucosal blood flow, sinusoidal filling, and mucosal thickness, and so restores nasal patency. Loss of sympathetic tone may contribute to some chronic, nonallergic rhinopathies. Human axon responses differ from those in animals, an important distinction that limits extrapolation from other species.