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Objective: To evaluate the efficacy and safety of mometasone furoate nasal spray (NS) for the treatment of nasal polyposis.

BackgroundAllergic rhinitis (AR) is a global health problem and is characterised by one or more symptoms, including sneezing, itching, nasal congestion and rhinorrhea.ObjectiveWe investigated the features of AR and the physician's approach to the management of AR patients in four geographical regions.MethodsIn this cross-sectional study, a questionnaire survey concerning AR was completed by Honorary and Corresponding Members of the Italian Society of Rhinology from different countries among 4 world geographical regions—Asia, Europe, the Americas, and Africa.ResultsThe prevalence of AR was reported to be 15%–25%. Children and adolescents, as well as young adults, were the age groups more affected by AR with comorbidities of asthma, sinusitis, conjunctivitis, and nasal polyposis. Nasal symptoms of AR were more intense in the spring (51.92%) and autumn (28.85%). The most common aero-allergens were pollen and mites (67.31%), animal dander and pollutants (23.08%), and fungal allergens (21.15%). Allergen-specific immunotherapy was prescribed for both perennial and seasonal allergens (32.69%) via sublingual swallow (46.15%) and subcutaneous (32.69%) routes. For the AR patients, the most prescribed drugs were intranasal corticosteroids (86.54%) and oral H1-antihistamines (82.69%).ConclusionA network of experts can improve our knowledge concerning AR epidemiology, and together with guidelines, could assist practitioners and otolaryngologists in standardising the diagnosis and treatment of AR.

Recurrent or chronic adenotonsillar infections mainly affect children and frequently involve otherwise healthy subjects. Therefore, having excluded systemic immunological deficiencies, this disease may be due to a local dysfunction of the epithelial structures at either the rhino or oropharyngeal level. The aim of the present investigation was to analyze structural and immunological aspects of tonsils and adenoids in subjects who underwent adenotonsillectomy because of recurrent inflammatory episodes with fever. Histological studies and analyses of the cytokine patterns were carried out in palatine tonsils and adenoid samples from 105 patients who underwent adenoidectomy and bilateral extracapsular tonsillectomy for chronic inflammatory hypertrophy of these organs; 46 of the 105 cases examined presented hyperkeratosis of the crypt epithelium; in the remaining 59, the epithelium was hyperplastic with no signs of keratosis. Scanning electron microscopy revealed a continuous epithelial surface of polygon-shaped flattened cells with fissures towards the cryptic depressions. Titration of interleukin-1␤ and tumor necrosis factor alpha in serum and tissues demonstrated higher concentrations in the adenotonsillar specimens, whereas the rise in interleukin-6 was more modest.There are still some controversies among specialists in internal medicine, pediatrics, and otorhinolaryngologists concerning the diagnostic and therapeutic approach to recurrent and chronic inflammatory conditions of adenoids and tonsils in children.Over the last few decades, immunobiological techniques have allowed the identification of tonsillar cells responsible for inflammatory immune reactions (2, 5). Recurrent or chronic adenotonsillar infections mainly affect children and frequently involve otherwise healthy subjects. Therefore, having excluded systemic immunological deficiencies, this disease may be due to a local dysfunction of the epithelial structures, at either the rhino or oropharyngeal level.Several authors (4, 6, 8) have tried to explain why and how a modification in the balance between the local immunological function of the host and the infectious agents would lead to a clinical process characterized by recurrent inflammatory events.The complex histological configuration of the parenchyma is fundamental for the uptake and presentation of antigens to the subepithelial immunocompetent cells. This allows the whole organ to act as a functional unit and hence to play an important role in fighting microorganisms. It may therefore be hypothesized that persistent local inflammatory reactions in adenotonsillitis may, with time, lead to histomorphological changes and functional deficiencies in defense barriers (3).The aim of the present investigation was to analyze structural and immunological aspects of tonsils and adenoids in subjects who underwent adenotonsillectomy because of recurrent inflammatory episodes with fever. MATERIALS AND METHODS Patients.We selected 105 children affected by chronic inflammatory hypertrophy of palatine tonsils an...

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The development of ototoxicity was evaluated using auditory brainstem response (ABR) in cancer patients randomized to receive a cisplatin-based chemotherapy (cisplatin dose: 70 mg/m2) or a carboplatin-based chemotherapy (carboplatin dose: 250 mg/m2). The ABR measurements were performed in a sound-treated room using 2000 clicks of alternating polarity at an intensity of 100 dB PESPL presented to the patients at a rate of 21 clicks per second. Of 59 patients, 21 (9 in the cisplatin group and 12 in the carboplatin group) met our pre-established criteria and were included in the ototoxicity study. Two patients of the cisplatin group developed evidence of clinically occult ototoxicity after two cycles of chemotherapy; the latency of wave V of the ABR increased significantly from 5.874 to 6.336 msec and from 5.826 to 6.458 msec in both patients; these patients had a hearing loss detected by conventional audiometry (125 to 8,000 Hz) after five and six cycles of chemotherapy, respectively. None of the 12 examined carboplatin patients developed ABR-measured ototoxicity or abnormal audiograms during treatment. Our results suggest that ABR might prove to be useful in detecting early hearing deterioration from cisplatin.

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The specific Nasal Provocation Test (sNPT) is a third level diagnostic tool. Fitted to reproduce natural exposure condition to pick the responsible allergen for nasal symptoms out, it is applied when prick test and RAST responses are doubtful. SNPT results have been evaluated measuring nasal resistance (anterior rhinomanometry) and nasal symptoms (clinical score), reaching 50% of sensitivity. This study focused on the determination of allergic response markers, triggered by nasal challenge: tryptase levels in the nose, specific IgE and ECP (Eosinophil Cationic Protein). The aim was to increase sNPT sensitivity. Twenty patients suffering from allergic rhinitis and 16 age-matched-nonallergic subjects were enrolled in the study. Tryptase, specific IgE and ECP were determined in nasal mucosa applying a new method, based on in situ incubation, before and after sNPT. The latter was performed following a standardized method. Tryptase levels increased in 13 patients (65%), were unchanged in four patients (20%), and slightly decreased in three patients (15%). The increase recorded was significant in mite allergic patients (p=0.005), but not significant (p> 0.05) in pollen allergic patients. ECP values increased in 13 patients (65%), were unchanged in two patients (10%), and highly decreased in five patients (25%). ECP increase was not significant (p> 0.05). Specific IgE levels increased in seven patients (35%), were unchanged in 11 patients (55%) and decreased in two patients (10%). The IgE increase was significant in pollen-allergic patients (p<0.05), while it was not significant in mite-allergic patients (p>0.05). Tryptase, ECP, and specific IgE were not detected in the control group. The data obtained showed a positive sNPT response in 12 patients (60%). Comparing our results with those derived from classical-parameter employment, we gathered an improvement of 10%. On the basis of the usual parameters, in fact, we recorded 50% positivity, while the use of mediators provided an additional 10% improvement in sNPT sensitivity: taking together the usual parameters and nasal allergic mediators values, we reached an sNPT over-all sensitivity of 85%.