Immunologic evaluation of patients with recurrent ear, nose, and throat infections

Abstract

Major causes of olfactory disorders are sinonasal disease, viral upper respiratory tract infection, head trauma and old age. Olfactory testing is an important part of objective assesment of the severity of the disease in chronic rhinosinusitis and nasal polyposis. The aim of this study was to correlate results of objective smell testing with subjective scores on olfaction and other nasal symptoms in different subgroups of patients with smell impairment.Data were extracted from questionnaires filled by patients sent to smell testing by the ENT specialist. For the analysis data were divided in subgroups: 20 with chronic rhinosinusitis (CRS), 24 patients operated for nasal polyps, 7 patients with nasal polyps on medical treatment, 7 with hyposmia after common cold, 4 with anosmia and 11 controls with no smell impairment. Smell testing was done by using the Sniffin Sticks 12 complete odorant. This test is based on the assessment of odor identification abilities for 12 standard odors with forced choice. Subjective scores on (0-4) were taken for olfaction, nasal obstruction, hypersecretion and headache.The correlation between subjective score for olfaction and olfactometry score was significant for the whole group (r 0.682), and was similar when anosmic and controls were excluded. Subjective olfaction and olfactometry score did not correlate with any other symptom. Comparing correlation coefficients between the subgroups, it seems that patients with CRS and nonoperated nasal polyp patients have better correlation between subjective and objective smell assesment than patients operated for nasal polyps and those who had olfactory lesion following viral infection.Although correlation between subjective and objective smell assesment is significant, some subgroups of patients overrate their ability to recognize odors. STRESS EFFECTS ON ALLERGIC INFLAMMATION OF THE AIRWAYS Pontus Stierna and Susanna GeorenDepartment of Otorhinolaryngology, Karolinska University Hospital, Stockholm, SwedenWe have used a mouse model to investigate the effects of endogenous GC synthesis and GC receptor inhibition, as well as acute stress, and different doses of exogenous administered GCs on inflammatory cells in different cellular compartments in allergic airway inflammation. including nerve growth factor (NGF) in the airways, during allergic inflammation.First we investigated the effects of endogenous GCs on eosinophilic airway inflammation. Inhibition of GC release with metyrapone (ME) induced an increase of bone marrow eosinophilia and when the ME treatment was combined with a GC receptor antagonist (RU 486) the allergen-induced bone marrow eosinophilia was further enhanced.The second study was focused on the effects of timing of a short acute stress on allergic airway inflammation in upper and lower airways. Short stress applied before an allergen challenge decreased the allergen-induced eosinophilia in bronchoalveolar lavage fluid and lungs and also the inflammation in the nasal tissue. No effects on eosinophilia or inflammation were seen...

Analysis of Switched Memory B Cells in Patients with IgA Deficiency

“…All patients received unconjugated pneumococcus polysaccharide vaccine (PNEUMO 23® 123; Aventis Pasteur, France). Specific antibodies against whole pneumococcal antigen were measured using the protocol of the third-generation ELISA assay format before and 4 weeks after vaccination [25]. …”

Bajo índice de sospecha para deficiencia de anticuerpos en niños sometidos a procedimientos quirúrgicos de Otorrinolaringología

“…10 Otras posibilidades diagnósticas remotas en niños con rinosinusitis crónica refractaria son la enfermedad asociada a IgG4 antes conocida como de Miculicz 11 y la vasculitis asociada a anticuerpos contra citoplasma de neutrófilos (ANCA), como la poliangitis granulomatosa, antes llamada de Wegener. 2 Una serie de procedimientos quirúrgicos de otorrinolaringología: adenoamigdalectomía, drenaje endoscópico de senos paranasales y colocación de tubos timpánicos de ventilación, se indican en pacientes con infecciones respiratorias de repetición que no han respondido satisfactoriamente al manejo médico. 12 En series retrospectivas de pacientes adultos con rinosinusitis crónica refractaria se ha encontrado una prevalencia alarmantemente alta de deficiencias de anticuerpos.…”

“…El diagnóstico diferencial detrás de las infecciones de vías aéreas superiores de repetición incluye alergia, inmunosupresión, defectos anatómicos (obstrucción ostial), trastornos del movimiento mucociliar (síndrome sinobronquial), poliposis, fibrosis quística e inmunodeficiencias secundarias y primarias. 1,2 El principal papel del sistema inmunitario es protegernos del peligro que suponen los microorganismos patógenos invasores. Las mutaciones en los genes que codifican para las proteínas del sistema inmunitario resultan en las Inmunodeficiencias primarias, un grupo de más de 250 enfermedades congénitas de presentación clínica variable con una susceptibilidad incrementada a infecciones.…”

Important differences in the diagnostic spectrum of primary immunodeficiency in adults versus children

“…Although conductive hearing loss is a shared feature of both children and adult PID patients due to recurrent otitis media [67][68][69], pediatric ear-nose-throat specialists should consider cases with congenital inner ear deafness and signs of phagocytosis defect with mutation in the G6PC3 gene, leading to SCN type 4 [39].…”