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Fulltext The prevalence of anatomical variations in osteomeatal unit in patients with chronic rhinosinusitis

Azila A, Irfan M, Rohaizan Y, Shamim AK

Med J Malaysia, 2011 Aug;66(3):191-4.
PMID: 22111438 MyJurnal

The complexities of the anatomy of the nose and paranasal sinuses, as well as its variations may create technical difficulties during surgery. The significance of these anatomical variations in pathogenesis of rhinosinusitis, which is the commonest disease in the region, is still unclear.

Matched MeSH terms: Turbinates/pathology*
A case of nasal chromoblastomycosis causing epistaxis

Penjor D, Khizuan AK, Chong AW, Wong KT

J Laryngol Otol, 2014 Dec;128(12):1117-9.
PMID: 25382114 DOI: 10.1017/S0022215114002655

Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue that most commonly affects the feet and lower limbs. It is rare for this infection to occur on the face, and it is exceptionally rare for it to involve the nose and sinuses. This paper reports a rare case of nasal chromoblastomycosis in a 50-year-old Malaysian male.

Matched MeSH terms: Turbinates/pathology
Isolated extramedullary plasmacytoma of the middle turbinate

Shahrizal TA, Prepageran N, Rahmat O, Mun KS, Looi LM

Ear Nose Throat J, 2009 Feb;88(2):786-9.
PMID: 19224479

Extramedullary plasmacytoma is a rare plasma cell proliferative disorder with a predilection for the head and neck region. Occasionally, it presents as a solitary lesion in the nasal cavity. We report a case of an isolated lesion in the middle turbinate of the right nasal cavity. The lesion was completely excised via an endoscopic approach. We also review the pathology and management of plasmacytomas in general.

Matched MeSH terms: Turbinates/pathology*
Middle turbinate edema as a diagnostic marker of inhalant allergy

Hamizan AW, Christensen JM, Ebenzer J, Oakley G, Tattersall J, Sacks R, et al.

Int Forum Allergy Rhinol, 2017 01;7(1):37-42.
PMID: 27530103 DOI: 10.1002/alr.21835

BACKGROUND: Middle turbinate edema could be a characteristic feature of aeroallergen sensitization. In this study we sought to determine the diagnostic characteristics of middle turbinate edema as a marker of inhalant allergy.
METHODS: A cross-sectional diagnostic study was performed on patients who had undergone nasal endoscopy and allergy testing. Allergy status was determined by positive serology or epicutaneous testing. Endoscopy was reviewed by blinded assessors for middle turbinate head edema. Appearance was graded as either normal, focal, multifocal, diffuse, or polypoid edema. Receiver-operator (ROC) analysis, likelihood ratio (LR), sensitivity, specificity, and positive predictive value (PPV) were determined.
RESULTS: One hundred eighty-seven patients representing 304 nasal cavities were assessed (42% female, age 39.74 ± 14.7 years, 57% allergic). Diffuse edema (PPV 91.7%/LR = 8) and polypoid edema (PPV 88.9%/LR = 6.2) demonstrated the strongest association with inhalant allergy. Multifocal edema was used as a cut-off to represent inhalant allergy from ROC analysis, which demonstrated 94.7% specificity and 23.4% sensitivity. The PPV for multifocal was 85.1% and LR = 4.4.
CONCLUSION: Middle turbinate edema is a useful nasal endoscopic feature to predict presence of inhalant allergy and, although not sensitive, has excellent PPV.

Matched MeSH terms: Turbinates/pathology*
Fulltext Swiftlase assisted CO2 laser ablation in the treatment of nasal obstruction due to hypertrophy of the inferior turbinates

Sani A, Primuharsa P

Med J Malaysia, 2001 Jun;56(2):174-9.
PMID: 11771077

Hypertrophy of the inferior turbinates are the major cause of nasal obstruction. CO2 lasers have been used to reduce the size of the inferior turbinates over the last 20 years. However, the many techniques of delivery of the laser show that there is no one standard method reducing the size of the turbinates. We now describe how the laser can be applied directly to the turbinates using a handpiece with a special nasal tip, thus overcoming the disadvantages delivery via arthroscopic devices, microscopes and fibers. This technique is further enhanced by coupling it with Swiftlase which swirls the focused beam in a 3 mm spot thus ablating tissue more quickly. This procedure is done under local anaesthesia. The ablation of the anterior third of the inferior turbinates effectively overcomes nasal obstruction. This new method was compared to the more traditional submucus diathermy. 22 patients were subjected to laser treatment whilst 20 patients were subjected to diathermy. The outcome was evaluated subjectively by the patients themselves at 2 weeks, 3 months and 6 months. At the end of the study, the laser group reported a more significantly improved nasal airway (91% against 75%) and decreased rhinorrhea (72.7% against 35%) when compared to the diathermy group.

Matched MeSH terms: Turbinates/pathology*
Turbinate-Specific IgE in Normal and Rhinitic Patients

Hamizan AW, Rimmer J, Alvarado R, Sewell WA, Tatersall J, Barham HP, et al.

Am J Rhinol Allergy, 2019 Mar;33(2):178-183.
PMID: 30656948 DOI: 10.1177/1945892418825224

BACKGROUND: Specific immunoglobulin E (sIgE) within the nasal airway is likely to be the most ideal marker of allergic status, but little is known of the normative values in asymptomatic patients and those with rhinitis.
OBJECTIVE: The aim of this study was to assess the diagnostic characteristics of inferior turbinate tissue biopsy sIgE in asymptomatic and rhinitic patients.
METHODS: A diagnostic cross-sectional study was undertaken, involving patients who underwent inferior turbinate surgery with or without other surgical interventions. Inferior turbinate tissue biopsy was performed during surgery and was assessed for allergen sIgE (dust mite, grass [temperate or subtropical], and animal epithelium) using an automated immunoassay. Tissue sIgE was assessed among asymptomatic patients and those with nasal symptoms. Data were presented as median (interquartile range). A receiver operating curve was used to predict the diagnostic utility of turbinate tissue sIgE in determining allergic rhinitis.
RESULTS: A total of 160 patients (41.89 ± 14.65 years, 36.9% females) were included. The median tissue sIgE concentration among the asymptomatic nonatopic group of patients was 0.09 (0.08-0.10) kUA/L and tissue sIgE > 0.10 kUA/L was determined as a positive threshold. Inferior turbinate tissue sIgE was shown to be a predictive test for allergic rhinitis (area under curve: 0.87, 95% confidence interval: 0.84-0.90) with 90% sensitivity and 89% negative predictive value.
CONCLUSION: Inferior turbinate tissue biopsy sIgE is a sensitive tool to predict allergic rhinitis. The threshold value of 0.1 kUA/L corresponded well with the asymptomatic nonatopic group of patients. This method detects sIgE in the nasal mucosa and may be a useful test for allergic rhinitis in future research.

Matched MeSH terms: Turbinates/pathology
Optimizing Protein Harvest From Nasal Brushings for Determining Local Allergy Responses

Saricilar EC, Hamizan A, Alvarado R, Rimmer J, Sewell W, Tatersall J, et al.

Am J Rhinol Allergy, 2018 Jul;32(4):244-251.
PMID: 29785855 DOI: 10.1177/1945892418777668

Background Rhinitis is a highly prevalent yet often misdiagnosed condition. Patients who have local allergic rhinitis are regularly mislabeled as having a nonallergic etiology. Thus, a highly accurate, reproducible, and noninvasive assessment, which can be performed quickly and with minimal discomfort to the patient, is required. Objective The aim of this research was to identify the efficiency of various nasal brushes as tools for harvest and collection of epithelial proteins and its suitability for identification of rhinitis. Methods Nasal epithelial mucosa samples were taken from patients undergoing turbinate surgery using a cytology brush, a dental brush, and a nasal curette in random order. After washing in phosphate-buffered saline, the suspended cells were sonicated. Total protein content was assessed for all samples by bicinchoninic acid assay measured using a Nanodrop machine. Identification of nasal-specific immunoglobulin E (spIgE) was then assessed using immunoassay and compared to the patient's allergic status from epicutaneous and serum testing. The lower threshold limit for the spIgE in nasal brushings was determined using the results of serum spIgE tests as the reference. The diagnostic accuracy of this new established cutoff value was determined. Results The cytology brush was found to be the optimal tool for maximal nasal mucosa protein collection followed by dental brush and nasal curette (0.75 ± 0.45 mg/mL vs 0.43 ± 0.24 mg/mL vs 0.071 ± 0.55 mg/mL, respectively; P

Matched MeSH terms: Turbinates/pathology*
Assessment of 3-D nasal airway morphology in Southeast Asian adults with obstructive sleep apnea using acoustic rhinometry

Banabilh SM, Suzina AH, Mohamad H, Dinsuhaimi S, Samsudin AR, Singh GD

Clin Oral Investig, 2010 Oct;14(5):491-8.
PMID: 19806371 DOI: 10.1007/s00784-009-0342-9

The aim of the present study is to investigate nasal airway morphology in Asian adults with and without obstructive sleep apnea (OSA) using acoustic rhinometry (AR), principal components analysis (PCA), and 3-D finite-element analysis (FEA). One hundred eight adult Malays aged 18-65 years (mean ± SD, 33.2 ± 13.31) underwent clinical examination and limited channel polysomnography, providing 54 patients with OSA and 54 non-OSA controls. The mean minimal cross section area 1 (MCA1) and the mean minimal cross sectional area 2 (MCA2) were obtained from AR for all subjects and subjected to t tests. The OSA and control nasal airways were reconstructed in 3-D and subjected to PCA and FEA. The mean MCA1 and MCA2 using AR were found to be significantly smaller in the OSA group than in the control group (p < 0.001). Comparing the 3-D OSA and control nasal airways using PCA, the first two eigenvalues accounted for 94% of the total shape change, and statistical differences were found (p < 0.05). Similarly, comparing the nasal airways using FEA, the 3-D mean OSA nasal airway was significantly narrower in the OSA group compared to the control group. Specifically, decreases in size of approx. 10-22% were found in the nasal valve/head of inferior turbinate area. In conclusion, differences in nasal airway morphology are present when comparing patients with OSA to controls. These differences need to be recognized as they can improve our understanding of the etiological basis of obstructive sleep apnea and facilitate its subsequent management.

Matched MeSH terms: Turbinates/pathology
The Distinguishing Clinical Features of Nonallergic Rhinitis Patients

Hamizan AW, Azer M, Alvarado R, Earls P, Barham HP, Tattersall J, et al.

Am J Rhinol Allergy, 2019 Sep;33(5):524-530.
PMID: 31106562 DOI: 10.1177/1945892419850750
Matched MeSH terms: Turbinates/pathology