- Email: [email protected]
Severe nasal polyposis and its impact on sinus opacification
Otolaryngology–Head and Neck Surgery (2006) 135, 994-996
LETTERS TO THE EDITOR Correlation of atopy and sinus opacification in patients with nasal polyposis Alobid et al1 recently published a study titled “The impact of atopy, sinus opacification, and nasal patency on quality of life in patients with severe nasal polyposis” in the April 2006 issue of Otolaryngology–Head and Neck Surgery. Because I am concerned about the role of atopy in nasal polyposis, I read the article very carefully. That article is very well-written, but a controversial point needs to be explained. Table 2 shows a statistically significant (P ⬍ 0.05) correlation between the computed tomographic scan score and the presence of atopy in patients with nasal polyposis, but the authors of that article state the opposite in the Results and Discussion sections. If the information in Table 2 is accurate, nasal polyposis is more extensive in atopic patients than in non atopic patients. If that is not so, the ways in which atopy worsens the effect of nasal polyposis on the patient’s quality of life should be discussed. I also think that assessing the correlation of the serum levels of eosinophils and total immunoglobulin E with the severity of nasal polyposis would be of benefit to readers. The prevalence of atopy in patients with nasal polyposis varies from 10 to 64 percent,2 and the role of atopy in the etiopathogenesis of nasal polyposis is controversial. Studies evaluating the effect of atopy on the severity of nasal polyposis are very limited. However, it is well-known that atopy leads to high recurrence rates and a poor outcome of endoscopic sinus surgery.3 In this respect, the role of atopy in patients with nasal polyposis needs to be well-established. Selim S. Erbek, MD Department of Otolaryngology Baskent University Konya Teaching and Research Center Konya, Turkey E-mail, [email protected]
REFERENCES 1. Alobid I, Benitez P, Valero A, et al. The impact of atopy, sinus opacification, and nasal patency on quality of life in patients with severe nasal polyposis. Otolaryngol Head Neck Surg 2006;134:609 –12.
2. European Academy of Allergology and Clinical Immunology. European position paper on rhinosinusitis and nasal polyps. Rhinol Suppl 2005; (18):1– 87. 3. Dursun E, Korkmaz H, Bayiz U, et al. Clinical predictors of long-term success after endoscopic sinus surgery. Otolaryngol Head Neck Surg 2003;129:526 –31.
doi:10.1016/j.otohns.2006.07.015
Severe nasal polyposis and its impact on sinus opacification In reply to the Letter to the Editor by Selim Erbek, MD, our recently published study,1 “The Impact of Atopy, Sinus Opacification, and Nasal Patency on Quality of Life in Patients With Severe Nasal Polyposis” showed that severe nasal polyposis (NP) impaired all SF-36 domains except for physical functioning and atopy increased the impact of severe NP on quality of life (QoL). No effect of atopy was found on nasal symptoms, paranasal sinuses opacification, polyp size, nasal patency, nasal and blood eosinophilia, and serum total IgE. There is a mistake in Table 2 that shows significant differences in the computed tomography (CT) scan of paranasal sinus between atopic and non-atopic patients with NP. There was no correlation between CT scan and atopy and polyps size scores. These results may be explained due to the severe NP in our patient population (polyp size was 2.6 ⫾ 0.1 according to the score system of Lildholdt) and the severity of nasal symptoms, without differences between atopic and non-atopic patients. In addition, no significant correlations between QoL and nasal symptoms, polyp size, paranasal sinuses opacification, nasal patency, nasal eosinophilia, blood eosinophilia, and serum total IgE were found. It has been shown that patients with NP do not have a higher incidence of allergies, nor the rate of positive allergy skin test are elevated. However, a potential allergic involvement has been suggested in recent publications, and the role of IgE remains controversial.2 Kramer et al3 showed significant elevation of the IgE concentrations of allergic patients. IgE was increased significantly in comparison with controls, patients with chronic nonallergic sinusitis, and patients with nonallergic NP. Settipane and Chafee4 showed that more NPs were found in the non-atopic group than in the atopic group, and subsequent studies showed that mul-
0194-5998/$32.00 © 2006 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved. doi:10.1016/j.otohns.2006.07.015
Letters to the Editor tiple positive skin test responses were less common in patients with NPs compared with responses in the general population.5 Di Lorenzo et al6 showed recently that blood eosinophil levels in patients with NP were significantly higher than those observed in patients without NP. With regard to serum total IgE, no significant differences were observed between rhinitis patients with NP and those without nasal polyps. The relationship between NP, IgE, and allergy is not clearly understood. Isam Alobid E-mail, [email protected] Jose María Guilemany Alfonso García-Piñero Joaquim Mullol Department of Otorhinolaryngology (ICEMEQ) Hospital Clínic, Barcelona, Spain
REFERENCES 1. Alobid I, Benitez P, Valero A, et al. The impact of atopy, sinus opacification, and nasal patency on quality of life in patients with severe nasal polyposis. Otolaryngol Head Neck Surg 2006;134:609 –12. 2. Sin A, Terzioglu E, Kokuludag A, et al. Allergy as an etiologic factor in nasal polyposis. J Investig Allergol Clin Immunol 1997;7:234 –7. 3. Kramer MF, Ostertag P, Pfrogner E, et al. Nasal interleukin-5, immunoglobulin E, eosinophilic cationic protein, and soluble intercellular adhesion molecule-1 in chronic sinusitis, allergic rhinitis, and nasal polyposis. Laryngoscope 2000;110:1056 – 62. 4. Settipane GA, Chafee FH. Nasal polyps in asthma and rhinitis. A review of 6,037 patients. J Allergy Clin Immunol 1977;59:17–21. 5. Drake-Lee AB. Histamine and its release from nasal polyps: preliminary communication. J R Soc Med 1984;77:120 – 4. 6. Di Lorenzo G, Drago A, Esposito Pellitteri M, et al. Measurement of inflammatory mediators of mast cells and eosinophils in native nasal lavage fluid in nasal polyposis. Int Arch Allergy Immunol 2001;125: 164 –75.
doi:10.1016/j.otohns.2006.07.016
Thyroid dysfunction - underestimated but important prognostic factor in sudden sensorineural hearing loss We read with interest the results of Psifidis et al1 on the long-term follow-up results of sudden sensorineural hearing loss (SSHL). We agree only with a part of authors’ final conclusion that suggests that steroid-vasodilatator therapy lasting more than 2 months in SSHL patients is ineffective. The optimal time of therapy in SSHL is different in many already published data, depending on authors’ experience and scientific experiments performed in this field.2 The results presented by Psifidis et al show that profound and total SSHL associated with vertigo has a poor prognosis. At the ENT Department of the Medical University of Gdansk, Poland, in the years 1980 to 2000, there were 133 patients treated for SSHL. Multivariate
995 stepwise linear regression in this population, to our surprise, has not shown any relationship between the initial shape of the audiometric curve, tinnitus, vestibular symptoms, and the final treatment outcome. We had only observed a correlation between caloric test results and prognosis in SSHL; the worst prognosis was related to “canal paresis.”2 Psifidis et al performed only routine biochemical tests on their patients that did not include thyroid gland function parameters. In 52 patients treated in our ENT Department in the years 1997 to 2000, we checked not only parameters such as blood morphology parameters, ESR, glucose level, coagulogram, lipidogram, autoantibodies (AMA, SMA, ABBA), immunoglobulins (G, A, M), but we also tested patients for TSH (thyroid-stimulating hormone) level. In 15.4% of our patients, a low level of TSH was observed, and this parameter was found to be a negative prognostic factor in the multivariate analysis. The literature contains many references that describe an association between thyroid disorders and auditory system dysfunctions. This relationship has been confirmed not only by clinical observations, but also by basic histologic studies of Lautermann and tenCate3 who identified alpha-thyroid hormone receptors in spiral ganglion cells as well as inner and outer hair cells of the rat cochlea using immunohistochemical stains. Most reports are based on the observations of association between hypothyroid states and hearing loss, both in animal experiments and in human studies. Many electrophysiologic and morphologic changes of the inner ear caused by hypothyroidism were identified in animal experiments. A review of the literature by Ritter4 showed that in cretinism there is a 35% incidence of deafness and that hearing loss in hypothyroidism can be reversed with treatment of the hypometabolic state. On the other hand, Mra and Wax5 did not detect any changes in the audiogram and otoacoustic emission configurations during 6 weeks of acute thyroxin depletion after total thyroidectomy. Influence of the hyperfunction of the thyroid gland on the auditory system in human beings has been subjected to only few studies. Himelfarb et al6 observed characteristic patterns of ABR in hyperfunction and hypofunction of the thyroid gland, the most conspicuous change taking place in the brainstem conduction time.6 In Englishlanguage literature we have not found any review of the influence of hyperfunction of the thyroid gland on the inner ear and prognostic value of the low TSH levels in SSHL, which would be based on such large material as ours. Waldemar Narozny Jerzy Kuczkowski Boguslaw Mikaszewski Department of Otolaryngology Medical University of Gdansk Gdansk, Poland
LETTERS TO THE EDITOR Correlation of atopy and sinus opacification in patients with nasal polyposis Alobid et al1 recently published a study titled “The impact of atopy, sinus opacification, and nasal patency on quality of life in patients with severe nasal polyposis” in the April 2006 issue of Otolaryngology–Head and Neck Surgery. Because I am concerned about the role of atopy in nasal polyposis, I read the article very carefully. That article is very well-written, but a controversial point needs to be explained. Table 2 shows a statistically significant (P ⬍ 0.05) correlation between the computed tomographic scan score and the presence of atopy in patients with nasal polyposis, but the authors of that article state the opposite in the Results and Discussion sections. If the information in Table 2 is accurate, nasal polyposis is more extensive in atopic patients than in non atopic patients. If that is not so, the ways in which atopy worsens the effect of nasal polyposis on the patient’s quality of life should be discussed. I also think that assessing the correlation of the serum levels of eosinophils and total immunoglobulin E with the severity of nasal polyposis would be of benefit to readers. The prevalence of atopy in patients with nasal polyposis varies from 10 to 64 percent,2 and the role of atopy in the etiopathogenesis of nasal polyposis is controversial. Studies evaluating the effect of atopy on the severity of nasal polyposis are very limited. However, it is well-known that atopy leads to high recurrence rates and a poor outcome of endoscopic sinus surgery.3 In this respect, the role of atopy in patients with nasal polyposis needs to be well-established. Selim S. Erbek, MD Department of Otolaryngology Baskent University Konya Teaching and Research Center Konya, Turkey E-mail, [email protected]
REFERENCES 1. Alobid I, Benitez P, Valero A, et al. The impact of atopy, sinus opacification, and nasal patency on quality of life in patients with severe nasal polyposis. Otolaryngol Head Neck Surg 2006;134:609 –12.
2. European Academy of Allergology and Clinical Immunology. European position paper on rhinosinusitis and nasal polyps. Rhinol Suppl 2005; (18):1– 87. 3. Dursun E, Korkmaz H, Bayiz U, et al. Clinical predictors of long-term success after endoscopic sinus surgery. Otolaryngol Head Neck Surg 2003;129:526 –31.
doi:10.1016/j.otohns.2006.07.015
Severe nasal polyposis and its impact on sinus opacification In reply to the Letter to the Editor by Selim Erbek, MD, our recently published study,1 “The Impact of Atopy, Sinus Opacification, and Nasal Patency on Quality of Life in Patients With Severe Nasal Polyposis” showed that severe nasal polyposis (NP) impaired all SF-36 domains except for physical functioning and atopy increased the impact of severe NP on quality of life (QoL). No effect of atopy was found on nasal symptoms, paranasal sinuses opacification, polyp size, nasal patency, nasal and blood eosinophilia, and serum total IgE. There is a mistake in Table 2 that shows significant differences in the computed tomography (CT) scan of paranasal sinus between atopic and non-atopic patients with NP. There was no correlation between CT scan and atopy and polyps size scores. These results may be explained due to the severe NP in our patient population (polyp size was 2.6 ⫾ 0.1 according to the score system of Lildholdt) and the severity of nasal symptoms, without differences between atopic and non-atopic patients. In addition, no significant correlations between QoL and nasal symptoms, polyp size, paranasal sinuses opacification, nasal patency, nasal eosinophilia, blood eosinophilia, and serum total IgE were found. It has been shown that patients with NP do not have a higher incidence of allergies, nor the rate of positive allergy skin test are elevated. However, a potential allergic involvement has been suggested in recent publications, and the role of IgE remains controversial.2 Kramer et al3 showed significant elevation of the IgE concentrations of allergic patients. IgE was increased significantly in comparison with controls, patients with chronic nonallergic sinusitis, and patients with nonallergic NP. Settipane and Chafee4 showed that more NPs were found in the non-atopic group than in the atopic group, and subsequent studies showed that mul-
0194-5998/$32.00 © 2006 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved. doi:10.1016/j.otohns.2006.07.015
Letters to the Editor tiple positive skin test responses were less common in patients with NPs compared with responses in the general population.5 Di Lorenzo et al6 showed recently that blood eosinophil levels in patients with NP were significantly higher than those observed in patients without NP. With regard to serum total IgE, no significant differences were observed between rhinitis patients with NP and those without nasal polyps. The relationship between NP, IgE, and allergy is not clearly understood. Isam Alobid E-mail, [email protected] Jose María Guilemany Alfonso García-Piñero Joaquim Mullol Department of Otorhinolaryngology (ICEMEQ) Hospital Clínic, Barcelona, Spain
REFERENCES 1. Alobid I, Benitez P, Valero A, et al. The impact of atopy, sinus opacification, and nasal patency on quality of life in patients with severe nasal polyposis. Otolaryngol Head Neck Surg 2006;134:609 –12. 2. Sin A, Terzioglu E, Kokuludag A, et al. Allergy as an etiologic factor in nasal polyposis. J Investig Allergol Clin Immunol 1997;7:234 –7. 3. Kramer MF, Ostertag P, Pfrogner E, et al. Nasal interleukin-5, immunoglobulin E, eosinophilic cationic protein, and soluble intercellular adhesion molecule-1 in chronic sinusitis, allergic rhinitis, and nasal polyposis. Laryngoscope 2000;110:1056 – 62. 4. Settipane GA, Chafee FH. Nasal polyps in asthma and rhinitis. A review of 6,037 patients. J Allergy Clin Immunol 1977;59:17–21. 5. Drake-Lee AB. Histamine and its release from nasal polyps: preliminary communication. J R Soc Med 1984;77:120 – 4. 6. Di Lorenzo G, Drago A, Esposito Pellitteri M, et al. Measurement of inflammatory mediators of mast cells and eosinophils in native nasal lavage fluid in nasal polyposis. Int Arch Allergy Immunol 2001;125: 164 –75.
doi:10.1016/j.otohns.2006.07.016
Thyroid dysfunction - underestimated but important prognostic factor in sudden sensorineural hearing loss We read with interest the results of Psifidis et al1 on the long-term follow-up results of sudden sensorineural hearing loss (SSHL). We agree only with a part of authors’ final conclusion that suggests that steroid-vasodilatator therapy lasting more than 2 months in SSHL patients is ineffective. The optimal time of therapy in SSHL is different in many already published data, depending on authors’ experience and scientific experiments performed in this field.2 The results presented by Psifidis et al show that profound and total SSHL associated with vertigo has a poor prognosis. At the ENT Department of the Medical University of Gdansk, Poland, in the years 1980 to 2000, there were 133 patients treated for SSHL. Multivariate
995 stepwise linear regression in this population, to our surprise, has not shown any relationship between the initial shape of the audiometric curve, tinnitus, vestibular symptoms, and the final treatment outcome. We had only observed a correlation between caloric test results and prognosis in SSHL; the worst prognosis was related to “canal paresis.”2 Psifidis et al performed only routine biochemical tests on their patients that did not include thyroid gland function parameters. In 52 patients treated in our ENT Department in the years 1997 to 2000, we checked not only parameters such as blood morphology parameters, ESR, glucose level, coagulogram, lipidogram, autoantibodies (AMA, SMA, ABBA), immunoglobulins (G, A, M), but we also tested patients for TSH (thyroid-stimulating hormone) level. In 15.4% of our patients, a low level of TSH was observed, and this parameter was found to be a negative prognostic factor in the multivariate analysis. The literature contains many references that describe an association between thyroid disorders and auditory system dysfunctions. This relationship has been confirmed not only by clinical observations, but also by basic histologic studies of Lautermann and tenCate3 who identified alpha-thyroid hormone receptors in spiral ganglion cells as well as inner and outer hair cells of the rat cochlea using immunohistochemical stains. Most reports are based on the observations of association between hypothyroid states and hearing loss, both in animal experiments and in human studies. Many electrophysiologic and morphologic changes of the inner ear caused by hypothyroidism were identified in animal experiments. A review of the literature by Ritter4 showed that in cretinism there is a 35% incidence of deafness and that hearing loss in hypothyroidism can be reversed with treatment of the hypometabolic state. On the other hand, Mra and Wax5 did not detect any changes in the audiogram and otoacoustic emission configurations during 6 weeks of acute thyroxin depletion after total thyroidectomy. Influence of the hyperfunction of the thyroid gland on the auditory system in human beings has been subjected to only few studies. Himelfarb et al6 observed characteristic patterns of ABR in hyperfunction and hypofunction of the thyroid gland, the most conspicuous change taking place in the brainstem conduction time.6 In Englishlanguage literature we have not found any review of the influence of hyperfunction of the thyroid gland on the inner ear and prognostic value of the low TSH levels in SSHL, which would be based on such large material as ours. Waldemar Narozny Jerzy Kuczkowski Boguslaw Mikaszewski Department of Otolaryngology Medical University of Gdansk Gdansk, Poland