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The number of Japanese cedar and/or cypress pollinosis patients has been clearly increasing. Not only nasal symptoms but also pharyngo-symptoms impair the QOL of pollinosis patients. In this study, the correlations with coughs and the other symptoms with the QOL, were studied. Four thousand, seven hundred and sixty-five patients with seasonal allergic rhinitis were enrolled in the Osaka area as subjects in this study. Thirty-nine point nine percent of patients had a cough: 49.7% of those began to cough with pollen scattering and 33.6% of them began to cough during the pollen scattering peak period. Moreover in 52.0% of those patients with a cough, the coughing became most severe during the scattering peak. The onset of coughing showed the highest correlation with nasal obstruction and/or mouth respiration with obstruction, so it seemed that nasal obstruction participated as an exacerbating factor of the cough in pollinosis patients.

Allergic rhinitis, especially Japanese cedar pollinosis, is a major problem in Japan. On the other hand, recently Asian sand dust (ASD) phenomenon originating in the deserts of Mongolia and China has also been reported to affect human health. The ASD concentrations measured by laser radar beginning in 2007 made it possible to detect atmospheric ASD particles even when ASD phenomenon is not observed. Objective: As ASD phenomenon occurs concomitantly with pollen season in Japan, the aim of this study is to investigate the effects of ASD on allergic rhinitis in periods when ASD phenomenon is observed and is not observed. Patients of allergic rhinitis were retrospectively investigated between April 1st and May 31st, 2007. Results: Although the floating pollen counts were low during this study, 53 of 77 patients (68.8%) with allergic rhinitis complained of aggravated nasal symptoms, and developed respiratory symptoms such as sore throat, abnormal sensation in the pharyngolarynx and cough. This trend was noted in those with seasonal allergic rhinitis such as Japanese cedar pollinosis both when ASD phenomenon was observed and non-observed. Conclusion: The results suggest that ASD may adversely affect allergic rhinitis symptoms regardless ASD levels. Although further investigation is required, it is important to pay more attention to ASD to maintain good quality of life of the patients with allergic rhinitis.

Effectiveness and safety of olopatadine hydrochloride were studied in 30 patients with cedar pollenosis by administering the agent before and after cedar pollen began to disperse. After receiving a pre-scription for olopatadine hydrochloride 5mg twice a day, patients recorded nasal symptoms, any hindrance in daily activities, itching of the eye and compliance daily from the first day of treatment to the eighth week after pollen began to disperse. Patients were divided into two groups; one group of patients started the agent before pollen began to disperse (the pre-dispersion group, n=15) and the other group of patients started after pollen began to disperse (the post-dispersion group, n=15). Symptoms and findings were compared between the two groups. All scores for runny nose, nasal obstruction, severity of hindrance in daily activities, itching of the eyes, severity of symptoms and symptom-medication were lower in the pre-dispersion group than in the post-dispersion group. In the post-dispersion group, the minimol sectional area of the nasal cavity and the capacity of the nasal cavity tended to increase following administration of olopatadine hydrochloride. Olopatadine hydrochloride could be sufficiently effective for cedar pollenosis, even when administration started after pollen began to disperse. However, it seemed that when administration started before dispersion, the onset of nasal symptoms was delayed and exacerbation of symptoms was decreased. In addition, the agent seemed to be more effective for relief of itching eyes and preventing hindrance in daily activities.

Several reports indicate that the severity of perennial allergic rhinitis is related to levels of dust-mite allergens. In this study, the levels of dust-mite allergens measured in the homes of 13 people with allergic rhinitis and 10 healthy volunteers. Dust specimens were collected with a vacuum cleaner and analyzed for the presence of major mite allergens (Der 1=Der p1+Der f1, Der 2=Der p2+Der f2) by using ELISA. Levels of Der 1 were higher in bedclothes, in bedrooms, and on family room floors. There were no differences between the homes of the 13 people with allergic rhinitis and the 10 healthy volunteers. No association was found between levels of dust-mite allergens and the severity of nasal symptoms. Although the levels of mite allergens increased in most of homes 2 months after cleaning, there was an insignificant tendency for improvement in nasal symptoms in homes with decreased levels 2 months after cleaning.

We report a case of a foreign body in the maxillary sinus. The patient was a 25-year-old female who had been admitted in our hospital with hyperphagia and vomiting. A dentist incidentally found an abnormal shadow in the right maxillary sinus on X-ray examination, but the patient did not complain of any nasal symptoms. The foreign body in the maxillary sinus demonstrated a curvedshape, but we could not accurately identify the foreign body.Caldwell-Luc procedure was performed and the foreign body was removed from the maxillary sinus without any complications. The foreign body was identified as gutta-percha which had been used as a root canal filling material. We thought that a foreign body was accidentally inserted into the maxillary sinus during dental treatment.

Ventilation of the paranasal sinuses has been hypothesized to be a critical factor in curing rhinosinusitis, because blockage of the ventilating sinuses can lead to retention of nasal discharge or pus. In this report, we investigated the effect of treatment to clean and widen the middle nasal meatus in outpatients with rhinosinusitis. The outpatients were assigned to two groups: in the first group, cotton wool soaked with epinephrine was applied to the middle nasal meatus for 10minutes after cleaning the meatus at each consultation; in the second group, noepinephrine was used but the other conditions were the same. The treatment results were analyzed using X-rays, and subjective complaints via a the questionnaire survey, and nasal symptoms and X-rays scores were significantly better in the first group compared to the second group (p

Sarcoidosis is a systemic disease of unknown cause. Most cases involve the lungs, lymph nodes, skin, and eyes. However, sarcoidosis with nasal symptoms is less frequent. We present two cases of nasal sarcoidosis with nasal obstruction. One patient was a 29-year-old female with nasal obstruction, skin lesions, neck lymph node swelling, and BHL. The other patient was a 31-year-old female who was diag-nosed with sarcoidosis with skin lesions and BHL in 1994. She presented to our hospital with complaints of nasal obstruction. Both patients' pathological findings for the nasal mucosa were granulomatous structure without necrosis, and were diagnosed with nasal sarcoidosis. The first patient was treated with local steroids and the nasal symptoms nearly disappeared completely. The other patient was treated with surgical management and local steroids, and the nasal symptoms were controlled.

We investigated the effects of the combination therapy of leukotriene receptor antagonist (Pranlukast) and an antihistamine (Clemastine Fumarate) on patients with perennial allergic rhinitis. There was no significant difference between the combination (Pranlukast and Clemastine Fumarate) group (n=14) and the single (only Pranlukast) group (n=14) in terms of global improvement rating. In regard to improvements in the three major symptoms of allergic rhinitis, suppression of sneezing and rhinorrea were significantly better in the combination group in comparison with the single group at assessments one and two weeks after the start of administration (p

The aim of this study was to investigate the efficacy of suplatast tosilate prescribed before the pollen season and during the pollen season. Suplatast tosilate, 300mg/day, was prescribed for 10 patients before the start of the pollen season and for 6 patients during the pollen season. Patients kept a diary of nasal symptoms.Based on the nasal symptom diaries a nasal symptom score was prepared. The rate of improvement was 70% with preseasonal administration and 33% with administration after pollen scattering.Pollen levels showed three peaks (3/5, 3/14, 3/29) during the pollen season in 1998, and in the preseasonal administration, the symptoms were suppressed at these three peakses pecially at third peak in 70% of patients.In the administration during pollen season, the symptom score was high at second and third peaks in the noneffective patient, but the symptoms were suppressed at the second and third peaks in the effective patients.Based on these findings we suggest that suplatast tosilate should be administered more than one month before the first peak in pollen levels.

The effects of contact Nd-YAG laser surgey on perennial allergic rhinitis patients were studied in 100 patients. The bilateral inferior turbinates were vaporized under local anesthesia as an outpatient procedure. The patients were 44 males and 56 females, aged 9-70 years. About one month after surgery, the improved rates of sneezing, nasal discharge and nasal obstruction were 85%, 76% and 92%, respectively. Six months after surgery, the improved rates were 80%, 71% and 88%, respectively. One year after surgery, the improved rates were 67%, 60% and 74%, respectively. We believe that contact Nd-YAG laser surgery for perennial allergic rhinitis is useful, but in our study, a recurrence of nasal symptoms occurred in 16-18% after one year. We recommend revaporization in patients whose nasal symptoms recur.

Endoscopic CO2 laser surgery was performed before the onset of pollen scattering in 50 cases of severe Japanese cedar pollinosis, in which conservative treatment had no effect. Nineteen cases were pollinosis without perennial nasal allergy and 31 cases were pollinosis with perennial nasal allergy. A rigid endoscope and thin pipe guide were used in the surgical procedure. The inferior turbinate was prophylactically vaporized with a defocused carbon dioxide laser beam. During the first pollen season, 94% of the patients had excellent or good results without medication. No patients complained of severe nasal symptoms. During the second season after laser surgery, 79% of the patients had excellent or good results without medication. Two cases complained of severe nasal symptoms. The efficacy of laser surgery decreased somewhat during the second season. Prophylactic endoscopic laser surgery is a effective method of treatment for sever pollinosis.

The clinical usefulness of 200μg/day of mometasone furoate (MF) nasal spray administered over 2 weeks was compared against 31.2μg/day of disodium cromoglycate (DSCG) using a telephone nominating method in a total of 69 patients with Japanese cedar pollenosis.The Japanese cedar pollen count in 1996 was extremely low, apporoximately 1/10-4/20 of that in 1995. On an analysis of the overall improvement, marked or moderate improvement was observed in 69.0% (20/29) and 20.7% (6/29) of patients receiving MF and DSCG, respectively; this was statistically different. MF also showed significantly superior efficacy over DSCG in almost all subjective and objective nasal symptoms. A significant correlation between the total nasal symptom scores based on three main symptoms of nasal allergy and overall improvement judged by an independent investigator was confirmed. The proper discriminant rate by discriminant analysis was high at 93.1%. On an analysis of the overall safety, good safety was observed for both treatment groups. The above results suggest that MF is highly useful in the treatment of Japanese cedar pollenosis.

Aspirin-induced Asthma (AIA) is characterized by three clinical findings; asthma, aspirin intolerance and nasal polyps. We reported the outcome of endoscopic sinus surgery (ESS) in 12 patients with AIA, and compared the number of eosinophils in paraffin sections of nasal polyps between AIA and non-AIA patients. All ESSs were safely performed using drip injection of steroids and local anesthesia with 2% pure Xylocaine® during surgery. They improved asthma and nasal symptoms in all patients. Eosinophils in nasal polyps from AIA patients were significantly more abundant than those in nasal polyps of non-AIA patients (p

In 1992, a nasal allergy questionnare study of randomly chosen junior high school students was conducted in China and Japan during high pollen seasons. The months in which pollen scatters the most in Japan are March and April, and in China August and September. One school in each area was chosen and 200'-400 students in each school were questioned. The schools chosen were in mountanous, agricultural areas (a suburb of Sheiang City in China, and Tsukechi-cho, Gifu Prefecture, Japan), and in urban areas (Beijing City and Sheiang City, China, and Nagoya City, Japan). In Beijing City 17.2% of the students had nasal symptoms (sneezing, nasal obstruction and nasal discharge), in Sheiang City 31.0%, in the surburb of Sheiang City 28.6%, in Nagoya City 28.1% and in Tsukechi-cho Gifu Prefecture 37.5%. It is obvious from these results that the students in the mountainous, agricultural areas had more symptoms of nasal allergy than did those in the urban areas. However, in Sheiang City and Nagoya City the percentage was higher than in Beijing City. Other allergy symptoms appearing in the questionnare included itching of the throat and eyes. Itching of the throat appeared to be higher in China, and itching of the eyes was higher in Japan. Among the students with nasal allergy symptoms, more consulted hospital doctors in Japan than in China. In both countries there was a family history of atopic disease in 15-'20% of the students with nasal allergy.

Three hundred and twenty eight patients with allergic rhinitis were treated with Azelastine chloride. Nasal symptoms were improved in 77.7% of those allergic to Japanese cedar pollen, in 89.1% of those with housedust allergy, and in 87.3% of those allergy to both Japanese cedar pollen and housedust. The clinical effects were examined for at least two weeks after the initial administration. Side effects were seen in 2.2% of the patients. These data indicate that Azelastine is a good medicine for the treatment of allergic rhinitis.

To control the recurrence of nasal allergic symptoms, we performed revaporization with CO2 Laser beam in 27 patients with perennial nasal allergy whose nasal symptoms had been alleviated after the initial laser surgery. Revaporization was effective in 85% of the patients one month after surgery in 78% 2 years after surgery and in 64% 3 years after the revaporization. Patients with relapse within one year after surgery had little improvement in subjective symptoms, while patients with relapse later than one year after surgery responded well, and long-term results were good. No differences were found in the severity of the preoperative symptoms, RAST score, or IgE values between patients with early and with late recurrence.

Seventeen adult patients with chronic sinusitis, who had been operated on or received conservative therapy for a long time but still complained of nasal symptoms, were treated with 150mg roxithromycin (RXM) per day for 6 months or more.1) Significant improvement both in nasal symptoms and in rhinoscopic findings was noted after 6 months, little improvement after 1 month of therapy.2) Great subjective improvement in nasal obstruction was noted, and volume and quality of nasal discharge showed objective improvement.3) No significant side effects were noted in any of the patients during this therapy.4) Long-term, low-dose RXM therapy was effective even when RXM-resistant bacteria were present. Therefore, this effect was not considered to be associated with its antibacterial activity but with some as not yet unknown mechanism.

Between December 1986 and February 1991, endonasal sinus surgery under endoscopic guidance was performed on 95 patients with chronic paranasal sinusitis. Forty-six of the 95 patients were followed for more than one year, ranging from 12 to 53 months with an average of 26 months. Each patients rated the severity of nasal symptoms on admission to the hospital and during the latest visit after one year follow-up. Rating was based on a 4-point scale (O: normal, 1: slight, 2: moderate, 3: severe). Nasal symptoms checked include 1) times blowing nose per day, 2) difficulty in blowing nose, 3) amount of choanal discharge, 4) difficulty in expelling choanal discharge, 5) nasal obstruction, 6) disturbance in the sense of smells, and 7) headache. The number of patients with grade 2 or 3 nasal obstruction and headache decreased to 4-6% of the total. On the other hand, more than 20% still complained of choanal discharge or hyposmia. Nasal obstruction was relieved in 88.4% of the patients who had complained of it while choanal discharge was relieved in only 65.9%. Other symptoms were relieved in over 70% of the patients. Greater improvement in each symptom on long-term follow-up occurred when the preoperative degree was more severe. Choanal discharge appeared in four patients and worsened in two patients. The nose became slightly stuffy in one patient.

Twenty five children with chronic otitis media with effusion received low-dose and long-term erythromycin treatment (EM treatment), and the clinical and bacteriological effects were studied. After the EM treatment, resolution of middle ear effusion (MEE) was observed in 18 of the 25 patients. Within the 3-month follow-up period after EM treatment, 13 of the 18 patients were completely effusion-free, while recurrence of MEE was observed in 5 cases. The final rate of resolution, therefore, was 52%. EM treatment was not effective for younger children, especially for those under 2 years of age.Patients with accompanying chronic sinusitis tended to become effusion-free after EM treatment along with reduction of their nasal symptoms. Persistence of nasopharyngeal pathogens during the EM treatment was demonstrated, indicating that the resolution of MEE by the treatment did not depend on antimicrobial effects but on some antiinflammatory effects. The present results show that EM treatment can increase the resolution of MEE in children with OME.

Eleven patients with perennial allergic rhinitis were treated with 2mg of ketotifen, an anti-allergic drug, for 8 weeks, and the clinical effect and improvement on hyperresponsiveness of the nasal mucosal glands to acetylcholine chloride were studied. Acetylcholine chloride was employed at low concentrations of 1 μg/ml and 10 μg/ml to provoke nasal secretion without sneezing. The provoked nasal secretions were measured by a fluorestinstained thread method.Overall improvement of the nasal symptoms was 81.8% with no side effects. Acetylcholine provoked nasal secretion was significantly inhibited with 1 μg/ml (p

Twenty six adult patients with chronic sinusitis who had undergone Caldwell-Luc operation and received conservative therapy for a long time, but still complained of nasal symptoms, were treated with 400-600mg of erythromycin (EM) per day for 7.9 months on the average.1) Rhinorrhea was reduced in 60.0%, postnasal drip in 50.0%, nasal obstruction in 60.0%, hyposmia in 11.8% and sense of dullness in the head in 100%.2) Rhinoscopy showed reduced mucosal swelling in 10.5%, lower volume of rhinorrhea in 80.0%, better quality of rhinorrhea in 70.0% and reduced postnasal drip in 85.7%.3) This therapy was effective even when EM-resistant bacteria such as Hemophilus influenzae were present.4) No significant side effects were noted in any of the patients during this therapy. Long-term low-dose EM therapy is useful in the treatment of chronic sinusitis. We consider that its effect is not due to its antibacterial activity but to some as yet unknown mechanism.

The effects of early seasonal administration of topical glucocorticosteroids for Japanese cedar pollinosis were examined. In a group that received the drug one week prior to the onset of the season, nasal symptoms were significantly suppressed in the early period of the season. When treatment was started at the onset of the season, the same effects were achieved but commenced one week later. In both groups, nasal congestion was greatly alleviated.

From 1980 to 1985, 678 patients with nasal allergy were found to have perennial sensitivity to house dust at the ENT clinic of Nippon Medical School. These patients were divided into two groups, one was treated with immunotherapy until May 1987. Questionnair were mailed to all the patients asking about severity of nasal symptoms at the time of the first visit and after Immunotherapy, and whether or not they were being treated with other methods at the present time.Answers were received from 235 patients. Improvement was noted in 40% of the patients after 6 months, in 52% after 7-l2 months, in 61% after 13-24 months, in 64% after 25-36 months, in 81% after 37 months or more of the immunotherapy. Of the 87 patients in the non-immunotherapy group 56% improved, but more of these patients had milder symptoms than did those treated with immunotherapy. There was a statistically significant difference in improvement between the immunotherapy group for more than 37 months and the non-immunotherapy. Treatment with other drugs is still needed in 51% of the patients who did not have immunotherapy, in 40% of those with immunotherapy for less than 6 months, in 39% of those with 7-12 months, in 33% of those with 13-24 months, in 16% of those with 25-36 months, in 18% of those with over 37 months of immunotherapy.

Ketotifen, an anti-allergic drug, was administered orally to 22 patients with perennial nasal allergy twice a day (2mg/day) for 8 weeks, and the following results were obtained:1) The overall improvement rate was 54.5%, and the usefulness rate was 50%.2) In 63.6% of the patients, its efficacy started within 2 weeks. In 50% of the remaining 36.4% patients, there was no response even after 8 weeks.3) Among the nasal symptoms, sneezing was reduced in 68.2%, and nasal obstruction in 63.2%. The relief of nasal obstruction was especially noteworthy.4) Among the objective symptoms, decreased nasal secretion was noted in 31.8%, and nasal discomfort in 28.6%. The number of eosinophils in the nasal discharge was decreased in 27.3%.5) The patients' diaries indicated marked reduction of nasal symptoms, such as frequency of sneezing attacks, frequency of nose blowing and nasal obstruction 2 to 3 weeks after the start of treatment.6) Side effects were reported in 30.4%, drowsiness in 21.7%.7) Blood tests showed no abnormalities.It is concluded that Ketotifen is clinically useful in the long-term treatment of perennial nasal allergy and is especially effective for nasal obstruction.

One third of avial of Histaglobin with 2ml of distilled water was given by nebulizer to patients suffering from Japanese cedar pollinosis 2 or 3 times a week. This treatment was started preseasonally and continued during the pollen season for an average of 53.2 days. The records of nasal symptoms of 12 patients were analyzed by scoring the symptoms: number of days with severe nasal discharge or sneezing; comparison with previous year's experience, when the pollen counts were much lower than during the year of this trial; and the amount of other drugs used in 6 cases.A good effect was obtained in 5 of the 7 patients who were able to continue the nebulizer more than twice a week throughout the observation period. Of the other 5 patients who had less frequent treatment 3 reported a good effect. These results suggest that this nebulizer could be useful prophylactically in a large number of patients with Japanese cedar pollinosis.

Traxanox sodium was given in a dose of 360 mg/day to 19 patients with nasal allergy. Improvement was “moderate” or better in 65% and “slightly” or better in 84%. The safety score was “safe” or “almost safe” in 95%.Its clinical usefulness was rated “moderately useful” or more in 68% and in “slightly useful” or more in 84%. Improvement in nasal symptoms was 76%, for sneezing attacks, 76%, for nasal discharges and 58%, for nasal obstruction. Adverse reaction were observed in 3 patients.It is concluded that the oral administration of traxanox sodium in a dose of 360 mg/day is usefull for patients with nasal allergy.

A questionnaire survey on treatment and nasal symptoms during pregnancy was conducted in 47 patients with nasal allergy. Seventy percent of the patients developed nasal allergy within two years after the delivery. Nasal symptoms in patients with pernnial allergy worsened during pregnancy, but those in patients with seasonal allergy significantly improved during pregnancy compared with that before pregnancy.

In 50 patients with an allergic rhinitis, the Chinese herb “Shoh-shei-ryuh-toh” was effective in 84 per cent. The efficacy of this compound was evident in 2-4 weeks, and in patients on the drug for 3-6 months, the nasal symptoms decreased considerably or disappeared altogether. The only side-effect was a slight abdominal swelling (subjective) in one patient.