Objective: To analyse the effects of noise exposure in emergency resuscitation rooms (ERRs) on cognitive function and hyperalgesia in patients with trauma. Methods: Clinical data from 110 patients with trauma who were treated in the ERR of Suizhou Central Hospital between June 2022 and July 2023 were retrospectively analysed. Participants were divided into the following two groups on the basis of real-time noise monitoring: the high-noise-exposure (n = 85) and low-noise-exposure (n = 25) groups. Neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF), homocysteine (Hcy), the Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA) were used to measure cognitive performance. Mechanical pain threshold and serum nerve growth factor (NGF), substance P (SP), calcitonin gene-related peptide (CGRP) and 5-hydroxytryptamine (5-HT) levels were applied to assess hyperalgesia. Pearson correlation was employed to investigate the connections between noise levels and outcome factors. Results: The high-noise-exposure group demonstrated significantly lower MMSE scores, MoCA scores and serum BDNF levels but higher serum NSE and Hcy levels compared with the low-noise-exposure group (P < 0.05). Additionally, compared with the low-noise-exposure group, the high-noise-exposure group exhibited larger mechanical hyperalgesia areas around incisions and on the volar forearm, as well as elevated serum CGRP, NGF and SP levels, while showing reduced mechanical pain thresholds and lower serum 5-HT levels (P < 0.05). Pearson analysis revealed that noise exposure values had negative correlations with mechanical pain threshold, MMSE and MoCA scores and serum BDNF and 5-HT levels (r < 0, P < 0.05) but positive correlations with mechanical hyperalgesia area and serum CGRP, NSE, Hcy, NGF and SP levels (r > 0, P < 0.05).Conclusion: High noise exposure in ERRs may be associated with cognitive dysfunction and hyperalgesia in patients with trauma. Clinical management should recognise and control noise levels in these settings.
Jordyn A. Hurly, Anna Christina Clements, Marisa A. Ryan
et al.
ABSTRACT Objectives Intracapsular tonsillectomy is associated with decreased postoperative pain, shortened recovery, and decreased bleeding risk. No study has specifically investigated its use in patients with exclusively severe or very severe obstructive sleep apnea syndrome (OSAS). Our study aimed to report severe OSAS outcomes following intracapsular (IT) compared to total tonsillectomy (TT) in pediatric patients with severe and very severe OSAS. Methods We conducted a retrospective study including patients ≤ 18 years of age who underwent adenotonsillectomy or tonsillectomy between June 2018 and June 2022 at a tertiary care center. Patients were categorized preoperatively as having severe OSAS (OAHI ≥ 10) or very severe OSAS (OAHI ≥ 30). Primary outcomes included obstructive apnea‐hypopnea index (OAHI), oxygen saturation nadir, presence of hypercarbia, and respiratory disturbance index (RDI) as measured on postoperative polysomnography, as well as residual OSAS requiring CPAP. Results Of 57 patients in this study, the mean age was 4.5 (±2.9) and 59.7% were male. There was no significant difference in postoperative residual OSAS outcomes following surgery for patients in either severity group, with a mean time to follow up polysomnogram of 237 (range: 24–885) days. Conclusion Our study reveals that for both severe OSAS and very severe OSAS, there is no difference in the primary outcome of postoperative OAHI with regard to surgical technique; however, long‐term postoperative outcomes are still needed. Level of Evidence 4.
Salwa Ahmed Abd Elhay Ahmed, Ahmed Abdelhamid Abdelgoad, Dina Mohamed Fouad Khaled
Abstract Background In children, oropharyngeal dysphagia increases the risk of aspiration, pneumonia, and even mortality. It has been demonstrated that dysphagia screening improves health outcomes. The purpose of the study is to investigate the clinical value of the 3-oz water swallow test for detecting aspiration risk and the possibility for oral feeding in children and determine whether it is a suitable tool for identifying swallowing issues. Method This study included 90 children with dysphagia: 48 boys and 42 girls, aged 2–12 years old with an average age of 6.2 ± 2.3 years, and 80% of them were older than 3 years. Sixty percent were orally fed, while 40% were on modified oral feeding. More than half the children (53.3%) had dysphagia for more than 1 week. All study participants underwent 3-oz water swallow test and flexible endoscopic evaluation of swallowing test consecutively. Results The flexible endoscopic evaluation of swallowing revealed 42 positive cases (46.7%) and 48 negative (53.3%). The 3-oz water swallow test yielded 39 positive cases (i.e., failed) and 51 negatives (i.e., passed the test), with no statistically significant difference from the flexible endoscopic evaluation of swallowing test results (p = 0.701). There were no statistically significant differences between positive and negative cases regarding their age, gender, or mode of feeding. However, positive cases had significantly longer duration of dysphagia than negative cases (p = 0.001). The best-fit model (3-oz water swallow test model) includes the following: the 3-oz water swallow test result, age, gender, and the dysphagia duration. This model accurately identified aspiration risk among dysphagic children in 76.7% compared to 70.0% by the 3-oz water swallow test alone. Conclusion The use of 3-oz water swallow test in children with dysphagia was recommended in consideration with the three mentioned predictor variables with a well-trained, good observer clinician who will be ready for any complications in order to be able to take the best and safest decision to the patient.
Fery Mai Rafanan, Eduard Alfanta, Romulus Roberto Peter Instrella
Objective: To investigate the association between the time intervals of key clinical time points and tumor progression (increase in clinical staging) in head and neck cancer patients before and during the pandemic.
Methods:
Design: Retrospective Cohort Study
Setting: Tertiary Government Training Hospital
Participants: A total of 81 head and neck cancer patients who consulted at the OPD and underwent elective surgery between January 1, 2018, and December 31, 2022, under the Department of Otorhinolaryngology – Head and Neck Surgery of East Avenue Medical Center were included in the study; 40 patients comprised the pre-pandemic group and 41 patients-the pandemic group.
Results:Majority of patients were men (61.73%), and the mean age was 54 years. The most prevalent tumor site was the oral cavity (37.04%). Most patients were Clinical Stage IV at the time of diagnosis (32.10%) and at the time of surgery (58.02%). In the pre-pandemic period, median time-to-consult was 180 days, time-to-diagnosis was 14 days, and time-to-treatment was 57 days. During the pandemic, median time-to-consult significantly increased to 365 days (Mann-Whitney test, U = 589, p = .028), but time-to-diagnosis decreased to 10 days, and time to-treatment decreased to 43 days, although these were not significant (U = 775, p = .667; U = 809, p = .917). Among the 81 patients in the study, 14 (17.28%) showed tumor progression (pre-pandemic: 6; 15%; pandemic: 8; 19.51%), but there was no significant association between time-to-consult and increase in clinical staging for both pre-pandemic (χ2(38) = 34.2, p = .646) and pandemic groups (χ2(16) = 23.1, p = .110) or between time-to-diagnosis and increase in clinical staging for pre-pandemic (χ2(56) = 36.8, p = .978) and pandemic groups (χ2(23) = 28.3, p = .267). Overall, there was no significant association between time-to-treatment and increase in clinical staging for both pre-pandemic (χ2(62) = 80.00, p = .062) and pandemic groups (χ2(32) = 30.4, p = .548), but a subset of patients with larynx primary tumor site had a statistically significant association between time-to-treatment and tumor progression (χ2(5) = 12.00, p = .035).
Conclusion:This study revealed that there was an increase in time to-consult for head and neck cancer patients during the pandemic. However, there was no significant difference in time-to-diagnosis and time-to-treatment. This shows that the Department of ORL-HNS, East Avenue Medical Center has provided pandemic head and neck cancer care similar to before the pandemic. No significant associations were found between tumor progression and time intervals of the key clinical time points but patients who had an increase in clinical stage were noted with longer time-to treatment. It was also observed that more patients were in advanced clinical stages during the pandemic.
Abstract Objective Hemorrhage is the most common complication caused by transoral laryngopharyngeal surgery. It is believed that proper management of the superior laryngeal artery (SLA), the main feeding artery for the larynx and pharynx, may reduce intra‐ and postoperative hemorrhage incidence. The aim of this study was to illustrate the anatomy of the SLA via transoral endoscopic approach. Methods Fourteen sides of SLA from heads of seven fresh‐frozen and silicone‐injected cadavers were dissected. Transoral dissections were performed for the intra‐laryngeal segment of SLA, and transcervical dissections were performed to confirm the anatomical measurements. Results SLA had a slightly descending course from the origin to the larynx, and there was a major branch supplying the epiglottis, named pharyngo‐epiglottic artery (PEA). Parallel with the internal superior laryngeal nerve (ISLN), SLA passed through the thyrohyoid membrane and ended into the hypopharynx. The distance from SLA to the superior horn of thyroid cartilage (SHTC) was (9.11 ± 0.58)mm on the left and (9.01 ± 0.37)mm on the right; the distance from SLA to the inferior margin of the hyoid bone (IMHB) was (2.00 ± 0.11)mm on the left and (1.95 ± 0.08)mm on the right; the distance from SLA to ISLN was (5.98 ± 0.48)mm on the left and (5.78 ± 0.36)mm on the right. No significant difference was found between bilateral sides (p > 0.05). Moreover, the distance from SLA to superior margin of thyroid cartilage (SMTC) was (5.52 ± 0.24)mm on the left and (5.80 ± 0.15)mm on the right. A significant difference was also found between bilateral sides (p = 0.03), which might suggest the SLA is located further from the SMTC on the right side. Conclusion SHTC, SMTC, and IMHB could be regarded as anatomical landmarks to locate SLA when applying a transoral approach. Moreover, a complete understanding of the detailed anatomy of the superior laryngeal artery may improve the detection of hemostasis in transoral laryngeal or hypo‐pharyngeal surgery.
Objectives: Although the cause of Meniere’s disease (MD) is not fully understood, endolymphatic hydrops is widely believed to be responsible for MD. Previous studies have used Air-Conducted Sound (ACS)-induced Vestibular Evoked Myogenic Potentials (VEMPs) to evaluate otolithic function in patients with MD. However, the use of Galvanic Vestibular Stimulation-VEMPs (GVS-VEMPs) with other vestibular tests in MD has been rare. This study aimed to explore the application of galvanic VEMPs in assessing MD. Methods: Normal individuals and patients with unilateral definite MD were included in this retrospective study. All participants underwent pure tone audiometry. Ocular and cervical VEMPs induced by GVS, and ACS were recorded. The characteristic parameters of VEMPs (n1 latency, p1 latency, amplitude, and AR) were analyzed. Results: The provocation rates of GVS-VEMPs did not differ between MD patients and control individuals. Compared with ACS, GVS could evoke potentials with longer latencies. MD patients presented GVS-VEMPs with lower amplitudes and ACS-cVEMP with shorter latencies and had a higher response rate in GVS-oVEMP. However, no differences or correlations were found in the characteristic parameters of GVS-VEMPs among the different stages of MD. Conclusions: GVS is as effective as ACS for inducing VEMP, and GVS-VEMP recording can detect retrolabyrinthine degeneration in MD. Further research is needed to assess the utility of GVS-VEMP in the evaluation of MD severity. Level of evidence: Level 4.
Mehrdad Jafari, Mehdi Aghili, Elham Kamali Hakim
et al.
The aim of this non-randomized clinical trial was to evaluate tumor outcomes and subjective quality of voice following radiotherapy and partial laryngectomy in early-stage glottic laryngeal cancers. Non-Randomized Clinical Trial. Otolaryngology and radiation oncology clinics of Imam Khomeini (an affiliated hospital of Tehran University of Medical Sciences) and Amir Aalam Hospitals. Fifteen patients with early-stage glottic laryngeal carcinoma were admitted to the otolaryngology clinic, divided into two treatment groups: radiotherapy and partial laryngectomy. Of the total 50 patients, 25 had a partial laryngectomy and 25 radiotherapies. The comparison of the average of the Voice Handicap Index (VHI) showed significant improvement of vocal quality after treatment for both partial laryngectomy and radiotherapy (P<0.0001 for both). But there was no significant difference in VHI mean scores between the two treatment groups (patients treated by partial laryngectomy and radiotherapy). Short- and long-term complication was higher in patients undergoing surgery than radiotherapy group (P<0.0001). With regard to oncological outcome after one and eight-year after treatment, no differences were observed in the two treatment groups; there was a significant relationship between smoking cessation and recurrence of disease in the partial laryngectomy treatment group (P=0.012). There was no significant difference in voice quality and life expectancy of patients operated on using open surgery and patients treated with radiotherapy in this series. Open surgery may have more noticeable complications than radiotherapy.
Ana Moreno Valor, Mikel García Martín, Ignacio Toribio Cuesta
et al.
El meningocele congénito transesfenoidal es una condición rara y poco estudiada. Presentamos el caso de una paciente prematura y de bajo peso que desde el nacimiento presenta clínica respiratoria y mala tolerancia oral. Durante su estudio, en una prueba de imagen se identifica un meningocele transesfenoidal que ocupa rinofaringe; Ante este hallazgo y la mala evolución clínica,decidimos intervenir quirúrgicamente a la paciente. Pese a que en la bibliografía revisada no se reportan casos tratados quirúrgicamente de menos de 3 meses de edad y que el abordaje endoscópico puede ser muy complicado por sus limitaciones anatómicas, nos decidimos por un abordaje endonasal endoscópico con éxito y buena evolución posterior.
Alvaro Torres-Gomez, Jose Luis Sanchez-Trincado, Víctor Toribio
et al.
The phagocytic integrins and complement receptors α<sub>M</sub>β<sub>2</sub>/CR3 and α<sub>X</sub>β<sub>2</sub>/CR4 are classically associated with the phagocytosis of iC3b-opsonized particles. The activation of this receptor is dependent on signals derived from other receptors (inside-out signaling) with the crucial involvement of the Rap1-RIAM-Talin-1 pathway. Here, we analyze the implication of RIAM and its binding partner VASP in the signaling events occurring downstream of β<sub>2</sub> integrins (outside-in) during complement-mediated phagocytosis. To this end, we used HL-60 promyelocytic cell lines deficient in RIAM or VASP or overexpressing EGFP-tagged VASP to determine VASP dynamics at phagocytic cups. Our results indicate that RIAM-deficient HL-60 cells presented impaired particle internalization and altered integrin downstream signaling during complement-dependent phagocytosis. Similarly, VASP deficiency completely blocked phagocytosis, while VASP overexpression increased the random movement of phagocytic particles at the cell surface, with reduced internalization. Moreover, the recruitment of VASP to particle contact sites, amount of pSer157-VASP and formation of actin-rich phagocytic cups were dependent on RIAM expression. Our results suggested that RIAM worked as a relay for integrin complement receptors in outside-in signaling, coordinating integrin activation and cytoskeletal rearrangements via its interaction with VASP.
Monika Pokharel, Bikash Lal Shrestha, Dharmendra Karn
et al.
Introduction: The prevalence of allergic rhinitis has increased significantly globally over the last two decades. Detection of sensitizing aeroallergens plays a crucial role in the diagnosis and management of this troublesome disease. This study aims to investigate the spectrum of aeroallergens sensitization in patients with allergic rhinitis in a tertiary care hospital.
Methods: A descriptive cross-sectional study conducted in the Department of Otorhinolaryngology of our hospital between January 2016 to December 2019. Ethical approval was taken from the Institutional Review Committee (No: 210/19). Patients diagnosed with allergic rhinitis were enrolled using the convenience sampling technique. Data entry and analysis was done using IBM Statistical Package for Social Sciences version 20.0.
Results: Among 170 patients, altogether 103 (60.6%) patients yielded positive responses on the skin prick test. The most prevalent aeroallergens were Lepidoglyphus 86 (50.60%), Dermatophagoides pteronyssinus 85 (50%), Dermatophagoides farina 82 (48.20%), Thyrophagus 50 (29.40%), Blomia 46 (27.10%), Acarus 43 (25.30%), cat dander 26 (15.30%), dog dander 24 (14.10%), cow and buffalo dander 20 (11.8%), ragweed 20 (11.8%), grass pollen 18 (10.60%) and mugwort 17 (10%).
Conclusions: This study highlights that the frequency of aeroallergens based on skin prick test in patients presenting to a tertiary care hospital which showed the dominance of house dust mites, dog and cat hair, pollen, and grasses. Reduced exposure and training of patients about protection against these agents will possibly help in controlling the severity of allergic rhinitis in this region.
Carlo Cappelli, Ilenia Pirola, Elena Gandossi
et al.
Background. Serum TSH levels in the upper-normal range were reported to be associated with increased risk of thyroid malignancy. However, measurement of TSH levels is currently not recommended for assessing the risk of malignancy in patients with newly diagnosed thyroid nodules. Objective. To evaluate a possible relationship between the serum levels of TSH and the histological outcome of patients undergoing thyroidectomy for thyroid nodules with indeterminate cytology. Materials and Methods. We collected the clinical data of all patients who had performed ultrasound-guided FNA of thyroid nodules with cytological diagnosis of indeterminate lesions (TIR3A and TIR3B) and serum TSH levels within the normal range. All patients had been submitted to thyroid surgery (hemi or thyroidectomy, as appropriate), and histological diagnosis had been performed. Results. A histological diagnosis of thyroid malignancy was rendered in 74/378 (19.6%) nodules. Patients with histologically proven thyroid malignancy were characterized by higher serum levels of TSH as compared to patients with histologically proven benign nodules (3.03 ± 1.16 vs. 2.37 ± 1.19 mIU/L, p<0.001). To further analyze the role of serum TSH in predicting thyroid cancer, patients were stratified in 4 groups according to quartiles of TSH concentrations. The prevalence of malignancy was 12.2% for the first quartile and 50.0% for the last quartile. ROC curve analysis identified that a serum TSH level of ≥2.7 mIU/L predicted thyroid malignancy with a sensitivity of 61% and a specificity of 65%. Conclusions. TSH levels in the upper-normal range are associated with an increased risk of thyroid malignancy in patients affected by thyroid nodules with indeterminate cytology at FNA. The measurement of serum TSH levels represents an easily performed additional tool for decision-making in patients with indeterminate cytological findings.
Diseases of the endocrine glands. Clinical endocrinology
Introduction: Functional endonasal endoscopic surgery is a frequent surgical procedure among otorhinolaryngologists. In 2014, the European Society of Rhinology published the “European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses”, aiming to unify the terms in the English language. We do not yet have a unified terminology in the Portuguese language. Objective: Transcultural adaptation of the anatomical terms of the nose and paranasal cavities of the “European Anatomical Terminology of the Internal Nose and Paranasal Sinuses” to Portuguese. Methods: A group of rhinologists from diverse parts of Brazil, all experienced in endoscopic endonasal surgery, was invited to participate in the creation of this position paper on the anatomical terms of the nose and paranasal sinuses in the Portuguese language according to the methodology adapted from that previously described by Rudmik and Smith. Results: The results of this document were generated based on the agreement of the majority of the participants according to the most popular suggestions among the rhinologists. A cross-cultural adaptation of the sinonasal anatomical terminology was consolidated. We suggest the terms “inferior turbinate”, “nasal septum”, “(bone/cartilaginous) part of the nasal septum”, “(middle/inferior) nasal meatus”, “frontal sinus drainage pathway”, “frontal recess” and “uncinate process” be standardized. Conclusion: We have consolidated a Portuguese version of the European Anatomical Terminology of the Internal Nose and Paranasal Sinuses, which will help in the publication of technical announcements, scientific publications and the teaching of the internal anatomical terms of the nose and paranasal sinuses in Brazil. Resumo: Introdução: A cirurgia endoscópica funcional endonasal é um procedimento cirúrgico frequente entre os otorrinolaringologistas. Em 2014, a Sociedade Europeia de Rinologia publicou o “Documento Europeu para Posicionamento sobre a Terminologia Anatômica Interna do Nariz e das Cavidades Paranasais” com o objetivo de unificar os termos na língua inglesa. Ainda não dispomos de uma terminologia unificada na língua portuguesa. Objetivo: Adaptação transcultural dos termos anatômicos do nariz e das cavidades paranasais para o português da “European Anatomical Terminology of the Internal Nose and Paranasal Sinuses”. Método: Um grupo de rinologistas de todo o Brasil, com experiência em cirurgia endoscópica endonasal, foi convidado a participar da elaboração desse posicionamento sobre os termos anatômicos do nariz e das cavidades paranasais para o português conforme metodologia adaptada da previamente descrita por Rudmik e Smith. Resultados: Os resultados desse documento foram gerados a partir da concordância da maioria dos participantes conforme as sugestões mais populares entre os rinologistas. Uma adaptação transcultural da terminologia anatômica nasossinusal foi consolidada. Sugerimos que se busque uniformizar termos como “concha inferior”, “septo nasal”, “porção (óssea/cartilagionasa) do septo nasal”, “meato (médio/ inferior) nasal”, “via da drenagem do seio frontal”,“recesso frontal” e “processo uncinado”. Conclusão: Consolidamos uma versão adaptada em português da “European Anatomical Terminology of the Internal Nose and Paranasal Sinuses” que auxiliará a publicação de comunicados técnicos, publicações científicas e o ensino dos termos anatômicos internos do nariz e das cavidades paranasais no Brasil. Keywords: Cross-cultural adaptation, Anatomy, Nose, Paranasal sinus, Consensus, Palavras-chave: Adaptação transcultural, Anatomia, Nariz, Cavidades paranasais, Consenso
A 54-year-old man who presented to the clinic for a routine examination was found to have a hard swelling in the floor of mouth. The swelling was noticed at the age of ten years and had been gradually progressing over the years. However, there was no history of chewing difficulty, dysphagia, dysarthria, oral ulcers or sleep disturbances. On examination, a 4x4 cm bony swelling was noted arising from the lingual surface of mandible, with an intact overlying mucosa. The findings were typical of torus mandibularis, a benign bony outgrowth from the mandible which was also confirmed radiologically. About 80 to 90% of the lesions present as small, bilateral bony protrusions near the pre-molars and are incidental findings on routine oral examination. Despite the large size, our patient declined any treatment as the lesion was asymptomatic.
Carla Aparecida Cielo, Bruna Franciele da Trindade Gonçalves, Joziane Padilha de Moraes Lima
et al.
OBJETIVO:verificar a diferença entre o tempo máximo de fonação /a/ e tempo máximo de fonação previsto em relação ao tipo respiratório, e correlacionar os tempos máximos em mulheres adultas com capacidade vital dentro da normalidade e sem afecções laríngeas.MÉTODOS:pesquisa transversal analítica, quantitativa e retrospectiva, em banco de dados, de 51 sujeitos do sexo feminino, com diagnóstico otorrinolaringológico de ausência de afecção laríngea, com idades entre 18 e 44 anos (média 27,64). Utilizaram-se os dados: maior valor de tempo máximo de fonação de /a/, tempo máximo de fonação previsto, capacidade vital e tipo respiratório. O valor do tempo máximo previsto para mulheres foi calculado multiplicando-se a capacidade vital por 0,0051, e o valor encontrado foi determinante para a classificação do tempo de /a/ em normal, abaixo ou acima do previsto.RESULTADOS:houve diferença significante entre tempo de fonação previsto e os tipos respiratórios superior (17,44s) e misto (15,17s). Não houve diferença significante do tempo máximo de fonação /a/ nos diferentes tipos respiratórios, nem correlação entre tempo de fonação /a/ e tempo previsto.CONCLUSÃO:não houve correlação entre tempo de /a/ e tempo de fonação previsto e este último foi significantemente maior no tipo respiratório superior do que no misto na população estudada.
The use of intravenous thrombolytic agents has revolutionised the treatment of acute myocardial infarction. However, the improvement in mortality rate achieved with these drugs is tempered by the risk of serious bleeding complications, including intracranial haemorrhage. Tenecteplase is a genetically engineered mutant tissue plasminogen activator. Haemorrhagic complications of tissue plasminogen activator (tPA) are well known. Compared to other tPAs, tenecteplase use leads to lower rates of bleeding complications. Here, we report a case of unusual site of spontaneous bleeding, intralingual haematoma during tenecteplase therapy following acute myocardial infarction, which caused significant upper airway obstruction and required tracheotomy to maintain the patient’s airway. Clinical dilemmas related to securing the airway or reversing the effects of tissue plasminogen activator are discussed.
Seung-Youp Shin, Gil Soon Choi, Kun Hee Lee
et al.
ObjectivesAlpha1-antitrypsin (AAT) is the main inhibitor of human neutrophil elastase, and plays a role in counteracting the tissue damage caused by elastase in local inflammatory conditions. The study evaluated the involvement of AAT in nasal allergic inflammation.MethodsForty subjects with mono-sensitization to Dermatophagoides pteronyssinus (Dpt) were enrolled. Twenty allergic rhinitis patients frequently complained of nasal symptoms such as rhinorrhea, stuffiness, sneezing, and showed positive responses to the nasal provocation test (NPT) with Dpt (Group I). The other 20 asymptomatic patients showed sensitization to Dpt but negative NPT (Group II). The levels of AAT, eosinophil cationic protein (ECP), and Dpt-specific IgA antibodies were measured in the nasal lavage fluids (NLFs), collected at baseline, 10 minutes, 30 minutes, 3 hours, and 6 hours after the NPT. Nasal mucosa AAT expression was evaluated with immunohistochemical staining from Group I and Group II.ResultsAt baseline, only the Dpt-specific IgA level was significantly increased in the NLFs of Group I compared with Group II, while ECP and AAT levels were not significantly different between two groups. After Dpt provocation, AAT, ECP, and Dpt-specific IgA levels were significantly increased in the NLFs of Group I during the early and late responses. The protein expression level of AAT was mostly found in the infiltrating inflammatory cells of the nasal mucosa, which was significantly increased in Group I compared to Group II.ConclusionThe increment of AAT showed a close relationship with the activation of eosinophils induced by allergen-specific IgA in the NLFs of patients with allergic rhinitis after allergen stimulation. These findings implicate AAT in allergen-induced nasal inflammation.