Hyperresponsiveness of Lower Airway Before and After Nasal Surgery in Chronic Sinusitis Patients with Nasal Polyps

• Published in: JIBI INKOKA TEMBO Vol. 40; no. 5; pp. 539 - 545
• Main Authors: Usui Nobuo, Watanabe Mituhiro, Hara Toshiaki, Ogoshi Toshio
• Format: Journal Article
• Language: Japanese
• Published: Society of Oto-rhino-laryngology Tokyo 1997; 耳鼻咽喉科展望会
• Subjects: hyperresponsiveness; lower airway; nasal polyp; nasal surgery; 下気道; 過敏性; 鼻内手術; 鼻茸
• ISSN: 0386-9687; 1883-6429
• DOI: 10.11453/orltokyo1958.40.539

The purpose of this study is to evaluate lower airway hyperresponsiveness in chronic sinusitis patients with nasal polyps before and after nasal surgery (nasal polypectomy and endonasal sinus surgery), and to assess the effect of inhalation of methacholine through nose on the hyperresponsiveness of the lower airway.The subjects were 14 males and 8 females. The age of the subjects ranged between 25 and 67 years, with an average age of 48 years.A methacholine test through nose was performed with Astograph. The lower respiratory tract hyperresponsiveness was determined based on the respiratory resistance through the mouth, flow-volume curve and expiratory spirogram during the maximum forced vital capacity maneuver before and after methacholine inhalation through the nose. Data were obtained from 22 patients and the measurements were carried out in the follow-up period, before and after nasal surgery repeatedly.Results : 1) The forced expiratory volume in one second percent (FEV1.0%) was suitable for assessing the level of lower respiratory tract hyperresponsiveness in these cases.2) In the methacholine-positive group (testing positive for methacholine before nasal surgery), the lower respiratory tract hyperresponsiveness increased significantly 12 months after surgery.3) In the methacholine-positive group, the lower respiratory tract hyperresponsiveness decreased most 18 months after surgery.4) In the methacholine-negative group (testing negative for methacholine before nasal surgery), a marked decrease in FEV1.0% was demonstrated by methacholine inhalation 12 months after surgery.As a result, the period necessary for treatment after nasal surgery was considered to be approximately 18 months. 鼻茸を伴う慢性副鼻腔炎手術症例の下気道過敏性に及ぼす影響について, メサコリン鼻吸入試験前後の換気機能検査をもとに経過を追って調べ, 治療効果判定のための指標と, それによる術後治療期間を検討することを目的とした。対象は鼻茸摘出術と鼻内鯖骨洞開放術を受けた22症例 (男性14例, 女性8例) であった。結果 : 1) 鼻茸を伴う副鼻腔炎手術症例の気道過敏性評価の指標としては1秒率が適していた。2) 術前のメサコリン鼻吸入試験陽性群の下気道過敏性は術後12ヵ月で最も亢進していた。3) 術前のメサコリン鼻吸入試験陽性群の下気道過敏性は術後18ヵ月で最も低下していた。4) 術前のメサコリン鼻吸入試験陰性群においても術後12ヵ月で吸入後1秒率の下降が認められた。5) アレルギー検査陰性群においては術後6ヵ月と12ヵ月でメサコリン鼻吸入後1秒率の下降が認められた。6) 鼻茸を伴う慢性副鼻腔炎術後治療に要する期間は18ヵ月前後と考えられた。