Dear group members:

Post surgical atrophic rhinitis is a real problem, patients present with ozena and halitosis secondary to crust formation and mucoperulant discharge. For those who fail medical therapy what is the most effective surgical therapy?. In your experience is closure of the nostrils is well tolerated by patients?, does partial closure of the nostrils by leaving small whole in the closed nostrils give the same results?, when to open the closed nostrils?, what is the theory behind closing the nostrils and how does it work. What about nasal reduction surgeries?, are these as effective as nasal closure surgeries?. Is there a cure from atrophic rhinitis? 

Thank you for sharing your experiences with me.

Sincerely.

-----Original Message-----
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Sent:	Thursday, September 03, 1998 9:15 PM
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Subject:	Digest of nose - volume 1 #10

Subjects of messages in this digest:

	Sensory system of the nose


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Date: Thu, 3 Sep 1998 16:43:26 +0100
From: blom <[log in to unmask]>
To: nose group <[log in to unmask]>
Subject: Sensory system of the nose
Message-Id: <[log in to unmask]>

Dear group members,

In a recent study we found a benificial effect of topical capsaicin in
patients with a non-allergic non-infectious perennial rhinitis.
Suggestions have been made, amongst others by Lacroix, that this
benificial effect is generated through modulation of the anti-dromic
reflex which is presumed to be overactive in NANIPER patients. Capsaicin
treatment should either through toxicity or receptor modulation of the
unmyelinated C-afferent system diminish the anti-dromic reflex. A
beautifull hypothesis.

Fang"s group, Wolf's group, and our group, however, were unable to
gather evidence for an increased neuropeptide concentration in the nasal
mucosa of NANIPER patients. This means we have to evaluate the
hypothesis again.
In a recent publication in Nature by Caterina the capsaicin receptor was
identified as a heat activated ion channel. Moreover capsaicin was shown
to kill cells expressing the heat receptor.

The sensation of airflow is generated by cooling of the turbinates.
(Eccles, 1983). Cold receptors may have been identified (Krause's
corpuscles).  A big problem in NANIPER patients is the sensation of
decreased nasal passage.

I would like to suggest the hypothesis that the efficacy of capsaicin in
this group of patients is the result of a decrease of the number of
functional heat receptors. As the number of cold receptors is not
modulated the net effect in the cortex is the sensation of increased
nasal flow. Of course this train of thought requires a balance between
heat and cold receptors. Unfortunately I'm not aware of the existence of
such a mechanism.

I would very much like your comments on this hypothesis.

With kind regards,
Henk Blom, ENT-surgeon.



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