Le septum nasal joue un rôle prépondérant dans la croissance de l’étage moyen de la face et la physiologie ventilatoire. Sa solidité, sa rectitude et sa position sagittale sont déterminantes pour percevoir un confort respiratoire diurne et nocturne. Vulnérable aux traumatismes de part sa projection antérieure, la destruction ou l’inefficience de son squelette entraîne une demande de réparation fonctionnelle et esthétique. Dans les cas les plus sévères, le remplacement tissulaire fait appel à des volumineux greffons autologues pour lesquels la morbidité du site donneur et leurs imperfections propres restent un écueil. Pour les remplacer, certains biomatériaux ont été essayés de manière empirique sans donner de résultats fiables. Le premier objectif de notre travail été d’évaluer le comportement d’un implant phosphocalcique biphasique pour la reconstruction du septum nasal afin d’éviter ces greffons tout en répondant aux objectifs biofonctionnels locaux, au contact d’un milieu septique et susceptible d’être exposé aux particules aéroportées de l’environnement. Le deuxième objectif était d’évaluer la cytotoxicité des nanotubes de carbone à double paroi sur des cellules de l’arbre respiratoire, premier organe concerné par une exposition potentielle lors de leur fabrication. Par la suite, les résultats de ces deux sujets différents ont été utilisés de manière synergique pour répondre au troisième objectif qui était, d’évaluer l’influence des nanotubes de carbone sur la cicatrisation du septum nasal en présence ou non de l’implant phosphocalcique. / The nasal septum plays a paramount role in the growth of the face and respiratory physiology. Its solidity, its straightness and its sagittal position are determining to perceive a diurnal and night respiratory comfort. Vulnerable to the traumas, the destruction or the inefficiency of its skeleton involves request for a functional and aesthetic repair. In severe cases, the tissue replacement requires large autologous grafts for which the morbidity of the donor site and their own imperfections remain a problem. To replace them, certain biomaterials were tested in an empirical way without giving reliable results. The primary goal of our work was to evaluate the behaviour of a biphasic phosphocalcic implant to repair nasal septum in order to avoid these grafts with an adapted biofunctional implant, exposed to the septic nasal content and the airborne particles of the environment. The second objective was to evaluate the cytotoxicity of the double wall carbon nanotubes on epithelial respiratory cells, first organ concerned by a potential exposure during their manufacture. Thereafter, the results of these two different subjects were used in a synergistic way to answer the third objective which was, to evaluate the influence of the carbon nanotubes on the cicatrization of the nasal septum in presence or not of the phosphocalcic implant.

La ventilation nasale est vitale pour le nouveau-né, respirateur nasal exclusif. Le tiers antérieur des fosses nasales peut être modifié par une sténose congénitale de l’orifice piriforme, tandis leur partie postérieure peut être fermée par une atrésie choanale uni ou bilatérale ou par des lésions du nasopharynx.Les simulations numériques permettent d’analyser l’écoulement et le conditionnement de l’air en contournant les limites techniques et éthiques rencontrées in vivo. Devant la rareté des données dans la littérature, une étude de faisabilité a été nécessaire et concluante : les modèles numériques sont qualitativement proches de la réalité. Un travail sur les conditions physiologiques chez le nouveau-né a ensuite été réalisé, avec une méthodologie retravaillée. La reconstruction tridimensionnelle des fosses nasales est possible dès la naissance. La création d’une sphère centrée sur la pointe du nez, éloignant le domaine d’entrée de la zone d’intérêt, a permis d’analyser le rôle du tiers antérieur des fosses nasales.La valve nasale joue un rôle majeur en inspiration : perte de charge, accélération, guidage des flux et réchauffement de l’air. Les trois quarts du réchauffement ont lieu en amont du cornet inférieur. Une obstruction nasale entraîne une réduction des vitesses et une augmentation des températures de l'air. La simulation de l’inspiration d’air à 0°C a permis de constater que les fosses nasales permettent d’amortir les effets du refroidissement de l’air extérieur.Ce travail constitue une première approche de la physiologie de la ventilation nasale du nouveau-né par modélisation numérique, indispensable à la compréhension de la pathologie nasale néonatale. / Nasal breathing is essential for the newborn, exclusive nasal breather. The anterior third of the nasal fossae may be modified by a congenital stenosis of the pyriform aperture, while their posterior part may be closed by unilateral or bilateral choanal atresia.Numerical simulations are a good means to analyze airflow and air-conditioning: they circumvent the technical and ethical limits encountered in vivo. Given the rarity of available data in the literature, a feasibility study was necessary and was conclusive: numerical models are qualitatively close to reality. A work on the physiological conditions in newborns was conducted, using refined methodology. The three-dimensional reconstruction of the nasal fossae is possible from birth. The creation of a sphere centered on the tip of the nose, moving the boundary conditions away from the area of interest, made it possible to analyze the role of the anterior third od the nasal fossae.The nasal valve plays a major in inspiration: it is a zone of pressure loss, acceleration, flow guidance and air warming. Three-fourths of the warming takes place upstream the inferior turbinate. A partial nasal obstruction modifies these results with lower velocities and higher temperature of the air. The simulation of the inspiration of cold air (0°C) has shown that the nasal fossae can dampen, without canceling, the effects of air cooling. This work is a first approach to the physiology of nasal ventilation of the newborn by numerical modeling, which is essential to the understanding of neonatal nasal pathology.

No description available.

Nasal high flow (NHF) therapy is a recent form of non-invasive respiratory support for patients suffering from respiratory distress that supplies high flows of heated and humidified air, oxygen or a mix via a nasal cannula. A number of in vivo studies have proven its effectiveness at improving blood oxygenation; however, its mechanisms of action remain widely unproven. Two proposed mechanisms of action, the CO2 washout of anatomic dead space and the production of positive airway pressure, are investigated in this thesis for the use of the Fisher & Paykel Healthcare Ltd (FPH) Optiflow™ adult nasal cannula through a range of experiments. Five anatomically correct upper airway models produced from computed tomography (CT) scan data via 3D printing were employed during in vitro experiments and two live subjects participated in in vivo measurements. The human respiratory system was faithfully replicated for CO2 washout experiments with physiological CO2 diffusion into the lung replicated by a constant flow of CO2 into the lung pump. In vivo measurement of a natural breathing flow pattern was scaled to an average population tidal volume and respiratory rate for in vitro use. In vitro measurements of static pressure during natural breathing found similar flow resistances across the nasal passage for inspiratory and expiratory flow directions; however, across the entire upper airway greater resistance was seen for inspiration. Introduction of NHF therapy produced significant increases in all mean and peak airway pressures within the upper airway with a flow rate of 30 LPM fulfilling the inspiratory work requirements presented by the upper airway resistance. In vivo and in vitro hot wire anemometry measurements at the exterior nares indicated low velocity and turbulence intensity flows at peak inspiration and a high velocity jet with high turbulence during peak expiration. At natural breathing an in vitro anterior-posterior velopharynx traverse captured low turbulence intensities during peak inspiration and high turbulence intensities during peak expiration. Introduction of NHF therapy had little influence on the turbulence intensity profile of peak expiration yet did cause significant increases in the turbulence intensities during peak inspiration. Measurements of the CO2 concentration near the lung volume over many breath cycles were used to find time-averaged CO2 concentrations. For the standard airway model an average CO2 concentration of 4.88 ± 0.07 %V/V was determined during natural breathing. Implementation of increasing levels of NHF therapy generated significant washout of CO2 reducing this average concentration to a minimum of 3.81 ± 0.11 %V/V at a flow rate of 80 LPM. It was determined that airway geometry significantly affected the efficacy of the NHF therapy though CO2 washout was observed in all five airway models.

En Amérique du Nord, Mycoplasma bovis est le plus pathogène des mycoplasmes retrouvés chez les bovins. Les principales maladies qu’on lui associe (maladies respiratoires, mammites, arthrites septiques et otites moyennes et/ou internes) constituent un défi à l’industrie laitière à cause de la difficulté à les traiter et à les prévenir par une vaccination. L’objectif principal de ce projet était d’étudier l’excrétion nasale et la réponse sérologique à M. bovis chez les génisses de remplacement, entre la naissance et 7 mois d’âge, dans 4 troupeaux laitiers au Québec. Quatre-vingt-trois paires mère/génisse provenant de 4 cohortes de bovins laitiers étaient prélevées mensuellement (génisses : 0 à 7 mois ; mères : 0, 1 et 5 mois après vêlage). Écouvillons nasaux et échantillons de lait étaient analysés par culture bactériologique et par immunofluorescence indirecte. Les anticorps circulants étaient détectés par le test ELISA. À la naissance, la prévalence sérologique des génisses était supérieure à celle des mères (P = 0,01). La transmission de M. bovis aux génisses par le lait et par l’excrétion nasale des mères était faible. L’âge moyen (jour) d’une génisse à sa 1ère excrétion nasale et sa 1ère séroconversion à M. bovis était loin de la période néonatale: 77,5 ± 11,2 (n = 22) et 96,8 ± 7,4 (n = 36) respectivement. Conclusion, les vaches adultes n’ont constitué qu’une voie mineure de transmission de M. bovis aux génisses, la principale voie de transmission était fort probablement le contact direct ou indirect avec d’autres génisses excrétrices nasales de M. bovis. / In North America, Mycoplasma bovis is the most pathogenic mycoplasma found in cattle. The main diseases associated with it (respiratory disease, mastitis, septic arthritis and otitis median and/or internal) are a challenge to the dairy industry because of the difficulty to treat them and to prevent them by vaccination. The principal objective of this project was to study nasal shedding and serological response to M. bovis in replacement heifers, between birth and 7 months of age, in four dairy herds in Quebec. Eighty three pairs cow/heifer in 4 cohorts of dairy cattle were sampled monthly (heifers: 0 to 7 months; cows: 0, 1 and 5 months after calving). Nasal swabs and milk samples were analyzed by bacteriological culture and by indirect immunofluorescence. Circulating antibodies were detected by ELISA test. At birth, the serologic prevalence of heifers was significantly higher than the serologic prevalence of cows (P = 0,01). Transmission of M. bovis to heifers in milk and nasal shedding from cows was low. The average age (days) of a heifer for first nasal shedding and first seroconversion to M. bovis was far from the neonatal period: 77,5 ± 11,2 days (n = 22) and 96,8 ± 7,4 days (n = 36) respectively. Conclusion, cows were only a minor route of transmission of M. bovis to heifers, the main route of transmission was most likely the direct or indirect contact with other heifers shedding M. bovis in their upper respiratory tract.

Esta tese é composta por três capítulos. O primeiro capítulo teve por objetivo analisar quais as técnicas de reconstrução nasal mais consistentes em contexto forense através de uma revisão sistemática da literatura. No total, existem 15 métodos de reconstrução nasal descritos na literatura. Para localizar a ponta do nariz e estimar a projeção nasal em indivíduos brasileiros, o método que se demonstrou, em meta-análise, o mais apropriado foi o que considera que o ângulo (ponto Pronasale) formado pelas retas que partem dos pontos Rhinion e Prosthion possui valor aproximado de 90º. O capítulo II teve como propósito testar, mediante análise de imagens tomográficas, o método desenvolvido em indivíduos brasileiros para estimar a localização da ponta do nariz em casos de reconstrução facial forense. De acordo com a técnica, o ângulo (ponta do nariz) formado pela união de retas traçadas a partir dos pontos Rhinion e Prosthion corresponde a 90º. O programa Horos® foi utilizado para analisar as imagens dos exames de tomografia computadorizada de feixe cônico. Os critérios de seleção da amostra foram semelhantes aos utilizados no trabalho que propõe o método, assim como as análises realizadas. Os resultados mostraram que o ângulo de interesse correspondeu em média a 96.5º. Esta diferença resultou em uma inacurácia de aproximadamente 3 mm da localização estimada da ponta do nariz em relação à sua localização real. Em termos práticos, esta diferença não impede o reconhecimento facial. O terceiro capítulo teve o propósito de testar o método proposto para estimar a largura nasal de indivíduos brasileiros em reconstrução facial forense, além de determinar parâmetros em tecido duro para estimar a largura nasal e verificar relações entre o tipo facial e a morfologia do perfil nasal. A amostra foi composta por 246 imagens de tomografia computadorizada de feixe cônico (feminino: 183; masculino: 63). O programa Horos® foi utilizado. As análises em tecido duro foram realizadas na visualização de reconstrução multiplanar com projeção de máxima intensidade igual a zero, e a análise do perfil nasal foi realizada em tecido mole na ferramenta de visualização de superfícies. Os resultados mostram que o método proposto para estimar a largura nasal em brasileiros apresentou uma inacurácia de aproximadamente 1 mm, fato que não interfere no reconhecimento facial. Não houve relação de proporção direta entre a largura do nariz e a abertura piriforme, nem entre a largura do nariz e a distância intercanina, mesmo quando foram consideradas variáveis como sexo, idade e tipo facial. O biótipo facial longo apresentou relação moderada com o perfil nasal reto (r=0.037). / This thesis contains three chapters. The first chapter aimed to conduct a systematic review to analyze what are the most consistent techniques of nasal reconstruction in a forensic context. There are fifteen nasal reconstruction methods described in the literature. To predict the Pronasale point and the nasal projection, the method that considers that the confluence between the lines traced from Rhinion and from Prosthion is an angle (Pronasale point) with a value of 90º presented good results when meta-analysis was performed. The aim of the second chapter was to test, trough CT images, the method developed on a sample of Brazilian subjects to predict the Pronasale point in forensic facial reconstruction. According to this technique, the union of the Rhinion and the Prosthion lines creates an 90º angle (Pronasale point). The software Horos® was used in order to perform the analysis on the cone-beam tomography images. The inclusion criteria of the sample were the same used by the primary study as well as the performed analysis. The results showed a mean value of 96.5º from the projection Pronasale and Rhinion. This difference results in an inaccuracy of approximate 3 mm of the Pronasale point and it is not impeditive for facial recognition of a familiar face. The third chapter aimed to test the method proposed to predict nasal length in Brazilian subjects, to determine hard tissue parameters to predict nasal length and to observe if there was any relation between facial pattern and nasal profile. The sample was composed by 246 cone beam computed tomography (183 female, 63 male). The software Horos® was used. The hard tissue analysis were performed on 3D multiplanar reconstruction with maximum intensity projection equal to zero, and the 3D surface rendering was used to verify the nasal profile in soft tissue. The proposed method to predict nasal length presented an inaccuracy of approximate 1 mm and it certainly does not influence facial recognition of familiar faces. There was no relation between nor nasal length and piriform aperture nor nasal length and intercanine distance even when sex, age and facial type were considered. The long facial type showed moderate relation with strength nasal profile (r=0.037).

Abstract Surgery for ear, nose and throat (ENT) diseases most often aims to improve quality of life (QoL). The extent of having QoL as an outcome in papers included in evidence-based medicine databases is not known. In primary sinonasal surgery, the QoL outcomes and predictors and usability of various QoL instruments need more clarification. The aim was to: 1. Find out with a systematic literature review how the Cochrane database currently includes the QoL dimension. 2. Investigate the effect of primary sinonasal surgery on QoL, to identify predictors of QoL outcomes and to compare QoL instruments. In total 160 adults undergoing primary septoplasty (SP) or endoscopic sinus surgery (ESS) were recruited in 2010–2014 with 206 controls for a prospective matched cohort study. QoL was measured with a disease-specific Sino-Nasal Outcome Test–22 (SNOT–22) and generic RAND–36 before surgery and 12 months after surgery. Retrospective Glasgow Benefit Inventory (GBI) was also used. QoL was an outcome measure in 10% (3 out of 30) of trials included in Cochrane databases on most common ENT surgeries. The use of QoL since the year 2000 has increased. The total SNOT–22 score improved in both patient groups after surgery, almost to the level of the controls, In the SP group (N=64) from 34.9 to 19.1 and in ESS (N=70), from 35.1 to 19.3. The control cohort’s SNOT–22 was 17.7 at entry and after follow-up, 15.3 (N=165). RAND–36 and GBI also improved after surgery. The best predictor for a good QoL outcome in multivariate analysis after surgery was a high preoperative (≥20) SNOT–22 score in the SP and ESS groups (adjusted odds ratio 10; 95% confidence interval 1.6–64 and 12; 2.5–55, respectively). In receiver operating characteristic curve analysis, the highest preoperative SNOT–22 total score of 30 was the most sensitive (74%) and specific (70%). GBI seemed to be the most sensitive instrument to detect a change, but the three instruments in this study agreed in only about 10% of the patients who had the worst impact before surgery or best outcome. The results suggest that papers on the Cochrane databases on ENT surgeries have rarely addressed the QoL outcome. Septal deviation and recurrent acute or chronic rhinosinusitis lowered QoL. Primary surgery on these conditions improved QoL almost to the level of the control population, which was not symptom-free either. A high preoperative SNOT–22 total score was the best predictor of a beneficial outcome. The QoL instruments identified different patients experiencing the best improvement after surgery. / Tiivistelmä Korva-, nenä- ja kurkkutautien (KNK) kirurgia tähtää useimmiten elämänlaadun (EL) parantamiseen. EL:n huomioinnin yleisyys näyttöön perustuvien tietokantojen sisältämissä tutkimuksissa ei ole tiedossa. Primaareissa nenäleikkauksissa EL:n tulokset, ennustekijät ja eri mittareiden käytettävyys kaipaavat lisätietoja. Tarkoituksena oli 1: Tutkia systemaattisella kirjallisuuskatsauksella miten nykyiset Cochrane-suositukset huomioivat EL:n. 2: Tutkia primaarin nenäkirurgian vaikutus EL:uun, tunnistaa EL:n ennustekijöitä ja vertailla eri mittareita. Yhteensä 160 primaariin nenän väliseinäleikkaukseen (VL) tai sivuonteloiden tähystysleikkaukseen (ESS) tulevaa aikuista ja 206 ikä- ja sukupuolivakioitua verrokkia osallistui etenevään kaltaistettuun kohorttitutkimukseen vv. 2010-2014. EL mitattiin tautispesifillä Sino-Nasal Outcome Test -22:lla (SNOT–22) ja yleisellä RAND–36:lla ennen leikkausta ja 12 kk leikkauksen jälkeen. Kolmantena mittarina käytettiin taannehtivaa Glasgow Benefit Inventoryä (GBI). Cochrane-tietokannan yleisimpien KNK-leikkausten tutkimuksista 10 %:ssa (3 30:stä) sisälsi EL-tuloksia. Vuoden 2000 jälkeen EL:n käyttö on lisääntynyt. SNOT–22 kokonaispistemäärä parani VL- ja ESS-ryhmissä lähes kontrollien tasolle, VL-ryhmässä (N=64) 34.9:stä 19.1:een ja ESS-ryhmässä (N=70) 35.1:stä 19.3:een. Kontrollien SNOT–22 oli alussa 17.7 ja seurannan jälkeen 15.3. Myös RAND–36 ja GBI paranivat leikkauksen jälkeen. Monimuuttuja-analyysissä hyvän EL-tuloksen paras ennustetekijä oli korkea leikkausta edeltävä SNOT–22 sekä VL- että ESS-ryhmissä (vakioitu vetokertoimien suhde 10; 95 % luottamusväli 1.6–64 ja 12; 2.5–55, ryhmittäin). ROC (receiver operating characteristic) -käyräanalyysissä leikkausta edeltävä arvo 30 antoi parhaan herkkyyden (74 %) ja tarkkuuden (70 %). GBI vaikutti herkimmältä aistimaan muutoksen, mutta mittarit olivat samaa mieltä vain noin 10%:ssa niistä potilaista, joilla oli huonoin EL ennen leikkausta tai paras tulos leikkauksen jälkeen. Tulosten mukaan Cochrane-tietokannassa olevat KNK-tautien kirurgian tutkimukset ovat ottaneet harvoin elämänlaadun huomioon. Nenän väliseinän vinous ja toistuva äkillinen tai krooninen sivuontelotulehdus laskivat EL:ua. Näiden tautien primaarikirurgia paransi EL:n lähes samalle tasolle kuin kontrolliryhmällä. Korkea leikkausta edeltävä SNOT–22 –kokonaispistemäärä ennusti parhaiten hyvää tulosta. Eri EL-mittarit tunnistivat eri potilaat, jotka hyötyivät parhaiten leikkauksista.

Contexte : Le pronostic de la fonction olfactive après chirurgie de la fente olfactive (FO) dans la polypose nasosinusienne (PNS) n'est pas connu. Objectifs : 1) Préciser la localisation des polypes dans les différents sous-compartiments de l'ethmoïde ; 2) Déterminer la corrélation entre l'auto-évaluation de l'odorat et les résultats de Sniffin'Sticks test ainsi qu'entre l'auto-évaluation de l'odorat et de l'obstruction nasale chez les patients porteurs d'une PNS avec ou sans hamartome épithélial respiratoire adénomatoïde des fentes olfactives (HERA - FO); 3) Évaluer la fonction olfactive avant et 6 semaines après chirurgie de la PNS comportant une chirurgie de la FO et rechercher les facteurs pronostiques de la récupération de l'olfaction après chirurgie. Échantillons : Ce travail repose sur des études observationnelles rétrospectives et prospectives chez les patients atteints de PNS opérés par voie endoscopique selon la procédure de nasalisation de Septembre 2009 à Novembre 2010 dans le service ORL du CHU de Nancy. Résultats : 1) Dans la PNS, les polypes se développaient dans tous les compartiments ethmoïdaux (au niveau du méat moyen dans 98%, de la fente olfactive postérieure dans 75%, du méat supérieur dans 61%, du cornet moyen dans 50% et de la FO antérieure dans 40% des cas); 2) Il existait une forte corrélation entre l'auto-évaluation et la mesure de l'olfaction avant la chirurgie (r =-0,66 ; p<0,0001) et après la chirurgie (r =-0,67 a 6 semaines r = -0.66 a 7 mois, p<0,0001). La corrélation était plus faible avant chirurgie (r =-0,35; p=0,01) qu'après chirurgie chez les patients hypo-anosmiques (r =-0,74 ; p<0,0001 a 6 semaines et r =-0,73 ; p=0,0002 a 7 mois). Les auto-évaluations de l'obstruction nasale et des troubles de l'odorat n'étaient pas corrélées lorsque les deux symptômes étaient dissocies ; 3) Il existait une relation étroite entre la présence de l'HERA dans les FO et l'ancienneté de la PNS (p= 0,0009), l'asthme (p = 0,004) et les antécédents de la chirurgie de PNS (p = 0,0006). Les facteurs prédictifs de non-récupération de la fonction olfactive après la chirurgie étaient un bas score TI préopératoire (p = 0,028), l'antécédent de résection des cornets moyens au cours des procédures chirurgicales précédentes (p = 0,0018), et la résection récente des cornets moyens (p = 0,04). L'histologie des polypes (HERA vs Polype éosinophile) et le type de geste sur les FO (biopsies vs exérèse des polypes) n'étaient pas des facteurs prédictifs pour la non-récupération de l'odorat. Conclusion : l'évaluation de l'odorat dans la PNS est complexe et nécessite une combinaison de tests psychophysiques et d'auto-évaluation. La chirurgie de la fente olfactive dans la PNS n'est pas un facteur péjoratif du pronostic olfactif en post-opératoire / Background: The olfactory outcome after surgery of the olfactory clefts (OC) in patients with nasal polyposis (NP) is unknown. Objectifs: 1) to refine the description of the polyps' origin within the different subcompartments of the ethmoidal bone; 2) to investigate correlations, before and after surgery, between the sense of smell self-ratings and measures of olfactory function, and self-ratings of sense of smell and nasal obstruction; 3) to assess the olfactory outcome after surgery of ethmoidal labyrinths and OC for either Eosinophilic Polyps (EP) or Respiratory Epithelial Adenomatoid Hamartoma (REAH) in patients with nasal polyposis (NP). Samples: All patients with NP operated according to the nasalization procedure from September 2009 to November 2010 in our tertiary hospital (CHU de Nancy) were enrolled in these retrospective and prospective studies. Results: 1) Polyps were found in the middle meatus (98%), in the posterior olfactory fossa (75%), in the superior meatus (61%), on the middle turbinate proper (50%) and in the anterior olfactory fossa (40%); 2) Overall, self-ratings and measures of olfactory function correlated strongly preoperatively (r = - 0.66, p < 0.0001) and postoperatively (r = -0.67 at 6 weeks and -0.66 at 7 months, p < 0.0001). This relationship was better in patients with previous surgery. The correlation was weaker before (r = -0.35, p=0.01) than after surgery in hyposmic/anosmic patients (r = -0.74, p < 0.0001 at 6 weeks and r = -0.73, p = 0.0002 at 7 months) and wasn't found in normosmic patients. Self-ratings of nasal patency and smell were not correlated when the two complaints were dissociated; 3) There was a close relationship between the presence of REAH-OC and the duration of NP disease (p=.0009), asthma (p=.004) and previous surgery (p=.0006). Predictors of poor olfactory outcomes after surgery were low TI score before surgery (p = 0.028), history of previous middle turbinate resection (p = 0.0018), and recent middle turbinate resection (p = 0.04). Polyp histology and surgery of the OC were not predictors of poor olfactory outcomes. Conclusion: The evaluation of the sense of smell in patients with NP should be performed in combination of psychophysic tests and self-ratings of the olfactory function. The resection of REAH or EP of the OC in patients with NP does not worsen but instead can improve the postoperative olfaction

Contexte – La stimulation de la muqueuse trachéale peut provoquer une réponse défensive à type de toux. La finalité de cette réponse est la protection des voies aériennes via la clairance du mucus et des particules déposées au sein de l’arbre trachéo-bronchique. La stimulation de la muqueuse nasale est à l’origine de réponses défensives n’incluant toutefois pas la toux. La modulation de la toux suggère de possibles interactions centrales des afférences provenant de localisations anatomiques distinctes. Objectif – Déterminer si une stimulation trachéale mécanique discriminante est capable de provoquer une toux lors d’une apnée provoquée par l’instillation nasale d’eau distillée. Méthodes – Douze lapins anesthésiés et trachéotomisés ont été étudiés. Les stimulations trachéales mécaniques ont été réalisées dans 3 conditions : contrôle, après instillation nasale de sérum physiologique, et lors d’apnée suite à l’instillation d’eau distillée. Résultats – Les paramètres ventilatoires de références ne sont pas différents dans les 3 conditions. Un total de 171 stimulations trachéales a été réalisé. Lors de l’apnée, 81% des réponses sont des réflexes expiratoires et le pic de débit expiré est inférieur (p < 0.0001) à celui observé dans les conditions contrôle et sérum physiologique. L’incidence des réponses comprenant un réflexe de toux est plus faible (p < 0,0001) en cas d’instillation d’eau distillée que dans les 2 autres conditions.Conclusion – La stimulation nasale par l’eau distillée désensibilise les réflexes de défense respiratoire faisant suite à une stimulation trachéale mécanique / Context - Cough may be triggered by irritation of afferents located in the airway mucosa. Primary role is to expel inhaled foreign matter from the lungs or clear the airways of endogenous mucus. Stimulation of the nasal mucosa provokes defensive responses but not cough. The ‘cough center’ can be tuned by various afferent inputs, suggesting possible interactions at a central level of neural pathways originating from distant anatomical sites. Objective - The present study was designed to determine whether brief mechanical stimulation of the trachea could trigger cough during apnoea elicited by nasal instillation of water. Method - Twelve anesthetized, tracheotomized rabbits were studied. Mechanical stimulation of the trachea was performed under 3 conditions: baseline control, after instillation of saline into the nose and during apnoea following instillation of water. Results - Baseline breathing pattern did not differ between the 3 conditions. In a series of 171 stimulations, expiration reflex occurred in 81% of stimulations during apnoea with a significantly (p < 0.0001) lower peak expiratory flow than at baseline or during saline instillation. The incidence of responses comprising a cough reflex was also lower during water instillation than at either baseline or with saline (p < 0.0001). Conclusion - These results indicate that stimulation of nasal afferents with distilled water likely down-regulates cough

Introdução: A polipose nasal (PN) é considerada uma condição inflamatória crônica da mucosa da cavidade nasal e seios paranasais de etiologia não muito clara. Há poucos dados sobre alterações epiteliais em PN e sua relação com a ação dos radicais livres. Muitas doenças estão ligadas a danos causados por espécies reativas de oxigênio (ROS) e de nitrogênio (RNSS) e ocorrem de um desequilíbrio entre eles e antioxidantes, o que for maior atividade de espécies reativas, o que chamamos de estresse oxidativo. Objetivo: O objetivo principal deste estudo é avaliar o estresse oxidativo em pólipos removidos cirurgicamente em 3 grupos de pacientes com polipose nasal (com PN unicamente, PN associado à asma e PN associado à asma e intolerância ao ácido acetilsalicílico) a fim de elucidar possíveis diferenças no perfil redox nestes grupos. Material e Métodos: Cinquenta e nove pacientes com diagnóstico de polipose nasal foram divididos em três grupos clínicos: um grupo controle PN unicamente, um grupo asma (PN associado à asma) e um grupo Widal (PN associado à asma e intolerância ao ácido acetilsalicílico). Medição e Resultados Principais: Neste trabalho defesas enzimáticas (superóxido dismutase, consumo de peróxido de hidrogênio, glutationa peroxidase e glutationa S-transferase) e defesas não enzimáticas (glutationa total, nitritos e nitratos, vitamina C e E) foram analisados. Também foi realizada a medição de danos em lipídios (malondialdeído) e proteínas (carbonila). No grupo asma, o consumo de peróxido de hidrogênio, atividade da glutationa peroxidase, níveis de malondialdeído e vitamina E foram significativamente menores do que no grupo de controle. Também foi realizada a medição de danos em lipídios (malondialdeído) e proteínas (carbonila). No grupo Widal foram encontrados níveis significativamente maiores de glutationa e nitritos e nitratos em relação ao grupo controle. Não foram encontradas diferenças entre os grupos em relação ao nível de carbonila e glutationa, tamanho dos pólipos, atividades da superóxido dismutase e S-transferase. Conclusões: A classificação redox dos grupos de PN foi parcialmente alcançada. Os pólipos do grupo asma possuem alterações nas defesas enzimáticas relacionadas com o peróxido de hidrogênio e a peroxidação lipídica, enquanto pólipos do grupo Widal apresentaram alterações nos níveis de óxido nítrico e glutationa. / Introduction: Nasal polyposis (NP) is considered a chronic inflammatory condition of the mucosa of the nasal cavity and paranasal sinuses of etiology is not very clear. There are few data on epithelial changes in nasal polyposis and its relation to the action of free radicals. Many diseases are linked to damage caused by reactive oxygen species (ROS) and nitrogen (RNSs) and occur from an imbalance between them and antioxidants, whichever is greater activity of reactive species, what we call oxidative stress. Objective: The primary objective of this study is to evaluate oxidative stress in polyps surgically removed in 3 groups of patients with nasal polyposis, in order to elucidate possible differences in redox profile in these groups. Methods: Fifty nine patients diagnosed with nasal polyposis were divided into three groups: a control group, an asthma group (NP with asthma) and a Widal group (NP with asthma and aspirin intolerance) in which patients had an association of NP, asthma and aspirin intolerance. Measurement and main results: In this work enzymatic defenses (superoxide dismutase, hydrogen peroxide consumption, glutathione peroxidase and glutathione S-transferase) and non-enzymatic defenses (total glutathione, measurement of nitrites and nitrates, vitamin C and E) were analyzed. Also the measurement of damage in lipids (malondialdehyde) and proteins (carbonyl) was conducted. In the asthma group, hydrogen peroxide consumption, glutathione peroxidase activity, malondialdehyde, and vitamin E levels were significantly lower than in the control group. The Widal group showed significant higher glutathione levels, nitrite and nitrate levels than found in the control group. No differences were found among the groups regarding carbonyl level, polyp size, superoxide dismutase, and glutathione S-transferase activities. Conclusions: The redox classification of the groups of NP was partly achieved. Polyps of patients with asthma have changes in enzymatic defense pathways related to hydrogen peroxide and lipid peroxidation while polyps of patients with Widal triad present changes in nitric oxide and glutathione.