Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Laryngoscope. 2021 Jan;131(1):E14-E18. doi: 10.1002/lary.28586. Epub 2020 Mar 3.
OBJECTIVES/HYPOTHESIS: Empty nose syndrome (ENS) is a controversial disorder and the change of histopathology has never been discussed. This study aimed to conduct a structured histological review to improve the diagnosis and understanding of ENS. Further immunohistochemical staining of transient receptor potential channel melastatin 8 (TRPM8) was performed.
A prospective case-control study in a tertiary medical center.
Consecutive patients with ENS who were diagnosed and received surgical intervention after failure of conservative management were included. Patients with benign pituitary gland tumor receiving transsphenoidal excision were enrolled as control group. Biopsy of inferior turbinate was obtained during surgery for histological review and immunohistochemical staining.
Seventeen patients with ENS and six patients as a control group were established for structured histological review. Patients with ENS presented significantly more squamous metaplasia, a higher rate of submucosal fibrosis, and a lower submucosal gland number grading. Additionally, a unique histological change called goblet cell metaplasia was found in the ENS group. The respiratory epitheliums of ENS were mostly intact with preservation of ciliated cells and goblet cells. The ENS group had a significantly lower expression level of TRPM8.
The nasal mucosa of ENS experienced some airway remodeling and thermoreceptors downregulation, which contribute to clinical symptoms. The distinct histology of ENS included preserved respiratory epithelium and goblet cell metaplasia, accompanying with characteristics similar to atrophic rhinitis. Biopsy of the inferior turbinate may help diagnose ENS.
4 Laryngoscope, 131:E14-E18, 2021.
目的/假设：空鼻综合征（ENS）是一种有争议的疾病，其组织病理学变化从未被讨论过。本研究旨在进行结构化的组织学回顾，以提高 ENS 的诊断和认识。进一步对瞬时受体电位通道 melastatin 8（TRPM8）进行免疫组织化学染色。
在一家三级医疗中心进行的前瞻性病例对照研究。
连续纳入诊断为 ENS 并在保守治疗失败后接受手术干预的患者。将接受经蝶窦切除术的良性垂体瘤患者纳入对照组。手术中获取下鼻甲活检进行组织学检查和免疫组织化学染色。
建立了 17 例 ENS 患者和 6 例对照组患者进行结构化的组织学回顾。ENS 患者表现出明显更多的鳞状化生，更高的黏膜下纤维化率，以及更低的黏膜下腺数量分级。此外，在 ENS 组还发现了一种独特的组织学变化，称为杯状细胞化生。ENS 组的呼吸上皮大多完整，保留有纤毛细胞和杯状细胞。ENS 组的 TRPM8 表达水平显著降低。
ENS 的鼻黏膜经历了一些气道重塑和热敏感受器下调，这导致了临床症状。ENS 的明显组织学特征包括保留的呼吸上皮和杯状细胞化生，伴有类似于萎缩性鼻炎的特征。下鼻甲活检可能有助于诊断 ENS。
4 Laryngoscope, 131:E14-E18, 2021.
