ObjectivesThe primary aim of this study was to assess whether one can use levels of nasal nitric oxide (nNO) and exhaled nitric oxide (eNO) as a means of evaluation in allergic rhinitis.MethodsWe used a chemiluminescence analyzer to measure nNO and eNO in normal controls (n=34) and allergic rhinitis patients (n=35), and compared these measurements with various parameters of clinical symptoms and laboratory data.ResultsMean nNO (389±119 ppb) in allergic rhinitis patients was significantly higher than normal controls (276±88 ppb). Without asthma, mean eNO (64.8±55.9 ppb) in allergic rhinitis patients was significantly higher than normal controls (33.0±24.0 ppb). In the persistent allergic rhinitis group, eNO concentration was significantly higher, while nNO concentration was significantly lower than the intermittent group.ConclusionWe can use nNO and eNO levels for evaluation of allergic rhinitis. However, we should consider the fact that nNO levels can be reduced, when symptoms are severe and long-lasting. Additionally, in allergic rhinitis, eNO can be elevated without asthma.

OBJECTIVE: 1) Establish current opinion from medico-legal sources based upon the following questions: Does the surgeon owe a duty of care to advise an x-ray for nasal fracture secondary to assault? Does a fracture demonstrated by x-ray result in the ability of the prosecution to establish a greater degree of harm against the victim? 2) Identify patients who underwent manipulation under anesthetic (MUA) of nasal fracture secondary to assault and investigate their legal outcomes. METHOD: A number of relevant medical and legal sources were contacted. The above questions were posed and advice sought. In this retrospective study, all adult patients who underwent MUA of a nasal fracture over a 1-year period (1st January 2007-1st January 2008) were contacted. If reported as a non-accidental fracture, further questions were asked; whether a facial x-ray was performed pre-operatively; did the patient proceed to press charges; if so, the outcome of the prosecution and court hearing. RESULTS: 97 patients underwent MUA of nasal fracture in the unit over the year. Information was available for 68 patients, non-accidental injury accounted for 26 cases (38%). Six patients within this group proceeded to press charges. The legal outcome of these patients is discussed. Literature review highlights controversy regarding the value of imaging but little is published giving guidance in cases of non-accidental nasal fractures where legal action is likely to proceed. CONCLUSION:We present an up-to-date review of medical and legal perspectives and the legal outcome of patients presenting with non-accidental nasal fractures managed in our department.

The incidence of bilateral temporal bone fractures are reported in 9% to 20%. Otic capsule violating temporal bone fractures are highly related to sensorineural hearing loss, when compared with otic capsule sparing fractures. Patients with bilateral temporal bone fractures and profound bilateral sensorineural hearing loss may benefit from cochlear implantation. We present the case of a 44-year-old male with bilateral profound sensorineural hearing loss caused by bilateral temporal bone fractures who achieved successful auditory rehabilitation after a cochlear implantation.

Background and ObjectivesZZNitric oxide (NO) is present in high concentrations in the upper respiratory tract. The physiological role of this mediator is to contribute to the local host's defense, modulate ciliary motility and serve as an aerocrine mediator in helping to maintain adequate ventilation-perfusion matching in the lung. Subjects and MethodZZThe purpose of the study was to assess the relationship of nasal NO (nNO) and exhaled NO (eNO) in nasal airway disease patients. NO concentration was measured using a chemiluminescence analyzer. nNO was analyzed by aspiration at a sampling flow rate of 700 mL/min with velum closure. eNO was analyzed during expiration against a constant resistance of 10 cm H 2 O. ResultsZZNO concentration of the normal control group (n=32) was compared with that of the allergic rhinitis group (n=31) and the rhinosinusitis with that of the nasal polyp group (n= 30). The mean nNO level in the control group was 241±89 ppb and eNO was 20.5±6.4 ppb. The mean nNO level was significantly increased in the allergic rhinitis group (332±125 ppb) but decreased in the chronic sinusitis group (89±55 ppb). The mean eNO level was significantly increased both in the allergic rhinitis group (26.9±10.1 ppb) and chronic sinusitis group (29.8±12.8 ppb). ConclusionZZnNO concentration was increased in patients with allergic rhinitis and decreased in patients with chronic sinusitis; however, eNO was increased in both patients. This shows that patients with upper respiratory inflammation may also have lower respiratory inflammation, supporting the concept of 'one airway, one disease'. This study shows that measurement of NO is useful for the study or evaluation of nasal diseases.

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