Abstract
Objective
The author previously demonstrated that the levels of oral exhaled nitric oxide (NO)
were reduced by repeated epipharyngeal abrasive therapy (EAT) for chronic epipharyngitis
along with the patients’ symptoms, suggesting that exhaled NO may be a useful outcome
parameter of repeated EAT. This study aimed to investigate whether the levels of oral
exhaled NO indicate the severity of epipharyngitis and whether an epipharyngeal abrasion
immediately influences the amount of exhaled NO.
Methods
Participants visited the author's clinic for the diagnosis and treatment of chronic
epipharyngitis from November 2020 to March 2021. NO levels were measured orally before
EAT, after nasal anesthesia and EAT without zinc chloride (ZnCl2), and after EAT with ZnCl2. The correlation between the endoscopic finding scores in conventional light and
black spots and the cobblestone appearance with granular changes in band-limited light
as well as the exhaled NO levels were determined.
Results
The study included 102 patients (30 males, 72 females; median age, 45.7 years). NO
levels were significantly lower (p < 0.01) in EAT without ZnCl2 (17.0 [11.0–25.3]) and even lower with ZnCl2 (12.0 [8.0–21.0]) than before EAT (21.5 [15.8–35.0]). NO was significantly higher
(p <0.01) in chronic epipharyngitis with the cobblestone appearance with granular
changes (23.5 [17.0–37.8]) than without it (19.0 [15.0–23.5]). The total number of
endoscopic finding scores and the exhaled NO levels showed a positive correlation
(r = 0.251; p = 0.015). Additionally, the cobblestone appearance with granular changes
and exhaled NO levels showed a positive correlation (r = 0.256; p = 0.013).
Conclusion
EAT decreased immediately exhaled NO levels with or without ZnCl2, suggesting that physical stimulation with a cotton swab without ZnCl2 is therapeutic, and ZnCl2 may increase this effect. The endoscopic scores were significantly associated with
the exhaled NO levels, suggesting that the exhaled NO levels represent the severity
of epipharyngitis. The cobblestone appearance with granular changes, which indicates
that pathologic ciliated epithelium, was significantly correlated and increased exhaled
NO levels, suggesting that NO may be exhaled from ciliated epithelia. These results
indicated that exhaled NO levels may be useful as an objective parameter to express
the severity of epipharyngitis as well as the outcomes of repeated EAT.
Keywords
Abbreviations:
NO (nitric oxide), EAT (epipharyngeal abrasive therapy), ACE2 (angiotensin-converting enzyme 2), TMPRSS2 (transmembrane protease, serine 2), ZnCl2 (zinc chloride), NOS (nitric oxide synthase)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 02, 2022
Accepted:
November 21,
2022
Received:
May 25,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.
