title: Effect of snuff on nasal mucosa.
abstract: OBJECTIVE
  The inhalation of nasal snuff (powdered tobacco) is a common addiction in the Indian subcontinent. In the western world, there is a resurgence of interest in nasal snuff because it does have the morbidity associated with smoked tobacco. Very few studies have reported the long-term effects of snuff on nasal mucosa. The objective of the present study was to investigate the effect of long-term use of snuff on the nasal mucosa.
  
  
  METHODS
  We conducted a retrospective study on 29 snuff users. We investigated the reasons for initiation of this particular form of addiction along with the clinical signs and symptoms of long-term snuff usage. At the time of the study, all patients complained of one or more nasal symptoms. Nasal obstruction and nasal discharge taken together were reported by 62.5% of patients. Gross mucosal edema of the septum and turbinates was the main finding on nasal examination. The absolute eosinophil count and total serum immunoglobulin E were elevated in 62.5% and 66.7% of patients, respectively. On skin prick test, 41% of patients reacted positively to snuff and 25% to tobacco. Histopathologic examination of the turbinates (16 patients) showed squamous metaplasia, capillary proliferation, capillary and venous dilatation, inflammatory cell reaction, subepithelial edema, and fibrosis.
  
  
  CONCLUSIONS
  Much has been written about the advantages of nasal snuff over products that deliver tobacco smoke. Our study shows that snuff users, after long-term abuse, develop a form of chronic rhinitis, as a consequence of which they develop blocked and stuffy noses. We conclude that nasal snuff is not a suitable substitute for smoked tobacco because it does not avoid ill health.
authors.affiliation: Department of ENT, Katurba Medical College, Attavar, Manglore, Karnataka, India. sujasreedharan@yahoo.com
authors.forename: Suja
authors.initials: S
authors.lastname: Sreedharan
authors.forename: Mulki Panduranga
authors.initials: MP
authors.lastname: Kamath
authors.forename: Urmila
authors.initials: U
authors.lastname: Khadilkar
authors.forename: Mahesh Chandra
authors.initials: MC
authors.lastname: Hegde
authors.forename: Rajeev M
authors.initials: RM
authors.lastname: Kumar
authors.forename: Ravikumar Raju
authors.initials: RR
authors.lastname: Mudunuri
authors.forename: Satish Chandra
authors.initials: SC
authors.lastname: Tripuraneni
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003367:Cotinine / Q000097:blood; D006801:Humans; D008875:Middle Aged; D009297:Nasal Mucosa / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D012189:Retrospective Studies; D012220:Rhinitis / Q000209:etiology / Q000473:pathology; D014030:Tobacco, Smokeless / Q000494:pharmacology*; D014057:Tomography, X-Ray Computed; D014420:Turbinates / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D003367:Cotinine