Exhaled and nasal nitric oxide in laryngectomized patients.
BACKGROUND
Nitric oxide (NO) shows differing concentrations in lower and upper airways. Patients after total laryngectomy are the only individuals, in whom a complete separation of upper and lower airways is guaranteed. Thus the objective of our study was to assess exhaled and nasal NO in these patients.


METHODS
Exhaled bronchial NO (FENO) and nasal nitric oxide (nNO) were measured in patients after total laryngectomy (n = 14) and healthy controls (n = 24). To assess lung function we additionally performed spirometry. Co-factors possibly influencing NO, such as smoking, infections, and atopy were excluded.


RESULTS
There was a markedly (p < 0.001) lower FENO in patients after total laryngectomy (median (range): 4 (1-22) ppb) compared to healthy controls 21 (9-41) ppb). In contrast, nNO was comparable between groups (1368 versus 1380 in controls) but showed higher variability in subjects after laryngectomy.


CONCLUSIONS
Our data suggest that either bronchial NO production in patients who underwent laryngectomy is very low, possibly due to alterations of the mucosa or oxidant production/inflammation, or that substantial contributions to FENO arise from the larynx, pharynx and mouth, raising FENO despite velum closure. The data fit to those indicating a substantial contribution to FENO by the mouth in healthy subjects. The broader range of nNO values found in subjects after laryngectomy may indicate chronic alteration or oligo-symptomatic inflammation of nasal mucosa, as frequently found after total laryngectomy.
Kramer
Matthias F
MF
Department of Oto-Rhino-Laryngology, Head- and Neck Surgery, Ludwig-Maximilians-University, Munich, Germany. matthias.kramer@med.uni-muenchen.de
Olzowy
Bernhard
B
Bihler
Annette
A
de la Motte
Dorothea
D
Nowak
Dennis
D
Jörres
Rudolf A
RA
Dressel
Holger
H
D000328:Adult; D000368:Aged; D001944:Breath Tests; D001980:Bronchi / Q000378:metabolism*; D005260:Female; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000378:metabolism*; D009569:Nitric Oxide / Q000378:metabolism*; D020545:Respiratory Mucosa / Q000378:metabolism; D012907:Smoking / Q000378:metabolism; D013147:Spirometry; D014140:Tracheotomy; D055815:Young Adult
D009569:Nitric Oxide