The importance of improved nasal breathing: a review of the Nozovent nostril dilator

The Nozovent nostril dilator improves nasal breathing to the same degree as topical decongestants and reduces mouth dryness at night in 51% of nocturnal mouth breathers. It does not help every snorer but reduces the snoring heard by the sleeping partner in about 50%, improves the respiratory disturbance index significantly in 19% and gives less morning and daytime tiredness in 40% of snorers. The medium CPAP pressure can be significantly reduced with the dilator.

Nitric oxide production in the sphenoidal sinus by the inducible and constitutive isozymes of nitric oxide synthase

OBJECTIVE

To study the production of nitric oxide (NO), and the presence of different isoforms of the NO-synthesising enzyme, NO-synthase (NOS), in the paranasal sinus.

MATERIALS AND METHODS

Ten patients, undergoing surgery for pituitary adenoma, were examined for the presence of NO gas in the sphenoidal and maxillary sinus. The distribution of different NOS isozymes in mucosal biopsies from sphenoid and maxillary sinus and ethmoidal cells was studied.

RESULTS

The mean concentration of NO was 2575 ppb in the sphenoidal sinus and 6792 ppb in the maxillary sinus. Morphological analyses revealed intense NADPH-diaphorase staining throughout the epithelium. Immunoreactivity against NOS2 (inducible NOS) was observed in the apical cell layer but not of the basal layer. NOS1 (neuronal NOS)-immunoreactivity was mainly seen in the subapical part of the epithelium and NOS3 (endothelial NOS)-immunoreactivity was observed only in the most apical part of the epithelium.

CONCLUSION

NO concentration in the sphenoidal sinus is about the same as in the nasal cavity and approximately half of the concentration found in the maxillary sinus. All of the three main different isozymes of NOS can be demonstrated in the mucosa of the sphenoidal and maxillary sinus and ethmoidal cells, NOS2 being the most abundant isoform.

Zygoma fixture in the management of advanced atrophy of the maxilla: technique and long-term results

Despite refinements in surgical technique, including bone grafting and sophisticated prosthetic reconstructions, there are limitations to what can be achieved with bone-anchored fixed prostheses in patients with advanced atrophy of the maxillae. A new approach was suggested by a long-term study on onlay bone grafting and simultaneous placement of a fixture based on a new design: the zygoma fixture, and the aim of this study was to assess its potential. Twenty-eight consecutive patients with severely resorbed edentulous maxillae were included, 13 of whom had previously had multiple fixture surgery in the jawbone that had failed. A total of 52 zygoma fixtures and 106 conventional fixtures were installed. Bone grafting was deemed necessary in 17 patients. All patients have been followed for at least five years, and nine for up to 10 years. All patients were followed up with clinical and radiographic examinations, and in some cases rhinoscopy and sinoscopy as well. Three zygoma fixtures failed; two at the time of connection of the abutment and the third after six years. Of the conventional fixtures placed at the time of the zygoma fixture, 29 (27%) were lost. The overall prosthetic rehabilitation rate was 96% after at least five years of function. There were no signs of inflammatory reaction in the surrounding antral mucosa. Four patients with recurrent sinusitis recovered after inferior meatal antrostomy. To conclude, the zygoma fixture seems to be a valuable addition to our repertoire in the management of the compromised maxilla.

Sinuscopy in patients with titanium implants in the nose and sinuses

Foreign bodies in the nose and sinuses can cause chronic infections. Long titanium fixtures through the maxilla to the zygomatic bone were followed up with a sinuscope in 14 patients after more than one year. There were no signs of infection or inflammation in the mucosa around the fixtures.

[Follow-up of Cushing syndrome in western Sweden. More than one treatment method needed for cure, hormonal deficiencies common]

Results from a follow-up of all patients with Cushing's syndrome who visited the Division of Endocrinology at Sahlgrenska University Hospital, Göteborg, Sweden, during 1997-1998 revealed 28 patients with ACTH-dependent disease and 3 with ACTH-independent disease. Female/male ratio was 4:1 with mean age at diagnosis 30 years. Mean time from first symptoms to diagnosis was three years (range 0-8). The most frequent signs were hypertrichosis, easy bruising, hypertension, osteoporosis and diabetes mellitus. Out of the 28 patients with ACTH-dependent disease, 16 underwent more than one treatment method (transcranial/transsphenoidal pituitary surgery, pituitary irradiation, adrenalectomy), 26 were cured and 25 developed hormonal deficiencies after treatment. Five of the 11 patients who underwent adrenalectomy developed Nelson tumors. All patients in the ACTH-independent group were cured after unilateral adrenalectomy.

Dynamics of visual improvement following chiasmal decompression. Quantitative pre- and postoperative observations

PURPOSE

To study early visual restoration following surgical removal of pituitary adenomas compressing the optic chiasm.

METHODS

Eleven patients were examined with high-pass resolution perimetry (HRP) before and after trans-sphenoidal adenomectomy. Visual fields were examined on the second postoperative day. The result was interpreted in terms of the estimated fraction of functioning retino-cortical connections.

RESULTS

In the upper and lower temporal visual field quadrants, the mean increases in the fraction of functioning neural channels were 19% (p < 0.001) and 17% (p = 0.001), respectively, on day 2 after surgery. These increased to 35% on day 12. The nasal hemifield showed no change on day 2, but functioning neural channels had increased by 15% on day 5 (p = 0.017). Mean visual acuity improved from 0.6 preoperatively to 1.0 on day 2 (p = 0.030) but did not change significantly thereafter.

CONCLUSION

All visual field sectors and visual acuity improved after surgery. Improvement starting in the temporal hemifield was already evident on the second postoperative day.

Nasopharyngeal glioma in a new-born girl

Nasal gliomas are uncommon tumours of neurogenic origin that occur sporadically. They are diagnosed with MRI and a preoperative biopsy, and surgery is the treatment of choice. Most of the gliomas emerge from the nasal cavity, but only a few cases of nasopharyngeal gliomas have been reported. We present one case of a nasopharyngeal glioma and two cases of nasal gliomas.

Juvenile nasopharyngeal angiofibroma: long-term results in preoperative embolized and non-embolized patients

A treatment and follow-up study of 32 patients with juvenile nasopharyngeal angiofibroma (JNA) was performed at our clinic between 1974 and 1998. The majority had undergone surgery either via an antral approach or with a lateral rhinotomy. In the 1970s, surgery was combined with ligature of the external carotid artery and, since 1981, it has been combined with preoperative embolization. Two patients received radiotherapy (45 Gy) as primary treatment and the 3 cases of multiple recurrence received radiotherapy (30-45 Gy) as secondary treatment. No recurrence was found in patients treated with radiotherapy. The overall recurrence rate was 25%; the recurrence rate in non-embolized patients was 8% and among embolized patients it was 41%. We found no statistically verified differences in recurrence rate between embolized and non-embolized patients. No statistically significant difference was found in either recurrence or peroperative bleeding when comparing preoperatively embolized patients with non-embolized patients. Regression analyses showed that the only factor affecting recurrence was age, i.e. the younger the patient was at diagnosis the greater the risk of developing recurrence. The development of imaging and embolization techniques will hopefully contribute in the future towards reducing the recurrence rate.

Pure sesame oil vs isotonic sodium chloride solution as treatment for dry nasal mucosa

OBJECTIVE

To evaluate whether there was any difference in efficacy when nasal mucosa dryness was treated with pure sesame oil (Nozoil) compared with isotonic sodium chloride solution (ISCS).

DESIGN

In a randomized, crossover study, 79 subjects with nasal mucosa dryness were enrolled. Half the subjects received pure sesame oil for 14 days followed by ISCS for 14 days, and the other half received ISCS for 14 days followed by pure sesame oil for 14 days. During the test period from March 13 to May 30, 2000, the outdoor absolute humidity was low. Nasal mucosa dryness, stuffiness, and crusts were scored every evening with a visual analog scale.

SETTING

The County Hospital, Skellefteå, Sweden.

RESULTS

Nasal mucosa dryness improved significantly when pure sesame oil was used compared with ISCS (P<.001). The improvement in nasal stuffiness was also better with pure sesame oil (P<.001) as was improvement in nasal crusts (P<.001). Eight of 10 subjects reported that their nasal symptoms had improved with pure sesame oil compared with 3 of 10 for ISCS (P<.001). Adverse events were few and temporary.

CONCLUSION

When nasal mucosa dryness due to a dry winter climate was treated, pure sesame oil was shown statistically to be significantly more effective than ISCS.

Different methods for evaluating daytime tiredness in snoring men

Many snorers complain of daytime tiredness and reduced mental energy. In 42 middle-aged snoring men, the results of sections relating to mental energy in 2 quality-of-life instruments, energy in the Nottingham Health Profile (NHP) and vitality in the Psychological General Well-Being (PGWB) questionnaire, were compared with those of population samples. The snorers were significantly more tired than the population samples (p < 0.001). The scores for the NHP and PGWB were then correlated with a visual analogue scale (VAS) of drowsiness. The correlation coefficient between NHP (energy) and the corresponding VAS value was r = 0.52 (p < 0.001). The correlation coefficient between PGWB (vitality) and the VAS value for drowsiness was r = -0.56 (p <0.001). When nasal breathing was improved with the use of the Nozovent nostril dilator at night for 1 month, NHP (energy) and the VAS value for drowsiness improved significantly (p < 0.001). A single VAS value for drowsiness is a good instrument for evaluating daytime tiredness and for measuring the clinical effect of treatment in snorers.

Fewer problems with dry nasal mucous membranes following local use of sesame oil

Many people experience problems with a dry nasal mucous membrane, often without wondering why. Their noses itch and burn and dried mucus collects there. These problems are exacerbated during the winter, in air-conditioned environments and after nasal irradiation. Twenty patients experiencing problems with dryness of the nose were selected from outpatient clinics, together with twenty patients who had previously undergone nasal irradiation. During the first five days no treatment was administered. For the following twenty days the patients sprayed sesame oil into each nostril three times a day. For the last five days no treatment was given. When both groups received treatment and sprayed sesame oil (Nozoil) in their noses, the nasal problems decreased significantly. The greatest effect is exerted on dryness. The side effects from using this oil are few in number and mild.

Better quality of life when nasal breathing of snoring men is improved at night

OBJECTIVE

To evaluate whether improved nasal breathing changes the quality of life in snoring men and improves the female sleeping partners' well-being in the morning.

DESIGN

During 1 month, 42 heavily snoring men slept with a nostril dilator. Before and after 1 month, the snorers rated their daytime tiredness and completed the Nottingham Health Profile questionnaire. Female sleeping partners rated the snoring, the quality of their sleep, and their sense of well-being in the morning. A population sample was used for comparison.

SETTING

The Central Hospital, Skövde, Sweden.

RESULTS

The snorers' quality of life before the study was significantly worse (P<.001) than that of the comparison population and improved significantly (P = .001). The men were significantly (P<.001) less tired during the day when their nasal airflow was increased. Female sleeping partners had significantly (P = .005) better sleep and an improved sense of well-being in the morning during the test period. Both were correlated with a significant reduction in the snoring (P<.001).

CONCLUSIONS

When nasal breathing of snoring men was improved at night, their quality of life was significantly improved. The female sleeping partners had a reduction in sleep disturbance that correlated well with an improvement in their own sleep and feelings of well-being in the morning.

Improved nasal breathing in snorers increases nocturnal growth hormone secretion and serum concentrations of insulin-like growth factor 1 subsequently

In snoring men improved nasal breathing during sleep has been shown to decrease snoring and morning tiredness. The aim was to evaluate whether improved nasal breathing had any effect on growth hormone (GH) secretion, the nocturnal secretion of GH being associated with deep sleep. Forty-two snoring men, mean age 45 years and mean body mass index 26 kg.m-2, slept every night during one month with the Nozovent nostril dilator. Before and at the end of the test period, we analysed serum insulin-like growth factor 1 (IGF-1), thyrotropin (TSH), free thyroxine (free T4), free 3,5,3'-triiodothyronine (free T3), cortisol and testosterone in blood sampled at 08:00 h. Fifteen of the 37 snoring men who completed the study experienced a reduction in snoring and were less tired in the morning during the test period. In this group, the mean IGF-1 concentration was significantly increased (p < 0.05) after one month. There was no significant difference in mean IGF-1 level between the snorers and a population sample. Likewise, TSH, free T4, free T3, cortisol and testosterone concentrations were within normal limits. Snorers with reduced snoring and morning tiredness due to improved nasal breathing showed an increase in morning IGF-1 concentration which can probably be explained by higher nocturnal GH secretion induced by more deep sleep.

Evaluation of the quality of life of male snorers using the Nottingham Health Profile

Many snorers complain of tiredness during the day, but little is known about the impact of snoring on daily life in other respects. The objective of this study was to assess the quality of life of middle-aged men who were heavy snorers. We used the Nottingham Health Profile (NHP), which has been utilized during the last two decades as an instrument for evaluating the influence different medical conditions have on quality of life. Forty-two men (median 45 years, mean BMI 26 kg/m2 and mean Respiratory Disturbance Index 8.6) completed quality of life questionnaires. The answers were compared with those of a population sample of 786 men from the region with the same mean age. There were significant differences between the snorers and the population sample in the total score for quality of life (p=0.001) and the sections about energy (p < 0.001) and emotional reactions (p=0.02). There were highly significant differences in the frequency of health-related problems among the snoring men compared with the population sample in the ability to perform tasks around the home (p < 0.001). social life (p=0.003), family relationship (p < 0.001 ) and sexual life (p=0.001). When the snorers were compared with results reported from patients suffering from other medical conditions (hypertensives, growth hormone deficiency, myocardial infarction, chronic obstructive pulmonary disease), we found an equal level of total mean score and negative influence on their quality of life. The study illustrates that snoring men have a poor quality of life, comparable to that of patients with chronic diseases.

Transsphenoidal adenomectomy in Cushing's disease via a lateral rhinotomy approach

BACKGROUND

Cushing's disease may be treated by surgical pituitary adenomectomy. We present a surgical approach to the pituitary gland that increases the possibilities of a selective adenomectomy, and compare our results with those of other studies.

METHODS

A retrospective study of patients with Cushing's disease undergoing transsphenoidal selective adenomectomy via a lateral rhinotomy at Sahlgrenska University Hospital from 1984-93 is presented. Thirty-one patients (26 women, five men; mean age: 44 years, range: 13-75 years) with Cushing's disease were followed for a median time of 4.5 years after operation (range: 1-10 years). Preoperative and postoperative urinary and serum cortisol, and circadian rhythm of serum cortisol were measured. We also measured serum TSH, T4, PRL, FSH, LH, and testosterone as well as urine and plasma osmolality.

RESULTS

Our remission rate was 77% and the recurrence rate 3%. Hormonal insufficiency was rare. Hypothyroidism and hypogonadism were present in 3% of the patients, and diabetes insipidus occurred in 6% of the patients.

CONCLUSION

Selective adenomectomy with its good opportunities for cure and improvement should be regarded as the treatment of choice for Cushing's disease. Using the lateral rhinotomy approach to the sphenoidal cavity results in good accessibility to the sella turcica and its pituitary adenomas, a low frequency of postoperative pituitary insufficiency, and a high remission rate.

Improved nasal breathing reduces snoring and morning tiredness. A 6-month follow-up study

BACKGROUND

Dilation of the nasal valve region can increase the ability to breathe through the nose and reduce the negative intrathoracic pressure required for inspiration. Vibrations of the palate and soft tissues of the throat, which generate snoring sounds, can be prevented when patients inhale less heavily.

OBJECTIVES

To evaluate the effect a nostril dilator has on patient snoring and tiredness in the morning and to determine how many patients would continue to use the device for half a year.

DESIGN

For 6 months, 42 men who were heavy snorers graded their average tiredness in the morning and the patient's sleeping partner graded the average snoring using a visual analog scale from 0 to 100.

SETTING

All patients were examined at the Department of Otorhinolaryngology, Central Hospital, in Skövde, Sweden.

RESULTS

When the nostril dilator was used there was a significant decrease in snoring after both 1- and 6-month reports. There was a significant correlation between diminution of snoring and less tiredness in patients in the morning. The compliance was good since 60% of patients continued to use the device during the 6-month test period.

CONCLUSIONS

This study illustrates the benefits that reducing nasal airway resistance during sleep has on snoring and morning tiredness in patients.

Reduced nocturnal asthma by improved nasal breathing

The nose and not the mouth should be used for breathing as the nose has better air conditioning capacity. When air is inhaled through the mouth it may dry and cool the respiratory mucosa, which can lead to bronchoconstriction in sensitive patients with asthma. By dilating the nostrils you can increase nasal breathing in most subjects. The aim of this study was to investigate whether sleeping with dilated nostrils reduces nocturnal asthma. At the Asthma and Allergy Research Centre, Gothenburg, 15 out-patients with nocturnal asthma were selected. Every other night for 10 nights the test subjects slept with the nasal dilator Nozovent which has been shown to increase the nasal air-flow and decrease the need for mouthbreathing. Every morning the patients self-reported on a form whether they had woken with asthma during the night or if they had had to take asthma medication. When sleeping with the nasal dilator the patients woke up with asthma on 17 of 75 nights as compared with 32 of 75 when sleeping without the device (p < 0.01). Reduced nocturnal asthma was observed by 12 patients and less need for asthma medication at night by 7. None of the patients noted any side-effects due to the device. In conclusion, the easy-to-use and cheap medical device, Nozovent, which mechanically dilates the nostrils and improves nasal breathing, can reduce nocturnal asthma.

Effect of local tranexamic acid gel in the treatment of epistaxis

In patients with nosebleedings, the hemostatic effect of local application of tranexamic acid gel or placebo was compared in a randomized, double-blind, multicenter clinical trial with parallel groups. The times needed to arrest the initial bleeding were recorded, as well as any rebleedings within 10 days. The results showed no significant differences in any of the efficacy variables. Tranexamic acid was no better than placebo in the early treatment of nose bleedings, but the gel itself seemed to have a beneficial effect. The gel preparations were easy to insert into the nasal cavity and caused no discomfort to the patients.