Does hormone replacement therapy in post-menopausal women have any effect upon nasal physiology?

Rhinitis 2020: A practice parameter update

This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.

Alterations in nasal mucociliary activity in polycystic ovary syndrome

OBJECTIVES

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. It can affect various organ systems, and respiratory mucosa has been reported as being hormone responsive.

STUDY DESIGN

A case-control study consisting of 50 women with PCOS and 30 control subjects matched for age and body mass index was conducted, in order to investigate nasal mucociliary clearance time (NMCT) in patients with PCOS. Serum basal hormonal-biochemical parameters and NMCT were evaluated on menstrual cycle days 2-5 for all participants.

RESULTS

The mean NMCT in PCOS and control groups was 10.45±2.88 and 6.92±1.78, respectively (p=0.0001). A significant positive correlation was found between NMCT and duration of disease (r=0.52; p=0.001), serum total testosterone level (r=0.28; p=0.04), and luteinizing hormone/follicle stimulating hormone (r=0.29; p=0.04).

CONCLUSIONS

Our findings indicate that PCOS is associated with altered NMCT. Prolonged NMCT predisposes patients to respiratory tract and middle ear infections, and clinicians should be aware of this.

The rhinological manifestations of women's health

OBJECTIVE

To systematically review the literature and appraise the evidence reporting the effects of women's health, including pregnancy, postpartum, menstruation, oral contraception, menopause, and hormone replacement therapy, on common rhinological pathologies and nasal physiology.

DATA SOURCES

Systematic search strategy using MEDLINE (1966-2012) and EMBASE (1980-2012) databases.

REVIEW METHODS

Title review, abstract screening, and then full paper analysis were undertaken by 2 authors independently. Level of evidence was graded according to the Oxford Centre of Evidence Based Medicine 2011 criteria and risk of bias assessment using the Jadad scale for randomized controlled trials and Newcastle-Ottawa Scale for cohort and case-controlled studies.

RESULTS

Over the 46 years analyzed, the search strategy produced 2904 titles. In total, 314 abstracts were screened, from which 192 full-text articles were evaluated, and 145 research papers met all the criteria for inclusion in the study. Overall, the available evidence was of low quality. Seventy percent of studies (102 of 145) were case reports or case series from which only limited conclusions can be drawn. Only 3% of the included papers (4 of 145) were randomized controlled studies. The remaining data were mainly of a prospective cohort design. Study heterogeneity in design and measured outcomes resulted in data synthesis being limited to a descriptive/exploratory review. Study findings are presented by women's health category and then by rhinological manifestation with important clinical correlations highlighted.

CONCLUSION

Physiological and hormonal changes occurring as a normal part of women's health have an important influence on rhinological function and disease.

Clinical presentation and management of geriatric rhinitis

The population of Americans over 65 years of age is growing at an unprecedented rate. Rhinitis is a common and burdensome complaint in this group, and physicians should be aware of the diagnosis and management of the disease. Geriatric rhinitis is a nasal disorder of older persons that presents with a constellation of nasal symptoms. The etiologies of this condition include both inflammatory diseases and the effects of aging on physiology of the upper airway. Possible causes include allergic rhinitis, nonallergic rhinitis (vasomotor rhinitis and gustatory rhinitis), adverse effects of medications, hormonal changes, postnasal drip syndrome, chronic rhinosinusitis and atrophic rhinitis. Nasal symptoms in the older patient present a clinical challenge because of the physiologic effects of the aging nose, the unusual clinical presentation, the presence of multiple comorbidities and the problem of polypharmacy. A number of therapeutic options exist for this disorder, although definitive studies of effective regimens are needed.