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Ozaki N, Sakamoto N, Horikami D, Tachibana Y, Nagata N, Kobayashi K, Arai YT, Sone M, Hirayama K, Murata T. 15-Hydroxyeicosatrienoic acid induces nasal congestion by changing vascular functions in mice. Allergol Int 2024; 73:464-472. [PMID: 38286715 DOI: 10.1016/j.alit.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Nasal congestion in allergic rhinitis (AR) is caused by vascular hyperpermeability and vascular relaxation of the nasal mucosa. We previously detected high levels of a lipoxygenation metabolite of dihomogammalinolenic acid, 15-hydroxy-8Z,11Z,13E-eicosatrienoic acid (15-HETrE) in the nasal lavage fluid of AR model mice. Here, we investigated the effects of 15-HETrE on vascular functions associated with nasal congestion. METHODS We measured 15-HETrE levels in the nasal lavage fluid of ovalbumin-induced AR model mice and nasal discharge of patients with AR. We also assessed nasal congestion and vascular relaxation in mice. Vascular contractility was investigated using isolated mouse aortas. RESULTS Five ovalbumin challenges increased 15-HETrE levels in AR model mice. 15-HETrE was also detected in patients who exhibiting AR-related symptoms. Intranasal administration of 15-HETrE elicited dyspnea-related behavior and decreased the nasal cavity volume in mice. Miles assay and whole-mount immunostaining revealed that 15-HETrE administration caused vascular hyperpermeability and relaxation of the nasal mucosa. Intravital imaging demonstrated that 15-HETrE relaxed the ear vessels that were precontracted via thromboxane receptor stimulation. Moreover, 15-HETrE dilated the isolated mouse aortas, and this effect was attenuated by K+ channel inhibitors and prostaglandin D2 (DP) and prostacyclin (IP) receptor antagonists. Additionally, vasodilatory effects of 15-HETrE were accompanied by an increase in intracellular cAMP levels. CONCLUSIONS Our results indicate that 15-HETrE, whose levels are elevated in the nasal cavity upon AR, can be a novel lipid mediator that exacerbates nasal congestion. Moreover, it can stimulate DP and IP receptors and downstream K+ channels to dilate the nasal mucosal vasculature.
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Affiliation(s)
- Noriko Ozaki
- Animal Radiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan; Veterinary Public Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Naoaki Sakamoto
- Animal Radiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Daiki Horikami
- Animal Radiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Yuri Tachibana
- Animal Radiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Nanae Nagata
- Animal Radiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Koji Kobayashi
- Food and Animal Systemics, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | | | | | - Kazuhiro Hirayama
- Veterinary Public Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Takahisa Murata
- Animal Radiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan; Food and Animal Systemics, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan; Veterinary Pharmacology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan.
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Rossi Meyer MK, Most SP. Quantifying the Subjective Experience of Nasal Obstruction: A Review. Facial Plast Surg 2024; 40:336-340. [PMID: 37625460 DOI: 10.1055/a-2160-4998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Nasal obstruction is an exceedingly common problem and challenging to treat due to its multifactorial etiology. Therefore, measuring treatment outcomes of nasal obstruction can be equally complex yet vital to appropriately assessing symptom improvement or resolution. Both physiologic and anatomic assessments of the nasal airway exist in addition to validated patient-reported outcome measures (PROMs), which objectify subjective nasal obstruction and sinonasal symptoms. Correlation between objective and subjective treatment outcome measures is controversial with clinical guidelines favoring the use of PROMs for surgical treatment of nasal obstruction. In this review, the anatomic and physiologic measurements of the nasal airway and validated PROMs will be discussed, as well as the rationale for implementing PROMs into the rhinoplasty surgeon's practice.
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Affiliation(s)
- Monica K Rossi Meyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Harvey RJ, Roland LT, Schlosser RJ, Pfaar O. Chief Complaint: Nasal Congestion. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1462-1471. [PMID: 38677589 DOI: 10.1016/j.jaip.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
Nasal obstruction is the subjective perception and objective state of insufficient airflow through the nose. Nasal congestion, conversely, describes a state of not just inadequate airflow or obstructive phenomena but also pressure- and mucus-related states to the patient. Nasal receptors belonging to the transient receptor potential (TRP) protein family mediate the sense of nasal patency via the trigeminal nerve. The transient receptor potential melastatin-8 (TRPM8) responds to temperatures around 8°C to 22°C, and is stimulated by menthol and other cooling agents. The radiant effects of airflow create heat loss to activate these receptors and humans perceive this as nasal patency rather than the direct detection of airflow. The thermovascular state of the mucosa, in conditions such as rhinitis, influence TRPM8 activation. Nasal endoscopy can show signs of rhinitis and should be considered an essential part of the workup of nasal congestion. Efforts to relieve nasal congestion need to manage the mucosal state and surgery needs to ensures that the nasal cavity mucosa is exposed to the cooling effects of airflow rather than simply creating a passage to the nasopharynx.
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Affiliation(s)
- Richard John Harvey
- Rhinology & Skull Base, University of New South Wales and Macquarie University, Sydney, Australia.
| | - Lauren T Roland
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Mo
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
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Abreu VRLS, Xavier JA. Imaging Nasal Obstruction: An Objective Evaluation for a Subjective Complaint. Facial Plast Surg 2024; 40:294-303. [PMID: 38016660 DOI: 10.1055/a-2218-7060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Nasal obstruction (NO) is a common clinical symptom characterized by a subjective sensation of insufficient airflow through the nasal cavity and may result from various factors, including changes in nasal anatomy, inflammatory conditions, tumoral lesions, and other etiologies. While a thorough medical history and physical examination can often identify its cause, imaging is usually necessary to fully understand the problem. Computed tomography (CT) is the primary imaging modality used to evaluate the nasal cavity and paranasal sinuses, allowing for the identification of potential causes and structural abnormalities. However, when soft tissue characterization is required, magnetic resonance imaging (MRI) is also useful. Understanding the anatomical and pathological basis of NO is crucial for accurate diagnosis and appropriate management. Imaging techniques provide valuable information for identifying the underlying causes of NO and guiding treatment decisions. This article reviews the normal anatomy of the nasal cavity and adjacent paranasal sinuses as well as the several conditions that may affect breathing comfort (tumors, inflammatory diseases, bony and cartilaginous anatomical variants, and "nonobstructive" mucosal thickenings), showing their normal presentation on CT and MRI.
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Affiliation(s)
- Vasco R L S Abreu
- Neuroradiology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - João A Xavier
- Neuroradiology Department, Centro Hospitalar Universitário de Santo António, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
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Bartley J, Hankin R. A nasal airflow oscillation device targeting nasal congestion: a preliminary report. Eur Arch Otorhinolaryngol 2024; 281:2743-2747. [PMID: 38436754 PMCID: PMC11024000 DOI: 10.1007/s00405-024-08576-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Upper respiratory tract complaints are common in the general population. A safe, non-pharmacologic treatment would be an attractive option for many patients either as an alternative to existing therapies, or as a complementary therapy. This study assessed the acceptability, safety and possible efficacy of a nasal airflow oscillation device in a group of people suffering chronic nasal congestion. METHODS Subjects with a known history of nasal congestion, but without fixed anatomical obstruction, participated in a prospective clinical study. Efficacy was assessed using peak nasal inspiratory flow (NPIF) and a 10-point visual analogue scale (VAS) administered before and after the oscillation device had been worn for twenty minutes. RESULTS Twenty-one subjects (mean age 37 years; 43% female) were enrolled in the study. After treatment with the small nasal airflow oscillation device for twenty minutes, average NPIF increased significantly from 84.8 L/minute to 99.0 L/minute (p < 0.05). There was a corresponding significant reduction in the VAS score for nasal congestion (p < 0.05). Similar significant improvements were also seen for the immediate sensation of nasal drainage, sinonasal pressure and overall sinonasal symptoms (p < 0.05). There was no change in the sense of smell (p = 0.37). Subjects rated ease of use highly; average = 9.1 (Range 7-10). CONCLUSION Treatment of nasal congestion with the nasal airflow oscillation device was found to result in significant improvement in NPIF after twenty minutes of use. Initial patient-reported outcomes improved significantly, and the treatment was safe and highly acceptable. TRIAL REGISTRATION Public clinical trial registration: Universal Trial Number (U1111-1259-0704). Australian New Zealand clinical trials registration: ACTRN12623001307695.
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Affiliation(s)
- Jim Bartley
- Department of Otolaryngology - Head and Neck Surgery, Manukau Superclinic, 901 Great South Road, Manukau City Centre, Auckland, 2104, New Zealand.
| | - Robin Hankin
- Computer and Mathematical Sciences, University of Stirling, Stirling, FK9 4LA, Scotland, UK
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Luong AU, Yong M, Hwang PH, Lin BY, Gopi P, Mohan V, Ma Y, Johnson J, Yen DM, DeMera RS, Bleier BS. Acoustic resonance therapy is safe and effective for the treatment of nasal congestion in rhinitis: A randomized sham-controlled trial. Int Forum Allergy Rhinol 2024; 14:919-927. [PMID: 37812532 DOI: 10.1002/alr.23284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/16/2023] [Accepted: 09/23/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Acoustic resonance therapy (ART) is a novel vibrational treatment that delivers patient-specific resonant frequency acoustic energy to the sinonasal cavities. In a pilot study, ART was effective for the acute treatment of nasal congestion. We conducted a sham-controlled randomized trial to validate the efficacy of ART when administered daily for 2 weeks. METHODS A total of 52 adult patients were enrolled in a multi-center, randomized, double-blinded, sham-controlled, interventional study evaluating ART administered by a vibrational headband. Patients received either active treatment or a non-therapeutic sham treatment twice daily over 2 weeks. Clinical endpoints were the average change in nasal congestion sub-score of the Total Nasal Symptom Score (TNSS) and the average change in composite TNSS. RESULTS ART resulted in a significantly greater mean change in the nasal congestion sub-score compared to sham (-0.87 [95% confidence interval [CI] -1.11, -0.62] vs. -0.44 [95% CI -0.64, -0.23], p = 0.008). ART also resulted in a significantly greater reduction in the composite TNSS versus sham, (-2.85 [95% CI -3.85, -1.85], vs. -1.32 [95% CI -2.27, -0.36], p = 0.027). The response rate, determined by a nasal congestion sub-score minimal clinically important difference of 0.23, was 80.8% for ART and 46.2% for sham, with an adjusted risk ratio of 1.95 (95% CI 1.26, 3.02, p = 0.003) in favor of ART. Safety endpoints showed no adverse events. CONCLUSION ART is a safe and effective non-pharmacologic alternative for the treatment of nasal congestion.
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Affiliation(s)
- Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School of The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Center for Immunology and Autoimmune Diseases, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, McGovern Medical School of The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael Yong
- Pacific Neuroscience Institute, Santa Monica, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Bryant Y Lin
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Vivek Mohan
- Sound Health Systems, Los Altos, California, USA
| | - Yifei Ma
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jacob Johnson
- San Francisco Otolaryngology Medical Group, San Francisco, California, USA
| | - David M Yen
- Specialty Physician Associates, Bethlehem, Pennsylvania, USA
| | | | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Root ZT, Lepley TJ, Wu Z, Chapman RJ, Schneller AR, Formanek VL, Kelly KM, Otto BA, Zhao K. How Does Oxymetazoline Change Nasal Aerodynamics and Symptomatology in Patients with Turbinate Hypertrophy? Laryngoscope 2024; 134:1100-1106. [PMID: 37589314 DOI: 10.1002/lary.30968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES Oxymetazoline relieves nasal obstructive symptoms via vasoconstriction, however, the changes in nasal structures and aerodynamics that impact symptoms the most remain unclear. METHODS This prospective, longitudinal, and single blinded cohort study applied Computational Fluid Dynamic (CFD) modeling based on CT scans at baseline and post-oxymetazoline on 13 consecutive patients with chronic nasal obstruction secondary to inferior turbinate hypertrophy from a tertiary medical center. To account for placebo effect, a sham saline spray was administered with subject blindfolded prior to oxymetazoline, with 30 min rest in between. Nasal Obstruction Symptom Evaluation (NOSE) and unilateral Visual Analogue Scale (VAS) scores of nasal obstructions were collected at baseline, after sham, and 30 min after oxymetazoline. RESULTS Both VAS and NOSE scores significantly improved from baseline to post-oxymetazoline (NOSE: 62.3 ± 12.4 to 31.5 ± 22.5, p < 0.01; VAS: 5.27 ± 2.63 to 3.85 ± 2.59, p < 0.05), but not significantly from baseline to post-sham. The anatomical effects of oxymetazoline were observed broadly throughout the entire length of the inferior and middle turbinates (p < 0.05). Among many variables that changed significantly post-oxymetazoline, only decreased nasal resistance (spearman r = 0.4, p < 0.05), increased regional flow rates (r = -0.3 to -0.5, p < 0.05) and mucosal cooling heat flux (r = -0.42, p < 0.01) in the inferior but not middle turbinate regions, and nasal valve Wall Shear Stress (WSS r = -0.43, p < 0.05) strongly correlated with symptom improvement. CONCLUSION Oxymetazoline broadly affects the inferior and middle turbinates, however, symptomatic improvement appears to be driven more by global nasal resistance and regional increases in airflow rate, mucosal cooling, and WSS, especially near the head of the inferior turbinate. LEVEL OF EVIDENCE 3: Well-designed, prospective, single blinded cohort trial. Laryngoscope, 134:1100-1106, 2024.
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Affiliation(s)
- Zachary T Root
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Thomas J Lepley
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Zhenxing Wu
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Robbie J Chapman
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Aspen R Schneller
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Veronica L Formanek
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Kathleen M Kelly
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Bradley A Otto
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Kai Zhao
- Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA
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Fischer JL, Tolisano AM, Navarro AI, Trinh L, Abuzeid WM, Humphreys IM, Akbar NA, Shah S, Schneider JS, Riley CA, McCoul ED. Are you congested? A comparison of definitions between otolaryngologists and their patients. Int Forum Allergy Rhinol 2024; 14:86-95. [PMID: 37392085 DOI: 10.1002/alr.23228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To assess for differences of intended meaning in the description of congestion-related symptoms among otolaryngology patients and clinicians. MATERIALS AND METHODS Between June 2020 and October 2022, a questionnaire consisting of 16 common descriptors of congestion-related symptoms within four domains (obstructive-related, pressure-related, mucus-related, and other symptoms) was completed by patients and otolaryngologists at five tertiary otolaryngology practices. The primary outcome was to assess differences in patient and clinician perceptions of congestion-related symptoms. Differences based on geographic location was a secondary outcome. RESULTS A total of 349 patients and 40 otolaryngologists participated. Patients selected a median of 6.8 (standard deviation [SD] 3.0) terms compared with 4.0 (SD 1.6) terms for otolaryngologists (p < 0.001). Otolaryngologists were more likely to select obstruction-related symptoms (difference 6.3%; 95% confidence interval [CI] 3.8%, 8.9%). Patients were more likely to describe congestion using pressure-related (-43.7%; -58.9%, -28.5%), mucus-related (-43.5%; -59.3%, -27.8%), and other symptoms (-44.2; -51.3%, -37.1%) compared with otolaryngologists. There were no significant differences identified based on geographic location with regard to symptom domains on multivariate analysis. CONCLUSIONS There are differences between otolaryngologists and their patients in the interpretation of the symptoms of congestion. Clinicians tended to have a narrower interpretation of congestion that was limited to the obstruction-related symptom domain, while patients defined congestion more broadly. This has important counseling and communication implications for the clinician.
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Affiliation(s)
- Jakob L Fischer
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Anthony M Tolisano
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Alvaro I Navarro
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Lily Trinh
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Waleed M Abuzeid
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Ian M Humphreys
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Nadeem A Akbar
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sharan Shah
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
| | - John S Schneider
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Edward D McCoul
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA
- Department of Otorhinolaryngology and Communication Sciences, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
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Zhou AS, Prince AA, Maxfield AZ, Corrales CE, Shin JJ. The Impact of Sinonasal Symptoms in Relation to Potentially Life-Threatening Comorbidities. Otolaryngol Head Neck Surg 2023; 169:1462-1471. [PMID: 37313804 DOI: 10.1002/ohn.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE While general health may be influenced by sinonasal symptoms, their effects may be overshadowed by comorbid states which may be more serious. To assess the validity of this postulate, we measured the extent to which sinonasal symptoms and concurrent conditions influenced general health. STUDY DESIGN Observational outcomes study. SETTING Academic medical center, community care sites. METHODS Adults with sinonasal symptoms completed the 22-item Sinonasal Outcome Test, along with the Patient-Reported Outcomes Measurement Information System global health short form. Comorbidities were categorized with the Deyo modification of the Charlson comorbidity index. Multivariate regression analyses were utilized to determine the relative impact of sinonasal symptoms and concurrent comorbid conditions on general health. RESULTS Data from 219 consecutive patients demonstrated that sinonasal symptoms were associated with significantly diminished general physical (β = -1.431, p < .001), mental (β = -1.000, p < .001), overall (β = -1.026, p < .001), and social health (β = -0.872, p = .003), regardless of the presence of potentially life-threatening comorbid conditions. Comorbid conditions included cardiovascular disease, chronic obstructive pulmonary disease, connective tissue disease, peptic ulcer, diabetes mellitus, and hepatic disease. The effect of sinonasal symptoms was neither subsumed nor overshadowed by the effects of comorbid states. Nasal, ear, sleep, and psychological domain scores were also associated with general physical, mental, and global health while adjusting for the impact of comorbidities. CONCLUSION Sinonasal symptoms have a substantial effect on general health which is not subsumed by the presence of potentially life-threatening concurrent comorbidities. These data may help support the importance of funding and resource allocation for conditions causing sinonasal symptoms.
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Affiliation(s)
- Allen S Zhou
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony A Prince
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Alice Z Maxfield
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Carleton Eduardo Corrales
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Almarri FK, Alsaleh S. Are We Overlooking Nasal Decongestant Abuse? A Perspective. EAR, NOSE & THROAT JOURNAL 2023:1455613231197285. [PMID: 37688445 DOI: 10.1177/01455613231197285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Affiliation(s)
- Firas K Almarri
- Department of Otorhinolaryngology - Head and Neck Surgery, Ad Diriyah Hospital, Riyadh Third Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology - Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
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11
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Scheire S, Germonpré S, Van Tongelen I, Mehuys E, Crombez G, Gevaert P, Boussery K. The Indispensable Nasal Decongestant: Patients' Views and Perspectives on Nasal Decongestant Overuse. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:602-609.e1. [PMID: 36473623 DOI: 10.1016/j.jaip.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/04/2022] [Accepted: 11/13/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Rhinitis medicamentosa (RM) is a type of nonallergic rhinitis caused by prolonged use of nasal decongestants (NDs). Although it is a preventable phenotype of rhinitis, little is known about patients dealing with this condition. OBJECTIVE To gain a better understanding of patients' views and experiences of ND overuse, and potential facilitators and barriers to discontinue the overuse. METHODS We performed a qualitative study using in-depth semistructured interviews with 22 patients who have been using an ND on an almost daily basis for at least 6 months. The interviews were conducted face-to-face, audio-recorded, and transcribed verbatim. Data analysis followed the grounded theory approach. RESULTS Interviewees described the large impact of nasal congestion on their daily lives. Despite efforts to try other treatment options, the ND was considered the only effective aid to resolve the troublesome symptom. Most participants were aware that the prolonged use was problematic, sometimes leading to hiding behavior in order to avoid criticism by others including their health professionals. Many participants expressed a strong will to discontinue. However, multiple barriers to withdrawal were identified including fear of surgery or the impact of withdrawal on sleep, lack of good alternatives, and negative experiences with past withdrawal attempts. Patients thus face a dilemma in which the barriers to withdrawal currently outweigh the possible benefits. CONCLUSION The use of NDs is considered indispensable by many chronic users. The facilitators and barriers identified in this study provide opportunities to reduce the use of NDs and the prevalence of RM in the future.
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Affiliation(s)
- Sophie Scheire
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.
| | - Sophie Germonpré
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Inge Van Tongelen
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Els Mehuys
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Philippe Gevaert
- Upper Airway Research Laboratory, Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Koen Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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12
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Shin GC, Kang JW, Park JH, Lee HC, Kim KS. Changes in Subjective Outcomes during the Early Period after Septoturbinoplasty. Yonsei Med J 2023; 64:42-47. [PMID: 36579378 PMCID: PMC9826964 DOI: 10.3349/ymj.2022.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Septoturbinoplasty is frequently performed to correct nasal obstruction; however, there is still a lack of research on changes in nasal and nose-related symptoms early after septoturbinoplasty. Therefore, we aimed to investigate changes in subjective outcomes within 6 months after septoturbinoplasty. MATERIALS AND METHODS The medical records of patients who underwent septoturbinoplasty at Gangnam Severance Hospital were retrospectively analyzed. Symptom scores were evaluated using the Sino-nasal Outcome Test (SNOT-22) and obstruction scores. The SNOT-22 and obstruction scores were investigated before surgery and at 1, 3, and 6 months after surgery. RESULTS We noted significant decreases in both SNOT-22 and obstruction scores at 1 month after surgery, compared to those before surgery (p<0.001). However, there were no significant changes at 3 and 6 months after surgery, compared to scores at 1 month after surgery. Using multivariate logistic regression analysis, a larger difference between SNOT-22 scores preoperatively and 1 month after surgery was significantly associated with a significant improvement in symptoms at 3 or 6 months after septoturbinoplasty (p=0.029). CONCLUSION These results imply that subjective outcomes and degree of improvement in the first month after septoturbinoplasty can be used as a predictor of the results thereof and for counseling patients about its progress.
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Affiliation(s)
- Geun Cheol Shin
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Wan Kang
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Ha Park
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Han Cheol Lee
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Su Kim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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13
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Daoud A, Eisenbach N, Ronen O, Dror A, Ohayon TJ, Hajouj M, Sela E, Marshak T. Cross-cultural adaptation of the Hebrew Nasal Obstruction Symptom Evaluation (NOSE) scale. Laryngoscope Investig Otolaryngol 2022; 8:34-39. [PMID: 36846412 PMCID: PMC9948559 DOI: 10.1002/lio2.970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 12/05/2022] Open
Abstract
Objective Nasal obstruction is a common complaint. The Nasal Obstruction Symptom Evaluation scale (NOSE) is a reliable validated tool used to assess the quality of life of patients with nasal obstruction. The purpose of this study is to validate the Hebrew version of the NOSE scale (He-NOSE). Methods A prospective instrument validation was conducted. The NOSE scale was translated primarily from English to Hebrew and then back from Hebrew to English according to the accepted guidelines of the cross-cultural adaptation process. The study group included surgery candidates suffering from nasal obstruction due to a deviated nasal septum and/or inferior turbinate hypertrophy. The study group completed the validated He-NOSE questionnaire twice prior to the surgery and once again, a month post-surgery. A control group of individuals with no history of nasal complaints or surgeries was asked to complete the questionnaire once. Reliability, internal consistency, validity, and responsiveness to change of the He-NOSE were evaluated. Results Fifty-three patients and 100 controls were included in this study. The scale showed excellent ability to discriminate between the study and the control group, exhibiting significantly lower scores in the control group (73.8 and 7 average scores respectively, p < .001). Good internal consistency (Cronbach's alpha .71 and .76) and test-retest reliability (Spearman rank correlation r = .752, p < .0001) were measured. Moreover, the scale revealed remarkable responsiveness to change (p < .00001). Conclusion The translated and adapted He-NOSE scale can be a useful tool to be applied in both clinical and research fields when assessing nasal obstruction. Level of evidence N/A.
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Affiliation(s)
- Amani Daoud
- Department of Otolaryngology, Head and Neck SurgeryGalilee Medical CenterNahariyaIsrael,The Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Netanel Eisenbach
- Department of Otolaryngology, Head and Neck SurgeryGalilee Medical CenterNahariyaIsrael,The Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Ohad Ronen
- Department of Otolaryngology, Head and Neck SurgeryGalilee Medical CenterNahariyaIsrael,The Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Amiel Dror
- Department of Otolaryngology, Head and Neck SurgeryGalilee Medical CenterNahariyaIsrael,The Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | | | - Majd Hajouj
- Department of Otolaryngology, Head and Neck SurgeryGalilee Medical CenterNahariyaIsrael
| | - Eyal Sela
- Department of Otolaryngology, Head and Neck SurgeryGalilee Medical CenterNahariyaIsrael,The Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Tal Marshak
- Department of Otolaryngology, Head and Neck SurgeryGalilee Medical CenterNahariyaIsrael,The Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
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14
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Quality of Life and Symptoms Before and After Nasal Septoplasty With or Without Turbinoplasty Compared With Control Individuals in Saudi Arabia. J Craniofac Surg 2022; 34:922-925. [PMID: 36730854 PMCID: PMC10128898 DOI: 10.1097/scs.0000000000009115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Nasal septal deviation is a common health issue that can significantly impact the quality of life. Although nasal septoplasty is commonly performed in Otolaryngology practice, its effectiveness has been questioned. This was the first study to assess disease-specific quality of life in patients undergoing nasal septoplasty with or without turbinoplasty in Saudi Arabia. METHODS This was a prospective observational study of patients undergoing nasal septoplasty with or without turbinoplasty for nasal obstruction due to septal deviation with or without inferior turbinate hypertrophy. Nasal Obstruction Symptom Evaluation (NOSE) scores were collected preoperatively and 3 months postoperatively and were compared with controls. RESULTS This study involved 200 subjects, including 40 patients in the case group and 160 individuals in the control group. The mean preoperative and 3-month postoperative NOSE scores of the case group were (58.4±23.7 and 15.0±18.6, P<0.001), respectively. However, the postoperatively NOSE score did not reach NOSE score in control group (13.28±8.13, P=0.377). All nasal symptoms statistically and clinically improved postoperatively. There were no significant differences in NOSE score changes among cases preoperatively and postoperatively according to age, sex, or the presence of allergic rhinitis or asthma. CONCLUSIONS Nasal septoplasty with or without turbinoplasty leads to improvements in disease-specific quality of life as assessed by NOSE scores and significantly improved nasal symptoms 3 months after surgery.
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15
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Bin Lajdam G, Alaryani K, Ghaddaf AA, Aljabri A, Halawani A, Alshareef M, Algarni M, Al-Hakami H. Septoplasty versus septoplasty with turbinate reduction for nasal obstruction due to deviated nasal septum: a systematic review and meta-analysis. Rhinology 2022; 60:411-420. [PMID: 36150153 DOI: 10.4193/rhin22.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Compensatory inferior turbinate hypertrophy is a common accompanying manifestation in patients with nasal obstruction due to deviated nasal septum (DNS). The grounds for inferior turbinate reduction (ITR) in this population are still not well established. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of septoplasty with ITR versus septoplasty alone. METHODS Computerised search in Medline, Embase, and CENTRAL was performed. Eligible for inclusion were randomised controlled trials (RCTs) comparing septoplasty to septoplasty with unilateral, contralateral, ITR in adults with DNS. Primary outcomes were health-related quality of life and nasal patency. The secondary outcome was the occurrence of adverse events. Standardised mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated. RESULTS Twelve RCTs that enrolled 775 participants were found eligible. Data were reported at follow-up periods ranging from 1 month to 48 months. The pooled effect estimate showed a statistically significant improvement with unilateral, contralateral, ITR in Nasal Obstruction Symptom Evaluation scale (NOSE) scores. The rate of adverse events was significantly higher with ITR. CONCLUSIONS Unilateral reduction of the hypertrophied contralateral inferior turbinate during septoplasty resulted in better subjective relief of nasal obstruction in adults with DNS than septoplasty alone. However, caution is warranted since only few well-designed RCTs were identified.
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Affiliation(s)
- G Bin Lajdam
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - K Alaryani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - A A Ghaddaf
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - A Aljabri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - A Halawani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - M Alshareef
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - M Algarni
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - H Al-Hakami
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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16
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Varman R, Clark M. Butterfly Graft Technique for Addressing the Internal Nasal Valve. Facial Plast Surg 2022; 38:347-352. [PMID: 36270288 DOI: 10.1055/s-0042-1753521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Nasal airway obstruction is a common presenting complaint to otolaryngology clinics, with the internal valve a commonly implicated anatomic area of obstruction. The nasal butterfly graft is a robust technique to address this subsite with good reported functional and aesthetic outcomes in both primary and secondary rhinoplasty. We describe our approach to patient evaluation, surgical candidate selection, operative technique, and outcomes assessment for this technique.
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Affiliation(s)
- Rahul Varman
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech University Health Science Center, Lubbock, Texas
| | - Madison Clark
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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17
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Schmidt N, Behrbohm H, Goubergrits L, Hildebrandt T, Brüning J. Comparison of rhinomanometric and computational fluid dynamic assessment of nasal resistance with respect to measurement accuracy. Int J Comput Assist Radiol Surg 2022; 17:1519-1529. [PMID: 35821562 DOI: 10.1007/s11548-022-02699-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/05/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Computational fluid dynamics (CFD)-based calculation of intranasal airflow became an important method in rhinologic research. Current evidence shows weak to moderate correlation as well as a systematic underprediction of nasal resistance by numerical simulations. In this study, we investigate whether these differences can be explained by measurement uncertainties caused by rhinomanometric devices and procedures. Furthermore, preliminary findings regarding the impact of tissue movements are reported. METHODS A retrospective sample of 17 patients, who reported impaired nasal breathing and for which rhinomanometric (RMM) measurements using two different devices as well as computed tomography scans were available, was investigated in this study. Three patients also exhibited a marked collapse of the nasal valve. Agreement between both rhinomanometric measurements as well as between rhinomanometry and CFD-based calculations was assessed using linear correlation and Bland-Altman analyses. These analyses were performed for the volume flow rates measured at trans-nasal pressure differences of 75 and 150 Pa during inspiration and expiration. RESULTS The correlation between volume flow rates measured using both RMM devices was good (R2 > 0.72 for all breathing states), and no relevant differences in measured flow rates was observed (21.6 ml/s and 14.8 ml/s for 75 and 150 Pa, respectively). In contrast, correlation between RMM and CFD was poor (R2 < 0.5) and CFD systematically overpredicted RMM-based flow rate measurements (231.8 ml/s and 328.3 ml/s). No differences between patients with and without nasal valve collapse nor between inspiration and expiration were observed. CONCLUSION Biases introduced during RMM measurements, by either the chosen device, the operator or other aspects as for example the nasal cycle, are not strong enough to explain the gross differences commonly reported between RMM- and CFD-based measurement of nasal resistance. Additionally, tissue movement during breathing is most likely also no sufficient explanation for these differences.
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Affiliation(s)
- Nora Schmidt
- Department of Otorhinolaryngology and Facial Plastic Surgery, Park-Klinik Weissensee, Schönstraße 80, 13086, Berlin, Germany.
| | - Hans Behrbohm
- Department of Otorhinolaryngology and Facial Plastic Surgery, Park-Klinik Weissensee, Schönstraße 80, 13086, Berlin, Germany
| | - Leonid Goubergrits
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Hildebrandt
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Brüning
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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18
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Kumar RS, Jain MK, Kushwaha JS, Patil S, Patil V, Ghatak S, Sanmukhani J, Mittal R. Efficacy and Safety of Fluticasone Furoate and Oxymetazoline Nasal Spray: A Novel First Fixed Dose Combination for the Management of Allergic Rhinitis with Nasal Congestion. J Asthma Allergy 2022; 15:783-792. [PMID: 35712651 PMCID: PMC9196668 DOI: 10.2147/jaa.s357288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the efficacy and safety of a fixed dose combination of Fluticasone Furoate and Oxymetazoline Hydrochloride Nasal Spray 27.5/50 mcg (FDC) with Fluticasone Furoate Nasal Spray 27.5 mcg (Fluticasone) in the management of allergic rhinitis. Patients and Methods A prospective, randomized, double-blind, two-arm, active-controlled, parallel, multicenter, comparative clinical study was conducted in patients with allergic rhinitis aged 18 years and above having moderate-to-severe nasal congestion. Results A total of 250 patients were randomized (1:1) to receive either the FDC or Fluticasone alone in a dose of two sprays in each nostril once daily at night. There was a significantly (P<0.001) greater reduction in night-time Total Nasal Symptom Score with the FDC as compared to Fluticasone at all the time points starting from as early as day 3 and sustained till the end of treatment (Day 28) (Day 3: −3.1 vs −2.2; Day 7: −4.0 vs −3.4; Day 14: −5.7 vs −5.0; Day 28: −7.0 vs −6.4). A significantly greater number of patients (P<0.05) had complete relief in Nasal Congestion with the FDC (44.7%) as compared to Fluticasone (26.8%). Both the study medications were well tolerated by all the patients. The proportion of patients showing worsening of symptoms (rebound congestion/rhinitis medicamentosa) after stoppage of medication was similar in both groups (P>0.05). Conclusion The FDC was superior to Fluticasone alone in relieving the nasal congestion and reduction of Total Nasal Symptom Score in allergic rhinitis patients with moderate-to-severe nasal congestion when administered once daily in the evening. Oxymetazoline when used along with the nasal steroid in a once daily dose does not cause rebound congestion and rhinitis medicamentosa even after long-term continuous use of 28 days.
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Affiliation(s)
- R S Kumar
- Department of Pulmonary Medicine, Government Medical College & Government General Hospital, Srikakulam, India
| | - Manish Kumar Jain
- Department of Pulmonary Medicine, Maharaja Agrasen Superspeciality Hospital, Jaipur, India
| | | | - Santosh Patil
- Department of ENT, Jeevan Rekha Hospital, Belgavi, India
| | - Vasanti Patil
- Department of ENT, Rajarshi Chhatrapati Shahu Maharaj Government Medical College and CPR Hospital, Kolhapur, India
| | - Soumya Ghatak
- Department of ENT, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Jayesh Sanmukhani
- Department of Clinical Research and Regulatory Affairs, Cadila Healthcare Limited, Ahmedabad, India
| | - Ravindra Mittal
- Department of Clinical Research and Regulatory Affairs, Cadila Healthcare Limited, Ahmedabad, India
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19
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Bikhazi N, Ow RA, O'Malley EM, Perkins N, Sidle DM, Stolovitzky P. Long-Term Follow-up from the Treatment and Crossover Arms of a Randomized Controlled Trial of an Absorbable Nasal Implant for Dynamic Nasal Valve Collapse. Facial Plast Surg 2021; 38:495-503. [PMID: 34965603 DOI: 10.1055/s-0041-1740948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
We report the long-term safety and efficacy outcomes of the treatment and crossover arms of a randomized controlled trial evaluating an absorbable nasal implant to address dynamic nasal valve collapse. Participants were adults with severe/extreme nasal airway obstruction primarily due to nasal valve insufficiency who had implant placement. Follow-up visits were at 3, 6, 12, 18, and 24 months post implant. Visits included collection of the following patient-reported outcome measures: nasal obstructive symptom evaluation (NOSE), nasal obstruction visual analog scale (VAS), and the Epworth Sleepiness Scale (ESS). Adverse events were evaluated at each visit. One-hundred-eleven participants with implants were followed. Of the 111, 90 completed the 12-month visit and 70 completed the 24-month visit. NOSE responder rates are greater than 80% at all follow-ups through 24 months. Mean reduction from baseline in NOSE scores is ≥30 points and statistically significant (p <0.001) at all time points through 24 months. Mean VAS score reduction is ≥29.7 points and statistically significant (p <0.001) at all time points. The subgroup of participants with baseline ESS values >10 experienced statistically significant (p <0.001) and clinically meaningful reductions at all postimplant periods, suggesting that the reduction in nasal symptoms may reduce daytime sleepiness for patients who have problems with sleep quality. No serious device-/procedure-related adverse events were reported. Implant migration/retrieval rate was 4.5% (10/222) of total implants or 9% of participants (10/111). The implant is safe and effective for dynamic nasal valve collapse in patients with severe/extreme nasal obstruction and provides durable symptom improvement 24 months after placement.
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Affiliation(s)
| | - Randall A Ow
- Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville, California
| | | | - Nora Perkins
- Department of ENT, Albany ENT and Allergy Services, Albany, New York
| | - Douglas M Sidle
- Department of Otolarygology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pablo Stolovitzky
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
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20
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Abstract
Nasal airway obstruction is a very common phenomenon that can significantly decrease patients' quality of life. This review article summarizes in an evidence-based fashion the diagnosis and treatment of nasal airway obstruction. The nasal airway may be obstructed at the level of the nasal valve, septum, nasal turbinates, sinonasal mucosa, or nasopharynx. Nasal valve obstruction and septal deviations are usually treated surgically depending on the level of valve obstruction. Isolated turbinate hypertrophy is usually managed medically as part of the treatment of rhinitis, with surgery reserved for cases refractory to medical care. Sinonasal and nasopharyngeal conditions are treated according to the diagnosis.
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21
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Khanwalkar A, Johnson J, Zhu W, Johnson E, Lin B, Hwang PH. Resonant vibration of the sinonasal cavities for the treatment of nasal congestion. Int Forum Allergy Rhinol 2021; 12:120-123. [PMID: 34355851 DOI: 10.1002/alr.22877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Ashoke Khanwalkar
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jacob Johnson
- San Francisco Otolaryngology Medical Group, San Francisco, California, USA.,Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Wendy Zhu
- San Francisco Otolaryngology Medical Group, San Francisco, California, USA
| | - Ezekiel Johnson
- San Francisco Otolaryngology Medical Group, San Francisco, California, USA
| | - Bryant Lin
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, USA
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22
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Constant S, Saaid A, Jimenez-Chobillon M. Efficacy and safety evaluation of a hypertonic seawater solution enriched with manganese and copper salts. RHINOLOGY ONLINE 2021. [DOI: 10.4193/rhinol/21.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Nasal irrigation is commonly recommended as an adjuvant treatment for blocked nose. In the present study, the safety and efficacy profile of Stérimar Blocked Nose (SBN), a hypertonic seawater solution enriched with manganese and copper salts, has been evaluated on nasal epithelium, in vitro. Methodology: 3D reconstituted human nasal epithelium tissue model, MucilAir™, has been used to investigate the safety of SBN on nasal epithelium by measuring trans-epithelial electrical resistance (TEER), cytotoxicity (lactate dehydrogenase (LDH) release) and phlogosis-related effects (interleukin-8 secretion). Efficacy assessment was measured by ciliary beat frequency (CBF), mucociliary clearance (MCC) and antimicrobial activities (against Staphylococcus aureus and Pseudomonas aeruginosa). Results: Four-day SBN treatment did not compromise the nasal epithelium integrity as TEER values were over the tissue integrity limit. SBN treatment did not exert cytotoxic (LDH release) or pro-inflammatory effects (IL-8 secretion). SBN treatment significantly increased the CBF and MCC rates compared to untreated cells. SBN treatment exerted a bactericidal effect on S. aureus and P. aeruginosa cultures, whereas seawater not enriched in copper and manganese had only a bacteriostatic effect. Conclusions: The results demonstrate that SBN is a safe formula for use on human nasal epithelium. The results also suggest a better potential therapeutic role for SBN in comparison to not-enriched seawater when used to control nasal congestion and inhibit bacterial growth which may cause nasal congestion.
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23
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Sobh E, Elhussieny F, Ismail T. Elimination of nasal obstruction improves pulmonary functions and oxygenation. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [DOI: 10.1186/s43168-021-00079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nasal obstruction is a significant medical problem. This study aimed to examine the effect of nasal obstruction and nasal packing on arterial blood gases and pulmonary function indices, and the impact of the elimination of nasal obstruction on preoperative values.
Results
The mean age of the study population was 26.6 ± 10.1 years, males represented 50.8%. Spirometric indices showed statistically significant improvement (preoperative forced expiratory volume in 1st second 66.9 ± 13.9 vs 79.6 ± 14.9 postoperative and preoperative forced vital capacity 65.5 ± 12.7 vs 80.4 ± 13.8 postoperative). Oxygen saturation was significantly lower during nasal packing (95.6 ± 1.6 preoperative vs 94.7 ± 2.8 with nasal pack), and significant improvement (97.2 ± 1.4) was observed after removal of the nasal pack. Nasal obstruction scores significantly improved.
Conclusion
The results of this study indicate that either simple nasal obstruction or nasal packing may cause hypoxemia and abnormalities in lung function tests. Hypoxemia was more evident with nasal packing.
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24
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Kim JK, Cho SW, Kim H, Jo SC, Kim HG, Won TB, Kim JW, Lim JH, Rhee CS. Development of HIGH-INTENSITY FOCUSED ULTRASOUND(HIFU) Therapy in Inferior Turbinate Hypertrophy. Clin Exp Otorhinolaryngol 2021; 15:160-167. [PMID: 33781059 PMCID: PMC9149228 DOI: 10.21053/ceo.2020.02383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives Inferior turbinate (IT) hypertrophy is the main cause of chronic nasal obstruction. We developed a high-intensity focused ultrasound (HIFU) ablation device to treat patients with IT hypertrophy. Methods First, computed tomography images of patients with no evidence of sinonasal disease were evaluated to measure and compare the IT, medial mucosal thickness (MT), and space between the nasal septum and IT according to clinical characteristics such as septal deviation. A HIFU prototype was developed based on the above human anatomical studies. The experimental study was performed in five pigs; the nasal volume and histological changes at 1 and 4 weeks postoperatively were evaluated to compare the efficacy of HIFU turbinoplasty with that of radiofrequency turbinoplasty and a control group. Results The mean medial MT of the anterior, middle, and posterior portions of the IT were 4.66±1.14, 4.23±0.97, and 6.17±1.29 mm, respectively. The mean medial space was 2.65±0.79 mm. The diameter and focal depth of the prototype were 4 mm and 3 mm, respectively. HIFU showed no postoperative complications, including bleeding or scar formation. After HIFU treatment, the nasal volume increased by 196.62 mm3 (7.8%) and 193.74 mm3 (8.3%) at 1 week and 4 weeks, compared with the increase of 87.20 mm3 (3.1%) and 213.81 mm3 (9.0%), respectively,after radiofrequency therapy. A qualitative histological analysis after radiofrequency turbinoplasty showed epithelial layer disruption at 1 week and increased fibrosis, along with decreased glandular structure, at 4 weeks. The HIFU group had an intact epithelial layer at 1 week postoperatively. However, significant differences were observed at 4 weeks, including increased fibrosis and decreased glandular structure. Conclusion The efficacy and safety of HIFU turbinoplasty were demonstrated in an animal study. Our results warrant further human clinical trials.
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Affiliation(s)
- Joon Kon Kim
- Department of Otorhinolaryngology- Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Woo Cho
- Department of Otorhinolaryngology- Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyojin Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | - Hyung Gu Kim
- Department of Otorhinolaryngology- Head and Neck Surgery, Hanyang National University Guri Hospital, Guri, Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology- Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology- Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyun Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, National Police Hospital, Seoul, Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology- Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Otorhinolaryngology- Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
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Li A, Zhao F, Zhao Y, Liu H, Wang Z. ATF4-mediated GDF15 suppresses LPS-induced inflammation and MUC5AC in human nasal epithelial cells through the PI3K/Akt pathway. Life Sci 2021; 275:119356. [PMID: 33737080 DOI: 10.1016/j.lfs.2021.119356] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022]
Abstract
AIMS Growth and differentiation factor 15 (GDF15) is a stress-related factor, which implicated in various diseases. This study aimed to investigate the role of GDF15 in LPS-mediated inflammation and to explore the potential underlying molecular mechanisms in human nasal epithelial cells (HNEpCs). MAIN METHODS HNEpCs were treated with LPS. GDF15 loss-of-function and gain-of-function experiments were performed. The expression of GDF15 by quantitative real-time PCR (RT-qPCR). The mRNA levels and secretion of inflammatory cytokines and MUC5AC were assessed by RT-qPCR and ELISA kits. LY294002 (PI3K inhibitor) and 740Y-P (PI3K agonist) were utilized to interfere with PI3k/Akt pathway. The relationship between GDF15 and ATF4 was identified by chromatin immunoprecipitation (ChIP) and luciferase reporter assay. KEY FINDINGS We observed that LPS triggered GDF15 expression. GDF15 ablation reduced the mRNA levels and secretion of inflammatory cytokines. GDF15 silencing led to the reduction of the MUC5AC mRNA level, protein level and secretion in response to LPS. Enhanced expression of GDF15 showed the opposite results. Furthermore, we found that GDF15 deficiency inhibited activation of the PI3K/Akt pathway, LY294002 treatment further enhanced the role of GDF15 suppression in inflammation and MUC5AC expression, while 740Y-P administration partly reversed the biological activities of GDF15 silencing. ATF4 could bind to the promoter of GDF15 and positively regulate GDF15 expression. Depression of ATF4 diminished the secretion of inflammatory cytokines and MUC5AC via regulation of GDF15. SIGNIFICANCE Our data suggest that GDF15 is regulated by ATF4 and suppresses LPS-induced inflammation and MUC5AC in human nasal epithelial cells through the PI3K/Akt pathway.
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Affiliation(s)
- An Li
- Department of Otolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, PR China
| | - Fangfang Zhao
- Department of Medical Imaging, Chang'an Hospital, Xi'an 710016, Shaanxi, PR China
| | - Yuxiang Zhao
- Department of Otolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, PR China
| | - Hui Liu
- Department of Otolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, PR China
| | - Zhou Wang
- Department of Otolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi, PR China.
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Unadkat SN, Pendolino AL, Auer D, Khwaja S, Randhawa PS, Andrews PJ, Saleh HA. The Evidence Base for the Benefits of Functional Septorhinoplasty and its Future Post COVID-19. Facial Plast Surg 2021; 37:625-631. [PMID: 33676375 DOI: 10.1055/s-0041-1725162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Ever since the introduction of the concept of Procedures of Limited Clinical Value (PoLCV), procedures such as functional septorhinoplasty have been subject to additional funding restrictions within the British National Health Service. Recent publications have suggested that 10% of Clinical Commissioning Groups in the United Kingdom no longer fund septorhinoplasty surgery irrespective of the indications, including congenital malformations or post-trauma, and despite the strong evidence available in the literature in treating a range of health conditions. Thus, inequity exists across the country. At present functional septorhinoplasty surgery is frequently but incorrectly grouped together with aesthetic rhinoplasty, both of which are deemed to be cosmetic interventions. Moreover, as we exit the peak of the current coronavirus disease 2019 (COVID-19) pandemic, procedures deemed to be of lower clinical priority will potentially be at risk throughout Europe. The purpose of this review is twofold; the first is to put forward the evidence to commissioners in favor of functional septorhinoplasty surgery on patient well-being and mental health; the second is to demonstrate why functional septorhinoplasty surgery is a distinct procedure from aesthetic rhinoplasty and why it ought not to be classified as a procedure of limited clinical value.
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Affiliation(s)
- Samit N Unadkat
- Department of Rhinology and Facial Plastic Surgery, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom
| | - Alfonso Luca Pendolino
- Department of Rhinology and Facial Plastic Surgery, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom.,Ear Institute, University College London, United Kingdom
| | - Deborah Auer
- Department of Otolaryngology, Charing Cross Hospital, London, United Kingdom
| | - Sadie Khwaja
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Premjit S Randhawa
- Department of Rhinology and Facial Plastic Surgery, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom
| | - Peter J Andrews
- Department of Rhinology and Facial Plastic Surgery, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom.,Ear Institute, University College London, United Kingdom
| | - Hesham A Saleh
- Department of Otolaryngology, Charing Cross Hospital, London, United Kingdom
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Balsevicius T, Padervinskis E, Pribuisiene R, Kuzminiene A, Vaitkus S, Liutkevicius V. Cross-cultural adaptation and validation of Lithuanian-NOSE scale. Eur Arch Otorhinolaryngol 2020; 278:1053-1058. [PMID: 32886183 DOI: 10.1007/s00405-020-06341-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate validity and reliability of Lithuanian version of Nasal Obstruction Symptom Evaluation Scale (L-NOSE), designed for the assessment of nasal obstruction. METHODS Cross-cultural adaptation of L-NOSE was accomplished according to generally accepted methodology. L- NOSE was tested for its reliability, validity, and responsiveness in the group of 50 septoplasty patients and 100 healthy volunteers' controls. RESULTS L- NOSE showed good internal consistency (Cronbach's alpha coefficient 0.796 for test, 0.791 for retest, 0.792 for post-operative group, and 0.817 for control group) scores and high test-retest reliability (r = 0.94, p < 0.01) scores. In patients' group, positive moderate correlations between L-NOSE scores and Sino-nasal Outcome Test-22 logically similar domain scores were found, thus indicating good convergent construct validity. L-NOSE scores for control subjects were generally lower than for patients with nasal obstruction (p < 0.001), thereby indicating good discriminant validity of questionnaire. The exploratory factor analysis confirmed one-factor structure of questionnaire. The component matrix of L-NOSE ranged from 0.667 to 0.781 (KMO = 0.754, p < 0.0001). The mean L-NOSE score improved from 58.4 ± 18.2 points to 11.1 ± 9.5 points after septoplasty (p < 0.0001), indicating good responsiveness of questionnaire. CONCLUSION The L-NOSE questionnaire is a valid instrument with satisfactory reliability, validity, and responsiveness.
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Affiliation(s)
- Tomas Balsevicius
- Department of Otorinolaryngology of Lithuanian, University of Health Sciences, Eivenių g. 2, 50161, Kaunas, Lithuania.
| | - Evaldas Padervinskis
- Department of Otorinolaryngology of Lithuanian, University of Health Sciences, Eivenių g. 2, 50161, Kaunas, Lithuania
| | - Ruta Pribuisiene
- Department of Otorinolaryngology of Lithuanian, University of Health Sciences, Eivenių g. 2, 50161, Kaunas, Lithuania
| | - Alina Kuzminiene
- Department of Otorinolaryngology of Lithuanian, University of Health Sciences, Eivenių g. 2, 50161, Kaunas, Lithuania
| | - Saulius Vaitkus
- Department of Otorinolaryngology of Lithuanian, University of Health Sciences, Eivenių g. 2, 50161, Kaunas, Lithuania
| | - Vykintas Liutkevicius
- Department of Otorinolaryngology of Lithuanian, University of Health Sciences, Eivenių g. 2, 50161, Kaunas, Lithuania
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Li CH, Sayeau K, Ellis AK. Air Pollution and Allergic Rhinitis: Role in Symptom Exacerbation and Strategies for Management. J Asthma Allergy 2020; 13:285-292. [PMID: 32922045 PMCID: PMC7457822 DOI: 10.2147/jaa.s237758] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/12/2020] [Indexed: 01/24/2023] Open
Abstract
This article reviews the current understanding of the role of air pollution in both the symptom exacerbation and rising prevalence of allergic rhinitis (AR) for the development of future AR therapeutics and management strategies. We discuss the epidemiological evidence for this relationship through birth cohort studies, the economic impact of AR, and the influence of air pollution through the lens of the exposome framework of allergic disease development. This is followed by a discussion on the influence of diesel exhaust and diesel exhaust particles (DEP) from motor vehicle emissions and their implication in the rising prevalence of allergic disease and allergic sensitization through triggering inflammatory signalling pathways that exacerbate AR symptoms. Finally, a summary is provided of clinical trials assessing the influence of air pollution on AR with a depiction of currently available therapies and management strategies. Future directions in the development of AR modalities given the air pollution-mediated symptom exacerbation are challenged with unfolding the complex gene–environment interaction product of heterogenous AR presentation.
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Affiliation(s)
- Carmen H Li
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.,Allergy Research Unit, Kingston Health Sciences Center - KGH Site, Kingston, ON, Canada
| | - Kyle Sayeau
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.,Allergy Research Unit, Kingston Health Sciences Center - KGH Site, Kingston, ON, Canada
| | - Anne K Ellis
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.,Allergy Research Unit, Kingston Health Sciences Center - KGH Site, Kingston, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada
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McCoul ED, Mohammed AE, Debbaneh PM, Carratola M, Patel AS. Differences in the Intended Meaning of Congestion Between Patients and Clinicians. JAMA Otolaryngol Head Neck Surg 2020; 145:634-640. [PMID: 31145430 DOI: 10.1001/jamaoto.2019.1023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Importance Disagreement in the presumed meaning of common medical terms may impair communication between patients and caregivers. Objective To clarify the intended meaning of the term congestion among otolaryngology clinic patients and to identify discrepancies in definitions between patients and otolaryngologists. Design, Setting, and Participants In this cross-sectional survey study from an otolaryngology clinic at an academic center, a semantics-based questionnaire was provided to consecutive new patients during intake for a clinical encounter from December 2016 through February 2017, and to 31 otolaryngologists and 28 nonotolaryngologist physicians in February 2018. Respondent definitions for congestion were selected from a list of 16 proposed terms covering 4 general categories. Main Outcome and Measures Symptom categories for term used to describe congestion by patients and clinicians. Results Among 226 patient respondents (133 female [58.8%]; mean [SD] age, 54 [15.6] years), the most commonly selected definitions for congestion were from the obstructive (199; 88.1%) and mucus-related (196; 86.7%) symptom categories. More than 1 general category was selected by 208 patients (92.0%), whereas 11 patients (4.9%) described congestion only in terms of mucus-related symptoms. Definitions were limited to upper respiratory tract symptoms by 83 (36.7%) patients and lower respiratory tract symptoms by 2 (0.9%) patients. Among 31 otolaryngologists, congestion was most frequently defined in terms of obstructive symptoms (difference, 11.9%; 95% CI, 7.4%-16.5%). In contrast, patients more often described congestion in terms of pressure-related (difference, 38.8%; 95% CI, 7.5%-70.1%) or mucus-related (difference, 51.2%; 95% CI, 22.6%-79.9%) symptoms. A total of 22 otolaryngologists (71.0%) defined congestion using 1 to 4 symptoms, compared with only 69 patients (30.5%). Conclusions and Relevance The definition of congestion appears to be highly variable and ambiguous for many patients. Moreover, the findings suggest that patients and otolaryngologists generally do not describe congestion using the same terms.
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Affiliation(s)
- Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana.,Ochsner Clinical School, University of Queensland, New Orleans, Louisiana.,Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,Associate Editor
| | - Alaa E Mohammed
- Center for Outcomes and Health Services Research, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Peter M Debbaneh
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Maria Carratola
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Amit S Patel
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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30
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Physiological changes in the size of the septal swell body correlate with changes in inferior turbinate size. The Journal of Laryngology & Otology 2020; 134:323-327. [PMID: 32241312 DOI: 10.1017/s0022215120000675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The nasal septal swell body is a normal anatomical structure located in the superior nasal septum anterior to the middle turbinate. However, the impact of the septal swell body in nasal breathing during normal function and disease remains unclear. This study aimed to establish that the septal swell body varies in size over time and correlates this with the natural variation of the inferior turbinates. METHOD Consecutive patients who underwent at least two computed tomography scans were identified. The width and height of the septal swell body and the inferior turbinates was recorded. A correlation between the difference in septal swell body and turbinates between the two scans was performed using a Pearson's coefficient. RESULTS A total of 34 patients (53 per cent female with a mean age of 58.3 ± 20.2 years) were included. The mean and mean difference in septal swell body width between scans for the same patient was 1.57 ± 1.00 mm. The mean difference in turbinate width between scans was 2.23 ± 2.52 mm. A statistically significant correlation was identified between the difference in septal swell body and total turbinate width (r = 0.35, p = 0.04). CONCLUSION The septal swell body is a dynamic structure that varies in width over time in close correlation to the inferior turbinates. Further research is required to quantify its relevance as a surgical area of interest.
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31
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Soler ZM, Nguyen SA, Salvador C, Lackland T, Desiato VM, Storck K, Schlosser RJ. A novel device combining acoustic vibration with oscillating expiratory pressure for the treatment of nasal congestion. Int Forum Allergy Rhinol 2020; 10:610-618. [PMID: 32104962 PMCID: PMC7317541 DOI: 10.1002/alr.22537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic nasal congestion affects 20% of the population with significant impact on quality of life. This study investigated the simultaneous administration of nasal acoustic vibration and oscillating expiratory pressure for the treatment of nasal congestion. METHODS Patients with chronic nasal congestion but without fixed anatomic obstruction participated in a prospective clinical study applying simultaneous acoustic vibrations and positive expiratory pressure to the nasal cavity twice daily over 5 weeks. Safety was assessed by rhinoscopy and patient questionnaires. Efficacy was assessed using peak nasal inspiratory flow (PNIF), visual analogue scale (VAS) of nasal symptoms, Total Nasal Symptom Score (TNSS), Nasal Obstruction and Septoplasty Effectiveness (NOSE) score, and the 22-item Sino-Nasal Outcome Test (SNOT-22). RESULTS Forty patients (mean age 39 years, 65% female) completed the study with no adverse effects. At the 2 week follow-up, PNIF improved by 25.0 L/min (31% increase from baseline, p < 0.001). At the 5 week follow-up, nasal congestion VAS improved from mean ± SD of 5.8 ± 2.4 to 2.6 ± 2.3, TNSS improved from 7.2 ± 3.5 to 3.5 ± 3.1, NOSE improved from 50.4 ± 19.9 to 23.3 ± 17.2, and SNOT-22 improved from 31.7 ± 20.3 to 14.2 ± 12.7, all p < 0.001. Eighty percent of patients would use the device again and 87.5% would recommend to others. CONCLUSION Simultaneous administration of acoustic vibration and oscillating expiratory pressure appears to be a safe treatment for chronic nasal congestion. Results from this initial study are promising with regard to efficacy but will require further study.
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Affiliation(s)
- Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Shaun A Nguyen
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Craig Salvador
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Thomas Lackland
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Vincent M Desiato
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Kristina Storck
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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32
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Clark JH, Baroody FM, Naclerio RM. A Pragmatic Approach Towards Sinonasal Diseases. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1556-1558. [PMID: 32081786 DOI: 10.1016/j.jaip.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/27/2020] [Accepted: 02/02/2020] [Indexed: 11/18/2022]
Abstract
Sinonasal disease in its multiple forms affects billions of people worldwide. Although physicians train to precisely diagnose a patient and then treat appropriately, the sheer number of people afflicted with sinonasal disease precludes this approach. We argue that patients should first be treated with an intranasal corticosteroid for 2 weeks. Based on their perceived response, they should be triaged. Those who respond well can be instructed on how to continue to manage their disease. Those who do not would be referred to allergists or otolaryngologists for diagnosis and treatment. We believe this pragmatic approach is safe, provided first-line physicians, physician assistants, and nurse practitioners recognize some warning symptoms and signs of serious, but infrequently occurring, sinonasal diseases that would not lend themselves to this proposed approach.
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Affiliation(s)
- James H Clark
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Fuad M Baroody
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Ill
| | - Robert M Naclerio
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
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Gadkaree SK, Fuller JC, Justicz NS, Derakhshan A, Mohan S, Yu PK, Lindsay RW. A Comparative Health Utility Value Analysis of Outcomes for Patients Following Septorhinoplasty With Previous Nasal Surgery. JAMA FACIAL PLAST SU 2020; 21:402-406. [PMID: 31194223 DOI: 10.1001/jamafacial.2019.0176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Using health utility values (HUVs) as an outcome measure for surgical procedures, including rhinoplasty, allows for a standardized measurement of the qualitative and financial benefit of that procedure on overall health. Objective To use Euroqol 5-Dimension (EQ-5D)-derived HUVs to evaluate nasal obstruction outcomes following surgery between primary rhinoplasty (PSRP) and rhinoplasty with previous nasal surgery (RNS) in a prospective cohort study. Design, Setting, and Participants A single-institution prospective cohort study between 2013 and 2017 was carried out including 185 patients who underwent RNS before functional rhinoplasty and 278 patients who underwent PSRP for nasal obstruction. The analysis was carried out between December 2018 and February 2019. Main Outcomes and Measures Patients in the RNS cohort and PSRP cohort who completed the EQ-5D questionnaire immediately prior to surgery and postoperatively at 2, 4, 6, and 12 months were included in the study. The EQ-5D scores were converted to HUV scores and compared to evaluate for improvement in health status following surgery. Results Of the 185 patients in the RNS cohort, 97 (52%) were women and the mean (SD) age was 42.6 (13.4) years. Of the 278 in the PSRP cohort, 156 (55%) were women and the mean (SD) age was 36.0 (15.8) years. Both cohorts experienced significant improvement in HUV postoperatively. The mean (SD) HUV values were decreased in the RNS cohort versus the PSRP cohort both preoperatively (0.85 [0.16] versus 0.89 [0.14]) and postoperatively at 1 year (0.92 [0.14] versus 0.94 [0.11]); however, the difference in HUV was not statistically significant after 6 months postoperatively. Patients in the RNS cohort were typically older (76 [41%] older than 40 years vs 84 [31%], P = .02) and more likely to have sleep apnea (31 [19%] vs 24 [10%], P = .01) than in the PSRP cohort. On multivariable analysis, the use of spreader grafts and alar rim grafts in the PSRP cohort was significantly associated with improved HUV at 12 months. (r = -0.06; 95% CI, -0.11 to -0.01, P = .03). Conclusions and Relevance Patients with a history of prior nasal surgery may represent a unique cohort when assessing health utility outcomes. Euroqol 5-dimension questionnaire-derived HUVs are a valid predictor of outcomes in all patients who undergo septorhinoplasty. Although outcomes were significantly improved for both cohorts, previous surgical history should be considered when performing cost utility analysis on the benefits of functional rhinoplasty. Level of Evidence 3.
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Affiliation(s)
- Shekhar K Gadkaree
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
| | | | - Natalie S Justicz
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Adeeb Derakhshan
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
| | | | - Phoebe K Yu
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Robin W Lindsay
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
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Wong E, Deboever N, Chong J, Sritharan N, Singh N. Isolated Topical Decongestion of the Nasal Septum and Swell Body Is Effective in Improving Nasal Airflow. Am J Rhinol Allergy 2020; 34:417-421. [PMID: 32008353 DOI: 10.1177/1945892420902913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Topical nasal decongestant sprays are used commonly in routine otolaryngology practice to reduce the symptoms of nasal airway obstruction (NAO) through vasoconstriction, thereby reducing the bulk of vasoerectile tissue and increasing nasal airflow. Such tissue is found predominantly on the lateral wall of the nose within the inferior turbinates (ITs), but recent evidence suggests that it may also be found medially within the nasal septal swell body (SSB). Objective To determine whether isolated topical decongestion of the medial nasal wall, targeting the SSB, is as effective as isolated decongestion of the lateral nasal wall, targeting the IT, in maximizing nasal patency. Methods A double-blinded, randomized controlled, crossover study was performed investigating the effect of decongestion of the lateral nasal wall or septum in isolation on nasal airflow. Isolated decongestion was performed by placing a cottonoid, soaked in oxymetazoline and attached to a silastic sheet, into the nasal cavity randomly facing either the septum or lateral nasal wall, bilaterally. Anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow (PNIF), and subjective patient-reported outcomes (Sinonasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation (NOSE) scores) were recorded at baseline and postdecongestion. Decongestion of the alternate site was then performed at a later date. Results A total of 20 healthy volunteers (30% females, mean age 26.6 ± 3.8 years) were recruited. Improvements in nasal obstruction and SNOT-22 scores were found following decongestion of the septum compared with baseline (mean difference: 0.82, t = 2.32, P = .04; mean difference: 3.30, t = 2.50, P = .04, respectively). Improvements in mean inspiratory flow, minimal cross-sectional area, volume, and PNIF were also demonstrated. Conclusion This study suggests that the SSB contains erectile tissue that responds to topical decongestant therapy in a similar manner to IT tissue. The SSB may represent a novel target in surgery for NAO.
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Affiliation(s)
- Eugene Wong
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Nathaniel Deboever
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Jessica Chong
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Niranjan Sritharan
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Narinder Singh
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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35
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Cairns A, Bogan R. The SinuSonic: reducing nasal congestion with acoustic vibration and oscillating expiratory pressure. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:305-310. [PMID: 31695522 PMCID: PMC6718060 DOI: 10.2147/mder.s212207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/24/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Nasal congestion is common, burdensome, and costly. Current treatments are limited by partial/temporary relief and untoward side-effects. The goal of this study was to evaluate the performance of a novel, non-pharmacologic nasal device designed to reduce nasal congestion via simultaneous administration of acoustic vibration and gentle oscillating expiratory pressure. Materials and methods Patients were recruited from a tertiary care sleep clinic and all reported moderate-to-severe nasal congestion for >2 weeks (N=14; 64% female; 71% Caucasian). Visual analog scale (VAS) (10 items) quantifying nasal congestion and ease-of-breathing were administered before and after SinuSonic application for 2–5 mins. Global and clinical impressions of change were assessed post-administration. Results Wilcoxon signed-rank tests indicated that post-test ranks were statistically improved from pre-test ranks for both VAS measures (congestion p=0.002; ease-of-breathing p=0.003). A binomial test indicated that the proportion of patients with ≥ minimal improvement on clinical and global impressions of change was higher than expected (100% vs expected 75%, p=0.018). Conclusion Overall, outcomes were encouraging from this small pilot study with effect sizes in the moderate to large range and no reports of discomfort. It is probable that this device will provide acute, and possibly chronic, relief of nasal congestion with minimal side-effects.
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Affiliation(s)
| | - Richard Bogan
- Sleepmed, Inc., Columbia, SC, USA.,Bogan Sleep Consultants, LLC, Columbia, SC, USA.,The University of South Carolina Medical School, Columbia, SC, USA.,The Medical University of South Carolina, Charleston, SC, USA
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36
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Evaluation of Nasal Decongestants by Literature Review. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2019-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Over-the-counter drugs are medicines that are available to consumers without a prescription. The most common оver - the-counter preparations in self - medication are nasal decongestants that can be used systemically or locally in the form of drops or nasal sprays. The most common indications for nasal decongest-ants are viral infections and allergic conditions in order to alleviate the symptoms so it is necessary to inform the users about the type of drug, the active substance it contains and the correct dosage regimen. Given their availability and the prevailing safety precaution, these preparations can lead to numerous prolonged conditions and complications. The mechanism of action of nasal decongestants is based on the reduction of blood vessels’ swelling in the nose, which helps the opening of the airway. As a result, most nasal decongestants cause vasoconstriction (narrowing of blood vessels). There are nasal decongestants that block histamine and have a good effect on people who suffer from seasonal allergies.
Availability (free sale) and prolonged use of the decongestant lead to a decrease in the sensitivity of the alpha receptor, which leads to the need to increase the dose at shorter time intervals to achieve the same effect. As a consequence, patients use excessive, uncontrolled doses of nasal decongestants, which is a public problem and warns of the necessity of identification and the taking of measures to prevent their uncontrolled procurement and use.
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Mengko SK, Soemantri RD, Juniati SH. Correlation Between Objective Evaluation Result of Nasal Congestion and Life Quality in Patients with Acute Rhinosinusitis. Indian J Otolaryngol Head Neck Surg 2019; 71:1929-1934. [PMID: 31763270 PMCID: PMC6848427 DOI: 10.1007/s12070-018-1333-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/28/2018] [Indexed: 11/28/2022] Open
Abstract
Rhinosinusitis is an inflammatory process involving the nasal mucosa and paranasal sinuses. Rhinitis and sinusitis generally occur simultaneously and thus the current terminology used is rhinosinusitis. The blind nose can negatively affect the overall quality of life including the physical or emotional condition of the sufferer and disruption to work or school (reduced productivity and difficulty in concentrating). To analyse correlation between objective evaluation results of nasal congestion through NIPF and life quality based on sinonasal outcome Test-20 score in patients with acute rhinosinusitis. The study was conducted at Otolaryngology Outpatient Clinic at Dr. Soetomo General Hospital Surabaya. The time of study began in July 2011 until the minimum sample size was met. The sample of the study was patients diagnosed with acute rhinosinusitis treated at Otolaryngology Outpatient Clinic at Dr. Soetomo General Hospital Surabaya and meet the research criteria. Based on statistical analysis with Spearman rank correlation test, correlation between NIPF value and SNOT-20 score on 16 samples got correlation coefficient-0.310 and p = 0.243. The scatter diagram showed the NIPF value variables and the SNOT-20 scores being scattered in uneven spots and erratic patterns. This indicated that an objective evaluation of nasal congestion based on NIPF and subjective assessment of quality of life based on SNOT-20 score was not obtained correlation (p > 0.05). The results of the objective nasal obstruction examination based on Nasal Inspiratory Peak Flow have no correlation with subjective subjective assessment of quality of life based on Sino-Nasal Outcome Test-20 score in patients with acute rhinosinusitis.
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Affiliation(s)
- Steward Keneddy Mengko
- Department of Otolaryngology, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Roestiniadi Djoko Soemantri
- Department of Otolaryngology, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Sri Herawati Juniati
- Department of Otolaryngology, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo General Hospital, Surabaya, Indonesia
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Mohan S, Fuller JC, Ford SF, Lindsay RW. Diagnostic and Therapeutic Management of Nasal Airway Obstruction: Advances in Diagnosis and Treatment. JAMA FACIAL PLAST SU 2019; 20:409-418. [PMID: 29801120 DOI: 10.1001/jamafacial.2018.0279] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Nasal airway obstruction (NAO) is a common complaint in the otolaryngologist's office and can have a negative influence on quality of life (QOL). Existing diagnostic methods have improved, but little consensus exists on optimal tools. Furthermore, although surgical techniques for nasal obstruction continue to be developed, effective outcome measurement is lacking. An update of recent advances in diagnostic and therapeutic management of NAO is warranted. Objective To review advances in diagnosis and treatment of NAO from the last 5 years. Evidence Review PubMed, Embase, CINAHL, the Cochrane Library, LILACS, Web of Science, and Guideline.gov were searched with the terms nasal obstruction and nasal blockage and their permutations from July 26, 2012, through October 23, 2017. Studies were included if they evaluated NAO using a subjective and an objective technique, and in the case of intervention-based studies, the Nasal Obstruction Symptom Evaluation (NOSE) scale and an objective technique. Exclusion criteria consisted of animal studies; patients younger than 14 years; nasal foreign bodies; nasal masses including polyps; choanal atresia; sinus disease; obstructive sleep apnea or sleep-disordered breathing; allergic rhinitis; and studies not specific to nasal obstruction. Findings The initial search resulted in 942 articles. After independent screening by 2 investigators, 46 unique articles remained, including 2 randomized clinical trials, 3 systematic reviews, 3 meta-analyses, and 39 nonrandomized cohort studies (including a combined systematic review and meta-analysis). An aggregate of approximately 32 000 patients were reviewed (including meta-analyses). Of the subjective measures available for NAO, the NOSE scale is outstanding with regard to disease-specific validation and correlation with symptoms. No currently available objective measure can be considered a criterion standard. Structural measures of flow, pressure, and volume appear to be necessary but insufficient to assess NAO. Therefore, novel variables and techniques must continue to be explored in search of an ideal instrument to aid in assessment of surgical outcomes. Conclusions and Relevance Nasal airway obstruction is a clinical diagnosis with considerable effects on QOL. An adequate diagnosis begins with a focused history and physical examination and requires a patient QOL measure such as the NOSE scale. Objective measures should be adjunctive and require further validation for widespread adoption. These results are limited by minimal high-quality evidence among studies and the risk of bias in observational studies. Level of Evidence NA.
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Affiliation(s)
- Suresh Mohan
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Jennifer C Fuller
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Stephanie Friree Ford
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Robin W Lindsay
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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Whyte A, Boeddinghaus R. Imaging of adult nasal obstruction. Clin Radiol 2019; 75:688-704. [PMID: 31515050 DOI: 10.1016/j.crad.2019.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/25/2019] [Indexed: 12/15/2022]
Abstract
The commonest causes of nasal obstruction are rhinitis and chronic rhinosinusitis, which affect up to 30% and 14% of the adult population, respectively. The global financial burden is huge, estimated at $5 billion for rhinitis and $8.6 billion for chronic rhinosinusitis per annum in the USA. On referral for imaging, computed tomography (CT) is indicated initially when there is a suboptimal response to medical treatment of these mucosal diseases or there are "red flags," such as persistent unilateral obstruction, epistaxis, pain, and orbital or neurological symptoms. A mass visible at rhinoscopy or endoscopy in the nose or nasopharynx and lymphadenopathy are further indications. The anterior (cartilaginous) nose plays a key role in the aetiology of nasal obstruction as it accounts for 50-75% of the total resistance to airflow in the upper airway. It has been ignored in the imaging literature, but extensively evaluated by clinicians using a range of methods, including CT. Oblique reconstructions perpendicular to the parabolic curve of lamellar airflow provide accurate assessment of the anterior nose. A thorough and systematic approach to assessing the nose addresses the discrepancy between imaging and clinical evaluation of structural causes of nasal obstruction, especially septal deviation, reported in the surgical literature. Nasal tumours are a very uncommon cause of nasal obstruction; magnetic resonance imaging is commonly performed to assess their full extent and improve the specificity of diagnosis.
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Affiliation(s)
- A Whyte
- Head and Neck Imaging, Perth Radiological Clinic, Subiaco, WA 6008, Australia; Department of Surgery, University of Western Australia, Nedlands, WA 6009, Australia; Departments of Radiology and Medicine, University of Melbourne, Carlton, Victoria 3000, Australia.
| | - R Boeddinghaus
- Head and Neck Imaging, Perth Radiological Clinic, Subiaco, WA 6008, Australia; Department of Surgery, University of Western Australia, Nedlands, WA 6009, Australia
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Paksoy ZB, Cayonu M, Yucel C, Turhan T. The treatment efficacy of nasal polyposis on olfactory functions, clinical scoring systems and inflammation markers. Eur Arch Otorhinolaryngol 2019; 276:3367-3372. [PMID: 31473779 DOI: 10.1007/s00405-019-05619-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 08/24/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effect of the medical and the surgical treatment on the olfactory functions, clinical scoring systems and inflammation markers in patients with nasal polyposis. In addition, the secondary aim was to investigate the correlation between those investigated parameters. SUBJECTS AND METHODS A total of 30 patients, who completed the standardized medical and surgical treatment and also came to 3 months of follow-ups regularly after the surgery, were included in the study. The Sniffin' Sticks olfactory tests, radiological and the endoscopic stagings, liver-expressed chemokine (CCL16) and endothelin (ET) levels and sino-nasal outcome test-22 (SNOT-22) were performed at the initial and at the end of the study. RESULTS The current study had four major findings: (1) significant improvement in odor functions after treatment was determined; however, the majority of the patients had been already hyposmic. (2) In addition, significant improvement was found in ET and CCL16 levels, SNOT-22 results, and radiologic and endoscopic stagings at the end of the study. (3) However, there was no correlation between the olfactory functions and the investigated parameters. (4) There was a positive correlation between polyp recurrence and ET levels. CONCLUSION The standardized medical and surgical treatment provided a significant improvement in the olfactory functions. However, only one patient (3.3%) had become normosmic at the end of the study.
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Affiliation(s)
- Zehra Betul Paksoy
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Talatpasa Avenue, Ankara, 06100, Turkey
| | - Melih Cayonu
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Talatpasa Avenue, Ankara, 06100, Turkey.
| | - Cigdem Yucel
- Department of Clinical Biochemistry, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Turan Turhan
- Department of Clinical Biochemistry, Ankara Numune Training and Research Hospital, Ankara, Turkey
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May JR, Dolen WK. Evaluation of Intranasal Corticosteroid Sensory Attributes and Patient Preference for Fluticasone Furoate for the Treatment of Allergic Rhinitis. Clin Ther 2019; 41:1589-1596. [PMID: 31402060 DOI: 10.1016/j.clinthera.2019.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Allergic rhinitis (AR) is a highly prevalent disease, affecting the quality of life of millions of Americans. Intranasal corticosteroids (INCs) are widely recommended as first-line therapy for moderate to severe AR. Although these drugs exhibit similar safety and efficacy, a potentially differentiating factor within this class is the varying sensory attributes associated with each INC. The objective of this literature review was to evaluate product characteristics, sensory attributes, and patient preferences of fluticasone furoate intranasal spray (FFNS) compared with other INCs. METHODS A narrative literature search for studies evaluating FFNS was performed in MEDLINE and Google Scholar. Key terms included "allergic rhinitis," "anti-allergic agents," "intranasal administration," "fluticasone furoate," and "patient preference." Studies published from 2007 to present were included. Nine trials met the search criteria, each evaluating FFNS versus placebo or other INCs for efficacy, safety, and/or preference, and were included. Approximately 2400 patients with AR were enrolled across varying study protocols. FINDINGS In 4 placebo-controlled trials, FFNS showed significant efficacy in relieving symptoms of AR and a tolerable safety profile. Three trials evaluating FFNS and fluticasone propionate nasal spray (FPNS) found that FFNS was significantly preferred over FPNS regarding scent, aftertaste, and leakage down the throat/nose. The results of 2 trials found that FFNS was preferred overall over mometasone furoate nasal spray (MFNS). IMPLICATIONS INCs are effective first-line treatments for AR and show significant reduction in nasal and ocular symptoms. Patients preferred the scent, aftertaste, and mist gentleness of FFNS ∼2:1 over the same sensory attributes of FPNS. Patients experienced less negative sensory characteristics with FFNS compared with MFNS, preferring FFNS to MFNS overall. Selecting an INC with favorable attributes in accordance with patient preferences could potentially improve adherence, therapeutic outcomes, and health care costs.
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Affiliation(s)
- J Russell May
- University of Georgia College of Pharmacy, Augusta, GA, USA.
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Saadi R, Loloi J, Schaefer E, Lighthall JG. Outcomes of Cadaveric Allograft versus Autologous Cartilage Graft in Functional Septorhinoplasty. Otolaryngol Head Neck Surg 2019; 161:779-786. [PMID: 31385746 DOI: 10.1177/0194599819866812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our goal was to elucidate the efficacy and outcome profile of cadaveric allografts (homograft costal cartilage) in functional septorhinoplasty as compared with autografts (quadrangular cartilage, conchal cartilage, and autologous costal cartilage). STUDY DESIGN Retrospective chart review. SETTING Otolaryngology division of the Penn State Health Milton S. Hershey Medical Center. SUBJECTS AND METHODS A chart review of a single surgeon's practice was conducted with Current Procedural Terminology codes for septorhinoplasty (30410, 30420, 30430, 30435, 30450, 30465) from August 1, 2014, to August 1, 2017. All patients underwent functional septorhinoplasty for a chief complaint of nasal obstruction. Outcomes were collected up to 12 months following the operation and included the validated Nasal Obstruction Symptom Evaluation (NOSE), infection rate, malposition/warping of the graft, need for revision surgery, and graft loss. RESULTS A total of 171 cases were included in our data analysis. On multivariate analysis, there were no significant differences between patients who had autografts and those who had allografts in 3-, 6-, or 12-month postoperative NOSE score. Preoperative NOSE score was the only covariate to demonstrate a significant positive relationship to postoperative NOSE score. Regarding outcomes between autograft and allograft, no significant differences were found in rate of graft resorption (3.4% vs 5.6%, P = .680), graft warping (3.4% vs 0%, P = .309), infection (0% vs 1.9%, P = .316), or need for revision surgery (4.3% vs 5.6%, P = .709). CONCLUSION Autologous grafting is often the first choice in septorhinoplasty because of its presumed resistance to infection and resorption. Similar to autologous grafts, allografts are resistant to infection and resorption and demonstrate prolonged efficacy following functional septorhinoplasty.
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Affiliation(s)
- Robert Saadi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Justin Loloi
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Eric Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Majidi MR, Asghari M, Abbaszadeh E, Saberi Demneh A, Hejrati S. Effect of Functional Endoscopic Sinus Surgery on the Voice Quality among Patients with Rhinosinus Polyposis. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2019; 31:197-202. [PMID: 31384584 PMCID: PMC6666942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 02/18/2018] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Rhinosinus polyposis is associated with voice quality reduction. There has been little evidence about the efficacy of rhinosinus polyps surgery on patients' voice quality so far. The aim of the present study was to evaluate the nasality and acoustic voice changes after rhinosinus polyposis surgery. MATERIALS AND METHODS The population in this study composed of 30 eligible patients with rhinosinusitis and rhinosinus polyposiss. The functional endoscopic sinus surgery (FESS) was the therapeutic intervention. Acoustic voice parameters were jitter (%), shimmer (db), noise to harmonic ratio (NHR), and fundamental frequency (F0) for the vowels [a, o, e, aa, ie, and ou]. For nasality evaluation, the articulation of vowel [a] was examined using nasometer device. The changes regarding the patients' voice were evaluated one day before and one month after the surgery. RESULTS The mean age of the participants was 41.2±14.3 years. Considering gender distribution, 20 (66.7%) subjects were men. After the operation, the nasality increased significantly from 40.8% to 74.3% (P<0.001). In addition, the findings revealed the increase of shimmer and F0 (P>0.05). On the other hand, jitter and NHR changes were insignificant. CONCLUSION The findings of the current study showed that hyponasality decreased a month after the treatment of rhinosinus polyposis with FESS. However, the acoustic quality of voice had no significant changes after the surgery.
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Affiliation(s)
- Mohammad Reza Majidi
- Sinus and Surgical Endoscopic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Asghari
- Department of Otorhinolaryngology, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Enciye Abbaszadeh
- Department of Speech and language Rehabitation, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Saberi Demneh
- Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Sohaila Hejrati
- Department of Speech and language Rehabitation, Faculty of Rehabitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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Association between Sleep Duration and Chronic Rhinosinusitis among the Korean General Adult Population: Korea National Health and Nutrition Examination Survey. Sci Rep 2019; 9:7158. [PMID: 31073196 PMCID: PMC6509136 DOI: 10.1038/s41598-019-43585-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/24/2019] [Indexed: 12/19/2022] Open
Abstract
An association between sleep duration and a wide spectrum of diseases has been reported, but little is known about its relationship with chronic rhinosinusitis (CRS). The present study aimed to investigate whether sleep duration was associated with CRS after adjusting for potential confounding factors in Korean adults. We analyzed data from the Korea National Health and Nutrition Examination Survey 2005–2009 and enrolled 24,658 participants aged ≥20 years. Data regarding sociodemographic characteristics, self-reported sleep duration, CRS, and other medical diseases were collected from questionnaires. Multiple logistic regression analyses were used to identify the relationship between sleep duration and CRS. The overall prevalence of CRS was 4.4%. Subjects with sleep duration ≤5 hours showed a highest prevalence for CRS (6.1%), compared to subjects with longer sleep duration (p = 0.02). After adjusting for covariates (age, sex, household income, residency, dwelling type, education, depression, alcohol, allergic rhinitis, chronic otitis media, angina or myocardial infarction, asthma, chronic obstructive pulmonary disease, bronchiectasis, and gastric ulcer), the sleep duration of ≤5 hours was significantly associated with CRS (OR = 1.502; 95% CI = 1.164–1.938). Only in older subgroup (≥50 years old), shorter sleep duration (≤5 hours) showed higher odds for CRS. These results suggested that sleep duration may be negatively associated with CRS in older Korean adults.
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Gillman GS, Staltari GV, Chang YF, Mattos JL. A Prospective Study of Outcomes of Septoplasty with Turbinate Reductions in Patients with Allergic Rhinitis. Otolaryngol Head Neck Surg 2019; 160:1118-1123. [PMID: 30909804 DOI: 10.1177/0194599819838761] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Examine outcomes of septoplasty with turbinate reductions in patients with allergic rhinitis as compared to patients without allergic rhinitis using validated outcome and quality-of-life (QOL) instruments. STUDY DESIGN Prospective observational cohort study. SETTING Single surgeon, university hospital. SUBJECTS AND METHODS Consecutive study-eligible patients with a symptomatic nasal septal deviation, with (n = 30) or without (n = 30) documented allergic rhinitis, were enrolled from March 2014 to February 2017. All patients subsequently underwent nasal septoplasty and inferior turbinate reductions. Outcomes were studied using the Nasal Obstruction Symptom Evaluation (NOSE) scale, mini-Rhinoconjunctivitis Quality of Life Questionnaire (mini-RQLQ), and Ease-of-Breathing (EOB) Likert scores completed preoperatively and, together with a patient satisfaction Likert, at 3 and 6 months postoperatively. RESULTS NOSE scores, EOB scores, and mini-RQLQ scores improved significantly in both groups at 3 and 6 months postoperatively. Results were sustained from 3 to 6 months. Although mini-RQLQ scores in allergic patients were higher at all intervals, the magnitude of change in scores in both groups was comparable. CONCLUSION Although patients with allergic rhinitis report greater allergy-related QOL impairment (mini-RQLQ) on a day-to-day basis than nonallergic patients, this does not appear to attenuate the benefit they might experience from septoplasty and turbinate reductions when indicated for nasal obstruction. Furthermore, the symptomatic relief of their structural nasal obstruction appears to significantly improve their overall allergy-related quality of life. If appropriate expectations are set pre-operatively, allergic rhinitis is neither a contraindication nor a deterrent to septoplasty and turbinate reductions and these patients can reasonably expect a high degree of satisfaction post-operatively.
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Affiliation(s)
- Grant S Gillman
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Giuseppe V Staltari
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yue-Fang Chang
- 2 Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jose L Mattos
- 3 Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
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Anti-allergic rhinitis effects of caffeoylquinic acids from the fruits of Xanthium strumarium in rodent animals via alleviating allergic and inflammatory reactions. REVISTA BRASILEIRA DE FARMACOGNOSIA-BRAZILIAN JOURNAL OF PHARMACOGNOSY 2019. [DOI: 10.1016/j.bjp.2018.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Ehi Y, Ozlece HK. Electrophysiological assessment of the concentration and attention in patient with nasal polyposis. Asia Pac Allergy 2018; 8:e27. [PMID: 30079305 PMCID: PMC6073176 DOI: 10.5415/apallergy.2018.8.e27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 07/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background Nasal polyposis is a chronic disease presenting with nasal obstruction as the most frequent complaint. It has been documented that nasal polyposis results in deterioration of quality of life and disturbances of sleep. However, remarkable consequences of nasal polyposis such as psychological and cognitive outcomes are relatively poorly studied. Objective The aim of the present study was to evaluate whether there is an impairment of concentration and attention in nasal polyposis patients due to hypoxia caused by nasal obstruction. Methods This cross-sectional, case-control study was carried out on 30 male patients with nasal polyps and 30 healthy subjects serving as controls. Participant ages were 41.6 ± 10.2 years in the nasal polyps group and 41.3 ± 6.2 in the control group. All participants underwent systemic, neurological, and otorhinolaryngological examinations together with routine hematological and biochemical tests. Patients with nasal polyposis had bilateral complete obstruction of nasal cavity. P300 component of electroencephalography-derived event related potentials were used to monitor concentration and attention. Nasal polyposis and control groups were compared in terms of amplitude and latency of P300. Results There were significant differences between control and nasal polyposis groups in terms of latency of P300 (p < 0.001). Nasal polyposis patient latencies in P300 were longer than controls (345.8 ± 16.6 msec, 309.3 ± 16.6 msec, respectively). However, there were no significant differences between control and nasal polyposis groups in terms of amplitude of P300 (p > 0.05). Conclusion Results of the current study indicate that hypoxia due to complete nasal obstruction may result in impairment of attention and concentration in nasal polyposis patients. Assessment of patients with P300 latency subcomponent can be a useful diagnostic tool to detect cognitive and psychological consequences.
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Affiliation(s)
- Yusuf Ehi
- Department of Neurology, Kafkas University Medical School, Kars, Turkey
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Kim HJ, Nam YR, Nam JH. Flos Magnoliae Inhibits Chloride Secretion via ANO1 Inhibition in Calu-3 Cells. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2018; 46:1079-1092. [PMID: 29976084 DOI: 10.1142/s0192415x18500568] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Flos Magnoliae (FM, Chinese name: Xin-yi) is an oriental medicinal herb commonly used for symptomatic relief from allergic rhinitis, sinusitis, and headache, including in traditional Chinese and Korean medicine formulations. FM inhibits histamine release from mast cells and cytokine secretion from T cells. However, the mechanism of action of FM on the anoctamin-1 (ANO1) ion channel, which is responsible for nasal hypersecretion in allergic rhinitis, has not been elucidated. Therefore, in this study, we investigated the effect of a 30% ethanolic extract of FM (FMEtOH) and its chemical constituents on ANO1 activity. We used high-performance liquid chromatography analysis to identify five major chemical constituents of FMEtOH: vanillic acid, tiliroside, eudesmin, magnolin, and fargesin. Using a conventional whole-cell patch clamp method, we found that FMEtOH (30, 100, and 300[Formula: see text][Formula: see text]g/mL) and its chemical constituent tiliroside inhibited ANO1 activity in ANO1-overexpressing HEK293T cells. In addition, we found that the treatment of the airway epithelial cell line Calu-3 with interleukin 4 significantly increased Ca[Formula: see text] activated Cl[Formula: see text] current (ICaCC), but not cystic fibrosis transmembrane conductance regulator (CFTR)-mediated chloride current (ICFTR). FMEtOH and tiliroside specifically inhibited ICaCC. Thus, in this study, we identified a novel mechanism underlying the alleviation of allergic rhinitis by FMEtOH. Our results indicate that FMEtOH and its chemical constituent tiliroside are promising and potent agents for the prevention and treatment of allergic rhinitis.
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Affiliation(s)
- Hyun Jong Kim
- 1 Department of Physiology, Dongguk University College of Medicine, Gyeongju 38066, Republic of Korea.,2 Channelopathy Research Center (CRC), Dongguk University College of Medicine, Gyeonggi-do 10326, Republic of Korea
| | - Yu Ran Nam
- 1 Department of Physiology, Dongguk University College of Medicine, Gyeongju 38066, Republic of Korea.,2 Channelopathy Research Center (CRC), Dongguk University College of Medicine, Gyeonggi-do 10326, Republic of Korea
| | - Joo Hyun Nam
- 1 Department of Physiology, Dongguk University College of Medicine, Gyeongju 38066, Republic of Korea.,2 Channelopathy Research Center (CRC), Dongguk University College of Medicine, Gyeonggi-do 10326, Republic of Korea
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Rao NG, Kumar A, Wong JS, Shridhar R, Goswami DY. Effect of a Novel Photoelectrochemical Oxidation Air Purifier on Nasal and Ocular Allergy Symptoms. ALLERGY & RHINOLOGY 2018; 9:2152656718781609. [PMID: 29977658 PMCID: PMC6028155 DOI: 10.1177/2152656718781609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Photoelectrochemical oxidation (PECO) is a new air purification technology developed to reduce circulating indoor allergens. PECO removes particles as small as 0.1 nm with the destruction of organic matter otherwise not trapped by a traditional filter and removes volatile organic compounds. Objective We hypothesized that with daily use, the device would reduce user nasal and ocular allergy total symptom scores (TSS) within 4 weeks. Methods The study was performed among 46 individuals with self-reported allergies using a portable PECO air purifier. Self-reported TSS were calculated at baseline and weekly for 4 weeks following initiation of continuous use of the system. TSS was the sum of total nasal symptom scores (TNSS) and total ocular symptom scores (TOSS) for the week. Results There was a statistically significant change in overall TSS from baseline to 4 weeks (10.1 at baseline and 4.35 postintervention) resulting in a mean difference of 5.75 (95% confidence interval [CI] 4.32-7.18; P < .0001). There was a statistically significant change in TNSS from baseline to 4 weeks (6.3 at baseline and 3.04 postintervention) resulting in a mean difference of 3.26 (95% CI 2.33-3.19; P < .0001). There was a statistically significant change in TOSS from baseline to 4 weeks (3.82 at baseline and 1.3 postintervention) resulting in a mean difference of 2.52 (95% CI 1.74-3.3; P < .0001). Conclusion With the use of PECO air purification technology, TSS, TNSS, and TOSS decreased significantly. These improvements were consistent over the 4-week course of device use.
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Affiliation(s)
| | - Ambuj Kumar
- University of South Florida College of Medicine, Tampa, Florida
| | | | - Ravi Shridhar
- University of Central Florida College of Medicine, Orlando, Florida
| | - Dharendra Y Goswami
- Department of Chemical and Biomedical Engineering, University of South Florida, Tampa, Florida
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Interaction Between Catalase Gene Promoter Polymorphisms and Indoor Environmental Exposure in Childhood Allergic Rhinitis. Epidemiology 2018; 28 Suppl 1:S126-S132. [PMID: 29028686 DOI: 10.1097/ede.0000000000000741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) is a highly prevalent chronic inflammatory disease affecting nearly 40% of the children in Taiwan. Genetic susceptibility may interact with specific environmental factors leading to allergic disease development. METHODS To assess the interactions between catalase gene promoter polymorphisms and environmental factors on the risk of AR, we conducted a case-control study in Taiwan. Data on AR and environmental factors were collected from 800 children using the ISSAC questionnaire. The case group consisted of 263 children with AR, and the control group consisted of =537 healthy children. Genotyping was performed for rs1001179 and rs769214 polymorphisms, and environmental exposure was assessed using four indicators including dwelling visible molds, mold odor, moisture on surfaces, and water damage. RESULTS We found that the presence of visible molds, mold odor, and moisture was associated with AR. An apparent joint effect of the GG genotype and mold odor, compared with the AA and AG combined genotypes and without any exposure indicator (adjusted odds ratio [OR] = 1.95 [95% confidence interval (CI) = 1.20, 3.18]; interaction adjusted odds ratio = 2.59 [95% CI = 1.27, 5.30]), was observed. CONCLUSIONS Our findings suggest that gene-environment interactions between the catalase polymorphism rs769214 and mold odor may play an important role in childhood AR development.
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