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Hutz MJ, Thuler E, Cheong C, Phung C, Evans M, Woo J, Keenan BT, Dedhia RC. The Association Between Transverse Maxillary Deficiency and Septal Deviation in Adults with Obstructive Sleep Apnea. Laryngoscope 2024; 134:2464-2470. [PMID: 37905744 PMCID: PMC11006575 DOI: 10.1002/lary.31122] [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: 03/11/2023] [Revised: 08/11/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES Recent evidence suggests that environmental factors impact craniofacial development. Specifically, the height and width of the maxilla may impact the degree of septal deviation. We sought to determine the relationship between transverse maxillary deficiency and severity of septal deviation. METHODS A prospective cohort of adult sleep surgery patients were evaluated by standardized CT imaging. Primary outcomes evaluated the relationship of a narrow, high-arched palate (the palatal height to width ratio) with the degree of septal deviation at the level of the 1st premolar and 1st molar. Secondary outcome evaluated the relationship of the palatal height-to-width ratio and nasal obstruction. Both adjusted and unadjusted linear regression were performed, including correction for multiple hypothesis testing. RESULTS Ninety-three patients were included. On average, the cohort was middle aged (54.7 ± 12.7 years), obese (BMI 30.1 ± 4.5 kg/m2), predominantly male (74.2%), White (73.1%), and with severe obstructive sleep apnea (OSA) (AHI 30.0 ± 18.7 events/h). A moderate correlation was observed between both the relative and absolute inter-premolar palatal height and the degree of septal deviation at the inter-molar region. No significant correlation was observed between palatal dimensions and NOSE score. CONCLUSION This study found that transverse maxillary deficiency is moderately associated with greater degree of septal deviation among a sample of OSA patients. This contributes to the concept that craniofacial development impacts the nasal airway, promoting a comprehensive evaluation of both endonasal and extranasal structures. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2464-2470, 2024.
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Affiliation(s)
- Michael J Hutz
- Section of Sleep Surgery, Department of Otolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
- Section of Sleep Medicine, Department of Pulmonary, Critical Care and Sleep Medicine, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Eric Thuler
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Crystal Cheong
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Chau Phung
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Marianna Evans
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - John Woo
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Raj C Dedhia
- Division of Sleep Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
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Seifelnasr A, Si X, Xi J. Assessing Nasal Epithelial Dynamics: Impact of the Natural Nasal Cycle on Intranasal Spray Deposition. Pharmaceuticals (Basel) 2024; 17:73. [PMID: 38256906 PMCID: PMC10819912 DOI: 10.3390/ph17010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
This study investigated the intricate dynamics of intranasal spray deposition within nasal models, considering variations in head orientation and stages of the nasal cycle. Employing controlled delivery conditions, we compared the deposition patterns of saline nasal sprays in models representing congestion (N1), normal (N0), and decongestion (P1, P2) during one nasal cycle. The results highlighted the impact of the nasal cycle on spray distribution, with congestion leading to confined deposition and decongestion allowing for broader dispersion of spray droplets and increased sedimentation towards the posterior turbinate. In particular, the progressive nasal dilation from N1 to P2 decreased the spray deposition in the middle turbinate. The head angle, in conjunction with the nasal cycle, significantly influenced the nasal spray deposition distribution, affecting targeted drug delivery within the nasal cavity. Despite controlled parameters, a notable variance in deposition was observed, emphasizing the complex interplay of gravity, flow shear, nasal cycle, and nasal morphology. The magnitude of variance increased as the head tilt angle increased backward from upright to 22.5° to 45° due to increasing gravity and liquid film destabilization, especially under decongestion conditions (P1, P2). This study's findings underscore the importance of considering both natural physiological variations and head orientation in optimizing intranasal drug delivery.
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Affiliation(s)
- Amr Seifelnasr
- Department of Biomedical Engineering, University of Massachusetts, Lowell, MA 01854, USA;
| | - Xiuhua Si
- Department of Mechanical Engineering, California Baptist University, Riverside, CA 92504, USA;
| | - Jinxiang Xi
- Department of Biomedical Engineering, University of Massachusetts, Lowell, MA 01854, USA;
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Hagen M, Clark K, Kalita P, Serra G, Sanchez E, Varbiro G, Albasser MM. A real-world study of quality of life following treatment with xylometazoline hydrochloride in individuals with common cold. Ther Adv Respir Dis 2024; 18:17534666241228927. [PMID: 38372128 PMCID: PMC10878222 DOI: 10.1177/17534666241228927] [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: 08/18/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND The common cold is a frequent, acute, and mild upper respiratory human disease. Nasal congestion has been considered the most bothersome symptom in the common cold, impacting quality of life (QoL). Topical decongestants containing steroids benefit QoL in allergic rhinitis, but no published research has assessed the impact of topical decongestants on QoL in the common cold. OBJECTIVE To evaluate the effects of xylometazoline hydrochloride 0.1% (Otrivin, GSK Consumer Healthcare SARL, Switzerland) for up to 7 days on QoL in participants with nasal congestion associated with the common cold. DESIGN This was a decentralized, longitudinal, open-label study. METHODS The study enrolled 136 participants (⩾18 years) with early symptoms of the common cold, of which 102 were included in the modified intention-to-treat (mITT) population. Within 24 h of study product receipt, participants confirmed a 'plugged nose' and ⩾1 other common cold symptom. Primary endpoints were Wisconsin Upper Respiratory Symptom Survey-21 (WURSS-21) total score, total and individual symptom scores, and total QoL score. Secondary endpoints were additional QoL scores. Exploratory and post hoc analyses included median days to resolution for each QoL factor and analyses of five QoL categories. RESULTS Consistent improvements in symptoms and QoL were seen in the mITT population. From day 1, improvements were seen in the 'plugged nose' symptom (p = 0.0023), WURSS-21 total QoL score, and all individual QoL scores (p < 0.0001 for all). After the last dose needed, significant improvements were seen in sleep quality (73%), vitality (76%), physical activity (71%), social activity (80%), and sensation (81%). No serious or unexpected adverse events were reported. CONCLUSION This study is the first to demonstrate in a real-life setting that treating nasal congestion in adults with xylometazoline hydrochloride 0.1% during the common cold positively impacts QoL factors relevant to daily living [Otrivin: Quality of Life (QoL) Impact in a Real-World Setting; https://clinicaltrials.gov/study/NCT05556148].
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Affiliation(s)
- Martina Hagen
- Haleon CH SARL, Route de l’Etraz 2, Nyon 1279, 1260, Switzerland
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Livier Castillo J, Flores Valdés JR, Maney Orellana M, Satish S, Ijioma CE, Benjamin J, Ramirez Alvarez E, Martinez Ramirez M, Arruarana VS, Calderon Martinez E. The Use and Efficacy of Oral Phenylephrine Versus Placebo Treating Nasal Congestion Over the Years on Adults: A Systematic Review. Cureus 2023; 15:e49074. [PMID: 38125218 PMCID: PMC10730950 DOI: 10.7759/cureus.49074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/23/2023] Open
Abstract
Nasal congestion is a common issue stemming from various factors such as allergies and anatomical variations. Allergic rhinitis frequently leads to nasal congestion. The pathophysiology involves inflammation, swelling, and mucus production in the nasal mucosa. Multiple treatments are available, including oral phenylephrine, an over-the-counter or prescription option. However, the effectiveness and safety of phenylephrine have been subjects of debate. This systematic review aims to provide an updated perspective on the efficacy of oral phenylephrine versus placebo in addressing nasal congestion in adults. We conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a systematic review involving searches on PubMed, Cochrane, and Scopus databases. Inclusion/exclusion criteria were defined to identify high-quality studies. The focus was on randomized controlled trials (RCTs) and case-control studies published in English between 1998 and 2023, involving adult populations. The interventions compared oral phenylephrine with placebo or standard care, with outcomes centering on changes in nasal congestion symptoms and nasal airway resistance. We identified four articles that met the criteria. These studies exhibited varied designs and populations. The findings consistently indicated that phenylephrine was not more effective than a placebo in relieving nasal congestion. This systematic review demonstrates that oral phenylephrine did not offer substantial relief from nasal congestion compared to a placebo in adults. The studies featured diverse designs, yet the prevailing conclusion was that phenylephrine's efficacy was limited. Safety assessments showed no life-threatening adverse events, with common side effects including headaches and mild discomfort. In summary, this systematic review indicates that oral phenylephrine is not significantly more effective than a placebo in alleviating nasal congestion in adults. Clinicians should explore alternative treatment options, considering the review's limitations. Additional research may be needed to clarify the role of oral phenylephrine in managing nasal congestion.
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Affiliation(s)
| | | | | | - Sruthi Satish
- Internal Medicine, Kasturba Medical College, Manipal, Manipal, IND
| | - Chimaobi E Ijioma
- Medicine and Surgery, Abia State University Faculty of Medicine, Uturu, Umuahia, NGA
| | - Janet Benjamin
- Internal Medicine, Ross University School of Medicine, Miramar, USA
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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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Gurov AV, Muzhichkova AV, Yushkina MA. [Pathogenetic approach in the treatment of inflammatory diseases of the nose and paranasal sinuses]. Vestn Otorinolaringol 2023; 88:91-96. [PMID: 37970776 DOI: 10.17116/otorino20238805191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
In recent years, inflammatory diseases of the nose and paranasal sinuses have been on the rise. In addition to infectious diseases, in the modern world a large percentage of the population suffers from allergic diseases. The approach to therapy and the choice of a drug should take into account the pathogenesis of the inflammatory reaction in the nasal cavity and paranasal sinuses. By exerting its effect, the drug should reduce hyperemia and swelling of the nasal mucosa, reduce the level of mucus secretion, improve the drainage of the paranasal sinuses, i.e. possess vasoconstrictive and anti-allergic properties. As such a drug, you can use the combined intranasal spray Frinozol, which basically contains cetirizine and phenylephrine. The use of Frinozol in the complex treatment of inflammation of the mucous membrane of the nasal cavity and paranasal sinuses contributes to the rapid and pronounced weakening of the symptoms of the disease, and is also the key to successful therapy.
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Affiliation(s)
- A V Gurov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Muzhichkova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M A Yushkina
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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7
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Cooper W, Ray S, Aurora SK, Shrewsbury SB, Fuller C, Davies G, Hoekman J. Delivery of Dihydroergotamine Mesylate to the Upper Nasal Space for the Acute Treatment of Migraine: Technology in Action. J Aerosol Med Pulm Drug Deliv 2022; 35:321-332. [PMID: 36108289 PMCID: PMC9807280 DOI: 10.1089/jamp.2022.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Oral tablets account for the majority of medications used to acutely treat migraine, but relief can be limited by their rates of dissolution and absorption. The nose is an attractive alternative route of drug delivery since it provides patient convenience of at-home use, gastrointestinal (GI) avoidance, and rapid absorption of drugs into systemic circulation because of its large surface area. However, the site of drug deposition within the nasal cavity should be considered since it can influence drug absorption. Traditional nasal devices have been shown to target drug delivery to the lower nasal space where epithelium is not best-suited for drug absorption and where there is an increased likelihood of drug clearance due to nasal drip, swallowing, or mucociliary clearance, potentially resulting in variable absorption and suboptimal efficacy. Alternatively, the upper nasal space (UNS) offers a permeable, richly vascularized epithelium with a decreased likelihood of drug loss or clearance due to the anatomy of this area. Traditional nasal pumps deposit <5% of active drug into the UNS because of the nasal cavity's complex architecture. A new technology, Precision Olfactory Delivery (POD®), is a handheld, manually actuated, propellant-powered, administration device that delivers drug specifically to the UNS. A dihydroergotamine (DHE) mesylate product, INP104, utilizes POD technology to deliver drug to the UNS for the acute treatment of migraine. Results from clinical studies of INP104 demonstrate a favorable pharmacokinetic profile, consistent and predictable dosing, rapid systemic levels known to be effective (similar to other DHE mesylate clinical programs), safety and tolerability on the upper nasal mucosa, and high patient acceptance. POD technology may have the potential to overcome the limitations of traditional nasal delivery systems, while utilizing the nasal delivery benefits of GI tract avoidance, rapid onset, patient convenience, and ease of use.
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Affiliation(s)
- Wade Cooper
- Headache and Neuropathic Pain Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Sutapa Ray
- Impel Pharmaceuticals, Seattle, Washington, USA
| | | | - Stephen B. Shrewsbury
- Impel Pharmaceuticals, Seattle, Washington, USA.,Address correspondence to: Stephen B. Shrewsbury, MB, ChB, Impel Pharmaceuticals, Seattle, WA 98119, USA
| | | | - Greg Davies
- Impel Pharmaceuticals, Seattle, Washington, USA
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Yim MJ, Lee JM, Ko SC, Kim HS, Kim JY, Park SK, Lee DS, Choi IW. Antifibrosis Efficacy of Apo-9-Fucoxanthinone-Contained Sargassum horneri Ethanol Extract on Nasal Polyp: An In Vitro and Ex Vivo Organ Culture Assay. Curr Issues Mol Biol 2022; 44:5815-5826. [PMID: 36421679 PMCID: PMC9689088 DOI: 10.3390/cimb44110395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 04/05/2024] Open
Abstract
Sargassum horneri is a seaweed species with diverse bioactivities. However, its antifibrotic effects during nasal polyp (NP) formation are not clearly understood. Therefore, we investigated the inhibitory effect of S. horneri on fibrosis progression in NP-derived fibroblasts (NPDFs) and NP tissues ex vivo. NPDFs were stimulated with TGF-β1 in the presence or absence of S. horneri ethanol extract (SHE). The extracellular matrix (ECM) protein production levels, myofibroblast differentiation (α-smooth muscle actin, α-SMA), and phosphorylation of Smad 2/3 and -ERK in TGF-β1-stimulated NPDFs were investigated using western blotting. Further, the contractile activity of SHE was assessed by performing a collagen gel contraction assay. The expression levels of collagen-1, fibronectin, and α-SMA were investigated in NP organ cultures treated with SHE. TGF-β1 stimulated ECM protein expression, myofibroblast differentiation, and collagen contractile activity while these were attenuated by pretreatment with SHE. We also found antifibrotic effect of SHE on ex vivo NP tissues. The antifibrotic effects of SHE were modulated through the attenuation of Smad 2/3 and ERK signaling pathways in TGF-β1-stimulated NPDFs. In conclusion, SHE inhibited ECM protein accumulation and myofibroblast differentiation during NP remodeling. Thus, SHE may be helpful as a treatment for NP recurrence after endoscopic sinus surgery.
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Affiliation(s)
- Mi-Jin Yim
- National Marine Biodiversity Institute of Korea, Seocheon 33662, Republic of Korea
| | - Jeong Min Lee
- National Marine Biodiversity Institute of Korea, Seocheon 33662, Republic of Korea
| | - Seok-Chun Ko
- National Marine Biodiversity Institute of Korea, Seocheon 33662, Republic of Korea
| | - Hyun-Soo Kim
- National Marine Biodiversity Institute of Korea, Seocheon 33662, Republic of Korea
| | - Ji-Yul Kim
- National Marine Biodiversity Institute of Korea, Seocheon 33662, Republic of Korea
| | - Seong Kook Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Republic of Korea
| | - Dae-Sung Lee
- National Marine Biodiversity Institute of Korea, Seocheon 33662, Republic of Korea
| | - Il-Whan Choi
- Department of Microbiology and Immunology, College of Medicine Inje University, Busan 47392, Republic of Korea
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9
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Zhang K, Pipaliya RM, Miglani A, Nguyen SA, Schlosser RJ. Systematic Review of Surgical Interventions for Inferior Turbinate Hypertrophy. Am J Rhinol Allergy 2022; 37:110-122. [DOI: 10.1177/19458924221134555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Various surgical interventions exist for treatment of inferior turbinate hypertrophy (ITH). Though mucosal-sparing techniques are generally preferred, there is lack of consensus on the optimal technique. Objective This systematic review sought to evaluate the evidence for treatment of bilateral nasal obstruction via inferior turbinate reduction (ITR) and provide a meta-analysis of expected results of various techniques. Methods PubMed, Scopus, Cochrane Library databases were queried to include articles describing surgical treatment for ITH. Exclusion criteria were concurrent nasal procedures or non-mucosal ITH. Primary outcomes included visual analog scale for nasal obstruction, nasal cavity volume by acoustic rhinometry, and resistance by anterior rhinomanometry. Subgroup analyses assessed outcomes by rhinitis diagnosis and length of follow-up, and radiofrequency ablation (RFA) was compared to microdebrider-assisted turbinoplasty (MAIT). Results A total of 1870 studies were identified with 62 meeting inclusion criteria. Reported techniques included turbinectomy, submucosal resection, RFA, MAIT, laser, or electrocautery. All techniques demonstrated significant improvements in nasal obstruction using the visual analog scale. Further comprehensive physiologic data for RFA, MAIT, and laser was available and, compared to baseline, these techniques resulted in significant improvements in nasal resistance, nasal cavity volume, and nasal airflow. Six studies directly compared RFA and MAIT with statistically similar results on VAS, nasal cavity volume, and resistance with median follow-up time of 3.5 months. Assessment of VAS congestion over time reveals peak benefit is achieved between 3–6 months follow-up. Conclusions All reviewed ITR techniques improve patient-reported nasal obstruction. RFA and MAIT provide comparable improvements in patient-reported and physiologic nasal airflow outcomes and while benefits are sustained long-term, the peak benefit for both techniques appears to be achieved within the first year.
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Affiliation(s)
- Kathy Zhang
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Royal M. Pipaliya
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Amar Miglani
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A. Nguyen
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rodney J. Schlosser
- Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Park MJ, Jang YJ. Changes in inflammatory biomarkers in the nasal mucosal secretion after septoplasty. Sci Rep 2022; 12:16164. [PMID: 36171394 PMCID: PMC9519558 DOI: 10.1038/s41598-022-20480-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/13/2022] [Indexed: 11/26/2022] Open
Abstract
Deviated nasal septum (DNS) is suggested to be associated with nonspecific inflammation of the nasal mucosa. The authors hypothesized septoplasty may reduce nasal mucosal inflammation, therefore the authors aimed to measure various inflammatory biomarkers in the nasal secretion following septoplasty. Prospectively, 17 patients undergoing elective septoplasty were included. Symptomatic changes after septoplasty were evaluated with Sino-nasal Outcome Test (SNOT-22) and Nasal obstruction symptom evaluation (NOSE) scores. Using acoustic rhinometry, changes of the nasal airway volume were measured. Nasal secretion was collected within 2 weeks and 3 months before and after septoplasty, respectively. The inflammatory biomarker high-mobility group box 1 (HMGB1) and vasoactive intestinal peptide (VIP), and inflammatory cytokines including tumor necrosis factor α (TNF α), interferon γ (IFN-γ), interleukin-4 (IL-4), eotaxin-1, and regulated upon activation, normal T cell expressed and presumably secreted (RANTES) were quantified in the nasal secretion by enzyme-linked immunosorbent assays or multiplex bead array assays. The patients' mean age was 30.5 ± 6.8 (ranging from 19 to 43), consisting of 15 male and 2 female patients. The median SNOT-22 and NOSE scores changed from 54 to 14 and 78 to 15, respectively, both showing a significant decrease. In acoustic rhinometry, nasal cavity volume of convex side significantly increased after septoplasty, whereas significant discrepancy of nasal airway volume between concave and convex sides became insignificant. No significant difference was noted both before and after septoplasty between the concave and convex sides in all seven biomarkers. The HMGB1, RANTES, IL-4, and TNF-α concentrations following septoplasty showed significant decrease in 34 nasal cavities of 17 patients (all p < 0.05). However, when the 17 concave and 17 convex sides were analyzed separately, the significant reduction in four biomarkers were only significant in the concave sides (all p < 0.05), but not significantly reduced in convex sides. Septoplasty may have benefited not only in normalizing the nasal airflow and symptom improvement, but also in nonspecific inflammation attenuation in the nasal airway.
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Affiliation(s)
- Marn Joon Park
- Department of Otorhinolaryngology - Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2-dong, Songpa-gu, Seoul, 138-736, Korea
| | - Yong Ju Jang
- Department of Otorhinolaryngology - Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2-dong, Songpa-gu, Seoul, 138-736, Korea.
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Chi JCY, Lee SD, Lee CY, Liu SY, Ting H, Tsai YJ. Endonasal Septoplasty Using a Septal Cartilaginous Batten Graft for Managing Caudal Septal Deviation. Healthcare (Basel) 2022; 10:healthcare10091739. [PMID: 36141351 PMCID: PMC9498541 DOI: 10.3390/healthcare10091739] [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: 07/17/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Caudal nasal septal deviation is an important condition altering nasal obstruction and cosmetic appearance and many surgical techniques have been published on how to correct caudal septal deviation, as successful management of caudal septal deviation is challenging. The goal of our study was to explore the effect of endonasal septoplasty using a septal cartilaginous batten graft for managing caudal septal deviation. We tested 26 participants with caudal septal deviation who received endonasal septoplasty using a septal cartilaginous batten graft from 1 April 2019 to 29 June 2022, and followed up for at least 6 months. Nasal Obstruction Symptom Evaluation (NOSE) Scale and visual analog scale (VAS) were recorded at baseline, 1 month, and 6 months after surgery. Valid samples were analyzed by repeated measures ANOVA and paired sample t-test. Average participant age was 36.15 ± 11.02 years old. The preoperative, 1-month postoperative, and 6-month postoperative NOSE scale decreased significantly (75.38 ± 15.62, 13.85 ± 7.79, and 14.04 ± 9.90; p < 0.001), while preoperative, 1-month postoperative, and 6-month postoperative VAS (convex/concave side) also improved (7.50 ± 0.81/3.38 ± 0.94, 2.27 ± 0.53/1.54 ± 0.58, and 2.31 ± 0.55/1.58 ± 0.58; p < 0.001). Our results showed that endonasal septoplasty using a septal cartilaginous batten graft had good surgical outcomes without an open scar or severe complications.
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Affiliation(s)
- Jessie Chao-Yun Chi
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Otorhinolaryngology, Head and Neck Surgery, Taichung Hospital, Ministry of Health and Welfare, Taichung 40343, Taiwan
| | - Shin-Da Lee
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung 40402, Taiwan
| | - Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Nobel Eye Institute, Taipei 100008, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 41265, Taiwan
| | - Stanley Yung Liu
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Hua Ting
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung 402367, Taiwan
- Sleep Medicine Center, Chung Shan Medical University Hospital, Taichung 402367, Taiwan
- Correspondence: (H.T.); (Y.-J.T.)
| | - Yih-Jeng Tsai
- School of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan
- Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111045, Taiwan
- Correspondence: (H.T.); (Y.-J.T.)
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12
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Saunders JL, Davis MD. Transnasal Aerosol Delivery During High-Flow Nasal Cannula Therapy. Respir Care 2022; 67:149-150. [PMID: 37068118 PMCID: PMC10027127 DOI: 10.4187/respcare.09814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jessica L Saunders
- Pediatric PulmonologyAllergy and Sleep MedicineRiley Hospital for ChildrenIndiana University School of MedicineIndianapolis, Indiana
| | - Michael D Davis
- Pediatric PulmonologyAllergy and Sleep MedicineWells Center for Pediatric ResearchRiley Hospital for ChildrenIndiana University School of MedicineIndianapolis, Indiana
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Clinical potential of pupillary light reflex parameters as objective indicators reflecting chronic rhinosinusitis-specific quality of life: a 12-month prospective longitudinal study. Sci Rep 2021; 11:21586. [PMID: 34732808 PMCID: PMC8566598 DOI: 10.1038/s41598-021-01153-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/25/2021] [Indexed: 11/09/2022] Open
Abstract
Pupillary light reflex (PLR) and heart rate variability (HRV) parameters can be objective indicators of chronic rhinosinusitis (CRS) status from the viewpoint of autonomic nervous system activity. This study aimed to establish objective indicators for CRS using the 22-item Sino-Nasal Outcome Test (SNOT-22) and PLR/HRV parameters. Sixty-seven patients were prospectively and longitudinally followed up after surgical treatment. We investigated changes in SNOT-22 scores, representing CRS-specific quality of life (QOL). We prepared two models: linear regression model adjusting clinical factors as predictor variables (model 1) and linear mixed-effects model adjusting clinical factors and among-individual variability (model 2). We compared Akaike's information criterion (AIC) values and regression coefficients. The model with lower AIC values was defined as the better-fit model. Model 2 showed lower AIC values in all parameters (better-fit model). Three parameters showed opposite results between the two models. The better-fit models showed significances in the five PLR parameters but not in any HRV parameters. Among these PLR parameters, constriction latency can be the most robust indicator because of the narrowest 95% confidence intervals. Adjusting the among-individual variability while investigating clinical potential of PLR/HRV parameters to reflect CRS-specific QOL can improve the model fit, thereby reaching robust conclusions from obtained data.
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Karpushkina ES, Zhdanova OA, Batishcheva GA, Petukhova YA. Pathogenetic features of acute naphazoline poisoning in children. RESEARCH RESULTS IN PHARMACOLOGY 2021. [DOI: 10.3897/rrpharmacology.7.70242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Acute poisoning by nasal decongestants is an important issue in pediatrics due to physiological and anatomical characteristics of the child’s body and pharmacokinetics of drugs in early childhood.
Epidemiology: The number of poisonings by this group of drugs ranged from 4% to 39% during the period from 2000 to 2018. All the studies reported that the most severe degree of intoxication was observed in children aged 1–3 years.
Mechanism of action of nasal decongestants: The peculiarity of selective alpha2-adrenergic agonists is that when taken orally, misused or overdosed, they lose their selectivity for the target receptor. As a result, the drug causes acute poisoning and most often this effect occurs in children and adolescents.
Clinical features and diagnostic criteria: Clinical signs of acute poisoning can appear both as a result of an overdose of the nasal decongestants and due to a therapeutic use of the drug according to the instruction. The symptoms are manifested by hypothermia, skin pallor, bradycardia, arterial hypotension, profuse sweating, and acrocyanosis.
Imidazoline receptors and new opportunities: It is assumed that toxic effect of topical decongestants occurs not only by activation of alpha2-adrenergic receptors, but also through their influence on the selective imidazoline receptors. Based on the structure of these drugs, it is assumed that imidazoline receptors are the primary binding site for these drugs.
Conclusion: Understanding the described mechanisms of alpha2-adrenergic agonist action and peculiarities of the child’s symptoms in acute poisoning is necessary for the timely diagnosis and selection of the correct treatment strategy.
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15
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Xiao Q, Bates AJ, Cetto R, Doorly DJ. The effect of decongestion on nasal airway patency and airflow. Sci Rep 2021; 11:14410. [PMID: 34257360 PMCID: PMC8277849 DOI: 10.1038/s41598-021-93769-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Nasal decongestant reduces blood flow to the nasal turbinates, reducing tissue volume and increasing nasal airway patency. This study maps the changes in nasal anatomy and measures how these changes affect nasal resistance, flow partitioning between superior and inferior cavity, flow patterns and wall shear stress. High-resolution MRI was applied to capture nasal anatomy in 10 healthy subjects before and after application of a topical decongestant. Computational fluid dynamics simulated nasal airflow at steady inspiratory flow rates of 15 L.min[Formula: see text] and 30 L.min[Formula: see text]. The results show decongestion mainly increases the cross-sectional area in the turbinate region and SAVR is reduced (median approximately 40[Formula: see text] reduction) in middle and lower parts of the cavity. Decongestion reduces nasal resistance by 50[Formula: see text] on average, while in the posterior cavity, nasal resistance decreases by a median factor of approximately 3 after decongestion. We also find decongestant regularises nasal airflow and alters the partitioning of flow, significantly decreasing flow through the superior portions of the nasal cavity. By comparing nasal anatomies and airflow in their normal state with that when pharmacologically decongested, this study provides data for a broad range of anatomy and airflow conditions, which may help characterize the extent of nasal variability.
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Affiliation(s)
- Qiwei Xiao
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alister J Bates
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Raul Cetto
- Department of Aeronautics, Imperial College London, South Kensington Campus, London, SW7 1AZ, UK
| | - Denis J Doorly
- Department of Aeronautics, Imperial College London, South Kensington Campus, London, SW7 1AZ, UK.
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Tiboc Schnell CN, Filip GA, Decea N, Moldovan R, Opris R, Man SC, Moldovan B, David L, Tabaran F, Olteanu D, Gheldiu AM, Baldea I. The impact of Sambucus nigra L. extract on inflammation, oxidative stress and tissue remodeling in a rat model of lipopolysaccharide-induced subacute rhinosinusitis. Inflammopharmacology 2021; 29:753-769. [PMID: 33881685 DOI: 10.1007/s10787-021-00805-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022]
Abstract
Rhinosinusitis is a common disorder related to inflammation of paranasal sinuses and nasal cavity mucosa. Herbal medicines could be an option in the treatment of rhinosinusitis due to their anti-inflammatory and anti-oxidative properties. The study aims to investigate the effect of intranasal Sambucus nigra L. subsp. nigra (SN) extract against inflammation, oxidative stress, and tissue remodeling in nasal and sinus mucosa, but also in serum, lungs, and brain, in Wistar rat model of subacute sinonasal inflammation induced by local administration of lipopolysaccharides (LPS), from Escherichia Coli. The cytokines (TNF-α, IL-1β, IL-6) and oxidative stress (malondialdehyde) in nasal mucosa, blood, lungs, and brain were analyzed. In addition, a histopathological examination was performed, and NF-kB, MMP2, MMP9, TIMP1 expressions were also evaluated in nasal mucosa. Both doses of LPS increased the production of cytokines in all the investigated tissues, especially in the nasal mucosa and blood (p < 0.01 and p < 0.05), and stimulated their secretion in the lungs, and partially in the brain. Malondialdehyde increased in all the investigated tissues (p < 0.01 and p < 0.05). In parallel, upregulation of NF-kB and MMP2 expressions with downregulation of TIMP1, particularly at high dose of LPS, was observed. SN extract reduced the local inflammatory response, maintained low levels of IL-6, TNF-α, and IL-1β. In lungs, SN reduced all cytokines levels while in the brain, the protective effect was noticed only on IL-6. Additionally, SN diminished lipid peroxidation and downregulated NF-kB in animals exposed to a low dose of LPS, with increased TIMP1 expression, while in animals treated with a high dose of LPS, SN increased NF-kB, MMP2, and MMP9 levels. In conclusion, SN extract diminished the inflammatory response, reduced generation of reactive oxygen species (ROS) and, influenced MMPs expressions, suggesting the benficial effect of SN extract on tissue remodeling in subacute rhinosinusitis and on systemic inflammatory response.
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Affiliation(s)
- C N Tiboc Schnell
- Department of Pediatrics, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006, Cluj-Napoca, Romania
| | - Gabriela Adriana Filip
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Clinicilor Street, No. 1-3, 400006, Cluj-Napoca, Romania.
| | - N Decea
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Clinicilor Street, No. 1-3, 400006, Cluj-Napoca, Romania
| | - R Moldovan
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Clinicilor Street, No. 1-3, 400006, Cluj-Napoca, Romania
| | - R Opris
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Clinicilor Street, No. 1-3, 400006, Cluj-Napoca, Romania
| | - S C Man
- Department of Pediatrics, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006, Cluj-Napoca, Romania
| | - B Moldovan
- Faculty of Chemistry and Chemical Engineering, "Babes-Bolyai" University, 400028, Cluj-Napoca, Romania
| | - L David
- Faculty of Chemistry and Chemical Engineering, "Babes-Bolyai" University, 400028, Cluj-Napoca, Romania
| | - F Tabaran
- Department of Pathology, University of Agricultural Sciences and Veterinary Medicine, 400035, Cluj-Napoca, Romania
| | - D Olteanu
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Clinicilor Street, No. 1-3, 400006, Cluj-Napoca, Romania
| | - A M Gheldiu
- Department of Pharmaceutical Botany, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, 400337, Cluj-Napoca, Romania
| | - I Baldea
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Clinicilor Street, No. 1-3, 400006, Cluj-Napoca, Romania
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Samancı B, Şahin E, Şen C, Samancı Y, Sezgin M, Emekli S, Kocasoy Orhan E, Orhan KS, Baykan B. Olfactory dysfunction in patients with cluster headache. Eur Arch Otorhinolaryngol 2021; 278:4361-4365. [PMID: 33713191 DOI: 10.1007/s00405-021-06738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Cluster headache (CH) is a primary headache characterized by strictly unilateral, short-lasting severe headache attacks accompanied by at least one ipsilateral autonomic symptom. Our study aimed to determine whether CH patients had olfactory dysfunction and to correlate it with clinical characteristics. MATERIALS AND METHODS Twenty patients and 57 healthy volunteers were included in the study. All participants were examined in the otorhinolaryngology outpatient clinics to exclude other clinical problems causing olfactory dysfunction. The Sniffin' Sticks test was performed, and threshold (T), discrimination (D), identification (I) scores, and TDI global olfactory score were evaluated. RESULTS The CH patients had significantly lower threshold scores than healthy controls (6.9 ± 1.70 vs. 7.8 ± 1.08, p = 0.007). The mean threshold scores of CH patients during in-bout (n = 9) were significantly lower than CH patients during out-of-bout (n = 11) in subgroup analysis (5.9 ± 1.16 vs. 7.6 ± 1.76, p = 0.038). CH patients with left-sided headache had significantly lower discrimination scores compared to CH patients with right-sided headache (12.8 ± 1.24 vs. 14.4 ± 1.51, p = 0.03). CONCLUSION There is marked impairment in olfactory function in CH patients compared to healthy controls.
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Affiliation(s)
- Bedia Samancı
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erdi Şahin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Cömert Şen
- Department of Otorhinolaryngology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz Samancı
- Neurosurgery Clinic, Koc University, Istanbul, Turkey.,Department of Neuroscience, Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Mine Sezgin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serkan Emekli
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kadir Serkan Orhan
- Department of Otorhinolaryngology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Wolkoff P, Azuma K, Carrer P. Health, work performance, and risk of infection in office-like environments: The role of indoor temperature, air humidity, and ventilation. Int J Hyg Environ Health 2021; 233:113709. [PMID: 33601136 DOI: 10.1016/j.ijheh.2021.113709] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022]
Abstract
Epidemiological and experimental studies have revealed the effects of the room temperature, indoor air humidity, and ventilation on human health, work and cognitive performance, and risk of infection. In this overview, we integrate the influence of these important microclimatic parameters and assess their influence in offices based on literature searches. The dose-effect curves of the temperature describe a concave shape. Low temperature increases the risk of cardiovascular and respiratory diseases and elevated temperature increases the risk of acute non-specific symptoms, e.g., dry eyes, and respiratory symptoms. Cognitive and work performance is optimal between 22 °C and 24 °C for regions with temperate or cold climate, but both higher and lower temperatures may deteriorate the performances and learning efficiency. Low temperature may favor virus viability, however, depending on the status of the physiological tissue in the airways. Low indoor air humidity causes vulnerable eyes and airways from desiccation and less efficient mucociliary clearance. This causes elevation of the most common mucous membrane-related symptoms, like dry and tired eyes, which deteriorates the work performance. Epidemiological, experimental, and clinical studies support that intervention of dry indoor air conditions by humidification alleviates symptoms of dry eyes and airways, fatigue symptoms, less complaints about perceived dry air, and less compromised work performance. Intervention of dry air conditions by elevation of the indoor air humidity may be a non-pharmaceutical treatment of the risk of infection by reduced viability and transport of influenza virus. Relative humidity between 40 and 60% appears optimal for health, work performance, and lower risk of infection. Ventilation can reduce both acute and chronic health outcomes and improve work performance, because the exposure is reduced by the dilution of the indoor air pollutants (including pathogens, e.g., as virus droplets), and in addition to general emission source control strategies. Personal control of ventilation appears an important factor that influences the satisfaction of the thermal comfort due to its physical and positive psychological impact. However, natural ventilation or mechanical ventilation can become sources of air pollutants, allergens, and pathogens of outdoor or indoor origin and cause an increase in exposure. The "health-based ventilation rate" in a building should meet WHO's air quality guidelines and dilute human bio-effluent emissions to reach an acceptable perceived indoor air quality. Ventilation is a modifying factor that should be integrated with both the indoor air humidity and the room temperature in a strategic joint control to satisfy the perceived indoor air quality, health, working performance, and minimize the risk of infection.
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Affiliation(s)
- Peder Wolkoff
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen Ø, Denmark.
| | - Kenichi Azuma
- Dept Environmental Medicine and Behavioral Science, Kindai University, Faculty of Medicine, Osakasayama, Osaka, Japan.
| | - Paolo Carrer
- Dept Biomedical and Clinical Sciences "L. Sacco", University of Milan, 20157, Milan, Italy.
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19
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Berson SR, Klimczak JA, Prezio EA, Abraham MT. House Dust Mite Related Allergic Rhinitis and REM Sleep Disturbances. Am J Otolaryngol 2020; 41:102709. [PMID: 32866850 DOI: 10.1016/j.amjoto.2020.102709] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/18/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Sleep disturbances are common in patients with allergic rhinitis (AR). Perennial allergens like house dust mites (HDM) are difficult to avoid and have nocturnal impacts on the respiratory system and Quality of Life (QOL). The Rapid Eye Movement (REM) sleep stage is associated with memory, cognition, dreams, and overall restfulness, which can be impaired in AR patients with Sleep Disordered Breathing (SDB) even when normal all-night apnea-hypopnea (AHI) or respiratory disturbance (RDI) indices are noted on polysomnography (PSG). We hypothesized that AR HDM allergen positive patients would show REM-specific SDB reflected in their objectively elevated REM-RDI values. MATERIALS AND METHODS This retrospective analysis of 100 patients included 47 with HDM positive allergy testing. All patients underwent PSG testing calculating the RDI during REM. Multivariate logistic regression models evaluated relationships between allergic statuses and sleep parameters while controlling for potential confounders. RESULTS Compared with allergy negative patients, HDM allergen positive patients were significantly more likely (OR 4.29, 95%CI 1.26-14.62) to have a REM-RDI in the moderate/severe range (≥15 events/h). CONCLUSIONS Our study highlighted the significance of respiratory allergies to HDM in patients with SDB. We revealed a significant relationship between HDM allergen positivity and SDB characterized by elevated REM-RDI regardless of all-night AHI, RDI, or REM-AHI values. Clinical implications of knowing about disturbed REM and/or HDM allergenicity include better preparation, treatment, outcomes, and QOL for allergic, SDB, and upper airway surgery patients.
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20
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Calvo-Henriquez C, Capasso R, Martínez-Capoccioni G, Rangel-Chaves J, Liu SY, O'Connor-Reina C, Lechien JR, Martin-Martin C. Safeness, subjective and objective changes after turbinate surgery in pediatric patients: A systematic review. Int J Pediatr Otorhinolaryngol 2020; 135:110128. [PMID: 32485468 DOI: 10.1016/j.ijporl.2020.110128] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Inferior turbinates are the main structure related to impaired nasal breathing. When medical treatment fails, surgery is the next step, according to clinical guidelines. However, despite the widespread acceptance of this procedure, there is some controversy about performing it in children. DATA SOURCES Pubmed (Medline), the Cochrane Library, EMBASE, Scopus, Science direct, SciELO and Trip Database. REVIEW METHODS We looked for articles in which the individual outcome of turbinate surgery in pediatric patients was investigated independently of whether it was the main objective of the study or not. RESULTS 13 papers (1111 patients) met the inclusion criteria. 6 authors performed diverse objective assessment and 11 authors used subjective scales. All of them found improvement after surgery. Due to the heterogeneity of the methods used, they could not be included in a metanalysis. Eleven out of the 13 authors reported 3.12% complication rates, being minor bleeding the most common (1.30%), followed by crust (0.49%) and pain (0.47%). CONCLUSIONS There is a lack of high quality studies in children. Turbinate surgery in children is a safe technique with low complication rates. The available evidence suggests improvement in subjective outcomes after turbinate surgery in children. We cannot make a formal recommendation of a surgical technique in children given the lack of high quality studies, and since comparison between available papers is not possible. Although the evidence at our disposal is weak, it suggests that the safest techniques are MAIT, radiofrequency, coblation and laser.
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Affiliation(s)
- Christian Calvo-Henriquez
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Rhinology Study Group, Spain; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Spain.
| | - Robson Capasso
- Department of Otolaryngology - Sleep Surgery Division, Stanford University Medical Center, Stanford, CA, USA
| | - Gabriel Martínez-Capoccioni
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Rhinology Study Group, Spain; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Spain
| | - Jesús Rangel-Chaves
- Department of Otolaryngology, Hospital Nuestra Señora de La Salud, San Luis de Potosi, Mexico
| | - Stanley Yung Liu
- Department of Otolaryngology - Sleep Surgery Division, Stanford University Medical Center, Stanford, CA, USA
| | | | - Jerome R Lechien
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Rhinology Study Group, Spain; Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos Martin-Martin
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) Rhinology Study Group, Spain; Department of Otolaryngology, University of Santiago de Compostela, Spain
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21
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The potential role of peak nasal inspiratory flow to evaluate active sinonasal inflammation and disease severity. Sci Rep 2020; 10:12674. [PMID: 32728055 PMCID: PMC7391672 DOI: 10.1038/s41598-020-69693-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 07/15/2020] [Indexed: 12/11/2022] Open
Abstract
Although the pathophysiology of nasal polyposis is incompletely understood, rhinologists have seldom studied it with rhinomanometry or peak nasal inspiratory flow (PNIF) due to technical limitations and the perception that polyp size might impair reproducibility and the usefulness of recordings. The objective of this study is to assess how measures of rhinomanometry and PNIF relate to disease activity. Nineteen patients with polyps, 15 patients with chronic sinusitis without polyps and 11 negative controls were evaluated with active anterior rhinomanometry and PNIF. Sinusitis and polyp patients were re-evaluated after medical treatment. Polyp patients had the highest median Lund-Mackay score (14) and a median Johansen score of 1. PNIF and its variation after treatment were also lowest in this group (median 90 L/min before and after treatment; median variation of 0 L/min). Nasal resistance was similar between groups, and only correlated with Johansen score (Spearman = 0.517, p = 0.048) after treatment. Our study suggests that evaluating polyp patients using rhinomanometry and PNIF may provide useful and reproducible data. Several findings considered together suggest that polyp size is not the main determinant of nasal functional changes in these patients, warranting further studies to verify whether PNIF changes reflect sinus inflammation or merely airway obstruction.
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22
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Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Dinakar C, Ellis AK, Finegold I, Golden DBK, Greenhawt MJ, Hagan JB, Horner CC, Khan DA, Lang DM, Larenas-Linnemann DES, Lieberman JA, Meltzer EO, Oppenheimer JJ, Rank MA, Shaker MS, Shaw JL, Steven GC, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Dinakar C, Ellis AK, Golden DBK, Greenhawt MJ, Horner CC, Khan DA, Lang DM, Lieberman JA, Oppenheimer JJ, Rank MA, Shaker MS, Stukus DR, Wang J, Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, Finegold I, Hagan JB, Larenas-Linnemann DES, Meltzer EO, Shaw JL, Steven GC. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol 2020; 146:721-767. [PMID: 32707227 DOI: 10.1016/j.jaci.2020.07.007] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tablet allergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.
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Affiliation(s)
- Mark S Dykewicz
- Section of Allergy and Immunology, Division of Infectious Diseases, Allergy and Immunology, Department of Internal Medicine, School of Medicine, Saint Louis University, St Louis, Mo.
| | - Dana V Wallace
- Department of Medicine, Nova Southeastern Allopathic Medical School, Fort Lauderdale, Fla
| | - David J Amrol
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC
| | - Fuad M Baroody
- Department of Otolaryngology-Head and Neck Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Ill
| | - Jonathan A Bernstein
- Allergy Section, Division of Immunology, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Timothy J Craig
- Departments of Medicine and Pediatrics, Penn State University, Hershey, Pa
| | - Chitra Dinakar
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, Calif
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ira Finegold
- Division of Allergy and Immunology, Department of Medicine, Mount Sinai West, New York, NY
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Department of Medicine, School of Medicine, John Hopkins University, Baltimore, Md
| | - Matthew J Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, Colo
| | - John B Hagan
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Caroline C Horner
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, School of Medicine, Washington University, St Louis, Mo
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | - Jay A Lieberman
- Division of Pulmonology Allergy and Immunology, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tenn
| | - Eli O Meltzer
- Division of Allergy and Immunology, Department of Pediatrics, School of Medicine, University of California, San Diego, Calif; Allergy and Asthma Medical Group and Research Center, San Diego, Calif
| | - John J Oppenheimer
- Division of Pulmonary & Critical Care Medicine and Allergic & Immunologic Diseases, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-Rutgers New Jersey Medical School, New Brunswick, NJ; Pulmonary and Allergy Associates, Morristown, NJ
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic in Arizona, Scottsdale, Ariz
| | - Marcus S Shaker
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Altrichter S, Frischbutter S, Fok JS, Kolkhir P, Jiao Q, Skov PS, Metz M, Church MK, Maurer M. The role of eosinophils in chronic spontaneous urticaria. J Allergy Clin Immunol 2020; 145:1510-1516. [DOI: 10.1016/j.jaci.2020.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 12/21/2022]
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Tong BK, Tran C, Ricciardiello A, Chiang A, Donegan M, Murray N, Szollosi I, Amatoury J, Carberry JC, Eckert DJ. Efficacy of a novel oral appliance and the role of posture on nasal resistance in obstructive sleep apnea. J Clin Sleep Med 2020; 16:483-492. [PMID: 32003735 DOI: 10.5664/jcsm.8244] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES High nasal resistance is associated with oral appliance treatment failure in obstructive sleep apnea (OSA). A novel oral appliance with a built-in oral airway has been shown to reduce pharyngeal pressure swings during sleep and may be efficacious in those with high nasal resistance. The role of posture and mandibular advancement on nasal resistance in OSA remains unclear. This study aimed to determine (1) the effects of posture and mandibular advancement on nasal resistance in OSA and (2) the efficacy of a new oral appliance device including in patients with high nasal resistance. METHODS A total of 39 people with OSA (7 females, apnea-hypopnea index (AHI) (mean ± standard deviation) = 29 ± 21 events/h) completed split-night polysomnography with and without oral appliance (order randomized). Prior to sleep, participants were instrumented with a nasal mask, pneumotachograph, and a choanal pressure catheter for gold standard nasal resistance quantification seated, supine and lateral (with and without oral appliance, order randomized). RESULTS Awake nasal resistance increased from seated, to supine, to lateral posture (median [interquartile range] = 1.8 [1.4, 2.7], 2.7 [1.7, 3.5], 3.4 [1.9, 4.6] cm H₂O/L/s, P < .001). Corresponding measures of nasal resistance did not change with mandibular advancement (2.3 [1.4, 3.5], 2.5 [1.8, 3.6], 3.5 [1.9, 4.8] cm H₂O/L/s, P = .388). The median AHI reduced by 47% with oral appliance therapy (29 ± 21 versus 18 ± 15 events/h, P = .002). Participants with high nasal resistance (> 3 cm H₂O/L/s) had similar reductions in AHI versus those with normal nasal resistance (61 [-8, 82] versus 40 [-5, 62] %, P = .244). CONCLUSIONS Nasal resistance changes with posture in people with OSA. A novel oral appliance with a built-in oral airway reduces OSA severity in people with OSA, including in those with high nasal resistance. CLINICAL TRIAL REGISTRATION Registry: ANZCTR; Title: Combination therapy for obstructive sleep apnoea; Identifier: ACTRN12617000492358; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372279.
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Affiliation(s)
- Benjamin K Tong
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Carolin Tran
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | | | - Alan Chiang
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Michelle Donegan
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Nick Murray
- Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Irene Szollosi
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Jason Amatoury
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.,Biomedical Engineering Program, American University of Beirut, Beirut, Lebanon
| | - Jayne C Carberry
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.,Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.,Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
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Tuttle R, Popescu L, Hill S, Slanczka A, Jankowski J, Barre K, Krueger E, Slade D, Croutch C, Robben M, Mesa Z, Mesa M, Dretchen KL. Intranasal epinephrine effects on epinephrine pharmacokinetics and heart rate in a nasal congestion canine model. Respir Res 2020; 21:78. [PMID: 32245384 PMCID: PMC7119008 DOI: 10.1186/s12931-020-01343-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/25/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Histamine release and vasodilation during an allergic reaction can alter the pharmacokinetics of drugs administered via the intranasal (IN) route. The current study evaluated the effects of histamine-induced nasal congestion on epinephrine pharmacokinetics and heart rate changes after IN epinephrine. METHODS Dogs received 5% histamine or saline IN followed by 4 mg epinephrine IN. Nasal restriction pressure, epinephrine concentration, and heart rate were assessed. Maximum concentration (Cmax), area under plasma concentration-time curve from 1 to 90 min (AUC1-90), and time to reach Cmax (Tmax) were measured. Clinical observations were documented. RESULTS In the 12 dogs in this study, nasal congestion occurred at 5-10 min after IN histamine administration versus no nasal congestion after IN saline. After administration of IN epinephrine, IN histamine-mediated nasal congestion was significantly reduced to baseline levels at 60, 80, and 100 min. There were no significant differences in Cmax and AUC1-90 between histamine and saline groups after IN epinephrine delivery (3.5 vs 1.7 ng/mL, p = 0.06, and 117 vs 59 ng/mL*minutes, p = 0.09, respectively). After receiving IN epinephrine, the histamine group had a significantly lower Tmax versus the saline group (6 vs 70 min, respectively; p = 0.02). Following IN epinephrine administration, the histamine group showed rapidly increased heart rate at 5 min, while there was a delayed increase in heart rate (occurring 30-60 min after administration) in the saline group. Clinical observations included salivation and emesis. CONCLUSION IN histamine led to more rapid epinephrine absorption and immediately increased heart rate compared with IN saline. IN epinephrine decreased histamine-induced nasal congestion.
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Affiliation(s)
- Richard Tuttle
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA.
| | - Luca Popescu
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA
| | - Scott Hill
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA
| | | | | | - Katherine Barre
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA
| | - Erika Krueger
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA
| | - Desmond Slade
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA
| | - Claire Croutch
- MRIGlobal, 425 Volker Boulevard, Kansas City, MO, 64110-2241, USA
| | | | - Zack Mesa
- Mesa Science Associates, Inc, Frederick, MD, USA
| | - Michael Mesa
- Mesa Science Associates, Inc, Frederick, MD, USA
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Goldsobel AB, Prabhakar N, Gurfein BT. Prospective trial examining safety and efficacy of microcurrent stimulation for the treatment of sinus pain and congestion. Bioelectron Med 2019; 5:18. [PMID: 32232107 PMCID: PMC7098235 DOI: 10.1186/s42234-019-0035-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/16/2019] [Indexed: 01/18/2023] Open
Abstract
Background Inflammation and swelling of the sinus and nasal mucosa are commonly caused by viral infection, bacterial infection, or exposure to allergens and irritants. Sinonasal inflammation can cause symptoms of nasal congestion, facial pressure, and rhinogenic facial pain or “sinus pain”. A previous randomized controlled study demonstrated that acute treatment with non-invasive periorbital microcurrent stimulation resulted in a rapid and clinically meaningful reduction in self-report of sinus pain that significantly outperformed sham control treatment. Here, we assessed the acute durability of microcurrent pain relief and longitudinal effects of 4 weeks of daily microcurrent treatment in patients presenting with sinus pain. Methods Thirty subjects with moderate facial pain (numeric rating scale ≥5) attributed to self-reported sinonasal disease were enrolled in a single-arm, prospective interventional study. At enrollment, subjects were given a microcurrent treatment device and written instructions and self-administered the device to the bilateral periorbital regions for 5 mins. Subjects were instructed to treat themselves at home once daily and up to four times daily as needed for 4 weeks. Pain was measured both acutely and weekly during the 4 weeks of treatment using the numeric rating scale. Congestion and medication use data were collected weekly using the Congestion Quantifier 7 (CQ7) and medication diary, respectively. Results Thirty patients were enrolled and completed the study. Microcurrent therapy rapidly reduced post-treatment numeric rating scale for pain by − 1.2 at 10 mins (p = 0.0076), − 1.6 at 1 hr (p = 0.0007), − 1.9 at 2 hrs (p < 0.0001), − 2.1 at 4 hrs (p < 0.0001), and − 2.1 at 6 hrs (p < 0.0001). With daily microcurrent treatment, numeric rating scale for pain was reduced over 4 weeks by − 1.3 (− 20.1%) after 1 week (p = 0.0018), − 2.1 (− 32.1%) after 2 weeks (p < 0.0001), − 2.4 (− 36.6%) after 3 weeks (p < 0.0001) and − 2.9 (− 43.3%) after 4 weeks (p < 0.0001). For subjects who enrolled with moderate or worse congestion, mean congestion scores (CQ7) were reduced by − 4.2 (− 22.0%) after 1 week (p < 0.0001), − 5.8 (− 33.0%) after 2 weeks (p < 0.0001), − 7.2 (− 37.4%) after 3 weeks (p < 0.0001) and − 8.6 (− 44.3%) after 4 weeks (p < 0.0001) of microcurrent treatment. Conclusion Self-administered periorbital microcurrent treatment given at home was efficacious in significantly reducing moderate sinus pain for up to 6 hrs and significantly reducing moderate pain and congestion over 4 weeks of daily use. Microcurrent therapy was found to be safe with only minor side effects that resolved without intervention. Trial registration ClinicalTrials.gov, NCT03888274. Registered 25 March 2019. Retroactively registered, https://clinicaltrials.gov/ct2/show/NCT03888274.
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Affiliation(s)
- Alan B Goldsobel
- Allergy and Asthma Associates of Santa Clara Valley Research Center, San Jose, CA USA.,2Stanford University School of Medicine, Stanford, CA USA.,3University of California San Francisco, San Francisco, CA USA
| | | | - Blake T Gurfein
- 3University of California San Francisco, San Francisco, CA USA.,Tivic Health Systems, Inc., 750 Menlo Ave #200, Menlo Park, CA 94025 USA
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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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Phaeohyphomycotic Rhinitis Caused by Bipolaris hawaiiensis in a Horse. J Equine Vet Sci 2019; 82:102798. [PMID: 31732112 DOI: 10.1016/j.jevs.2019.102798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/30/2019] [Accepted: 09/23/2019] [Indexed: 11/24/2022]
Abstract
This case represents the first reported case of Bipolaris hawaiiensis infection in an equid, and its aggressive clinical course. This case provides important descriptive and prognostic information for horses diagnosed with phaeohyphomycotic rhinitis. A 19-year-old American Quarter Horse mare was presented for second opinion of stertor and exercise intolerance of four-month duration. Endoscopy revealed generalized, proximal nasal edema, and computed tomography identified a soft tissue mass eroded through the rostral nasal bone. Biopsy of the mass was identified as a fungal granuloma caused by B. hawaiiensis resulting in chronic invasive fungal rhinitis. Treatment options were limited because of invasive infection, financial constraints, fungal sensitivity results, and published accounts of in vivo behavior of the organism. The infection progressed, resulting in euthanasia. In this case of equine phaeohyphomycosis, B. hawaiiensis was likely traumatically introduced into the patient's nasal cavity. Its aggressive nature in an apparently immunocompetent patient is noteworthy, in the face of surgical debridement and attempted medical therapy. Therapeutic decisions were challenging in this case based on limited in vivo efficacy data in equids, pharmacokinetic challenges with available antifungal agents, and client-driven limitations regarding management of airway restriction.
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Kirtsreesakul V, Leelapong J, Ruttanaphol S. Correlation Between Peak Nasal Flow Reversibility and Mucociliary Clearance in Allergic Rhinitis. Laryngoscope 2019; 130:1372-1376. [PMID: 31385622 DOI: 10.1002/lary.28226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/22/2019] [Accepted: 07/18/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Reversibility of nasal airflow after decongestion measured by rhinomanometry is associated with the severity of allergic inflammation. Peak nasal flow is a simpler alternative method for assessing nasal patency. The aim of this study was to evaluate the correlation between changes in peak nasal expiratory and inspiratory flows (PNEFs and PNIFs) after decongestion and nasal mucociliary clearance times (NMCCTs). STUDY DESIGN Single-center, prospective cross-sectional study. METHODS One hundred one allergic rhinitis patients were enrolled. Nasal symptoms and NMCCTs were assessed. PNEF and PNIF were performed before and after decongestion. Correlations between changes in PNEF and PNIF after decongestion and NMCCTs were analyzed. One-half the standard deviation of baseline peak nasal flows was used to estimate the minimal clinically important differences (MCIDs) and discriminate between patients with reversible mucosa and with irreversible mucosa. RESULTS PNEF showed more peak flow improvements after decongestion compared to PNIF. Changes in PNEF had better negative correlations with NMCCTs than PNIF (ρ = -0.49, P < .001 and ρ = -0.34, P < .001, respectively). The MCID values of the PNEF and PNIF were 27.93 and 19.74, respectively. In comparisons of NMCCTs between patients with or without MCID of peak nasal flow after decongestion, PNEF had better discrimination ability compared to PNIF (P = .003 and P = .026, respectively). CONCLUSIONS The limitation of reversibility as measured by peak nasal flows could indirectly point to the affection of mucosal inflammation as indicated by NMCCTs. PNEF is more sensitive to assess peak flow changes after decongestion than PNIF. LEVEL OF EVIDENCE 2 Laryngoscope, 130:1372-1376, 2020.
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Affiliation(s)
- Virat Kirtsreesakul
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Jitanong Leelapong
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Suwalee Ruttanaphol
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Kepekçi AH, İbişoğlu MS, Yılmaz S, Kığ C. IRAP-PCR As A Tool For Screening HERV Polymorphisms In Nasal Mucosal Swabs. ENT UPDATES 2019. [DOI: 10.32448/entupdates.578602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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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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CHIARUGI A, CAMAIONI A. Update on the pathophysiology and treatment of rhinogenic headache: focus on the ibuprofen/pseudoephedrine combination. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2019; 39:22-27. [PMID: 30936575 PMCID: PMC6444167 DOI: 10.14639/0392-100x-1882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 11/23/2017] [Indexed: 12/18/2022]
Abstract
Rhinogenic headache is frequently encountered in clinical practice. Treatment of this condition should be based on a proper evaluation of its underlying pathophysiology. Fixed-dose combinations of two or more active agents, and specifically the combination of ibuprofen plus pseudoephedrine, have been shown to be more efficacious than either monotherapy. At present, an ibuprofen/pseudoephedrine fixed-dose combination is available as an over-the-counter drug. This paper reviews in detail the pathophysiology of rhinogenic headache and discusses the rationale for treatment of this condition with a fixed-dose ibuprofen/pseudoephedrine combination.
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Affiliation(s)
- A. CHIARUGI
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Italy
| | - A. CAMAIONI
- Ear, Nose and Throat Department, San Giovanni Addolorata Hospital, Rome, Italy
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Infectious diseases of the ear, nose, throat, and bronchus. THE THEORY OF ENDOBIOGENY 2019. [PMCID: PMC7150014 DOI: 10.1016/b978-0-12-816908-7.00009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Infectious diseases occur based on the interrelationship of the capabilities of the host and the virulence of the microorganism. Each person has a terrain that determines the susceptibility to infection and response to an infection. According to the theory of endobiogeny, the majority of symptoms related to an infectious disease are related to the patient’s response to the infector and not the intrinsic agent itself. This chapter discusses common infectious maladies: rhinopharyngitis, sinusitis, otitis media, tonsillitis, and bronchitis. For each of these disorders, the neuroendocrine and emunctory elements in the precritical and critical terrain are discussed. Treatment options are discussed based on treating the patient rather than the microorganism.
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Wolkoff P. The mystery of dry indoor air - An overview. ENVIRONMENT INTERNATIONAL 2018; 121:1058-1065. [PMID: 30389384 DOI: 10.1016/j.envint.2018.10.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/23/2018] [Accepted: 10/26/2018] [Indexed: 06/08/2023]
Abstract
"Dry air" is a major and abundant indoor air quality complaint in office-like environments. The causality of perceived "dry air" and associated respiratory effects continues to be debated, despite no clear definition of the complaint, yet, has been provided. The perception of "dry air" is semantically confusing without an associated receptor but mimics a proto-state of sensory irritation like a cooling sensation. "Dry air" may also be confused with another common indoor air quality complaint "stuffy air", which mimics the sense of no fresh air and of nasal congestion. Low indoor air humidity (IAH) was dismissed more than four decades ago as cause of "dry air" complaints, rather indoor pollutants was proposed as possible exacerbating causative agents during the cold season. Many studies, however, have shown adverse effects of low IAH and beneficial effects of elevated IAH. In this literature overview, we try to answer, "What is perceived "dry air" in indoor environments and its associated causalities. Many studies have shown that the perception is caused not only by extended exposure to low IAH, but also simultaneously with and possibly exacerbated by indoor air pollutants that aggravate the protective mucous layer in the airways and the eye tear film. Immanent diseases in the nose and airways in the general population may also contribute to the overall complaint rate and including other risk factors like age of the population, use of medication, and external factors like the local ambient humidity. Low IAH may be the single cause of perceived "dry air" in the elderly population, while certain indoor air pollutants may come into play among susceptible people, in addition to baseline contribution of nasal diseases. Thus, perceived "dry air" intercorrelates with dry eyes and throat, certain indoor air pollutants, ambient humidity, low IAH, and nasal diseases.
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Affiliation(s)
- Peder Wolkoff
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark.
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Vakkilainen S, Mäkitie R, Klemetti P, Valta H, Taskinen M, Husebye ES, Mäkitie O. A Wide Spectrum of Autoimmune Manifestations and Other Symptoms Suggesting Immune Dysregulation in Patients With Cartilage-Hair Hypoplasia. Front Immunol 2018; 9:2468. [PMID: 30410491 PMCID: PMC6209636 DOI: 10.3389/fimmu.2018.02468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/05/2018] [Indexed: 11/14/2022] Open
Abstract
Background: Mutations in RMRP, encoding a non-coding RNA molecule, underlie cartilage-hair hypoplasia (CHH), a syndromic immunodeficiency with multiple pathogenetic mechanisms and variable phenotype. Allergy and asthma have been reported in the CHH population and some patients suffer from autoimmune (AI) diseases. Objective: We explored AI and allergic manifestations in a large cohort of Finnish patients with CHH and correlated clinical features with laboratory parameters and autoantibodies. Methods: We collected clinical and laboratory data from patient interviews and hospital records. Serum samples were tested for a range of autoantibodies including celiac, anti-cytokine, and anti-21-hydroxylase antibodies. Nasal cytology samples were analyzed with microscopy. Results: The study cohort included 104 patients with genetically confirmed CHH; their median age was 39.2 years (range 0.6–73.6). Clinical autoimmunity was common (11/104, 10.6%) and included conditions previously undescribed in subjects with CHH (narcolepsy, psoriasis, idiopathic thrombocytopenic purpura, and multifocal motor axonal neuropathy). Patients with autoimmunity more often had recurrent pneumonia, sepsis, high immunoglobulin (Ig) E and/or undetectable IgA levels. The mortality rates were higher in subjects with AI diseases (χ(2)2 = 14.056, p = 0.0002). Several patients demonstrated serum autoantibody positivity without compatible symptoms. We confirmed the high prevalence of asthma (23%) and allergic rhinoconjunctivitis (39%). Gastrointestinal complaints, mostly persistent diarrhea, were also frequently reported (32/104, 31%). Despite the history of allergic rhinitis, no eosinophils were observed in nasal cytology in five tested patients. Conclusions: AI diseases are common in Finnish patients with CHH and are associated with higher mortality, recurrent pneumonia, sepsis, high IgE and/or undetectable IgA levels. Serum positivity for some autoantibodies was not associated with clinical autoimmunity. The high prevalence of persistent diarrhea, asthma, and symptoms of inflammation of nasal mucosa may indicate common pathways of immune dysregulation.
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Affiliation(s)
- Svetlana Vakkilainen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Riikka Mäkitie
- Folkhälsan Research Center, Helsinki, Finland.,University of Helsinki, Helsinki, Finland
| | - Paula Klemetti
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Helena Valta
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mervi Taskinen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eystein Sverre Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway.,K.G. Jebsen Centre for Autoimmune Disorders, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Outi Mäkitie
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,Department of Molecular Medicine and Surgery, Karolinska Institutet and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
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Singer E, Miller JE. Improved quality of life associated with long-term daily use of guaifenesin (Mucinex®) in a patient with chronic rhinosinusitis: a case report. Oxf Med Case Reports 2018; 2018:omy060. [PMID: 30159154 PMCID: PMC6109196 DOI: 10.1093/omcr/omy060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/22/2018] [Indexed: 12/01/2022] Open
Abstract
Chronic rhinosinusitis (CRS) is a common disease, and although not life-threatening, carries a vast symptom and economic burden and is associated with significant impairment in quality of life. We report the rapid improvement of symptoms and quality-of-life following initiation of adjunctive daily oral guaifenesin therapy in a 41-year-old male patient with CRS, who presented to our primary care clinic with recurrent infections, severe sinonasal symptoms, cough and hearing loss. Continued daily use of over-the-counter guaifenesin, for almost 3 years, has broken his cycle of recurrent sinus infections. Given that CRS is the most common reason for ambulatory prescription of antibiotics, the observed reduction in infections may have also helped him to avoid antibiotics, thereby reducing his risk for antibiotic resistance and unnecessary adverse events.
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Affiliation(s)
- Ethan Singer
- Lakota Healthcare Family Practice, Unit #7, Gresham’s Landing, 2489 US 6, Hawley, PA 18428, USA
| | - Judi E Miller
- SRxA Strategic Pharmaceutical Advisors, 1750 Tysons Boulevard, Suite 1500, McLean, VA 22102, USA
- Correspondence address. SRxA Strategic Pharmaceutical Advisors, 1750 Tysons Boulevard, Suite 1500, McLean, VA 22102, USA. Tel: +1-202-316-8692; Fax: +1-202-747-3415; E-mail:
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Sawani A, Farhangi M, N CA, Maul TM, Parthasarathy S, Smallwood J, Wei JL. Limiting Dietary Sugar Improves Pediatric Sinonasal Symptoms and Reduces Inflammation. J Med Food 2018; 21:527-534. [PMID: 29851540 DOI: 10.1089/jmf.2017.0126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Excessive sugar consumption is associated with many chronic inflammatory diseases in adults. The effects of excessive sugar consumption in children have not been determined. In this study, we hypothesized that sinonasal symptoms and proinflammatory cytokine levels would be related and could be altered through reduction in sugar-sweetened beverage (SSB) consumption. To test this, we conducted a pilot study involving behavior modification and a 2-week follow-up. Seventeen children participants were recruited, and eleven completed the study. The experimental group presented with chronic nasal congestion or rhinorrhea defined by daily symptoms without acute illness for at least 3 months. The control group presented for non-nasal problems. Both groups received counseling to decrease SSB consumption. The Sinus and Nasal Quality of Life (SN-5) Survey was administered, and a blood sample was obtained by venipuncture at baseline and 2 weeks after counseling. Participants kept a 2-week food diary to document sugar intake. Serum lipid profile and inflammatory cytokines were measured. The experimental group reduced daily sugar intake, 46% versus 11% in the control. Baseline SN-5 scores were significantly worse in the experimental group and normalized to controls after intervention. Inflammatory cytokine levels were not different at baseline, but the experimental group significantly reduced in proinflammatory markers and increased the levels of anti-inflammatory markers after intervention. Our pilot data demonstrate higher sugar consumption may be associated with increased inflammatory stress and sinonasal symptoms. Reducing SSB and controlling inflammation in early childhood may have future health benefits.
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Affiliation(s)
- Ali Sawani
- 1 College of Medicine, University of Central Florida , Orlando, Florida, USA
| | - Monika Farhangi
- 1 College of Medicine, University of Central Florida , Orlando, Florida, USA
| | - Chandrakala Aluganti N
- 2 Burnett School of Biomedical Sciences and College of Medicine, University of Central Florida , Orlando, Florida, USA
| | - Timothy M Maul
- 3 Department of Pediatric Cardiovascular Surgery, Nemours Children's Hospital , Orlando, Florida, USA
| | - Sampath Parthasarathy
- 1 College of Medicine, University of Central Florida , Orlando, Florida, USA.,2 Burnett School of Biomedical Sciences and College of Medicine, University of Central Florida , Orlando, Florida, USA
| | - Jordan Smallwood
- 1 College of Medicine, University of Central Florida , Orlando, Florida, USA.,4 Division of Allergy and Immunology, Nemours Children's Hospital , Orlando, Florida, USA
| | - Julie L Wei
- 1 College of Medicine, University of Central Florida , Orlando, Florida, USA.,5 Division of Pediatric Otolaryngology, Nemours Children's Hospital , Orlando, Florida, USA
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Yao A, Wilson JA, Ball SL. Autonomic nervous system dysfunction and sinonasal symptoms. ALLERGY & RHINOLOGY 2018; 9:2152656718764233. [PMID: 29977656 PMCID: PMC6028164 DOI: 10.1177/2152656718764233] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The autonomic nervous system (ANS) richly innervates the nose and paranasal sinuses, and has a significant role in lower airway diseases, e.g., asthma. Nonetheless, its contribution to sinonasal symptoms is poorly understood. This review aimed to explore the complex relationship between the ANS and sinonasal symptoms, with reference to systemic diseases and triggers of ANS dysfunction. Methods A review of articles published in English was conducted by searching medical literature databases with the key words “autonomic nervous system” and (“sinusitis” or “nose” or “otolaryngology”). All identified abstracts were reviewed, and, from these, relevant published whole articles were selected. Results The ANS has a significant role in the pathophysiologic mechanisms that produce sinonasal symptoms. There was limited evidence that describes the relationship of the ANS in sinonasal disease with systemic conditions, e.g. hypertension. There was some evidence to support mechanisms related to physical and psychological stressors in this relationship. Conclusion The role of ANS dysfunction in sinonasal disease is highly complex. The ANS sits within a web of multiple factors, including personality and psychological distress, that contribute to sinonasal symptoms. Further research will help to clarify the etiology of ANS dysfunction and its contribution to common systemic conditions.
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Affiliation(s)
- Alexander Yao
- ENT Department, Stepping Hill National Health Service (NHS) Foundation Trust, Stockport, United Kingdom
| | - Janet A Wilson
- ENT Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Stephen L Ball
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, United Kingdom No external funding sources reported
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Berson SR, Klimczak J, Prezio EA, Hu S, Abraham M. Clinical associations between allergies and rapid eye movement sleep disturbances. Int Forum Allergy Rhinol 2018; 8:817-824. [PMID: 29461689 PMCID: PMC6055599 DOI: 10.1002/alr.22099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/14/2018] [Accepted: 01/18/2018] [Indexed: 12/17/2022]
Abstract
Background Allergic rhinitis, an immunoglobulin E inflammatory condition including nasal congestion, obstruction, sneezing, pruritus, and fatigue symptoms, has significant impact on quality of life and impairs sleep. Sleep‐disordered breathing (SDB) patients often have normal all‐night apnea‐hypopnea (AHI) or respiratory‐disturbance (RDI) indices on polysomnography (PSG). We hypothesized that the rapid eye motion–respiratory disturbance index (REM‐RDI) may be a novel predictor of allergic status. Methods A retrospective analysis of 100 patients compared REM‐RDI results in 67 allergen‐positive patients with 33 nonallergic patients who presented with nasal blockage. Subjects completed STOP‐Bang©, 22‐item Sino‐Nasal Outcome Test (SNOT‐22)©, and Epworth Sleepiness Scale© questionnaires and underwent skin‐prick testing (SPT) and PSGs including REM‐RDI values. Using multivariate logistic regression models, we evaluated relationships between allergic status and sleep parameters while controlling for possible confounders including body mass index (BMI). Results Using REM‐RDI as the outcome of interest, allergen‐positive patients were 3.92 times more likely to have REM‐RDI values in a moderate/severe range (≥15 events/hour); and patients with moderate/severe REM‐RDI values were more likely to be allergen positive (p < 0.05). Allergic status was not significantly related to all‐night AHI, RDI, or REM‐AHI. BMI was not significantly related to REM‐RDI. STOP‐Bang© was related to allergy status (p = 0.02) and REM‐RDI (p < 0.01). Allergic patients had increased REM latency and less total amount of REM. Conclusion We revealed significant bidirectional associations between allergen positivity and increased REM‐RDI values independent of BMI, AHI, RDI, and REM‐AHI. Allergic inflammation and REM‐RDI data may play important roles in diagnosing and treating fatigued SDB patients and as objective perioperative safety and outcomes measures.
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Affiliation(s)
- Shelley R Berson
- Department of Otolaryngology, School of Medicine, New York Medical College, Valhalla, NY
| | - Jaclyn Klimczak
- Department of Ear, Nose and Throat (Otolaryngology)-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY
| | | | - Shirley Hu
- Department of Ear, Nose and Throat (Otolaryngology)-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY
| | - Manoj Abraham
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mt. Sinai, New York, NY
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Karataş A. Pretreatment Prediction of the Outcomes of Intranasal Steroid Sprays in Cases with Inferior Turbinate Hypertrophy. Turk Arch Otorhinolaryngol 2018; 55:105-110. [PMID: 29392066 DOI: 10.5152/tao.2017.2443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/05/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Intranasal steroid sprays (INSS) are frequently prescribed for treating inferior turbinate hypertrophy (ITH). Complications due to the long-term application of INSS such as crusting, epistaxis, nasal mucosa dryness, and septal perforation may occur. Predicting patients who would benefit from INSS early might lower treatment costs and complication rates. We examined the predictive value of nasal decongestant response rates for the outcomes of INSS in ITH. Methods Fifty patients with bilateral ITH were included in two groups: patients benefiting from INSS and those not benefiting. Nasal airflow was assessed by peak nasal inspiratory flow (PNIF) measurement in all cases. Measurements were taken three times: before and after the application of nasal decongestant sprays and after the application of INSS. Results In both groups, the nasal air flow rates significantly increased after the application of nasal decongestant sprays; however, the nasal decongestant response rates were higher in the group with patients benefiting from INSS. There was a strong correlation between the nasal air flow rates measured after the application of nasal decongestant sprays and after the application of INSS. The cut-off value for the relationship between increased nasal air flow rates after the application of nasal decongestant sprays and outcomes of INSS was 23%. Conclusion Measurement of nasal airflow increase rate after the application of nasal decongestant sprays is a simple and easy method for the early prediction of the outcomes of INSS in ITH. A higher than 23% increase in nasal air flow rates after the application of nasal decongestant sprays indicates much better outcomes of INSS for patients.
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Affiliation(s)
- Abdullah Karataş
- Clinic of Otorhinolaryngology, Haseki Training and Research Hospital, İstanbul, Turkey
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Kalantar-Hormozi A, Ravar R, Abbaszadeh-Kasbi A, Rita Davai N. Teenage Rhinoplasty. World J Plast Surg 2018; 7:97-102. [PMID: 29651398 PMCID: PMC5890372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/23/2017] [Accepted: 10/03/2017] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Rhinoplasty is among the most popular aesthetic surgical procedures selected by teenagers. When it comes to teenagers' rhinoplasty, almost all surgeons believe that modified techniques should be considered because the nose is still growing. In this article, we prospectively followed teenagers who had undergone septorhinoplasty to assess the safety of procedure and its possible complications. METHODS All the patients who were under 18 years old but for those who had a bleeding disorder, allergic rhinitis, and cleft lip nose were included in the study. All the patients were operated by the Senior author through closed rhinoplasty. Age, gender, indication for surgery, postoperative complications, need for revision surgery, postoperative satisfaction, and disturbance in facial growth until puberty were gathered for each of patients. RESULTS Of all 40 patients, 38 (95%) patients were female and 2 (5%) patients were male. Mean age and follow up of patients was 16.1±0.8 years and 29.5±12.1 months, respectively. Fourteen (35%) patients had some degrees of nasal obstruction. Thirty-five (87.5%) patients expressed complete satisfaction with their rhinoplasty outcome. None of patients underwent revision rhinoplasty. CONCLUSION The study indicates that patients' craniofacial growth was not affected by the procedure, and it seems that septorhinoplasty is safe in teenagers.
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Affiliation(s)
- Abdoljalil Kalantar-Hormozi
- Department of Plastic and Craniofacial Surgery, Medical College of Shahid Beheshti University of Medical Sciences, 15 Khordad Hospital, Tehran, Iran
| | - Roozbeh Ravar
- Department of Plastic and Craniofacial Surgery, Medical College of Shahid Beheshti University of Medical Sciences, 15 Khordad Hospital, Tehran, Iran
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Katotomichelakis M, Van Crombruggen K, Holtappels G, Kuhn FA, Fichandler CE, Kuhn-Glendye CA, Anon JB, Melroy CT, Karanfilov B, Haegen TW, Kastanioudakis I, Bachert C, Zhang N. A herbal composition of Scutellaria baicalensis and Eleutherococcus senticosus shows vasocontrictive effects in an ex-vivo mucosal tissue model and in allergic rhinitis patients. CLINICAL PHYTOSCIENCE 2017. [DOI: 10.1186/s40816-017-0058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Juto A, Juto AJ, von Hofsten P, Jörgensen F. Kinetic oscillatory stimulation of nasal mucosa in non-allergic rhinitis: comparison of patient self-administration and caregiver administration regarding pain and treatment effect. A randomized clinical trial. Acta Otolaryngol 2017; 137:850-855. [PMID: 28498078 DOI: 10.1080/00016489.2017.1284342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
CONCLUSION Patient self-administration of the Kinetic Oscillatory Stimulation (KOS)-catheter was a fully acceptable alternative to insertion of the catheter by physician with helmet fixation, in patients with non-allergic rhinitis (NAR). The approaches were equivalent regarding pain. The treatment effect in the patient self-administration group was not inferior. OBJECTIVES To evaluate whether self-administration of a KOS-catheter was different compared to insertion by a physician, assessed with patient reported pain on a visual analogue scale (VAS). Also, to evaluate the difference in nasal stuffiness with the Sino-Nasal Outcome Test (SNOT-22) and Peak Nasal Inspiratory Flow (PNIF). METHODS Patients with NAR were randomized to group 1, patient insertion of catheter and manual fixation, and group 2, catheter insertion by physician and fixation with a helmet. Patients were treated once, 10 min in each nasal cavity, and followed up 14 days later. RESULTS Twenty-nine patients were included (group 1, n = 14; group 2, n = 15). There was no statistical significant difference in patient reported pain between groups. There was a decrease in nasal stuffiness after treatment in the total study population (n = 26, p = 0.001). In group 1 nasal stuffiness was decreased and in group 2 there was no change (group 1, p = 0.004; group 2, p = 0.071). No statistical significant change in PNIF was observed.
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Affiliation(s)
- Alexander Juto
- FOUU Halland, Halmstad County Hospital, Halmstad, Sweden
| | | | - Per von Hofsten
- Ear, Nose and Throat Clinic, Halmstad County Hospital, Halmstad, Sweden
| | - Finn Jörgensen
- Ear, Nose and Throat Clinic, Halmstad County Hospital, Halmstad, Sweden
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Chowdhury T, Bindu B, Singh GP, Schaller B. Sleep Disorders: Is the Trigemino-Cardiac Reflex a Missing Link? Front Neurol 2017; 8:63. [PMID: 28289401 PMCID: PMC5326750 DOI: 10.3389/fneur.2017.00063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/13/2017] [Indexed: 12/26/2022] Open
Abstract
Trigeminal innervated areas in face, nasolacrimal, and nasal mucosa can produce a wide array of cardiorespiratory manifestations that include apnea, bradypnea, bradycardia, hypotension, and arrhythmias. This reflex is a well-known entity called "trigemino-cardiac reflex" (TCR). The role of TCR is investigated in various pathophysiological conditions especially in neurosurgical, but also skull base surgery procedures. Additionally, its significance in various sleep-related disorders has also been highlighted recently. Though, the role of diving reflex, a subtype of TCR, has been extensively investigated in sudden infant death syndrome. The data related to other sleep disorders including obstructive sleep apnea, bruxism is very limited and thus, this mini review aims to investigate the possible role and correlation of TCR in causing such sleep abnormalities.
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Affiliation(s)
- Tumul Chowdhury
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba , Winnipeg, MB , Canada
| | - Barkha Bindu
- Department of Neuro-anaesthesiology and Critical Care, All India Institute of Medical Sciences , New Delhi , India
| | - Gyaninder Pal Singh
- Department of Neuro-anaesthesiology and Critical Care, All India Institute of Medical Sciences , New Delhi , India
| | - Bernhard Schaller
- Department of Research, University of Southampton , Southampton , UK
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Straumfors A, Heldal KK, Eduard W, Wouters IM, Ellingsen DG, Skogstad M. Cross-shift study of exposure-response relationships between bioaerosol exposure and respiratory effects in the Norwegian grain and animal feed production industry. Occup Environ Med 2016; 73:685-93. [PMID: 27473330 PMCID: PMC5036228 DOI: 10.1136/oemed-2015-103438] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/12/2016] [Indexed: 01/07/2023]
Abstract
Objective We have studied cross-shift respiratory responses of several individual bioaerosol components of the dust in the grain and feed industry in Norway. Methods Cross-shift changes in lung function and nasal congestion, as well as in respiratory and systemic symptoms of 56 exposed workers and 36 referents, were recorded on the same day as full-shift exposure to the inhalable aerosol fraction was assessed. Exposure–response associations were investigated by regression analysis. Results The workers were exposed on average to 1.0 mg/m3 of grain dust, 440 EU/m3 of endotoxin, 6 µg/m3 of β-1,3-glucans, 17×104/m3 of bacteria and 4×104/m3 of fungal spores during work. The exposure was associated with higher prevalence of self-reported eye and airway symptoms, which were related to the individual microbial components in a complex manner. Fatigue and nose symptoms were strongest associated with fungal spores, cough with or without phlegm was associated with grain dust and fungal spores equally strong and wheeze/tight chest/dyspnoea was strongest associated with grain dust. Bioaerosol exposure did not lead to cross-shift lung function decline, but several microbial components had influence on nose congestion. Conclusions Exposure to fungal spores and dust showed stronger associations with respiratory symptoms and fatigue than endotoxin exposure. The associations with dust suggest that there are other components in dust than the ones studied that induce these effects.
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Affiliation(s)
- Anne Straumfors
- Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
| | - Kari Kulvik Heldal
- Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
| | - Wijnand Eduard
- Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
| | - Inge M Wouters
- Faculty of Veterinary Medicine, Institute of Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Dag G Ellingsen
- Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
| | - Marit Skogstad
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
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Navarro-Locsin CG, Romualdez JA. Attitudes, practices on allergic rhinitis of three socioeconomic classes of Filipinos in the National Capital Region. Asia Pac Allergy 2016; 6:94-100. [PMID: 27141482 PMCID: PMC4850341 DOI: 10.5415/apallergy.2016.6.2.94] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 04/04/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Healthcare access and usage may vary according to socioeconomic class (SEC). Knowing this variable's effect on patient attitudes, practices, and health seeking behavior allows better understanding of compliance, adherence to treatment, and educational needs on allergic rhinitis (AR). OBJECTIVE This study seeks to assess the attitudes and practices on AR of Filipinos in the National Capital Region. METHODS A cross sectional survey of 301 Filipinos, stratified into socioeconomic groups ABC1, C2, and DE, was conducted from December 2014 to February 2015. A previously validated and pilot tested questionnaire on AR was administered via structured face to face interviews. RESULTS Most respondents attributed their symptoms to "colds" (ABC1 77%, C2 79%, DE 78%); most did not consult a physician for their symptoms. Only 26% of all respondents were aware of AR. Only the ABC1 group had respondents who specifically used the term AR. Most respondents' symptoms fulfilled criteria for moderate to severe disease. Sleep was the activity most affected by AR (62%). For symptom relief, over the counter antihistamine-decongestants were the most preferred drug preparations (ABC1 30%, C2 38%, DE 34%). Groups ABC1 and C2 cited family, television, and Internet as the top primary sources of health information; DE cited family, television, and friends. CONCLUSION Regardless of SEC, Filipinos are not aware of AR. Lack of awareness and gaps in knowledge can result to an underestimation of the condition, decrease in health seeking behavior, unmet patient needs, and undertreatment of disease.
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Affiliation(s)
| | - Joel A Romualdez
- Department of Otolaryngology-Head & Neck Surgery, St. Luke's Medical Center, Quezon 1112, the Philippines
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Suzuki H, Koizumi H, Ikezaki S, Tabata T, Ohkubo JI, Kitamura T, Hohchi N. Electrical Impedance and Expression of Tight Junction Components of the Nasal Turbinate and Polyp. ORL J Otorhinolaryngol Relat Spec 2015; 78:16-25. [PMID: 26633876 DOI: 10.1159/000442024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE We investigated the electrical impedance and expression of tight junction components of the turbinate mucosa, nasal polyp, and normal skin. PROCEDURES The inferior turbinate and nasal polyp of patients with chronic rhinosinusitis and the postauricular skin of patients with otitis media were examined. Electrical impedance was measured in vivo using a tissue conductance meter. Expressions of claudin-1 and tricellulin were examined by fluorescence immunohistochemistry and quantitative RT-PCR. RESULTS Electrical impedance was higher in the skin than in the turbinate and polyp, but did not differ between the turbinate and polyp. Immunoreactivities for claudin-1 and tricellulin were seen in the epithelial/epidermal layer. Expression of claudin-1 was higher in the skin than in the turbinate and polyp. The polyp tended to show higher expression of claudin-1 but showed lower expression of tricellulin than the turbinate. The ratio of claudin-1 to tricellulin was highest in the skin and lowest in the turbinate. The correlation between expressions of the two tight junction components was strongly positive in the skin (r = 0.964) and negative (r = -0.527) in the turbinate and polyp. CONCLUSIONS These results suggest that the roles of claudin-1 and tricellulin in barrier function may be complementary, and may thereby maintain a constant level of permeability of the mucosal tissues.
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Affiliation(s)
| | - Hiroki Koizumi
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Sozansky J, Houser SM. The physiological mechanism for sensing nasal airflow: a literature review. Int Forum Allergy Rhinol 2014; 4:834-8. [PMID: 25079504 DOI: 10.1002/alr.21368] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Nasal obstruction is a common otolaryngologic complaint, yet the mechanism of sensing airflow is not commonly understood. The objective of this work was to review current knowledge on the physiological mechanism for sensing nasal airflow. METHODS Current literature pertaining to nasal sensation to airflow was retrieved using PubMed and Google Scholar searches. RESULTS The primary physiological mechanism that produces the sensation of ample nasal airflow is activation of trigeminal cool thermoreceptors, specifically transient receptor potential melastatin family member 8 (TRPM8), by nasal mucosal cooling. The dynamic change in temperature is ultimately sensed. Nasal mucosal cooling is a result of conductive heat loss, driven by temperature gradient, and evaporative heat loss, driven by humidity gradient. The perception of ample nasal airflow is dependent on the overall nasal surface area stimulated by mucosal cooling, which is mainly governed by air flow patterns. Cool thermoreceptors in the nasal mucosa are connected to the respiratory centers and consequently can alter respiration patterns. Mechanoreceptors do not seem to play a role in sensing nasal airflow. Computational fluid dynamics (CFD) modeling could be a valuable objective tool in evaluating patients with nasal congestion. CONCLUSION Understanding the physiological mechanism of how the nose senses airflow can aid in diagnosing the cause behind patient symptoms, which allows physicians to provide better treatment options for patients.
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