Effects of phenylpropanolamine on ostial and nasal airway resistance in healthy individuals

Effects of Oxymetazoline on the Ventilation of Paranasal Sinuses in Healthy Subjects

Background

Impairment of sinus ostial function is considered an important factor in the pathophysiology of sinus disease. The use of the decongestants such as α2-agonists is thought to improve sinus ostial function. Previous studies have shown an effect of α2-agonists on maxillary sinus ostial function only when administered in nasal bellows, but not as a nasal spray or nasal drops. The effect of decongestants on ventilation of the frontal and posterior ethmoidal and sphenoidal sinuses has not been studied to date.

Methods

In this study, the 133-xenon washout method was used to determine ventilation for all paranasal sinuses before and after administration of oxymetazoline as nasal drops in eight subjects and from nasal bellows in nine healthy subjects.

Results

No significant effect of oxymetazoline on sinus ventilation was seen in either group.

Conclusions

The results indicate that α2-agonists do not have any effect on sinus ventilation in healthy subjects. However, one cannot exclude that decongestants improve sinus ventilation in patients suffering from sinus disease and this requires further studies.

Nasal reflexes: implications for exercise, breathing, and sex

Nasal patency, with both congestion and decongestion, is affected in a wide variety of reflexes. Stimuli leading to nasal reflexes include exercise; alterations of body position, pressure, and temperature; neurologic syndromes; and dentistry. As anticipated, the vagal and trigeminal systems are closely integrated through nasobronchial and bronchonasal reflexes. However, perhaps of greater pathophysiologic importance are the naso-hypopharyngeal-laryngeal reflexes that become aggravated during sinusitis. None other than Sigmund Freud saw deeply beyond the facial adornment and recognized the deeper sexual tensions that can regulate nasal functions and psychoanalytical status. Wine, women, and song are linked with airflow through the nose-the nose, which by any other name would still smell as sweetly.

Role of allergy in rhinosinusitis

PURPOSE OF REVIEW

Allergic rhinitis and rhinosinusitis are common diseases occurring in both children and adults that consume enormous amounts of health care dollars. In addition to its own costs, allergic rhinitis is considered a major predisposing factor for the development of rhinosinusitis. Whereas many authors suggest a clinical association between these two diseases, the mechanism of how allergic rhinitis predisposes to rhinosinusitis or affects the course of rhinosinusitis remains unclear.

RECENT FINDINGS

Limited progress has been made in understanding the pathophysiologic mechanism involved in the interaction. Progress in immunologic technique emphasizes the importance of inflammatory cells, especially eosinophils, mast cells, and T lymphocytes, and their mediators. Some authors have proposed a role for neurogenic pathways, whereas others have focused on systemic involvement. Little progress has been made in intervention studies that support the importance of allergic rhinitis in altering the course of acute or chronic rhinosinusitis.

SUMMARY

This paper reviews the limited new literature available to update knowledge that supports the association of allergic rhinitis with rhinosinusitis, mechanisms potentially underlying the association, and implications of this knowledge for therapy.

Pharmacological background to decongesting and anti-inflammatory treatment of rhinitis and sinusitis

A review is given of the literature concerning effects of oral and topical decongestants and anti-inflammatory drugs in rhinitis and sinusitis. Oral vasoconstrictors, effective in decongesting the nasal mucosa, need to be taken in doses that may induce disturbing systemic side-effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) have weak effects in allergic rhinitis as compared with glucocorticosteroids. No controlled clinical trials of systemic glucocorticosteroids in sinusitis have been published. Four studies in which different glucocorticosteroids were administered topically for sinusitis have been performed, but these gave very weak support for any positive effects of such a treatment.

Ostial function in allergic rhinitis

In order to evaluate the maxillary ostial function a double-blind, group comparative study with intranasal budesonide and placebo was carried out in 20 adult patients suffering from seasonal rhinitis. The trial started with an entry visit 3 weeks before pollen peak with clinical assessments (physical examination and ostial diameter measurements) followed by a 3-week treatment period. Treatment was either intranasal budesonide 200 micrograms b.i.d. or matching placebo b.i.d. The trail ended at pollen peak with clinical assessment. The results showed normal ostial diameters in the patients suffering from seasonal rhinitis. There were no statistical significant differences in ostial diameter change between the treatment groups except between budesonide and placebo in sitting position at measurement time 0 min. It seems that pollen does not reach the ostial region.

Therapeutical aspects of sinusitis in relation to pathogenesis

Modern aspects of the pathophysiology of sinusitis have given further evidence of the importance of ventilation and drainage as therapeutical procedures. A simple therapeutical method for implantation of a tube in the maxillary sinus for treatment of acute sinusitis is presented.