Alteration of barrier properties, stratum corneum ceramides and microbiome composition in response to lotion application on cosmetic dry skin

Xerosis, commonly referred to as dry skin, is a common dermatological condition affecting almost a third of the population. Successful treatment of the condition traditionally involves the application of cosmetic products facilitating the moisturisation of the skin with a range of ingredients including glycerol and fatty acids. While the effectiveness of these treatments is not in question, limited information exists on the impact on the skin microbiome following use of these products and the improvement in skin hydration. Here, we describe improvements in skin barrier properties together with increased levels of cholesterol, ceramides and long-chain fatty acids following application of Body Lotion. Concomitant alterations in the skin microbiome are also seen via 16S rRNA metataxonomics, in combination with both traditional and novel informatics analysis. Following 5 weeks of lotion use, beneficial skin bacteria are increased, with improvements in microbiome functional potential, and increases in pathways associated with biosynthesis of multiple long chain fatty acids.

In-vivo impact of common cosmetic preservative systems in full formulation on the skin microbiome

Preservatives play an essentially role in ensuring that cosmetic formulations remain safe for use via control of microbial contamination. Commonly used preservatives include organic acids, alcohols and phenols and these play an essential role in controlling the growth of bacteria, fungi and moulds in substrates that can potentially act as a rich food source for microbial contaminants. Whilst the activity of these compounds is clear, both in vitro and in formulation, little information exists on the potential impact that common preservative systems, in full formulation, have on the skin's resident microbiome. Dysbiosis of the skin's microbiome has been associated with a number of cosmetic conditions but there currently are no in vivo studies investigating the potential for preservative ingredients, when included in personal care formulations under normal use conditions, to impact the cutaneous microbiome. Here we present an analysis of four in vivo studies that examine the impact of different preservation systems in full formulation, in different products formats, with varying durations of application. This work demonstrates that despite the antimicrobial efficacy of the preservatives in vitro, the skin microbiome is not impacted by preservative containing products in vivo.

Maternal influences on oral and faecal microbiota maturation in neonatal calves in beef and dairy production systems

Background

The dam is considered an important source of microbes for the calf; consequently, the development of calf microbiota may vary with farming system due to differences between the contact the calf has with the dam. The objective of this study was to characterise the early changes in the composition of oral and faecal microbiota in beef and dairy calves (N = 10) using high-throughput sequencing of the 16S rRNA gene. The microbiota of calves was compared to selected anatomical niches on their dams which were likely to contribute to the vertical transfer of microbes.

Results

A total of 14,125 amplicon sequence variants (ASVs) were identified and taxonomically assigned. The oral microbiota of calves and their dams were composed of more similar microbes after the first 4 weeks of life than immediately after calving. The faecal microbiota of four-week old calves was composed of microbes which were more similar to those found in the oral microbiota of calves and adult cows than the faecal microbiota of adult cows. Specific ASVs were identified in the oral microbiota of four-week old calves that were also present in cow niches at calving, whereas very few ASVs were present in the calf faecal microbiota at four-weeks of age were present in any adult cow niche at calving. These results were observed in both beef and dairy calves.

Conclusions

We did not observe any marked differences in the maturation of the oral and faecal microbiota between beef or dairy calves, despite dairy calves having very limited contact with their dam. This suggests the development of gastrointestinal microbiota in calves may not be affected by continued vertical transmission of microbes from the dam. Although the calf faecal microbiota changed over the first four-weeks of life, it was composed of microbes which were phylogenetically closer to those in the oral microbiota of calves and adult cows than the faeces of adult cows. There was little evidence of persistent microbial seeding of the calf faeces from anatomical niches on the cow at calving in either beef or dairy animals.

Rapid through-container detection of fake spirits and methanol quantification with handheld Raman spectroscopy

The spirits drinks industry is of significant global economic importance and a major employer worldwide, and the ability to ensure product authenticity and maintain consumer confidence in these high-value products is absolutely essential. Spirit drinks counterfeiting is a worldwide problem, with counterfeiting and adulteration of spirit drinks taking many forms, such as substitution, stretching with lower-grade products, or creation of counterfeits with industrial, surrogate, or locally produced alcohols. Methanol for example, which has been used as a substitute alcohol for ethanol, has a high toxicity in humans. The counterfeiting of spirit drinks is consequently one of the few leading reported types of food fraud which can be directly and unequivocally linked to food safety and health concerns. Here, for the first time, we use handheld Raman spectroscopy with excitation in the near IR (1064 nm) for the through-container differentiation of multiple spirit drinks, detection of multiple chemical markers of counterfeit alcohol, and for the quantification of methanol. We established the limits of detection (LOD) of methanol in the analysed samples from four different spirit types (between 0.23-0.39%), which were considerably lower than a quoted maximum tolerable concentration (MTC) of 2% (v/v) methanol for humans in a 40% alcohol by volume (ABV) spirit drink, and even lower than the general EU limit for naturally occurring methanol in fruit spirits of 0.5% v/v (10 g methanol per L ethanol). We believe that Raman spectroscopy has considerable practicable potential for the rapid in situ through-container detection of counterfeit spirits drinks, as well as for the analysis and protection of other beverages and liquid samples.

The Identification of the Potential Limitations of Acoustic Rhinometery Using Computer-Generated, Three-Dimensional Reconstructions of Simple Models

The internal surface of the nasal cavity is geometrically complicated and does not lend itself readily to direct measurement. Simple geometric shapes were used as a model for changes in the nasal cavity. Following the introduction of specific changes to a particular system, the effect of these changes on the acoustic evaluation of the space was studied. Cylinders were chosen, as the wave path could be assumed to be perpendicular to the model surface. The acoustic rhinometer's accuracy was assessed in the presence of small and large variations in cross sectional area, in the presence of a series of consecutive area changes, and a gradual change in diameter. The effect of the introduction of acoustic leak was also modelled. The acoustic data acquired from these models was used to reconstruct the model in three dimensions. These reconstructions were compared to the original model. The acoustic rhinometer was found to resolve with reasonable accuracy the dimensions of small spaces; however, if regions of sudden large area changes were present in the space, the data beyond these regions was highly unreliable. Furthermore, the presence of acoustic leak in a system had a similar effect. Unless precautions are taken in the set-up and operation of the acoustic rhinometer, the potential for misinterpretation of data and the introduction of bias is very high.

Comparison of the Relative Abilities of Acoustic Rhinometry, Rhinomanometry, and the Visual Analogue Scale in Detecting Change in the Nasal Cavity in a Healthy Adult Population

The relative abilities of acoustic rhinometry, rhinomanometry, and subjective sensation of nasal patency, as recorded using a Visual Analogue Scale (VAS), were compared in a group of 51 healthy volunteers. All three methods were able to detect a change following the application of a nasal decongestant. A 27.5% change in minimum cross sectional area, a 13.29% change in nasal resistance, and a 30.7% change in the sensation of nasal patency was observed. No correlation was demonstrated between either acoustic rhinometry or rhinomanometry and subjective sensation, and only a weak correlation was found between acoustic rhinometry and rhinomanometry.

Comparison of the human gastric microbiota in hypochlorhydric states arising as a result of Helicobacter pylori-induced atrophic gastritis, autoimmune atrophic gastritis and proton pump inhibitor use

Several conditions associated with reduced gastric acid secretion confer an altered risk of developing a gastric malignancy. Helicobacter pylori-induced atrophic gastritis predisposes to gastric adenocarcinoma, autoimmune atrophic gastritis is a precursor of type I gastric neuroendocrine tumours, whereas proton pump inhibitor (PPI) use does not affect stomach cancer risk. We hypothesised that each of these conditions was associated with specific alterations in the gastric microbiota and that this influenced subsequent tumour risk. 95 patients (in groups representing normal stomach, PPI treated, H. pylori gastritis, H. pylori-induced atrophic gastritis and autoimmune atrophic gastritis) were selected from a cohort of 1400. RNA extracted from gastric corpus biopsies was analysed using 16S rRNA sequencing (MiSeq). Samples from normal stomachs and patients treated with PPIs demonstrated similarly high microbial diversity. Patients with autoimmune atrophic gastritis also exhibited relatively high microbial diversity, but with samples dominated by Streptococcus. H. pylori colonisation was associated with decreased microbial diversity and reduced complexity of co-occurrence networks. H. pylori-induced atrophic gastritis resulted in lower bacterial abundances and diversity, whereas autoimmune atrophic gastritis resulted in greater bacterial abundance and equally high diversity compared to normal stomachs. Pathway analysis suggested that glucose-6-phospahte1-dehydrogenase and D-lactate dehydrogenase were over represented in H. pylori-induced atrophic gastritis versus autoimmune atrophic gastritis, and that both these groups showed increases in fumarate reductase. Autoimmune and H. pylori-induced atrophic gastritis were associated with different gastric microbial profiles. PPI treated patients showed relatively few alterations in the gastric microbiota compared to healthy subjects.

Different conditions such as autoimmune atrophic gastritis and Helicobacter pylori associated atrophic gastritis are associated with different types of gastric cancer, specifically neuroendocrine tumours and adenocarcinoma. Both conditions result in reduced gastric acid secretion, potentially allowing non-H. pylori bacteria to colonise the stomach. However patients receiving proton pump inhibitors (PPI) experience similar levels of acid secretion, but do not develop gastric cancer. The aims of this study were to investigate the contribution of non-H. pylori microbiota to gastric tumour development in the presence of reduced gastric acid secretion. 16S rRNA sequencing identified relatively few alterations in the gastric microbiota in patients receiving PPI therapy, despite reduced acid secretion, but more substantial alterations in those patents who had atrophic gastritis. Significant differences were also found between the patients who had atrophic gastritis of autoimmune and H. pylori associated types. Differences in biochemical pathways that potentially contribute to gastric tumorigenesis were also predicted. This work increases understanding of the mechanisms involved in gastric tumour development, and demonstrates how non-H. pylori bacteria may be important. This work may eventually lead to the development of novel chemopreventive therapies for stomach cancer that are based on altering the composition of the gastric microbiota.

Exposure to cold and acute upper respiratory tract infection

The incidence of acute upper respiratory tract viral infections (URTI) is directly correlated to air temperature with most URTI occurring seasonally in cold weather. This review looks at four types of cold exposure and examines the evidence and possible mechanisms for any relationship to URTI. The effects of cold are discussed as: 1) Chilling of the nose and upper respiratory tract by breathing cold air, 2) Chilling of the mouth and upper digestive tract by ingestion of cold drinks and food, 3) Acute chilling of the body surface, and, 4) Chilling of the body as a whole with a fall in body temperature, hypothermia. Some studies were found to support a relationship between breathing cold air and chilling the body surface with the development of URTI, although this area is controversial. No evidence was found in the literature to support any relationship between ingestion of cold drinks and food and URTI, and similarly no evidence was found to link hypothermia and URTI.

Efficacy and safety of iota-carrageenan nasal spray versus placebo in early treatment of the common cold in adults: the ICICC trial

Abstract

Iota-carrageenan (I-C) is active against respiratory viruses in vitro and was effective as nasal spray in three previous clinical trials. The current trial served to further investigate I-C in patients with early common cold symptoms.

Methods

This randomized, placebo-controlled, double-blind phase IV trial was conducted in 200 adult patients with self-diagnosed colds of <48 h’ duration that were confirmed by baseline cold symptom scores. Patients were to self-administer 0.12 % I-C or placebo spray (NaCl 0.5 %) four times daily for four to ten days and record symptom information for ten days. Common respiratory viruses were quantified by RT-PCR during pretreatment and on Day 3 or 4. The primary endpoint was the mean total symptom score (TSS) of eight cold symptoms on Days 2–4 (TSS_2–4).

Results

Patients in both treatment groups had similar baseline TSSs (mean TSS: 6.75 for I-C and 6.79 for placebo). Viruses were detected in baseline samples from 53 of 98 I-C patients (54.1 %) and 54 of 97 placebo patients (55.7 %). Mean ± SE for TSS_2–4 was 5.78 ± 0.25 for I-C patients and 6.39 ± 0.25 for placebo (p = 0.0895). Exploratory analyses after unblinding (TSS_2–4 excluding a patient with aberrantly high symptom scores [TSS_{2–4, ex 1pt}]; mean of TSS over Days 1–4 [TSS_1–4]; change in TSS_1–4 relative to baseline [TSS_{1–4, rel}]) demonstrated treatment differences in favor of I-C (p = 0.0364, p = 0.0495 and p = 0.0421, respectively). For patients with quantifiable rhinovirus/enterovirus at baseline, there was a trend towards greater reduction of virus load at Day 3 or 4 (p = 0.0958; I-C: 90.2 % reduction in viral load; placebo: 72.0 %). Treatments were well tolerated with no differences in adverse event rates.

Conclusions

The primary endpoint did not demonstrate a statistically significant difference between I-C and placebo but showed a trend towards I-C benefit. Exploratory analyses indicated significant reduction of cold symptoms in the I-C group relative to placebo during the first four days when symptoms were most severe, and also substantiated I-C’s activity against rhinovirus/enterovirus.

Trial registration

NCT01944631 (clinicaltrials.gov)

Consumer attitudes on cough and cold: US (ACHOO) survey results

OBJECTIVE

The Attitudes of Consumers Toward Health, Cough, and Cold (ACHOO) survey was developed to better inform health care providers on the natural history and impact of common cold and cough, and related consumer experience and behaviors.

RESEARCH DESIGN AND METHODS

Randomly selected US Internet/mobile device users were invited to participate in an online survey (N = 3333) in October 2012. Response quotas modeled upon 2010 US Census data ensured a demographically representative sample. To reduce potential bias from the quota design, 75% of the completed surveys were randomly selected as the primary analysis pool.

MAIN OUTCOME MEASURES

Survey questions assessed participant demographics, frequency and duration of cough/cold symptoms, impact of symptoms on daily life, treatment preferences, and knowledge about cough/cold pathophysiology.

RESULTS

In the past year, 84.6% of respondents had experienced at least one cold. Colds typically started with sore/scratchy throat (39.2%), nasal congestion (9.8%), and runny nose (9.3%) and lasted 3-7 days. Cough, the most common cold symptom (73.1%), had a delayed onset (typically 1-5 days after cold onset) and a long duration (>6 days in 35.2%). Nasal congestion and cough were the most bothersome symptoms. Many respondents waited until symptoms were 'bad enough' (42.6%) or multiple symptoms were present (20.2%) before using nonprescription medications. Drivers of choice included effectiveness in relieving symptoms, safety, and past experience. Respondents rarely consulted clinicians regarding treatment, and more than three-quarters had never received instructions from a clinician on how to choose a nonprescription cough/cold medication. Misperceptions regarding etiology and treatment of the common cold were prevalent. The main limitation is potential recall bias, since respondents had to recall cough/cold episodes over the prior year.

CONCLUSIONS

The ACHOO survey confirms that cold is a common, bothersome experience and that there are gaps in consumers' knowledge of pathophysiology and appropriate management of cough/cold.

Is the common cold a clinical entity or a cultural concept?

Common cold is the most common infectious disease of mankind and the term is widely used in the clinical literature as though it were a defined clinical syndrome. Clinical studies on this syndrome often use elaborate symptom scoring systems to diagnose a common cold. The symptom scores are based on a study conducted over 50 years ago to retrospectively diagnose experimental cold and this method cannot be applied to diagnosis of common cold in the community. Diagnosis of the common cold by virology is not feasible because of the number of viruses and the variability in the disease states caused by the viruses. Because of the familiarity of subjects with common cold and the variability in symptomatology it seems a more reasonable approach to use self-diagnosis of common cold for clinical research studies and accept that the common cold is a cultural concept and not a clinical entity.

The relationship between nasal index and nasal airway resistance, and response to a topical decongestant

The differences in the shape and size of the nose have been proposed to be an adaptation to climate with broad noses (platyrrhine) evolving in a warm humid environment where there was little need for air conditioning and narrow noses (leptorrhine) evolving in colder climates where the air needed more warming. The main aim of this research was to determine if there was any relationship between the shape of the nose as expressed in terms of nasal height and width (nasal index) and total nasal airway resistance (NAR), as one would predict that the narrower leptorrhine noses would have a greater resistance to air flow than the broader platyrrhine noses. It was also proposed that the narrow leptorrhine nose would have better developed vascular tissue than the broad platyrrhine nose in order to condition cold air, and would exhibit a greater response to nasal decongestion. No correlation was found between nasal index and NAR (r = -0.09) and similarly no correlation was found between nasal index and response to a topical nasal decongestant (r = 0.02). The absence of any physiological differences between the different nose types may be due to acclimatisation of participants to the area of recruitment.

The relationship between nasal index and nasal airway resistance, and response to a topical decongestant

The differences in the shape and size of the nose have been proposed to be an adaptation to climate with broad noses (platyrrhine) evolving in a warm humid environment where there was little need for air conditioning and narrow noses (leptorrhine) evolving in colder climates where the air needed more warming. The main aim of this research was to determine if there was any relationship between the shape of the nose as expressed in terms of nasal height and width (nasal index) and total nasal airway resistance (NAR), as one would predict that the narrower leptorrhine noses would have a greater resistance to air flow than the broader platyrrhine noses. It was also proposed that the narrow leptorrhine nose would have better developed vascular tissue than the broad platyrrhine nose in order to condition cold air, and would exhibit a greater response to nasal decongestion. No correlation was found between nasal index and NAR (r = -0.09) and similarly no correlation was found between nasal index and response to a topical nasal decongestant (r = 0.02). The absence of any physiological differences between the different nose types may be due to acclimatisation of participants to the area of recruitment.

Objective evidence for the efficacy of surgical management of the deviated septum as a treatment for chronic nasal obstruction: a systematic review

BACKGROUND

Nasal septal surgery is a common procedure, but there are concerns that the benefits of this surgery are mainly cosmetic.

OBJECTIVE OF REVIEW

The primary aim is to identify any functional benefits of septal surgery and provide any evidence of a change in patency of the nasal airway, as assessed by objective methods such as rhinomanometry, acoustic rhinometry and peak nasal inspiratory flow.

TYPE OF REVIEW

Systematic review.

SEARCH STRATEGY

A systematic search of the available literature was performed, using Pubmed, Medline (1950-November 2010), Embase (1947-November 2010) and the Cochrane Controlled Trials Register. Papers written in English that objectively compared pre- and post-surgical treatment of nasal obstruction in adults because of septal deviation were reviewed. Objective measurements of rhinomanometry, acoustic rhinometry and nasal peak inspiratory flow were specified within the search. Searches were restricted to surgery on the nasal septum, which included septoplasty, submucous resection and septal (deviation) corrective surgery.

RESULTS

Seven studies (460 participants) involving rhinomanometry, six studies (182 participants) with acoustic rhinometry and one study (22 participants) using nasal peak inspiratory flow were included in the review. All the studies reported an objective improvement in nasal patency after septal surgery. Mean unilateral nasal resistance (data from six studies) decreased from preoperative 1.19 Pa/cm(3) /s to postoperative 0.39 Pa/cm(3) /s, mean minimum cross-sectional area (data from five studies) increased from preoperative 0.45 cm(2) to postoperative 0.61 cm(2) , median peak nasal inspiratory flow (data from one study) increased by 35 L/min after surgery.

CONCLUSIONS

There is sufficient evidence in the literature to conclude that septal surgery improves objective measures of nasal patency and that improved nasal airflow may have beneficial effects for the patient.

Mechanisms of the symptoms of rhinosinusitis

The review discusses the physiological and pathophysiological mechanisms associated with the symptoms of acute and chronic rhinosinusitis. An understanding of symptom mechanisms is important for the clinical diagnosis of rhinosinusitis and is important in assessing the efficacy of surgical and medical treatments for rhinosinusitis. The review will discuss the four primary symptoms used to diagnose rhinosinusitis: nasal obstruction, nasal discharge, facial pain and loss of sense of smell; and the secondary symptoms, cough, sneezing, sore throat and voice changes, epiphora, fever, and psychological effects and fatigue. The review will highlight that our understanding of a key diagnostic symptoms facial pain is limited, and that the incidence of pain with rhinosinusitis is controversial. Sneezing is a common symptom of acute rhinosinusitis with allergy but is not normally described as symptom in chronic rhinosinusitis and this anomaly is in need of more research. The mechanism of unilateral nasal obstruction with rhinosinusitis is discussed.

A guide to practical aspects of measurement of human nasal airflow by rhinomanometry

The guide is intended for all those interested in measuring human nasal airflow by rhinomanometry, either for clinical or research purposes. The guide is written in non-technical language so that it may be understood by nursing and support staff who may need to make measurements using rhinomanometry. It is not a systematic review of the literature but a personal view based on over 40 years experience of measuring nasal airflow. The guide introduces the basic principles of nasal airflow and pressure and their measurement. The following topics are discussed: anterior and posterior rhinomanometry and their relative problems and benefits, control of errors in measurement, standard operating procedures, calibration of equipment, measurement of the totally obstructed nose, reproducibility and sensitivity of rhinomanometry, hygiene, factors influencing nasal airflow such as rest and exercise, alcohol, medicines, temperature and humidity and diseases such as common cold and allergy.

Coblation® inferior turbinate reduction: a long-term follow-up with subjective and objective assessment

This article presents long-term outcomes following Coblation® inferior turbinate reduction surgery (CITR) using both subjective and objective outcome measures in a cohort of patients with nasal obstruction secondary to enlarged inferior turbinate. Subjective assessment of the severity of nasal obstruction was assessed using a 100 mm visual analogue scale anchored by the descriptors 'nose completely clear' (0 mm) and 'nose completely blocked' (100 mm). Nasal conductance of airflow was measured by posterior rhinomanometry. Of the original cohort of 18 patients, 13 patients (76%) were available for follow-up at 32 months after surgery. The mean baseline nasal conductance was 248.6 cm3/s (range 2.5-614.8), which improved significantly (p=0.033) to 342.1 cm3/s (range 166.7-500) at 32 months post-operatively. Improvement in the subjective sensation of nasal obstruction was indicated by a lower VAS score compared to baseline. The mean pre-operative VAS was 72 mm (range 49-98), which improved to 53 mm (range 2-93) but this did not achieve statistical significance (10/13 patients scored improved airflow). This was a pilot study of the long-term outcomes of CITR. Despite the small study cohort, there appears to be sustained improvement in nasal conductance of air-flow up to 32 months follow-up. Although there was improvement in the subjective assessment of nasal obstruction, this did not achieve statistical significance.

Paradoxical increase in nasal airway resistance following a topical nasal decongestant spray

Nasal obstruction is a very common problem associated with common cold and topical nasal decongestant sprays are effective symptomatic treatments causing a decrease in nasal airway resistance (NAR).

The role of anthropometric measurements in nasal surgery and research: a systematic review

BACKGROUND

Anthropometric measurements of the nose provide objective data about the size and shape of the nose. Data of average nasal anthropometric values for various ethnic groups is promoted to be of great importance in planning aesthetic nasal surgery, but there may be fundamental problems with this approach.

OBJECTIVE OF REVIEW

To collate existing knowledge on nasal anthropometry and, determine its value to the nasal surgeon, in planning aesthetic nasal surgery and in research.

SEARCH STRATEGY

A structured search of PubMed was performed from 1 January 1973 to 31 December 2009 focussing on nasal anthropometry. The MeSH keywords used were nasal/nose, anthropometry/history/methods/measurements, aesthetic, surgery, nose, otorhinolaryngologic surgical procedures.

RESULTS

There is published literature on the average values of the nasal dimensions for various ethnic groups, to aid surgeons in planning improvements of the face. However the large overlap of anthropometric data between racial groups and the lack of any scientific basis for the concept of race means that the published data for racial groups is of little use in planning nasal surgery. Nasal anthropometry, however, helps to answer important clinical questions in research. It has established the role of primary rhinoplasty in patients with cleft lip nasal deformity. It serves as an objective tool to investigate whether reconstructive nasal septoplasty in the paediatric population has any deleterious effect on nasal growth. Anthropometry also helps in the characterisation of dysmorphic syndromes.

CONCLUSIONS

The published anthropometric data for racial groups is of little use in planning nasal surgery. Anthropometric measurements of the nose may help to answer important clinical questions in research on the effects of surgery on nasal and facial development.

Efficacy and safety of intranasal xylometazoline and ipratropium in patients with common cold

BACKGROUND

Many over-the-counter medications are available to treat common cold nasal symptoms, but patients may be unsure which one to use.

METHODS

This review assesses two widely used intranasal treatments for nasal congestion and rhinorrhea in the common cold: xylometazoline hydrochloride and ipratropium bromide.

RESULTS

Xylometazoline quickly and effectively relieves nasal congestion, while ipratropium is effective at reducing rhinorrhea. When used in combination, a novel approach to treatment, nasal congestion and rhinorrhea are treated simultaneously, providing effective relief from two of the most troublesome symptoms of the common cold Both drugs are well tolerated, with only mild to moderate, nasal-related side effects.

CONCLUSIONS

The efficacy and safety of the combination product suggest that it should be used first-line in the symptomatic relief of nasal congestion and rhinorrhea, before the use of oral treatments.

A systematic review of the nasal index and the significance of the shape and size of the nose in rhinology

BACKGROUND

There was great interest in the 19th and early 20th century in classifying human races as Caucasian, Asian African etc. according to nasal shape and size, and the nasal index was the most commonly used measurement to differentiate races.

OBJECTIVE OF REVIEW

To determine if there is any clinical relevance of the shape and size of the nose in relation to physiology, pathology and surgery.

TYPE OF REVIEW

Systematic review.

SEARCH STRATEGY

A structured search of PubMed was performed from 1966 to 2008 for each section of the review focusing on the ethnic variations in nasal index, the effect of climate of nasal shape, ethic variations of nasal physiology and racial predilection for sinonasal pathology.

RESULTS

Nasal proportions do vary between ethnic groups but the size and shape of the nose does not define Caucasian, Asian and African races respectively. Anthropologists agree that the nasal variations are due to man's adaptation to the environment. However, this theory remains to be proven. Published data on nasal physiology have not shown significant differences between the ethnic groups despite obvious differences in nasal proportions. There is no evidence of ethnic specific predilection to disease due to anatomical variation, physiological vulnerability or genetic susceptibility. Rhinology research is often confounded by classifying populations according to race, as racial characteristics are not based on any scientific principles and the nasal index may be a more reliable discriminator. The only area in which the size and shape of the nose is of relevance is in aesthetic and reconstruction surgery.

CONCLUSIONS

Nasal proportions are important aesthetically but appear to have little relevance to the rhinologist.

Central mechanisms IV: conscious control of cough and the placebo effect

Early animal experiments on cough developed the concept that cough was an involuntary reflex controlled from areas in the brainstem and that cough could be inhibited by centrally acting medicines such as codeine. Studies on the voluntary control of cough, the urge to cough and the placebo effect of cough medicines have demonstrated that human cough is more complex than a brainstem reflex. The efficacy and mechanism of action of centrally acting cough medicines such as codeine and dextromethorphan is now in dispute, and codeine is no longer accepted as a gold-standard antitussive. This review puts forward a cough model that includes three types of cough: (1) reflex cough, caused by the presence of food or fluid in the airway--this type of cough is not under conscious control and can occur in the unconscious subject during general anaesthesia; (2) voluntary cough--under conscious control that is abolished with general anaesthesia; (3) cough in response to sensation of airway irritation--this type of cough causes an urge to cough that initiates voluntary cough and may only be present in the conscious subject. The review proposes that human cough associated with respiratory disease is under conscious control and is mainly related to a sensation of airway irritation and an urge to cough (type 3). The review discusses the summation of sensory input from the airway in a brainstem integrator that reaches a threshold to cause reflex cough. Subthreshold conditions in the cough integrator may be perceived as an urge to cough that is under voluntary control. The cough model presented in the review has implications for the development of cough medicines as it indicates that the older view of cough medicines acting in the brainstem area to inhibit the cough reflex may need to be revised to include conscious control of cough as an important mechanism of cough in man.

The effects of a hot drink on nasal airflow and symptoms of common cold and flu

Hot drinks are a common treatment for common cold and flu but there are no studies reported in the scientific and clinical literature on this mode of treatment. This study investigated the effects of a hot fruit drink on objective and subjective measures of nasal airflow, and on subjective scores for common cold/flu symptoms in 30 subjects suffering from common cold/flu. The results demonstrate that the hot drink had no effect on objective measurement of nasal airflow but it did cause a significant improvement in subjective measures of nasal airflow. The hot drink provided immediate and sustained relief from symptoms of runny nose, cough, sneezing, sore throat, chilliness and tiredness, whereas the same drink at room temperature only provided relief from symptoms of runny nose, cough and sneezing. The effects of the drinks are discussed in terms of a placebo effect and physiological effects on salivation and airway secretions. In conclusion the results support the folklore that a hot tasty drink is a beneficial treatment for relief of most symptoms of common cold and flu.

Postnasal drip syndrome. Two hundred years of controversy between UK and USA

This review discusses the trans-Atlantic controversy concerning Post Nasal Drip Syndrome (PNDS). PNDS was described as a common condition in the UK in the nineteenth century and was so extraordinarily prevalent in the USA that it was called 'American catarrh'. American chest physicians adopted PNDS as the most common cause of chronic cough. A relationship between PNDS and chronic cough was not accepted by UK chest physicians, who preferred to use the term 'rhinosinusitis' instead of PNDS. In the USA the diagnosis of PNDS was linked to a response to therapy with a sedating antihistamine and decongestant, but UK physicians doubted if this was a specific therapy and did not accept the therapy as diagnostic for PNDS. In 2006 the American College of Chest Physicians replaced the term PNDS with upper airway cough syndrome and some UK otolaryngologists proposed that PNDS should be replaced with rhinosinusitis. PNDS is now being replaced with more general descriptions of upper airway disease and a causal link with chronic cough is now disputed. PNDS may be caused by a mucus hypersecretory phenotype that develops following chronic exposure of the respiratory tract to particulate matter, allergens, irritants and pathogens. Current research on treating excessive airway mucus in the lower airways may be applicable to PNDS.

Do chronic changes in nasal airflow have any physiological or pathological effect on the nose and paranasal sinuses? A systematic review

.A reduction in nasal airflow associated with anatomical defects of the nose such as nasal septal deviation has been proposed to cause nasal pathology. . The majority of animal experiments where one nasal passage is surgically closed over several months report only minor changes in the histology of the nasal epithelium and no rhinitis or sinusitis. .Complete abolition of nasal airflow associated with laryngectomy or the treatment of atrophic rhinitis is not associated with the development of rhinitis or sinusitis. . Radiological studies have shown a lack of association between the degree of nasal septal deviation and evidence of rhinosinusitis. .Such studies provide evidence that reduced nasal airflow causes no significant nasal disease. . There is no convincing evidence that a reduction in nasal airflow is a causative factor for rhinitis or sinusitis.

Assessment of subjective scales for selection of patients for nasal septal surgery

OBJECTIVE

To investigate the use of subjective measures to assist the surgeon in patient selection for septal surgery.

STUDY DESIGN

Prospective, observational. Approved by local ethics committee.

SETTING

ENT outpatient department, University Hospital of Wales.

PARTICIPANTS

Forty-six participants on the waiting list for septal surgery for nasal obstruction.

MAIN OUTCOME MEASURE

Measurement of nasal partitioning of airflow by rhinospirometer (GM Instruments, Scotland), subjective scales, and investigator's assessment of septal deviation.

RESULTS

The subjective scores, and investigator's assessment of septal deviation, were compared with the rhinospirometer objective measurements for correlation, sensitivity and specificity. The rhinospirometry results showed that 20% of the patients on the waiting list had objective measures of partitioning of nasal airflow within a normal range for healthy subjects. The ordinal scale proved to be more useful than the visual analogue scale for patient selection. The subjective scores of airflow partitioning from the double ordinal scale correlated well with the rhinospirometry measurements (r = 0.8). The ordinal scale also had a sensitivity of 81% and a specificity of 60%. The investigator's subjective assessment of septal deviation had a high sensitivity at around 100% but had a lower specificity (30%).

CONCLUSIONS

The use of a subjective ordinal scale to measure partitioning of airflow greatly increased the specificity of patient selection and it is proposed that this scale may be useful to the surgeon when assessing patients for septal surgery.

Chronic inferior turbinate enlargement and the implications for surgical intervention

Nasal obstruction due to chronic enlargement of the inferior turbinate is a common problem for the ENT surgeon. This review will discuss the pathology of 'bilateral' and 'unilateral' turbinate enlargement associated with chronic rhinitis and nasal septal deviation, and focus on the structural changes in the turbinates. Cellular hyperplasia, tissue oedema and vascular congestion all contribute to turbinate enlargement, but there is some evidence that bony enlargement is associated with unilateral turbinate enlargement. There is no evidence for cellular hypertrophy despite the common use of the term 'turbinate hypertrophy' and this term should be replaced with the more correct term of 'turbinate enlargement'. The underlying pathology of turbinate enlargement has important implications for the surgical management of nasal obstruction.

Efficacy of a paracetamol-pseudoephedrine combination for treatment of nasal congestion and pain-related symptoms in upper respiratory tract infection

OBJECTIVE

This study compared the efficacy of 1000 mg of paracetamol combined with 60 mg of pseudoephedrine, with that of either paracetamol or pseudoephedrine alone and placebo for the treatment of symptomatic URTI.

RESEARCH DESIGN AND METHODS

A double-blind, parallel group study was performed on 305 patients with URTI (nasal airflow resistance [NAR] of > 0.25 Pa cm3 s and a global pain score of at least moderate intensity). NAR and pain relief/intensity scores were measured over 4 h after initial dose. Patients then dosed up to three times daily for 3 days and recorded nasal congestion and pain intensity scores.

MAIN OUTCOME MEASURES

Nasal airflow conductance (NAC) and pain relief after the initial dose were primary objectives. NAC was calculated from NAR. Pain relief was measured on a 5-point verbal rating scale (VRS) and pain intensity and nasal congestion on a 4-point VRS. Data were analysed using analysis of covariance. Safety was assessed by adverse events.

RESULTS

A single dose of the combination was superior to paracetamol and placebo for NAC (p = 0.0001) and was superior to pseudoephedrine and placebo for pain relief (p < or = 0.048). Multiple doses of the combination were also superior to paracetamol and placebo for decongestion (p < or = 0.021) and were superior to pseudoephedrine and placebo for pain reduction (p < or = 0.0057). All treatments were well tolerated.

CONCLUSIONS

The combination treatment provided a greater decongestant effect than either paracetamol or placebo and better pain relief than either pseudoephedrine or placebo. The additive effect of the combination was apparent for both single and multiple doses.

Understanding submucosal electrosurgery for the treatment of nasal turbinate enlargement

The surgical management of inferior turbinate enlargement is controversial. Submucosal electrosurgical techniques for turbinate reduction include conventional diathermy, radiofrequency tissue reduction and coblation. All electrosurgical techniques use radiofrequency electricity to damage turbinate tissue but differ in the control and delivery of energy. This review will examine the history of submucosal electrosurgery and clarify the various techniques. This review will also examine the evidence for the efficacy and safety of electrosurgery for the treatment of nasal turbinate enlargement, and will make a case that no progress will be made in clinical trials on the safety and efficacy unless there is standardisation of equipment and techniques in nasal electrosurgery.

Efficacy and safety of over-the-counter analgesics in the treatment of common cold and flu

RATIONALE

Common cold and flu are the most common human illnesses, and over-the-counter (OTC) analgesics are widely used to treat the pain and fever symptoms. Despite the every day use of these analgesic there is little information available in the literature on the efficacy and safety of these medicines in treating colds and flu symptoms. The aim of this review was to determine the safety and efficacy of the analgesics, aspirin, paracetamol and aspirin for the treatment of colds and flu.

METHODS

Electronic databases and a personal database were searched and the information retrieved together with information from relevant textbooks has been integrated in the review.

RESULTS

The literature search established that there is relatively little information on the use of analgesics in treating colds and flu and that much of the safety and efficacy data must be related to other pain and fever models. The review establishes that aspirin, paracetamol and ibuprofen are safe in OTC doses and that there is no evidence for any difference between the medicines as regards efficacy and safety for treatment of colds and flu (except in certain cases such as the use of aspirin in feverish children). There is also no evidence that these medicines prolong the course of colds and flu by any effect on the immune system or by reducing fever.

CONCLUSION

Despite the lack of clinical data on the safety and efficacy of analgesics for the treatment of colds and flu symptoms a case can be made that these medicines are safe and effective for treatment of these common illnesses.

Evidence for correlation of objective and subjective measures of nasal airflow in patients with common cold

OBJECTIVES

To utilize posterior rhinomanometry and conductance, as units of measurement, to further investigate the relationship between subjective and objective measures of nasal airflow.

DESIGN

A prospective, observational study.

SETTING

Common Cold Research Centre.

PARTICIPANTS

Sixty healthy volunteers from the staff and student population of Cardiff University with an upper respiratory tract infection.

MAIN OUTCOMES MEASURES

To determine correlations between visual analogue scores (VAS) and posterior rhinomanometry for total, unilateral, high and low conductance groups.

RESULTS

No correlation was found between total VAS and total conductance (r = 0.17, P = 0.10). A substantially significant correlation was found between unilateral VAS and unilateral conductance (rho = 0.50, P < 0.001). The unilateral VAS and conductance were highly correlated for the low total conductance group (rho = 0.61, P < 0.001).

CONCLUSIONS

Posterior rhinomanometry allows actual measurement of the combined and unilateral conductance of nasal passages. The units of conductance, as opposed to resistance, allow totally obstructed nasal passages to be included in analysis. Visual analogue scores and conductance correlate strongly in unilateral measures for participants with a low total nasal conductance. Posterior rhinomanometry and units of conductance are recommended for future studies investigating the relationship between objective and subjective measures of nasal airflow.

Nasal congestion: mechanisms, measurement and medications. Core information for the clinician

The article provides the clinician with core information about the aetiology and treatment of nasal congestion and discusses nasal blood vessels, autonomic nerves, nasal cycle, effects of posture, subjective sensation of congestion, objective assessments of congestion and medical and surgical treatments.

Cough induced by airway vibration as a model of airway hyperreactivity in patients with acute upper respiratory tract infection

Patients with acute upper respiratory tract infection (URTI) have been shown to be hyperreactive to inhaled tussigens such as citric acid and capsaicin, and the authors propose that this may be due to an increased sensitivity of airway receptors that mediate cough. In recent studies we have demonstrated that cough may be induced by vibration of the airway at the level of the throat or chest in patients with URTI but that the same stimuli induce little or no cough in healthy subjects. The difference between the patients with URTI and healthy subjects in their response to airway vibration may be explained on the basis of hyperreactivity of airway sensory receptors. We propose that the model of cough induced by airway vibration may be useful for studies on the pathophysiology and pharmacology of airway hyperreactivity in acute cough. The airway vibration model of cough may have some advantages over inhaled tussigens as the stimulus is easily controlled and the method is safe for use in children.

Efficacy of fusafungine in acute rhinopharyngitis: a pooled analysis

Upper respiratory tract infections are generally mild but they are associated with an enormous loss in productivity. Treatment consists of reduction of local symptoms e.g. local inflammation and prevention of potential superinfections. Besides its bacteriostatic activity against most micro-organisms involved in respiratory tract infections fusafungine displays original anti-inflammatory properties. To optimise nasal and throat deposition, a new fusafungine oro-nasal spray using HFA 134a was developed and its efficacy was evaluated in patients with acute rhinopharyngitis based on improvement of significant nasal symptoms. Three randomised double-blind placebo-controlled parallel-group studies with identical objectives design and dosage were performed and results were pooled for a better evaluation of treatment effect (532 patients). The percentage of responders (patients with nasal symptom score improvement from Day 0 to Day 4) was 61.5 +/- 2.9% with fusafungine vs 46.8 +/- 3.1% with placebo (p=0.009) with an odds ratio of 1.8 (p=0.01) in favour of fusafungine. The nasal symptom score distribution at Day 4 showed an odds ratio of 1.56 (p=0.011) also in favour of fusafungine. For patients treated early (onset of symptoms 1 pounds day) the percentage of responders was 65.9 +/- 4.1% with fusafungine vs 38.3 +/- 4.0% with placebo (p=0.022) with an odds ratio of 3.08 (p=0.033) in favour of fusafungine. Therefore fusafungine through its dual bacteriostatic and original anti-inflammatory properties is an effective treatment of acute rhinopharyngitis especially when administered early.

Cough induction by high-frequency chest percussion in healthy volunteers and patients with common cold

BACKGROUND

In patients with chronic obstructive pulmonary disease, chest percussion is often used to facilitate the drainage of respiratory secretions which may be removed from the airway by coughing. The cough reflex is believed to be mediated by mechanically sensitive rapidly adapting receptors (RARs). Chest percussion stimulation may stimulate RAR cough receptors, but there is no evidence that mechanical airway stimulation in man induces cough. The aim of this study was to determine if cough can be induced by high-frequency chest percussion in healthy subjects and in patients with acute upper respiratory tract infection (URTI).

METHODS

Two groups were studied: 15 healthy subjects and 29 subjects with URTI, mean age 22 years. Percussion stimulation (70 Hz) was applied to the chest. Cough frequency and latency were recorded. All subjects were asked to complete a questionnaire about how they felt after the chest percussion by questionnaires.

RESULTS

The results demonstrate that high-frequency chest percussion causes cough in human subjects with a recent history of URTI, but induces relatively little cough in healthy subjects. In URTI subjects there was a significant increase in the number of coughs after three periods of airway vibration, whereas in healthy subjects there was no change in cough. Furthermore, analysis of the questionnaires showed that more of the subjects with URTI felt an urge to cough compared to the healthy subjects in the subjective questionnaires.

CONCLUSIONS

This study demonstrates that cough can be induced in subjects with URTI by chest percussion. This method of inducing cough in subjects with URTI may be useful for studies on the mechanism of cough and for studies on antitussive medicines.