[Nasal irrigation for the treatment of vasomotor rhinitis: a pilot study].

Objective: To observe the therapeutic effect of simple 3.0% saline nasal irrigation and combined treatment of 3.0% saline nasal irrigation and budesonide nasal spray for vasomotor rhinitis (VMR), and explore the long-term effect for VMR. Through examination of levels of substance P (SP) and mucin (MUC)5B in nasal lavage fluid, the mechanisms of nasal irrigation treatment for VMR was discussed. Methods: One hundred and one patients from Department of Otorhinolaryngology Head and Neck Surgery, Huashan Hospital of Fudan University with VMR were randomly divided into 4 groups. The number of patients was 24 in control group, 25 in budesonide nasal spray treatment group (budesonide group), 25 in nasal irrigation treatment group (nasal irrigation group) and 27 in budesonide nasal spray + nasal irrigation group (combined treatment group). Control patients were left untreated. Budesonide group was under budesonide nasal spray treatment, nasal irrigation group was treated using 3.0% saline with a temperature of 40℃ and combined treatment group was given both treatments. The duration of the intervention period was 3 months (90 days). Visual Analog Scale (VAS) was used to evaluate nasal symptoms, and the health-related quality of life was assessed using the 12-item Short Form Health Survey version 2.0 (SF-12v2). Enzyme-linked immunosorbent assay (ELISA) was used to assess the contents of SP and MUC5B in nasal lavage fluid before and after 3-month treatments in budesonide and nasal irrigation group in the study. MUC5B in nasal lavage fluid after the SP challenge and anticholinergic drug intervention in control group were also evaluated with ELISA. Results: Nighty out of 101 patients completed the study. In the budesonide and combined treatment group after relevant interventions, the total VAS score of nasal symptoms decreased (5.91±0.21 vs 3.82±0.15, 6.18±0.17 vs 3.92±0.15, t value was 8.193, 10.060, respectively, all P<0.05) and SF-12v2 score increased (146.00±1.23 vs 152.30±0.97, 146.00±1.08 vs 155.40±0.90, t value was 3.982, 6.697, respectively, all P<0.05), with both scores showed no significant differences in the nasal irrigation group (5.96±0.17 vs 5.72±0.15, 146.10±1.17 vs 147.00±0.94, t value was 1.038, 0.607, respectively, all P>0.05) after the first month. In the budesonide and combined treatment group after relevant interventions, the total VAS score of nasal symptoms decreased (5.91±0.21 vs 5.05±0.15, 6.18±0.17 vs 5.10±0.12, t value was 3.374, 5.351, respectively, all P<0.05) and SF-12v2 score increased (146.00±1.23 vs 150.90±0.76, 146.00±1.08 vs 153.60±0.94, t value was 3.373, 5.343, respectively, all P<0.05), with both scores showed no significant differences in the nasal irrigation group (5.96±0.17 vs 5.78±0.17, 146.10±1.17 vs 148.10±0.80, t value was 0.716, 1.438, respectively, all P>0.05) after the second month. By the end of the third month, in nasal irrigation and combined treatment group, the VAS score was diminished (5.96±0.17 vs 4.80±0.12, 6.18±0.17 vs 4.44±0.13, t value was 5.485, 8.264, respectively, all P<0.05) and SF-12v2 score was elevated (146.10±1.17 vs 150.80±0.96, 146.00±1.08 vs 152.90±0.85, t value was 3.163, 5.008, respectively, all P<0.05), but there were no significant differences in budesonide group (5.91±0.21 vs 5.68±0.18, 146.00±1.23 vs 148.40±0.85, t value was 0.819, 1.587, respectively, all P>0.05). Additionally, SP in nasal lavage fluid decreased and MUC5B showed no statistical changes in budesonide group after three months, however, SP showed no any changes and MUC5B reduced significantly in nasal lavage fluid in nasal irrigation group. Furthermore, the anticholinergic drug could not decrease the concentration of MUC5B after the SP challenge in nasal cavity in control group. Conclusions: The therapeutic effect of simple nasal irrigation with 3.0% saline or combined treatment of 3.0% saline nasal irrigation and nasal corticosteroids is superior to simple nasal corticosteroids. Nasal corticosteroids plays a role in the inhibition of sensory nerve endings in nasal mucosa, but neurotransmitter plays a limited role in the pathogenesis of VMR.

[The clinical and functional evaluation of the combined treatment of vasomotor rhinitis in the children].

The objective of the present work was the comparative analysis of the results of the application of different methods for the treatment of the children presenting with vasomotor rhinitis. It was shown that the proposed combined approach including remedial therapy for the normalization of the function of the vegetative nervous system and the local application of fluctuating current to the nasal cavity mucosa has an advantage over the traditional modalities. Specifically, this newly developed simple and efficacious method for the combined conservative treatment of vasomotor rhinitis in the children has practically no contraindications for use, yields the most stable positive functional outcomes, and can by recommended for the application in both inpatient and outpatient settings to manage the patients with vasomotor rhinitis.

Clinical effect of pricking blood at neiyingxiang (ExHN 9) on non-allergic rhinopathy: study protocol for a randomized controlled trial.

BACKGROUND: Non-allergic rhinopathy (NAR), formerly known as vasomotor rhinitis, is a non-allergic and non-infectious chronic disease that is accompanied by nasal hyperemia, rhinorrhea, and no increase in the number of eosinophils. Although the medications for NAR, including intranasal corticosteroids and intranasal antihistamine, have been used in clinical practice, given the relative paucity of effective therapy with available medications, alternative non-pharmacologic treatments could play an important role in treating NAR. Acupuncture treatment is representative potential alternative therapy for the treatment of various diseases, including rhinitis. Therefore, the objective of this study was to evaluate the efficacy of pricking blood at Neiyingxiang (ExHN 9) relative to acupuncture treatment at Waiyingxiang (LI 20) in patients with NAR. METHODS/DESIGN: A randomized, parallel-group, controlled, assessor single-blinded, trial will be conducted. Fifty participants with NAR will be randomized into one of two groups: either the control group with acpuncture treatment at LI 20 or the experimental group with pricking blood at ExHN 9. After randomization, a total of three sessions of treatment will be performed once a week in both groups. The total nasal symptom score (TNSS) and the Mini-Rhinoconjunctivitis Quality-of-Life Questionnaire (MiniRQLQ) at baseline and the end of the trial will be used to evaluate the efficacy of each treatment. DISCUSSION: This study will be the first randomized trial to evaluate the efficacy of pricking blood for the treatment of NAR. The results of this study will help establish an alternative approach for treating patients with NAR that do not respond to Western medication.

Impact of acupuncture on vasomotor rhinitis: a randomized placebo-controlled pilot study.

OBJECTIVES: Chronic rhinitis without an allergic or infectious etiology (vasomotor rhinitis) is a common disease for which there are only few and not very effective therapeutic treatment options. The current placebo-controlled, partially double-blinded pilot study evaluated the effects of acupuncture on the symptoms of vasomotor rhinitis. DESIGN: A total of 24 patients with confirmed diagnosis of vasomotor rhinitis were randomly allocated to either acupuncture or sham laser acupuncture treatment. The sham laser was a deactivated laser pen beaming normal red light. The main outcome measure was the alteration of the nasal sickness score (NSS; score(max) 27 points). Secondary outcome measures were the evaluation of a subjective symptoms score by patients' diaries and of their quality of life (SF-12 health survey). A credibility assessment regarding the respective treatment was performed. The study is registered as an International Standard Randomised Controlled Trial, number NCT00682162. RESULTS: NSS of patients treated by acupuncture was significantly reduced from 9.3 +/- 3.89 to 4.1 +/- 3.20 points (p < 0.001), whereas NSS declined from 5.6 +/- 2.74 to 3.7 +/- 2.61 points after sham treatment (p < 0.05). Comparison between the groups revealed a significant change of NSS (Mann-Whitney, p < 0.01), an analysis that also considers the significant difference between the baseline values of both groups (p < 0.05). Secondary outcome measures did not show significant differences between both groups. The credibility assessment was comparable for both treatments. CONCLUSIONS: This pilot study showed significant effects of acupuncture compared to a sham treatment in the NSS on symptoms of vasomotor rhinitis. These results may justify the performance of a large randomized trial to strengthen our understanding of the therapeutic value of acupuncture in the treatment of vasomotor rhinitis.

Specific nasal provocation test with powder allergen.

Reported here are the results of a large-scale trial conducted under the guidance of Prof. Giovanni Motta, which I coordinated. A total of 656 patients with nasal hyperreactivity were recruited in 51 Italian centres (18 in the north of Italy, 20 in central Italy and 13 in the south). The trial's results were as follows. 1) A clear clinical prevalence of sensitization to different allergens in the different areas of Italy, which could be roughly classified thus: a) in Northern Italy birch and grasses were in the main species; b) in Central Italy mites prevailed but oleaceae were also significant; c) in Southern Italy parietaria and oleaceae were the prevailing species. 2) Most cases were sensitive to several allergens, although a considerable proportion (22%) actually presented reactions only to one allergen and those responding account of the patients sensitive to only one allergen and those responding to a main allergen, the proportion of patients reacting clinically to only one allergen rises to 64%. 4) The specific nasal provocation test (sNPT) offers specificity comparable to in vivo diagnostic methods such as the prick test, and in vitro methods such as RAST, but is much more sensitive. 5) The sNPT can be done in any season. 6) The sNPT is highly specific below a threshold value of nasal reactivity, which can be identified for each allergen studied and expressed in Allergenic Units. 7) In patients in whom the prick test shows multiple sensitivity, the specific NPT identifies the allergen presumably responsible for the nasal reactions (main allergen). In the light of these findings double-blind specific immunotherapy was started, to last 1 year, in 107 patients (49 given placebo and 58 active treatment), with nasal allergy to grasses, parietaria and mites. The results of this treatment were as follows: 74.1% of patients presented a reduction in nasal resistance, measured by dynamic anterior rhinomanometry, indicating relief of nasal obstruction; mucociliary transport time became normal in 81% of patients, meaning that rhinorrhoea had become less marked; there was significant rise in the nasal reactivity threshold in 74.1% of patients, illustrating the degree of desensitization achieved; nasal IgA increased by 62.5% of patients and IgG in 55.2% indicating improvement in the local immunological picture. No such improvements were detectable in the patients given placebo. In conclusion, therefore, the findings of this trial in allergic rhinitis underline that the specific NPT proved more sensitive than other in vivo and in vitro diagnostic methods and is unquestionably a fundamental investigational approach for assessing nasal allergies, identifying the allergens causing the symptoms and setting up rational local immunotherapy. The sNPT also showed the efficacy of specific intranasal immunotherapy.

Nasal scarring by joss stick burns.

Vasomotor rhinitis is a common condition in Malaysia. Patients' dissatisfaction with medical treatment of this recurring condition leads them to seek other forms of traditional cures. This paper highlights the complications in such patients who seek traditional cures for their chronic condition.

[Methods of intranasal vibromassage]. / K metodike éndonazal'nogo vibromassazha.

The advantages of the method of endonasal vibromassage with air pressure oscillations (at 10-12 Hz and 24-30 mm Hg) are: lack of injuries, lack of pain, and simultaneous effect on all nasal and nasopharyngeal structures. The application of endonasal vibropneumomassage in patients with vasomotor rhinitis proved effective in the case of the nervous form of the disease lasting for no longer than a year.

[Status of the autonomic nervous system and reflexotherapy in children with vasomotor rhinitis]. / Sostoianie vegetativnoi nervnoi sistemy i refleksoterapevti- cheskoe vozdeistvie pri vazomotornom rinite u detei.

Different variants of vegetative nervous system dysfunction were identified during the examination of 86 children with vasomotor rhinitis. Based on the findings of the examination a pathogenetically-based method of acupuncture was proposed for the management of this patients' group. Acupuncture with regard to vegetative dysfunction attenuated the latter's manifestations and corrected associated psychoemotional disorders. As a result the clinical manifestations of vasomotor rhinitis were eliminated.