Not Just a Drop in the Bucket-Inversion of Oxymetazoline Nasal Decongestant Container Increases Potential for Severe Pediatric Poisoning.

Oxymetazoline is an over-the-counter nasal decongestant with potent alpha agonist properties. In overdoses as small as 1-2 mL, toxicity can be seen including bradycardia and respiratory depression. We demonstrated that inverting the container increased the volume delivered 20- to 30-fold compared with holding it upright in an in vitro model.

Evaluation of nasal patency by acoustic rhinometry after repair of complete unilateral cleft lip and palate.

PURPOSE: The aim of the current study was to evaluate nasal patency by acoustic rhinometry in children aged 4-8 years with repaired complete unilateral cleft lip and palate (UCLP) compared with an age-matched control group without cleft lip and palate (CLP). METHODS: This comparative cross-sectional study was conducted at a tertiary care teaching hospital and a private ENT clinic in Porto Alegre, southern Brazil. The case group consisted of 38 children who had undergone surgery for complete UCLP (mean age, 6.44 years), and the control group of 21 children without CLP (mean age, 6.21 years) recruited among patients seeking medical care for ear diseases at the private clinic. Acoustic rhinometry was performed in all children after administration of oxymetazoline hydrochloride (2 × 0.25 mg/mL) for nasal vasoconstriction. RESULTS: The minimal cross-sectional area and nasal volume of the cleft side were smaller than those of the non-cleft side in the case group (p = 0.001). When the two groups were compared, the non-cleft side in the case group did not differ from the control group (p = 0.175), but the minimal cross-sectional area and volume of the cleft nasal cavity were smaller than the mean values of the two nostrils of controls (p = 0.001). CONCLUSION: In conclusion, our findings show that nasal patency on the cleft side is impaired in children surgically treated for complete UCLP.

Correlação entre a resistência nasal e diferentes parâmetros da rinometria acústica em crianças e adolescentes com e sem rinite alérgica / Correlation between nasal resistance and different acoustic rhinometry parameters in children and adolescents with and without allergic rhinitis

Rinometria acústica e rinomanometria são importantes técnicas de avaliação da função nasal. Ainda não está definido em que extensão suas variáveis se correlacionam. OBJETIVO: Avaliar as relações entre a resistência nasal (RN) e parâmetros da rinometria acústica em crianças e adolescentes com rinite alérgica e controles. MÉTODO: Vinte pacientes com rinite alérgica e 20 controles foram avaliados. RN, volumes (V4, V5, V2-5) e menores áreas transversais (MC1, MC2) foram mensurados em três momentos: basal, após indução de obstrução nasal e após descongestionante tópico. RESULTADOS: No grupo rinite, a RN se correlacionou significantemente com todos os volumes (V5: r = -0,60) e com MC2. Nos controles, MC1 foi o parâmetro com melhor correlação com a RN no momento basal (r = -0,53) e após descongestionante. Na análise conjunta dos dados, V5 foi o que apresentou as melhores correlações, no momento basal (r = -0,53), quando obstruído (r = -0,58) e após descongestionante (r = -0,46). CONCLUSÕES: Nossos dados demonstram haver correlação negativa e significante entre os valores de rinometria acústica e RN. Em geral, os volumes apresentaram melhor correlação com a RN do que as menores áreas transversais. V5 foi a variável com melhor correlação no grupo com rinite alérgica e na análise conjunta.

Acoustic rhinometry and rhinomanometry are important tests used to assess nasal function. The degree to which the parameters of these tests are correlated is yet to be established. OBJECTIVE: This paper aimed to study the correlations between nasal resistance (NR) and acoustic rhinometry parameters in children and adolescents with allergic rhinitis and controls. METHOD: Twenty patients with allergic rhinitis and 20 controls were enrolled. NR, volumes (V4, V5, V2-5), and minimal cross-sectional areas (MC1, MC2) were measured in three moments: baseline, after induction of nasal obstruction and after topical decongestant administration. RESULTS: Patients with allergic rhinitis had significant correlation between NR and all volumes (V5: r = -0.60) and with MC2. Among controls, MC1 was the parameter with the strongest correlation with NR at baseline (r = -0.53) and after decongestant administration. In the combined analysis, V5 had the highest correlation coefficients at baseline (r = -0.53), after obstruction (r = -0.58) and after decongestant (r = -0.46). CONCLUSIONS: Our data showed that NR and acoustic rhinometry parameters have negative and significant correlations. Nasal volumes are, in general, better correlated than minimal cross-sectional areas. V5 was the parameter with the highest correlation in the rhinitis group and in the combined analysis.

Correlation between nasal resistance and different acoustic rhinometry parameters in children and adolescents with and without allergic rhinitis.

UNLABELLED: Acoustic rhinometry and rhinomanometry are important tests used to assess nasal function. The degree to which the parameters of these tests are correlated is yet to be established. OBJECTIVE: This paper aimed to study the correlations between nasal resistance (NR) and acoustic rhinometry parameters in children and adolescents with allergic rhinitis and controls. METHOD: Twenty patients with allergic rhinitis and 20 controls were enrolled. NR, volumes (V4, V5, V2-5), and minimal cross-sectional areas (MC1, MC2) were measured in three moments: baseline, after induction of nasal obstruction and after topical decongestant administration. RESULTS: Patients with allergic rhinitis had significant correlation between NR and all volumes (V5: r = -0.60) and with MC2. Among controls, MC1 was the parameter with the strongest correlation with NR at baseline (r = -0.53) and after decongestant administration. In the combined analysis, V5 had the highest correlation coefficients at baseline (r = -0.53), after obstruction (r = -0.58) and after decongestant (r = -0.46). CONCLUSIONS: Our data showed that NR and acoustic rhinometry parameters have negative and significant correlations. Nasal volumes are, in general, better correlated than minimal cross-sectional areas. V5 was the parameter with the highest correlation in the rhinitis group and in the combined analysis.

Acoustic rhinometry: impact of external nasal dilator on the two first notches of the rhinogram.

BACKGROUND: Acoustic rhinometry is more accurate in the anterior portion of the nasal cavities, from the nostril to the nasal valve (NV), the most important site of nasal obstruction. Literature presents different opinions regarding the anatomical correlation of the two notches at the beginning of the rhinogram curve in normal adult white individuals. The aim of this study was to present new data for a better understanding of the anatomic correlation of these two notches. METHODS: This prospective study included 32 nasal cavities under the following conditions: (1) basal condition, (2) with external nasal dilator strip (ENDS), (3) after decongestion (0.05% oxymetazoline chloride applied as an aerosol spray), and (4) after decongestion with ENDS. RESULTS: No statistically significant variation was observed in the cross-sectional area of the first notch (CSA1) after decongestion. However, there was a statistically significant increase in the CSA2 after ENDS. CONCLUSION: Analysis of the results suggested that the first notch of the rhinogram refers to the nostril and the second notch refers to the NV as a whole. This study was part of the clinical trial NCT01411969 registered at http://www.clinicaltrials.gov.

Relationship between alpha-adrenoceptor occupancy and contractile response in rat vas deferens. Experimental and theoretical analysis.

The rat vas deferens has been considered to be the tissue of choice to study alpha-adrenergic drugs. However, some of these agonists have elicited complex responses in this organ. Therefore, detailed characterization of alpha-adrenoceptor-mediated responses of the rat vas deferens was the aim of this work. Experiments were designed to study the contractile response of this tissue to phenylethanolamine (noradrenaline) and to two imidazolines (oxymetazoline and naphazoline). These responses were related to receptor occupancy and to other parameters of drug action, i.e. dissociation constants, relative efficacies, ED50 and maximal responses. A theoretical model was used to check the experimental data. There was a non-linear relationship between response and receptor occupancy with all three agonists. The dissociation constants for noradrenaline, oxymetazoline and naphazoline were 11.06, 0.15 and 0.10 microM, respectively. The rat vas deferens had 75-80% spare receptors for noradrenaline. Oxymetazoline and naphazoline were shown to be partial agonists with low relative efficacies as compared to noradrenaline (0.0063 and 0.0056 respectively). The dose-response curves generated by the model for partial agonists were similar to the curves obtained experimentally in vitro.