How Does Oxymetazoline Change Nasal Aerodynamics and Symptomatology in Patients with Turbinate Hypertrophy?

OBJECTIVES: Oxymetazoline relieves nasal obstructive symptoms via vasoconstriction, however, the changes in nasal structures and aerodynamics that impact symptoms the most remain unclear. METHODS: This prospective, longitudinal, and single blinded cohort study applied Computational Fluid Dynamic (CFD) modeling based on CT scans at baseline and post-oxymetazoline on 13 consecutive patients with chronic nasal obstruction secondary to inferior turbinate hypertrophy from a tertiary medical center. To account for placebo effect, a sham saline spray was administered with subject blindfolded prior to oxymetazoline, with 30 min rest in between. Nasal Obstruction Symptom Evaluation (NOSE) and unilateral Visual Analogue Scale (VAS) scores of nasal obstructions were collected at baseline, after sham, and 30 min after oxymetazoline. RESULTS: Both VAS and NOSE scores significantly improved from baseline to post-oxymetazoline (NOSE: 62.3 ± 12.4 to 31.5 ± 22.5, p < 0.01; VAS: 5.27 ± 2.63 to 3.85 ± 2.59, p < 0.05), but not significantly from baseline to post-sham. The anatomical effects of oxymetazoline were observed broadly throughout the entire length of the inferior and middle turbinates (p < 0.05). Among many variables that changed significantly post-oxymetazoline, only decreased nasal resistance (spearman r = 0.4, p < 0.05), increased regional flow rates (r = -0.3 to -0.5, p < 0.05) and mucosal cooling heat flux (r = -0.42, p < 0.01) in the inferior but not middle turbinate regions, and nasal valve Wall Shear Stress (WSS r = -0.43, p < 0.05) strongly correlated with symptom improvement. CONCLUSION: Oxymetazoline broadly affects the inferior and middle turbinates, however, symptomatic improvement appears to be driven more by global nasal resistance and regional increases in airflow rate, mucosal cooling, and WSS, especially near the head of the inferior turbinate. LEVEL OF EVIDENCE: 3: Well-designed, prospective, single blinded cohort trial. Laryngoscope, 134:1100-1106, 2024.

The placebo effect in randomized-controlled trials of medical treatments for chronic rhinosinusitis: A systematic review and meta-analysis.

BACKGROUND: The placebo effect observed in clinical trials evaluating medical treatments for chronic rhinosinusitis (CRS) is not well understood. This systematic review and meta-analysis sought to characterize the placebo effect present within CRS outcomes. METHODS: A systematic review of PubMed, Scopus, and Cumulated Index in Nursing and Allied Health Nursing (CINAHL) was performed. Randomized controlled trials (RCTs) evaluating medical treatments for CRS versus placebo were included. We assessed patient-reported (sino-nasal outcome test 22 [SNOT-22], nasal obstruction, sense of smell, nasal obstruction visual analogue score [VAS], sense of smell VAS, anterior rhinorrhea, and postnasal drip) and objective (Lund-Mackay Computed tomography (CT) score, peak nasal inspiratory flow [PNIF], nasal polyp scores, 40-item Smell Identification Test, serum IgE, and blood eosinophil levels) outcomes. RESULTS: Twenty-one RCTs were included, comprising 1437 patients (mean age 49.2 years). Biologics were the most common treatment investigated (n = 9). Eleven studies administered background steroids along with placebo. Following placebo administration, multiple patient-reported outcomes significantly decreased, including SNOT-22 (mean difference -9.49, 95% confidence interval [CI] [-11.26, -7.73]), nasal obstruction (-0.33 [-0.54, -0.13]), sense of smell (-0.22 [-0.33, -0.11]), nasal obstruction VAS (-2.47 [-2.87, -2.06]), and loss of smell VAS (-2.31 [-4.14, -0.47]) scores. For objective measures, significant changes occurred in Lund-Mackay CT score (-0.82, [-1.48, -0.16]) and PNIF (4.70, [4.76, 24.64]) with placebo. Placebo arms had the greatest impact when no background medications were used. CONCLUSIONS: Placebo treatments have a statistically and potentially clinically significant effect on patient-reported and some objective CRS outcomes. Further investigation is required to fully understand placebo effect, which could improve assessment of RCTs and impact patient care.

Evaluating treatment response to mepolizumab in patients with severe CRSwNP.

BACKGROUND: The SYNAPSE study (NCT03085797) demonstrated that mepolizumab decreased nasal polyp (NP) size and nasal obstruction in patients with chronic rhinosinusitis with NP (CRSwNP). METHODS: SYNAPSE, a randomized, double-blind study, included patients with recurrent, refractory, severe CRSwNP, eligible for repeated surgery despite receiving standard of care (SoC). Patients received 4-weekly mepolizumab 100 mg or placebo subcutaneously plus SoC for 52 weeks. This post hoc analysis further characterized treatment responses and association with patient characteristics. The proportion of patients meeting any and each of five response criteria indicating improvement in disease-specific quality of life, NP size, nasal obstruction, loss of smell, and overall symptoms at Weeks 24 and 52, were assessed in subgroups: 1) no surgery; 2) neither surgery nor systemic corticosteroids (SCS). RESULTS: Of 407 patients in the intention-to-treat population, 381 and 343 patients had no sinus surgery by Weeks 24 and 52, respectively. More mepolizumab- versus placebo-treated patients without surgery by Weeks 24 and 52 met each response criteria. Of the mepolizumab-treated patients without surgery by Week 24, 109 (55%) responded across >=3 criteria, increasing to 126 (67%) by Week 52. Similar response trends were seen for patients with neither surgery nor SCS by Weeks 24 and 52. At either timepoint, there were no major differences in baseline characteristics between mepolizumab-treated full- (5/5 categories) and non-responders (0/5 categories). CONCLUSIONS: Most patients who completed SYNAPSE required neither surgery nor SCS use and in addition achieved a progressive and sustained clinical response to mepolizumab underscoring the therapeutic benefits of mepolizumab in severe CRSwNP.

Adjunctive Treatment of Pediatric Adenoidal Hypertrophy: A Review.

Context: Adenoids play an important role in the protection of the upper respiratory tract against pathogens. Nonphysiological enlargement of adenoids is defined as adenoid hypertrophy (AH). In treating AH, physicians prefer medical therapy and often disregard adjunctive methods. Studies on the effects of adjunctive methods on adenoid tissue are quite scarce. Objective: The current review aims to examine the clinical studies that have investigated adjunctive methods-nasal irrigation, herbal therapy, bacteriotherapy, and halotherapy-used to treat AH and its associated symptoms and to evaluate their effectiveness in pediatric patients. Design: The research team performed a narrative review by searching seven electronic databases (Pubmed, Cochrane Library, Google Scholar, Web of Science, EMBASE, Science Citation Index and Elsevier) were used for the literature search. The search used the keywords adenoid hypertrophy, adjunctive treatment, nasal irrigation, herbal medications, bacteriotherapy and halotherapy. Setting: This study was took place in Department of Anatomy, Medicine Faculty, Istanbul Medeniyet University. Results: The nasal irrigation with hypertonic solution decreased to size of enlarged adenoid tissue. The bacteriotherapy used with nasal spray and tablet form decreased to surgery rate and adenoid size.The adenoid and/or tonsillar hypertrophy were decreased by halotherapy used with micronized, iodized-salt aerosol. Conclusions: A review of studies on this matter indicates that the studied adjunctive methods can be used safely in the treatment of AH, either separately or in combination with conventional medical treatment. However further clinical studies are needed on this topic.

Nebulized hyaluronic acid improves nasal symptoms after orthognathic surgery: a randomized clinical trial.

PURPOSE: After maxillary osteotomy in orthognathic surgery, patients report nasal breathing discomfort in early postoperative period. Topical hyaluronic acid (HA) has been proven to have beneficial effects on the upper airway tract mucosa. This prospective randomized controlled study was designed to analyze the effect on nasal obstruction of nebulized HA during the recovery process after maxillary osteotomy. METHODS: Patients were randomized to control and treatment groups. The postoperative treatment differed only for additional nebulized HA provided to the treatment group. The level of nasal obstruction, and its impact on quality of life, was assessed every 3 days for the first 15 days postoperatively using a questionnaire. Demographic and other variables (maxillary osteotomy type and surgical movements) were analyzed. Differences in quantitative data were tested using Student's t-test, the Mann-Whitney U test, and mixed repeated measures ANOVA. RESULTS: Twenty-four subjects were included in each group; differences in age, sex, type of maxillary osteotomy, and movements were non-statistically significative. At the beginning of treatment (T0), the two groups had comparable questionnaire scores regarding nasal breathing discomfort (p >0.05), whereas statistically significant differences were found at days 3, 6, 9, and 12 (p <0.05). A significant decrease in nasal breathing discomfort over time was observed in both groups, with trends that differed between the two, indicating faster improvement in the treatment group. CONCLUSION: Nebulized HA can be a useful additional treatment in early postoperative period after orthognathic surgery. Patients reported more rapid improvement of nasal respiratory symptoms, indicating a potential role for HA in reducing recovery time and patient discomfort after maxillary surgery.

The independent role of nasal obstruction in resistant hypertension for uncontrolled hypertensive patients with obstructive sleep apnea.

PURPOSE: To determine the independent predictive role of nasal obstruction in resistant hypertension (RH) in uncontrolled hypertensive patients with obstructive sleep apnea (OSA). METHODS: This prospective cohort study comprised of 236 OSA patients with uncontrolled blood pressure (BP) using 1 or 2 classes of antihypertensive drugs visiting Sleep Medicine Center from April 2021 to March 2022. Information on demographic characteristics, comorbidities, BP control and classes of antihypertensive medication, sleep-related symptoms, Nasal Obstruction Symptom Evaluation (NOSE) Scale and sleep parameters was collected. RH incidence according to the BP control and classes of antihypertensive drugs data during the 5 month follow-up was collected. RESULTS: After 5 month follow-up, 217 participants were included for final data analysis. Ninety-five subjects had nocturnal nasal obstruction with a higher proportion of RH (36.8% vs. 17.2%, p = 0.001) compared to those without nocturnal nasal obstruction. After adjustment for demographic characteristics, sleep-related symptoms and OSA severity, multinomial logistic regression models showed that nocturnal nasal obstruction (all ORs > 2.5, p < 0.05) or NOSE ≥ 8 (all ORs > 4.5, p < 0.05) was independently associated with a higher odds of RH. Nasal obstruction treatment improved NOSE score significantly, but did not reduce the incidence of RH significantly. Effective nasal obstruction treatment was associated with antihypertensive drugs reduction (OR 4.43; 95% CI 1.20-16.27). CONCLUSIONS: Nasal obstruction is an independent predictor of RH in uncontrolled hypertensive patients with OSA. In addition to the treatment of OSA, assessment and treatment of nasal obstruction should be considered in the management of uncontrolled hypertensive patients with OSA.

Mometasone furoate nasal spray in Italian children with seasonal allergic rhinitis: a comprehensive assessment

Objective: Seasonal allergic rhinitis (SAR) is a common disease of childhood and is charac-terized by type 2 inflammation, bothersome symptoms, and impaired quality of life (QoL). Intranasal corticosteroids are effective medications in managing SAR. In addition, mometa-sone furoate nasal spray (MFNS) is a well-known therapeutic option. However, the literature provided no data about the effects of MFNS in European children with SAR. Thus, this study addressed this unmet requirement.Methods: MFNS was compared to isotonic saline. Both treatments were prescribed: one drop of spray per nostril, twice a day, for 3 weeks. Nasal cytology, total symptom score (TSS), visual analogic scale concerning the parental perception of severity of symptoms, and the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) were assessed at baseline, after 7 and 21 days, and 1 month after discontinuation. Results: MFNS significantly reduced eosinophil and mast cell counts, improved QoL, and relieved symptoms, as assessed by doctors and perceived by parents. These effects persisted over time, even after discontinuation. Both treatments were safe and well-tolerated.Conclusions: The present study documented that a 3-week MFNS treatment was able to signifi-cantly dampen type 2 inflammation, improve QoL, and reduce severity of symptoms in Italian children with SAR, and was safe (AU)

[Nasal toilet in infants with rhinitis: nasal passage crucial, so treat with xylometazoline]. / Neustoilet bij zuigelingen met rinitis.

A good nasal passage is crucial for neonates and infants, as they rely on obligate nasal breathing. Feeding problems and dyspnoea are commonly seen in infants with nasal obstruction.In this article, we emphasize the importance of relieving nasal congestion caused by an infection. An effective therapy to reduce nasal obstruction, caused by mucus, is rinsing with saline. Xylometazoline can be added if the effect of saline is insufficient. However, guidelines are often cautious with prescribing nasal decongestants in infants. These recommendations are mainly based on case reports, and often concern overdoses or other medication than xylometazoline. The risk of severe side effects with xylometazoline in young children is low if the dosage is adequate.

Nocturnal nasal congestion is associated with uncontrolled blood pressure in patients with hypertension comorbid obstructive sleep apnea.

OBJECTIVE: To determine the independent role of nasal obstruction on blood pressure (BP) control in patients with hypertension comorbid obstructive sleep apnea (OSA). SUBJECTS AND METHODS: This cross-sectional study comprised of 326 newly diagnosed OSA comorbid hypertension patients from March 2018 to December 2021. Sixty-six patients have controlled hypertension, two hundred and nine with uncontrolled hypertension and fifty-one with resistant hypertension. Information on demographic characteristics, sleep data, hypertension status was collected. Multivariate logistic regression models were used to determine the odds ratios (OR). RESULTS: Patients with nocturnal nasal congestion had more difficult to control blood pressure, with more numbers of antihypertensive drugs. They tended to have more severe OSA, lower nocturnal oxygen saturation and more severe sleepiness. Univariate analysis showed that nocturnal nasal congestion and Nasal Obstruction Symptom Evaluation (NOSE) Scale scores were associated with uncontrolled BP. After adjusting for age, sex, smoking, alcohol use, OSA severity and CT90, multivariate logistic analysis models showed that nocturnal nasal congestion was independently associated with uncontrolled hypertension (OR = 2.09, p = 0.023). When analyzed more severe resistant hypertension, nocturnal nasal congestion showed a higher association (OR = 2.96, p = 0.014). CONCLUSION: This cross-sectional study demonstrated that the nocturnal nasal congestion was independently associated with uncontrolled BP. The use of nasal decongestants or nasal surgery may be a potential therapeutic target for resistant hypertension in the future.

Efficacy and safety of the Chinese herbal medicine Xiao-qing-long-tang for allergic rhinitis: A systematic review and meta-analysis of randomized controlled trials.

ETHNOPHARMACOLOGICAL RELEVANCE: The classic Chinese herbal medicine formula Xiao-qing-long-tang (XQLT) is commonly recommended to manage allergic rhinitis (AR), but the treatment efficacy and safety of XQLT are uncertain. AIM OF THE STUDY: This study aimed to evaluate the effectiveness and safety of XQLT in treating AR. MATERIALS AND METHODS: Nine databases were searched from their inception to April 2021. Randomized controlled trials (RCTs) evaluating XQLT for AR were included. The methodological quality of the studies was assessed using the Cochrane risk-of-bias tool. A meta-analysis and a subgroup meta-analysis were conducted to evaluate the effectiveness of XQLT. RESULTS: Twenty-four RCTs were included in this meta-analysis. XQLT was compared to both placebo and Western medicine (WM), and XQLT combined with WM was compared with WM alone. Meta-analyses were conducted for total nasal symptom scores (TNSS), four individual nasal symptom scores, quality of life (QoL), effective rate, and recurrence rate. The TNSS decreased after XQLT treatment and combination treatment (mean difference (MD): -0.79; 95% confidence interval (CI) [-1.20, -0.38], standardized mean difference (SMD): -1.42; 95% CI [-1.59, -1.24], and SMD: -1.84; 95% CI [-2.08, -1.60]). The two individual nasal symptom scores decreased after XQLT treatment and combination treatment; these nasal symptoms comprised rhinorrhea (SMD: -0.30; 95% CI [-0.58, -0.02] and SMD: -0.48; 95% CI [-0.70, -0.26]), and nasal obstruction (SMD: -0.54; 95% CI [-0.78, -0.30] and SMD: -0.54; 95% CI [-0.76, -0.32). XQLT and XQLT combined with WM achieved a better effective rate than WM (risk ratio (RR): 1.18; 95% CI [1.11, 1.25] and RR: 1.16; 95% CI [1.10, 1.23]) and a lower recurrence rate than WM (RR: 0.24; 95% CI [0.13, 0.43] and RR: 0.47; 95% CI [0.31, 0.72]). XQLT was well tolerated in patients being treated for AR. CONCLUSION: Our results indicated that oral XQLT may alleviate the TNSS, rhinorrhea scores, and nasal obstruction scores of AR and is safe to use in clinical practice. However, more RCTs that follow rigorous methodologies and evaluate well-accepted outcome measures are required to evaluate the effectiveness of XQLT.

Mepolizumab for chronic rhinosinusitis with nasal polyps: Treatment efficacy by comorbidity and blood eosinophil count.

BACKGROUND: In the phase III SYNAPSE study, mepolizumab reduced nasal polyp (NP) size and nasal obstruction in chronic rhinosinusitis with NP. OBJECTIVE: We sought to assess the efficacy of mepolizumab in patients from SYNAPSE grouped by comorbid asthma, aspirin-exacerbated respiratory disease (AERD), and baseline blood eosinophil count (BEC). METHODS: SYNAPSE, a randomized, double-blind, 52-week study (NCT03085797), included patients with severe bilateral chronic rhinosinusitis with NP eligible for surgery despite intranasal corticosteroid treatment. Patients received 4-weekly subcutaneous mepolizumab 100 mg or placebo plus standard of care for 52 weeks. Coprimary end points were change in total endoscopic NP score (week 52) and nasal obstruction visual analog scale score (weeks 49-52). Subgroup analyses by comorbid asthma and AERD status, and post hoc by BEC, were exploratory. RESULTS: Analyses included 407 patients (289 with asthma; 108 with AERD; 371 and 278 with BEC counts ≥150 or ≥300 cells/µL, respectively). The proportion of patients with greater than or equal to 1-point improvement from baseline in NP score was higher with mepolizumab versus placebo across comorbid diseases (asthma: 52.9% vs 29.5%; AERD: 51.1% vs 20.6%) and baseline BEC subgroups (<150 cells/µL: 55.0% vs 31.3%; ≥150 cells/µL: 49.5% vs 28.1%; <300 cells/µL: 50.7% vs 29.0%; ≥300 cells/µL: 50.4% vs 28.1%). A similar trend was observed in patients without comorbid asthma or AERD. More patients had more than 3-point improvement in nasal obstruction VAS score with mepolizumab versus placebo across comorbid subgroups. CONCLUSIONS: Mepolizumab reduced polyp size and nasal obstruction in chronic rhinosinusitis with NP regardless of the presence of comorbid asthma or AERD.

Efficacy and safety of benralizumab in chronic rhinosinusitis with nasal polyps: A randomized, placebo-controlled trial.

BACKGROUND: Eosinophilic inflammation has been implicated in the pathogenesis, severity, and treatment responsiveness of chronic rhinosinusitis with nasal polyps (CRSwNP). OBJECTIVE: We sought to assess the efficacy and safety of benralizumab-mediated eosinophil depletion for treating CRSwNP. METHODS: The phase 3 OSTRO study enrolled patients with severe CRSwNP who were symptomatic despite treatment with intranasal corticosteroids and who had a history of systemic corticosteroid (SCS) use and/or surgery for nasal polyps (NP). Patients were randomized 1:1 to treatment with benralizumab 30 mg or placebo every 4 weeks for the first 3 doses and every 8 weeks thereafter. Coprimary end points were change from baseline to week 40 in NP score (NPS) and patient-reported mean nasal blockage score reported once every 2 weeks. RESULTS: The study population comprised 413 randomized patients (207 in the benralizumab group and 206 in the placebo group). Benralizumab significantly improved NPS and nasal blockage score compared to placebo at week 40 (P ≤ .005). Improvements in Sinonasal Outcome Test 22 score at week 40, time to first NP surgery and/or SCS use for NP, and time to first NP surgery were not statistically significant between treatment groups. Nominal significance was obtained for improvement in difficulty in sense of smell score at week 40 (P = .003). Subgroup analyses suggested influences of comorbid asthma, number of NP surgeries, sex, body mass index, and baseline blood eosinophil count on treatment effects. Benralizumab was safe and well tolerated. CONCLUSION: Benralizumab, when added to standard-of-care therapy, reduced NPS, decreased nasal blockage, and reduced difficulty with sense of smell compared to placebo in patients with CRSwNP. TRIAL REGISTRATION: ClinicalTrials.gov NCT03401229.

OnabotulinumtoxinA injection towards the SPG for treating symptoms of refractory chronic rhinosinusitis with nasal polyposis: a pilot study.

BACKGROUND AND OBJECTIVE: The main objective of this prospective, open, uncontrolled pilot study was to investigate the safety of administering onabotulinumtoxinA (BTA) towards the sphenopalatine ganglion (SPG) in 10 patients with refractory chronic rhinosinusitis with nasal polyposis (CRSwNP) using a novel injection tool, the MultiGuide®. MATERIAL AND METHODS: A one-month baseline period was followed by bilateral injections of 25 U BTA in the SPG and a follow-up of 12 weeks. The primary outcome was adverse events (AE), and the main efficacy outcome was a 50% reduction in visual analogue scale (VAS) symptoms for nasal obstruction and rhinorrhea in months 2 and 3 post-treatment compared to baseline. RESULTS: We registered 13 AEs, none of which were serious, however, one patient experienced diplopia which moderately affected his daily activities. The symptoms slowly improved and resolved 4 weeks after injection. Five patients were treatment responders with at least 50% median reduction in the nasal obstruction, and four were treatment responders concerning rhinorrhea. CONCLUSIONS: Injection of BTA toward the SPG using the MultiGuide® in patients with CRSwNP appears to be safe but with a potential for moderately disabling side effects. The study indicates a beneficial effect on nasal obstruction.

The Nasal Obstruction Balance Index: A Novel Approach to Improving Correlation Between Unilateral Nasal Airway Measurements and Evaluating Nasal Airway Asymmetry.

OBJECTIVES/HYPOTHESIS: Demonstrate that the Nasal Obstruction Balance Index (NOBI) model fulfils the unmet need of improving unilateral correlation between subjective and objective nasal obstruction outcome measures and identifying the more obstructed side. Improve correlation between unilateral objective nasal airway measurements (nasal inspiratory peak flow [NIPF] and acoustic rhinometry [AR]) and subjective Visual Analogue Scale for nasal obstruction (VAS-NO) scores. Improve assessment of nasal airway asymmetry by evaluating unilateral measurements both before and after the application of nasal decongestant; which the patient could better understand. NOBI represents a ratio calculated by taking the difference between left and right nasal airway measurements and divided by the maximum unilateral measurement. It is based on Poiseuille's law and aims to reduce the confounding variables which challenge nasal airway measurement. STUDY DESIGN: Prospective cohort study. METHODS: Forty-three controls and 34 patients with nasal obstruction underwent both unilateral and bilateral NIPF, AR and VAS-NO measurements; these were repeated after the application of nasal decongestant. The NOBI values for unilateral NIPF, AR, and VAS-NO were calculated both before and after decongestant. RESULTS: The correlation between unilateral NIPF and AR measurements was enhanced considerably (r = 0.57, P < .01) when NOBI was applied. The NOBI metric significantly increased the correlation between unilateral NIPF, AR, and VAS-NO scores. Postdecongestant NOBI for NIPF and AR measurements correctly identified the more obstructed side in 82.4% and 94.1% of the deviated nasal septum (DNS) cases, respectively. CONCLUSION: The NOBI model provides a better correlation between unilateral subjective and objective measurements and identifies the more obstructed side. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2833-E2840, 2021.

Efficacy and Safety of Sea Salt-Derived Physiological Saline Nasal Spray as Add-On Therapy in Patients with Acute Upper Respiratory Infection: A Multicenter Retrospective Cohort Study.

BACKGROUND The purpose of this study was to assess the effects of seawater on nasal congestion and runny nose symptoms in adults with an acute upper respiratory infection (URI). MATERIAL AND METHODS This was a multicenter retrospective cohort trial of patients with acute URI and symptoms of nasal congestion and runny nose. The patients were assigned to 2 groups and were administered regular non-drug supportive treatment or supportive treatment with nasal irrigation with sea salt-derived physiological saline. The primary efficacy endpoint was the effective rate (percentage of patients with ≥30% symptom score reduction from baseline for nasal congestion and runny nose). RESULTS In total, 144 patients were enrolled, including 72 in each group, and 143 patients completed the study. Both groups had similar demographics and vital signs. The effective rates for nasal congestion and runny nose were significantly increased in the seawater group compared with patients in the control group (87.3% vs 59.7% for nasal congestion; 85.9% vs 61.1% for runny nose; both P<0.001). In addition, the 2 groups showed markedly different degrees of patient symptom score improvement in sleep quality and appetite (both P<0.01), but not in cough and fatigue (both P>0.05). There were no adverse events in either group. CONCLUSIONS The sea salt-derived physiological saline nasal spray device satisfactorily improved nasal congestion, runny nose, sleep quality, and appetite in adults with URI, with no adverse effects.

Effect of rhinophototherapy on nasal congestion in patients with seasonal allergic rhinitis.

OBJECTIVE: The aim of the present study was to objectively and subjectively evaluate the effects of adding rhinophototherapy to intranasal beclomethasone dipropionate to treat nasal congestion in patients with seasonal allergic rhinitis. METHOD: Seventy-five seasonal allergic rhinitis patients were randomly divided into two groups. Patients in Group 1 received intranasal beclomethasone dipropionate for two weeks and patients in Group 2 had rhinophototherapy added to the same medical therapy as Group 1. The effectiveness of treatments was evaluated with the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Nasal Obstruction Symptom Evaluation scale (NOSE) questionnaires and active anterior rhinomanometry. RESULTS: After treatment, significant improvement was observed in Group 2 vs Group 1 in terms of RQLQ (p = 0.011) and NOSE (p = 0.001) scores. In Group 2, significant differences were observed between before and after treatment for inspiratory total nasal resistance (p = 0.004). However, no significant differences vs. baseline were observed in Group 1. CONCLUSION: Our study shows that adding intranasal phototherapy with a combination of UVA, UVB and visible light therapy to nasal beclomethasone dipropionate treatment objectively improves nasal patency in patients with seasonal allergic rhinitis.

Effect of topical corticosteroids on nasal patency after acute positive airway pressure exposure / Efeito dos corticosteroides tópicos na patência nasal após exposição aguda à pressão positiva nas vias aéreas

Abstract Introduction Nasal congestion and obstruction are reported in the majority of continuous positive airway pressure users and are frequently cited as reasons for noncompliance. Baseline inflammation due to allergic rhinitis could increase or exacerbate the inflammatory effect of high airflow in the nasal cavity as the result of continuous positive airway pressure and lead to greater continuous positive airway pressure intolerance. In this setting, intranasal steroids would be expected to counteract the nasal inflammation caused by allergic rhinitis and/or continuous positive airway pressure. Objective The aim of the present study is to evaluate the effects of topical corticosteroid use on nasal patency after acute exposure to positive pressure. Methods Ten individuals with allergic rhinitis were exposed to 1 h of continuous airway pressure (15 cm H2O) in the nasal cavity, delivered by a continuous positive airway pressure device. Visual analog scale, nasal obstruction symptom evaluation scale, acoustic rhinometry and peak nasal inspiratory flow were performed before and after the intervention. After 4 weeks topical nasal steroid (budesonide) application, positive pressure exposure was repeated as well as the first assessments. Results Patients reported a statistically significant improvement both on the visual analog (p = 0.013) and obstruction symptom evaluation scales (p < 0.01). Furthermore, objective measurements were improved as well, with increased nasal cavity volume on acoustic rhinometry (p = 0.02) and increased peak nasal inspiratory flow (p = 0.012), after corticosteroid treatment. Conclusion In patients with allergic rhinitis, intranasal corticosteroid therapy improved objective and subjective parameters of nasal patency after acute exposure of the nasal cavity to positive pressure.

Resumo Introdução Congestão e obstrução nasais são relatadas na maioria dos usuários de pressão positiva contínua nas vias aéreas e são frequentemente mencionadas como razões para a falta de aderência. A inflamação basal devida à rinite alérgica pode aumentar ou agravar o efeito inflamatório do alto fluxo de ar na cavidade nasal como resultado da pressão positiva contínua nas vias aéreas e aumentar a intolerância à mesma. Nesse cenário, espera-se que os esteróides intranasais neutralizem a inflamação nasal causada pela rinite alérgica e/ou pela pressão positiva contínua nas vias aéreas. Objetivo Avaliar os efeitos do uso tópico de corticosteroides na patência nasal após exposição aguda à pressão positiva. Métodos Dez indivíduos com rinite alérgica foram expostos a uma hora de pressão contínua nas vias aéreas (15 cm H2O) na cavidade nasal, fornecida por um dispositivo de pressão positiva contínua nas vias aéreas. A escala visual analógica, a escala Nasal Obstruction Symptom Evaluation, rinometria acústica e pico de fluxo inspiratório nasal foram aplicados antes e após a intervenção. Após 4 semanas de aplicação tópica de esteroide nasal (budesonida), a exposição positiva à pressão foi repetida, bem como as primeiras avaliações. Resultados Os pacientes relataram uma melhoria estatisticamente significante tanto na escala visual analógica (p = 0,013) quanto na escala Nasal Obstruction Symptom Evaluation (p < 0,01). Além disso, as medidas objetivas também foram melhoradas, com aumento do volume da cavidade nasal na rinometria acústica (p = 0,02) e aumento do pico de fluxo inspiratório nasal (p = 0,012), após o tratamento com corticosteroide. Conclusão Em pacientes com rinite alérgica, a terapia com corticosteroide intranasal melhorou os parâmetros objetivos e subjetivos da patência nasal após exposição aguda da cavidade nasal à pressão positiva.

Nasal irrigation with Glycyrrhiza glabra extract for treatment of allergic rhinitis - A study of in vitro, in vivo and clinical trial.

ETHNOPHARMACOLOGICAL RELEVANCE: Glycyrrhiza glabra, a family of licorice and a traditional Chinese medicine with sweet taste and favorable smell, has anti-inflammatory, anti-allergic and immunomodulatory functions. AIM OF THE STUDY: We developed a licorice extract (LE) by using glycyrrhiza glabra and administered it through nasal irrigation to treat allergic rhinitis (AR). MATERIALS AND METHODS: LE was prepared into extract powder, and the anti-inflammatory effect of the LE was evaluated by calcium ionophore-induced activated mast cell model (in vitro). Then, local passive anaphylaxis assays were applied to investigate the anti-IgE-mediated allergic reaction of the LE in mice (in vivo). A developed LE was administered through nasal irrigation to treat AR in clinic settings. A total of 60 participants diagnosed with AR were included in this clinical trial; they were randomly assigned to three interventions: licorice nasal irrigation (LNI), corticosteroid nasal irrigation (CNI), and saline nasal irrigation (SNI). They performed nasal irrigation once a day for 1 month. Both subjective questionnaires (22-item Sino-Nasal Outcome Test [SNOT-22] and visual analog scale [VAS]) and objective examinations (acoustic rhinometry and nasal endoscopy) were used for effectiveness assessments. RESULTS: All three interventions could improve SNOT-22 scores, but the effects of LNI and CNI were more significant. According to VAS scores for nasal blockage, rhinorrhea, sneezing, nasal pruritus, postnasal discharge, and olfactory disturbance, the effect of LNI was superior to those of CNI and SNI. The results of rhinometry revealed that LNI significantly improved nasal resistance. Endoscopic analysis showed that both LNI and CNI, but not SNI, could significantly improve turbinate hypertrophy. Moreover, the best procedural comfort was found for LNI, which had no side effects or complications during the trial. CONCLUSIONS: LNI is a natural, safe, and innovative therapy that can effectively treat AR. Its effect is superior to those of CNI and SNI, and it has greatly improved procedural comfort.

Impacto da fluticasona intranasal em pacientes com apneia obstrutiva do sono: um estudo prospectivo / The impact of intranasal fluticasone on patients with obstructive sleep apnea: a prospective study

Resumo Introdução: A apneia obstrutiva do sono é o tipo mais comum de apneia do sono, causada por obstrução completa ou parcial da via aérea superior. A obstrução nasal também é considerada como um dos fatores de risco independentes da apneia obstrutiva do sono. Objetivo: Avaliar pacientes com apneia obstrutiva do sono. Método: Pacientes com apneia obstrutiva do sono foram incluídos no estudo de junho a dezembro de 2015, tratados com spray de corticosteroide intranasal por quatro semanas. Vários parâmetros foram obtidos antes e após o tratamento, inclusive os escores da escala Nasal Obstruction Symptom Evaluation, do Pittsburgh Sleep Quality Index e do questionário Escala de Sonolência de Epworth. Resultados: Cinquenta pacientes completaram os questionários antes e após o tratamento intranasal com fluticasona. A média de idade era de 39,7 ± 15,6 anos, com uma proporção de homens para mulheres de 3:2. Os escores pós-tratamento da Escala de Sonolência de Epworth, do Pittsburgh Sleep Quality Index e do Nasal Obstruction Symptom Evaluation indicaram uma diminuição em comparação aos escores pré-tratamento, de 10,4 para 8,74, 7,86 para 6,66 e 9,08 para 6,48, respectivamente. Uma diminuição significativa foi observada no grupo Nasal Obstruction Symptom Evaluation ≥ 10 em todas as três categorias, mas não no grupo Nasal Obstruction Symptom Evaluation <10. Conclusões: Os autores concluíram que o tratamento com fluticasona intranasal pode ser útil em pacientes com apneia obstrutiva do sono relacionada a obstrução nasal para melhorar a qualidade do sono e limitar a disfunção diurna.