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2.
Cochrane Database Syst Rev ; 9: CD013876, 2022 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-36062970

RESUMO

BACKGROUND: Olfactory dysfunction is a common consequence of COVID-19 infection and persistent symptoms can have a profound impact on quality of life. At present there is little guidance on how best to treat this condition. A variety of interventions have been suggested to promote recovery, including medication and olfactory training. However, it is uncertain whether any intervention is of benefit. This is an update of the 2021 review with one additional study added.  OBJECTIVES: 1) To evaluate the benefits and harms of any intervention versus no treatment for people with persisting olfactory dysfunction due to COVID-19 infection.  2) To keep the evidence up-to-date, using a living systematic review approach.  SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the latest search was 20 October 2021.   SELECTION CRITERIA: We included randomised controlled trials (RCTs) in people with COVID-19 related olfactory disturbance that had persisted for at least four weeks. We included any intervention compared to no treatment or placebo.  DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were the recovery of sense of smell, disease-related quality of life and serious adverse effects. Secondary outcomes were the change in sense of smell, general quality of life, prevalence of parosmia and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included two studies with 30 participants. The studies evaluated the following interventions: systemic corticosteroids plus intranasal corticosteroid/mucolytic/decongestant and palmitoylethanolamide plus luteolin.  Systemic corticosteroids plus intranasal corticosteroid/mucolytic/decongestant compared to no intervention We included a single RCT with 18 participants who had anosmia for at least 30 days following COVID-19 infection. Participants received a 15-day course of oral corticosteroids combined with nasal irrigation (consisting of an intranasal corticosteroid/mucolytic/decongestant solution) or no intervention. Psychophysical testing was used to assess olfactory function at 40 days. This is a single, small study and for all outcomes the certainty of evidence was very low. We are unable to draw meaningful conclusions from the numerical results. Palmitoylethanolamide plus luteolin compared to no intervention We included a single RCT with 12 participants who had anosmia or hyposmia for at least 90 days following COVID-19 infection. Participants received a 30-day course of palmitoylethanolamide and luteolin or no intervention. Psychophysical testing was used to assess olfactory function at 30 days. This is a single, small study and for all outcomes the certainty of evidence was very low. We are unable to draw meaningful conclusions from the numerical results. AUTHORS' CONCLUSIONS: There is very limited evidence available on the efficacy and harms of treatments for persistent olfactory dysfunction following COVID-19 infection. However, we have identified a number of ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available.


Assuntos
COVID-19 , Corticosteroides , Anosmia , COVID-19/complicações , Expectorantes , Humanos , Luteolina , Descongestionantes Nasais , Ensaios Clínicos Controlados Aleatórios como Assunto , Olfato
3.
Expert Rev Clin Pharmacol ; 15(8): 911-919, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35951740

RESUMO

INTRODUCTION: Ocular redness, or conjunctival hyperemia, is a common ophthalmic sign associated with reduced quality of life. For redness without apparent underlying pathology, topical ophthalmic decongestants have been widely used. AREAS COVERED: Brimonidine tartrate was approved in 2017 as a topical vasoconstrictor at a 0.025% concentration for relief of ocular redness. Since then, investigators have reported on efficacy and safety findings from studies evaluating low-dose brimonidine for reducing ocular redness. EXPERT OPINION: Brimonidine is highly selective for α2-adrenergic receptors. Clinical trials have so far shown that the drug in low doses significantly reduces ocular redness in comparison to vehicle for up to 8 hours. Brimonidine-treated eyes did not present side effects of other vasoconstrictors, such as hypotension, cardiac arrhythmia, or drowsiness. Ocular adverse events, such as allergic reactions and redness rebound, were also minimal. In this review, we examine in detail published literature on the mechanism of brimonidine tartrate and its efficacy and safety in relieving conjunctival hyperemia.


Assuntos
Hiperemia , Agonistas alfa-Adrenérgicos , Tartarato de Brimonidina/efeitos adversos , Eritema/tratamento farmacológico , Humanos , Hiperemia/induzido quimicamente , Hiperemia/tratamento farmacológico , Descongestionantes Nasais , Soluções Oftálmicas/efeitos adversos , Qualidade de Vida , Quinoxalinas/efeitos adversos , Receptores Adrenérgicos
4.
Ned Tijdschr Geneeskd ; 1662022 05 10.
Artigo em Holandês | MEDLINE | ID: mdl-35736357

RESUMO

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.


Assuntos
Aparelho Sanitário , Obstrução Nasal , Rinite , Aparelho Sanitário/efeitos adversos , Criança , Pré-Escolar , Humanos , Imidazóis , Lactente , Recém-Nascido , Descongestionantes Nasais/efeitos adversos , Obstrução Nasal/complicações , Obstrução Nasal/tratamento farmacológico , Rinite/tratamento farmacológico
5.
Birth Defects Res ; 114(8): 277-294, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35238183

RESUMO

BACKGROUND: Many previous studies have identified risk factors for stillbirth, but few examine stillbirth among pregnancies affected with birth defects. Because many hypothesized etiologies of stillbirth work through vascular pathologies of the placenta, we examined maternal use of vasoactive medications in relation to stillbirth among pregnancies affected with birth defects. METHODS: Data were analyzed from the National Birth Defects Prevention Study (1997-2011). We examined use of nonsteroidal anti-inflammatory drugs (NSAIDs), decongestants, short- or long-acting beta-agonists (SABA/LABA), and antihypertensive medications in relation to pregnancies affected by birth defects ending in stillbirth compared to live birth. Associations were measured with odds ratios (ORs) for early pregnancy use and hazard ratios (HRs) for time-varying late pregnancy use. RESULTS: Among all birth defects (n = 12,394), the risk of stillbirth was associated with use of antihypertensive medications in early (odds ratio [OR]: 1.8; 95% confidence interval [CI]: 1.0, 3.1) and late pregnancy (HR: 2.0; 95% CI: 1.1, 3.6). Other vasoactive medications were not associated with increased risk of stillbirth. Of 27 specific defect groups, increased risks were observed for only one medication/defect pair: early decongestant use was more common among mothers of stillbirth versus live birth cases with spina bifida (OR: 2.4; 95% CI: 0.9, 6.5). CONCLUSION: This exploratory analysis of vasoactive medication use suggests that use of NSAIDs, decongestants, and SABA/LABA is not associated with increased risk of stillbirth among pregnancies affected with birth defects. Our finding of increased risks associated with antihypertensive medication use raises questions of confounding by indication, which we were not able to fully address.


Assuntos
Anti-Hipertensivos , Natimorto , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Feminino , Humanos , Descongestionantes Nasais , Razão de Chances , Gravidez , Natimorto/epidemiologia
7.
Eur Arch Otorhinolaryngol ; 279(8): 3963-3972, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35041066

RESUMO

BACKGROUND: Nasal obstruction is a frequent symptom in both adults and children and it is a common reason to see an otorhinolaryngologist. Endoscopy of the nasal cavity and the epipharyngeal space along with anterior rhinomanometry is regarded the gold standard since many years to estimate the severity of nasal obstruction in the particular patient. Endoscopy shows anatomical reasons for an obstruction, whereas the nasal flow volume and nasal resistance can be determined using anterior rhinomanometry. Currently, there are only few data available for rhinomanometry results in children. The purpose of the present study was to evaluate the application of this technique in the pediatric population for objective evaluation of nasal flow. Whether it achieves reproducible results and which clinical parameters have some influence on the results were studied. PATIENTS AND METHODS: 427 children (average age of 8.5 years, range 7 months through 17 years) who were admitted to evaluate nasal patency or for allergy testing were examined. After clinical examination and endoscopy of the nasal cavity and epipharyngeal space, anterior rhinomanometry was performed before and after application of decongestant nose drops separately for each nose side in 334 children. The nasal flow with a pressure of 150 Pasc was measured and served for statistical evaluation. Flow values were correlated to clinical and endoscopic parameters along with results of allergy tests (prick tests). RESULTS: Reproducible rhinomanometric measurements were possible in children age 3 years and older. However, the standard deviation and variation of measurements were significant in this cohort of patients. Statistically highest significant correlations were found between flow measurements and body height along with the age of the children (p < 0.01) and status following adenoidectomy (p < 0.05). No statistically significant correlations were found between rhinomanometry and results of prick tests. CONCLUSIONS: The study demonstrates that rhinomanometry can be applied in the pediatric population for objective evaluation of nasal obstruction and for determining the effects of decongestant nose drops. The highest correlation was found between nasal flow and children's body height, children's age and status following adenoidectomy. The correlation between nasal flow and clinically/endoscopically determined degree of nasal obstruction was lower. However, definition of normal flow values for particular age groups is challenging since the results showed high variation and standard deviation. Yet with regard to individual patient, the technique achieves reliable results in nasal provocation tests, which are widely used for allergy testing in children. When performed in children it should always be considered that there are age-specific requirements for the examination and interpretation of results in this patient cohort.


Assuntos
Hipersensibilidade , Obstrução Nasal , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Descongestionantes Nasais , Obstrução Nasal/diagnóstico , Obstrução Nasal/etiologia , Nariz , Rinomanometria/métodos
8.
Cochrane Database Syst Rev ; 1: CD004976, 2022 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-35060618

RESUMO

BACKGROUND: Although combination formulas containing antihistamines, decongestants, and/or analgesics are sold over-the-counter in large quantities for the common cold, the evidence for their effectiveness is limited. This is an update of a review first published in 2012. OBJECTIVES: To assess the effectiveness of antihistamine-decongestant-analgesic combinations compared with placebo or other active controls (excluding antibiotics) in reducing the duration of symptoms and alleviating symptoms (general feeling of illness, nasal congestion, rhinorrhoea, sneezing, and cough) in children and adults with the common cold. SEARCH METHODS: We searched CENTRAL, MEDLINE via EBSCOhost, Embase, CINAHL via EBSCOhost, LILACS, and Web of Science to 10 June 2021. We searched the WHO ICTRP and ClinicalTrials.gov on 10 June 2021. SELECTION CRITERIA: Randomised controlled trials investigating the effectiveness of antihistamine-decongestant-analgesic combinations compared with placebo, other active treatment (excluding antibiotics), or no treatment in children and adults with the common cold. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We assessed the certainty of the evidence using the GRADE approach. We categorised the included trials according to the active ingredients. MAIN RESULTS: We identified 30 studies (6304 participants) including 31 treatment comparisons. The control intervention was placebo in 26 trials and an active substance (paracetamol, chlorphenindione + phenylpropanolamine + belladonna, diphenhydramine) in six trials (two trials had placebo as well as active treatment arms). Reporting of methods was generally poor, and there were large differences in study design, participants, interventions, and outcomes. Most of the included trials involved adult participants. Children were included in nine trials. Three trials included very young children (from six months to five years), and five trials included children aged 2 to 16. One trial included adults and children aged 12 years or older. The trials took place in different settings: university clinics, paediatric departments, family medicine departments, and general practice surgeries.  Antihistamine-decongestant: 14 trials (1298 participants). Eight trials reported on global effectiveness, of which six studies were pooled (281 participants on active treatment and 284 participants on placebo). The odds ratio (OR) of treatment failure was 0.31 (95% confidence interval (CI) 0.20 to 0.48; moderate certainty evidence); number needed to treat for an additional beneficial outcome (NNTB) 3.9 (95% CI 3.03 to 5.2). On the final evaluation day (follow-up: 3 to 10 days), 55% of participants in the placebo group had a favourable response compared to 70% on active treatment. Of the two trials not pooled, one showed some global effect, whilst the other showed no effect. Adverse effects: the antihistamine-decongestant group experienced more adverse effects than the control group: 128/419 (31%) versus 100/423 (13%) participants suffered one or more adverse effects (OR 1.58, 95%CI 0.78 to 3.21; moderate certainty of evidence). Antihistamine-analgesic: four trials (1608 participants). Two trials reported on global effectiveness; data from one trial were presented (290 participants on active treatment and 292 participants on ascorbic acid). The OR of treatment failure was 0.33 (95% CI 0.23 to 0.46; moderate certainty evidence); NNTB 6.67 (95% CI 4.76 to 12.5). Forty-three per cent of participants in the control group and 70% in the active treatment group were cured after six days of treatment. The second trial also showed an effect in favour of the active treatment. Adverse effects: there were not significantly more adverse effects in the active treatment group compared to placebo (drowsiness, hypersomnia, sleepiness  10/152 versus 4/120; OR 1.64 (95 % CI 0.48 to 5.59; low certainty evidence). Analgesic-decongestant: seven trials (2575 participants). One trial reported on global effectiveness: 73% of participants in the analgesic-decongestant group reported a benefit compared with 52% in the control group (paracetamol) (OR of treatment failure 0.28, 95% CI 0.15 to 0.52; moderate certainty evidence; NNTB 4.7). Adverse effects: the decongestant-analgesic group experienced significantly more adverse effects than the control group (199/1122 versus 75/675; OR 1.62  95% CI 1.18 to 2.23; high certainty evidence; number needed to treat for an additional harmful outcome (NNTH 17).  Antihistamine-analgesic-decongestant: six trials (1014 participants). Five trials reported on global effectiveness, of which two studies in adults could be pooled: global effect reported with active treatment (52%) and placebo (34%) was equivalent to a difference of less than one point on a four- or five-point scale; the OR of treatment failure was 0.47 (95% CI 0.33 to 0.67; low certainty evidence); NNTB 5.6 (95% CI 3.8 to 10.2). One trial in children aged 2 to 12 years, and two trials in adults found no beneficial effect. Adverse effects: in one trial 5/224 (2%) suffered adverse effects with the active treatment versus 9/208 (4%) with placebo. Two other trials reported no differences between treatment groups. AUTHORS' CONCLUSIONS: We found a lack of data on the effectiveness of antihistamine-analgesic-decongestant combinations for the common cold. Based on these scarce data, the effect on individual symptoms is probably too small to be clinically relevant. The current evidence suggests that antihistamine-analgesic-decongestant combinations have some general benefit in adults and older children. These benefits must be weighed against the risk of adverse effects. There is no evidence of effectiveness in young children. In 2005, the US Food and Drug Administration issued a warning about adverse effects associated with the use of over-the-counter nasal preparations containing phenylpropanolamine.


Assuntos
Resfriado Comum , Descongestionantes Nasais , Adolescente , Adulto , Analgésicos/uso terapêutico , Criança , Pré-Escolar , Resfriado Comum/tratamento farmacológico , Tosse , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Descongestionantes Nasais/uso terapêutico , Estados Unidos
9.
Eur Arch Otorhinolaryngol ; 279(1): 1-24, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34296343

RESUMO

PURPOSE: Chronic rhinosinusitis (CRS) is observed in almost 100% of patients with cystic fibrosis (CF). CF-related CRS treatment is extremely challenging because of the underlying genetic defect leading to its development. CRS in CF is often refractory to standard therapy, while recurrences after surgical treatment are inevitable in the majority of patients. This study provides a precise review of the current knowledge regarding possible therapeutic options for CF-related CRS. METHODS: The Medline and Web of Science databases were searched without a time limit using the terms "cystic fibrosis" in conjunction with "otorhinolaryngological manifestation", "rhinology" and "sinusitis". RESULTS: Precise guidelines for CF-induced CRS therapy are lacking due to the lack of large cohort randomized controlled trials. None of the existing therapeutic agents has already been recommended for CRS in CF. Therapy targeting the underlying genetic defect, intranasal dornase alfa administration, and topical delivery of colistin and tobramycin showed promising results in CF-related CRS therapy. Besides the potential effectiveness of nasal steroids, strong recommendations for their usage in CF have not been provided yet. Systemic corticosteroid usage is controversial due to its potential negative influence on pulmonary disease. Ibuprofen revealed some positive effects on CF-related CRS in molecular and small cohort studies. Intranasal irrigation with saline solutions could relieve sinonasal symptoms. Nasal decongestants are not recommended. Endoscopic sinus surgery is the first-line surgical option for refractory CRS. Extensive surgical approaches should be considered as they could improve long-term outcomes in CRS. CONCLUSION: Further studies are warranted to establish consensus for CF-related CRS therapy.


Assuntos
Fibrose Cística , Rinite , Sinusite , Doença Crônica , Fibrose Cística/complicações , Fibrose Cística/terapia , Humanos , Descongestionantes Nasais/uso terapêutico , Rinite/tratamento farmacológico , Rinite/terapia , Sinusite/complicações , Sinusite/terapia
10.
Eur Arch Otorhinolaryngol ; 279(3): 1371-1381, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34089097

RESUMO

INTRODUCTION: Symptomatic relief of acute rhinosinusitis is commonly achieved with nasal decongestants. The current observational study investigated the efficacy and safety of treatment of acute rhinosinusitis with Ectoin® Rhinitis Spray compared to or in combination with Xylometazoline-containing decongesting nasal spray. METHODS: Patients with acute rhinosinusitis applied either Ectoin® Rhinitis Spray, Xylometazoline nasal spray or a combination of both products. Rhinosinusitis symptoms were assessed, and nasal oedema and endonasal redness were determined by rhinoscopy. Patient diaries based on the validated SNOT (Sino Nasal Outcome Test) questionnaire evaluated rhinosinusitis parameters over time and influences of the disease on quality of life. Following treatment, investigators and patients judged the efficacy and tolerability. RESULTS: Ectoin® Rhinitis Spray diminished common rhinosinusitis symptoms such as nasal obstruction, nasal secretion, facial pain/headache, and smell/taste impairment. Upon treatment over 7 days, rhinosinusitis sum scores decreased statistically significantly (p < 0.001) by - 64.25%, which was comparable to that achieved with Xylometazoline-containing decongesting nasal spray (- 67.60%). No side effects were observed during treatment with Ectoin® Rhinitis Spray, whereas treatment with Xylometazoline-containing nasal spray resulted in nasal mucosa dryness. Concomitant treatment with both products diminished the development of nasal dryness and required fewer applications of Xylometazoline-containing nasal spray. CONCLUSION: Ectoin® Rhinitis Spray is an effective, natural treatment option for acute rhinosinusitis, which may be used as monotherapy or as add-on treatment with a Xylometazoline-containing nasal spray. The concomitant use of Ectoin® Rhinitis Spray might reduce the needed dose of decongestant nasal spray and counteract bothersome side effects such as dry nasal mucosa. TRIAL REGISTRATION: The current study was registered in the ClinicalTrials.gov database under the identifier: NCT03693976 (date of registration: Oct 3, 2018).


Assuntos
Sprays Nasais , Rinite , Administração Intranasal , Diamino Aminoácidos , Humanos , Imidazóis , Descongestionantes Nasais , Mucosa Nasal , Qualidade de Vida , Rinite/complicações , Rinite/tratamento farmacológico
11.
J Laryngol Otol ; 136(3): 229-236, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34465402

RESUMO

OBJECTIVE: This study aimed to compare the effectiveness of pharmacological therapy with and without direct maxillary sinus saline irrigation for the management of chronic rhinosinusitis without polyps. METHODS: In this prospective randomised controlled trial, 39 non-operated patients were randomly assigned to be treated with direct maxillary sinus saline irrigation in conjunction with systemic antibiotics and topical sprays (n = 24) or with pharmacological therapy alone (n = 15). Endoscopy, Sino-Nasal Outcome Test and Lund-MacKay computed tomography scores were obtained before, six weeks after and one to two years after treatment. RESULTS: Post-treatment Lund-Mackay computed tomography scores were significantly improved in both cohorts, with no inter-cohort difference identified. Post-treatment nasal endoscopy scores were significantly improved in the study group but were similar to those measured in the control group. The Sino-Nasal Outcome Test-20 results showed improvement in both cohorts, with no difference between treatment arms. CONCLUSION: Maxillary sinus puncture and irrigation with saline, combined with pharmacological treatment improves endoscopic findings in patients with chronic rhinosinusitis without polyps, but has no beneficial effect on symptoms and imaging findings over conservative treatment alone.


Assuntos
Antibacterianos/uso terapêutico , Seio Maxilar , Descongestionantes Nasais/uso terapêutico , Lavagem Nasal , Rinite/terapia , Sinusite/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sprays Nasais , Estudos Prospectivos , Solução Salina/uso terapêutico , Resultado do Tratamento , Adulto Jovem
12.
J Laryngol Otol ; 136(1): 8-16, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34702392

RESUMO

OBJECTIVE: This study aimed to summarise the evidence for efficacy of combination treatment of intranasal corticosteroid spray with oxymetazoline hydrochloride nasal spray for chronic rhinitis. METHOD: Nine databases were systematically searched from study inception in September 2016 to 1 June 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed. RESULTS: A total of 130 studies were screened, and 4 randomised controlled trials comprising 838 patients met inclusion criteria. The study found superior improvement of nasal congestion from onset of treatment to completion in intranasal corticosteroid spray and oxymetazoline hydrochloride groups compared with control groups. Intranasal corticosteroid spray and oxymetazoline hydrochloride use resulted in higher nasal volume (standard error of mean 1, 15.8 + 1.1 ml; p < .03) compared with either placebo (12.1 + 0.9 ml) or oxymetazoline hydrochloride (12.4 + 0.8 ml) alone (p = 0.003). CONCLUSION: Intranasal corticosteroid spray and oxymetazoline hydrochloride combination treatment may be superior in reducing rhinitis symptoms compared with either intranasal corticosteroid spray or oxymetazoline hydrochloride alone, without inducing rhinitis medicamentosa.


Assuntos
Glucocorticoides/administração & dosagem , Descongestionantes Nasais/administração & dosagem , Oximetazolina/administração & dosagem , Rinite/tratamento farmacológico , Administração Intranasal , Doença Crônica , Humanos
13.
Int J Pediatr Otorhinolaryngol ; 153: 111010, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34942425

RESUMO

OBJECTIVES: Topical intranasal decongestants are essential in nasal surgery to improve operative field. There are concerns regarding safety in paediatric population. Data on safety and safe dosage are limited. This systematic review evaluated the literature on safety and dosage of intranasal decongestant in paediatric population. METHODS: We performed a systematic search of PubMed, EMBASE, Cochrane library for relevant articles. Quality assessment was done on included articles. RESULTS: A total of 10 articles were included: five case reports; three observational studies; and two randomised control trials. Decongestants evaluated were phenylephrine, oxymetazoline, epinephrine, xylometazoline, and cocaine. In total, 209 patients were included. Side effects reported included bradycardia, tachycardia and hypertension. These were mostly self-limiting and of no clinical compromise to the patients. A total of 4/209 (1.9%) of patients required treatment for these reported effects. No mortality was reported in the included studies. CONCLUSION: In the paediatric population, the literature suggests that when delivered in a pre-specified, controlled dosage, the haemodynamic effects of phenylephrine, oxymetazoline, xylometazoline are minimal and of no clinical significance. There is scope for further studies to establish safe dosage in the paediatric population given the paucity of current literature.


Assuntos
Descongestionantes Nasais , Procedimentos Cirúrgicos Nasais , Administração Intranasal , Administração Tópica , Criança , Humanos , Descongestionantes Nasais/efeitos adversos , Oximetazolina/efeitos adversos , Vasoconstritores/efeitos adversos
15.
Vestn Otorinolaringol ; 86(5): 103-108, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34783482

RESUMO

The article analyzes the problems of population aging that are relevant for the world civilization, the peculiarities of changes in the body in old age and senility, in particular, the nasal cavity and paranasal sinuses. The analysis of algorithms of actions of an otorhinolaryngologist when prescribing drugs for the treatment of inflammatory diseases of the nasal cavity and paranasal sinuses in elderly patients is given. The advantages of using a combined nasal spray containing a nasal decongestant of 0.1% xylometazoline and 5% dexpanthenol as a means that improves regeneration and reduces the cytotoxic effect of xylometazoline are reflected. The research of domestic and foreign authors testifying to the rationality of using this combined drug in the practice of an otorhinolaryngologist in the treatment of pathology of the nasal cavity and paranasal sinuses in elderly people is presented.


Assuntos
Cavidade Nasal , Seios Paranasais , Idoso , Algoritmos , Humanos , Descongestionantes Nasais , Mucosa Nasal
16.
Pediatrics ; 148(5)2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34607935

RESUMO

The over-the-counter nasal decongestant oxymetazoline (eg, Afrin) is used in the pediatric population for a variety of conditions in the operating room setting. Given its vasoconstrictive properties, it can have cardiovascular adverse effects when systemically absorbed. There have been several reports of cardiac and respiratory complications related to use of oxymetazoline in the pediatric population. Current US Food and Drug Administration approval for oxymetazoline is for patients ≥6 years of age, but medical professionals may elect to use it short-term and off label for younger children in particular clinical scenarios in which the potential benefit may outweigh risks (eg, active bleeding, acute respiratory distress from nasal obstruction, acute complicated sinusitis, improved surgical visualization, nasal decongestion for scope examination, other conditions, etc). To date, there have not been adequate pediatric pharmacokinetic studies of oxymetazoline, so caution should be exercised with both the quantity of dosing and the technique of administration. In the urgent care setting, emergency department, or inpatient setting, to avoid excessive administration of the medication, medical professionals should use the spray bottle in an upright position with the child upright. In addition, in the operating room setting, both monitoring the quantity used and effective communication between the surgeon and anesthesia team are important. Further studies are needed to understand the systemic absorption and effects in children in both nonsurgical and surgical nasal use of oxymetazoline.


Assuntos
Descongestionantes Nasais/efeitos adversos , Oximetazolina/efeitos adversos , Assistência Perioperatória , Fatores Etários , Criança , Pré-Escolar , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipertensão/induzido quimicamente , Complicações Intraoperatórias/induzido quimicamente , Masculino , Descongestionantes Nasais/administração & dosagem , Descongestionantes Nasais/farmacocinética , Uso Off-Label , Salas Cirúrgicas , Oximetazolina/administração & dosagem , Oximetazolina/farmacocinética
17.
Med Clin North Am ; 105(5): 859-870, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34391539

RESUMO

Based on a review of the most current medical literature, this article outlines the basic concepts and classifications of rhinosinusitis, and delineates best practices for clinical diagnoses and the most up-to-date management strategies. Learning to recognize and differentiate these conditions helps facilitate appropriate and timely diagnoses as well as helping practitioners provide their patients with better counseling and care.


Assuntos
Sinusite/patologia , Doença Aguda , Administração Intranasal , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Doença Crônica , Humanos , Descongestionantes Nasais/uso terapêutico , Atenção Primária à Saúde , Sinusite/diagnóstico , Sinusite/tratamento farmacológico , Sinusite/cirurgia
18.
Cochrane Database Syst Rev ; 7: CD013876, 2021 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-34291813

RESUMO

BACKGROUND: Olfactory dysfunction is an early and sensitive marker of COVID-19 infection. Although self-limiting in the majority of cases, when hyposmia or anosmia persists it can have a profound effect on quality of life. Little guidance exists on the treatment of post-COVID-19 olfactory dysfunction, however several strategies have been proposed from the evidence relating to the treatment of post-viral anosmia (such as medication or olfactory training). OBJECTIVES: To assess the effects (benefits and harms) of interventions that have been used, or proposed, to treat persisting olfactory dysfunction due to COVID-19 infection. A secondary objective is to keep the evidence up-to-date, using a living systematic review approach.  SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane COVID-19 Study Register; Cochrane ENT Register; CENTRAL; Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished studies. The date of the search was 16 December 2020. SELECTION CRITERIA: Randomised controlled trials including participants who had symptoms of olfactory disturbance following COVID-19 infection. Only individuals who had symptoms for at least four weeks were included in this review. Studies compared any intervention with no treatment or placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. Primary outcomes were the recovery of sense of smell, disease-related quality of life and serious adverse effects. Secondary outcomes were the change in sense of smell, general quality of life, prevalence of parosmia and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included one study with 18 participants, which compared the use of a 15-day course of oral steroids combined with nasal irrigation (consisting of an intranasal steroid/mucolytic/decongestant solution) with no intervention. Psychophysical testing was used to assess olfactory function at baseline, 20 and 40 days. Systemic corticosteroids plus intranasal steroid/mucolytic/decongestant compared to no intervention Recovery of sense of smell was assessed after 40 days (25 days after cessation of treatment) using the Connecticut Chemosensory Clinical Research Center (CCCRC) score. This tool has a range of 0 to 100, and a score of ≥ 90 represents normal olfactory function. The evidence is very uncertain about the effect of this intervention on recovery of the sense of smell at one to three months (5/9 participants in the intervention group scored ≥ 90 compared to 0/9 in the control group; risk ratio (RR) 11.00, 95% confidence interval (CI) 0.70 to 173.66; 1 study; 18 participants; very low-certainty evidence). Change in sense of smell was assessed using the CCCRC score at 40 days. This study reported an improvement in sense of smell in the intervention group from baseline (median improvement in CCCRC score 60, interquartile range (IQR) 40) compared to the control group (median improvement in CCCRC score 30, IQR 25) (1 study; 18 participants; very low-certainty evidence). Serious adverse events andother adverse events were not identified in any participants of this study; however, it is unclear how these outcomes were assessed and recorded (1 study; 18 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS: There is very limited evidence available on the efficacy and harms of treatments for persistent olfactory dysfunction following COVID-19 infection. However, we have identified other ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available. For this (first) version of the living review we identified only one study with a small sample size, which assessed systemic steroids and nasal irrigation (intranasal steroid/mucolytic/decongestant). However, the evidence regarding the benefits and harms from this intervention to treat persistent post-COVID-19 olfactory dysfunction is very uncertain.


Assuntos
COVID-19/complicações , Expectorantes/administração & dosagem , Glucocorticoides/administração & dosagem , Descongestionantes Nasais/administração & dosagem , Transtornos do Olfato/tratamento farmacológico , Administração Oral , Ambroxol/administração & dosagem , Betametasona/administração & dosagem , Viés , Humanos , Lavagem Nasal/métodos , Transtornos do Olfato/etiologia , Prednisona/administração & dosagem , Prevalência , Qualidade de Vida , Recuperação de Função Fisiológica , Olfato/efeitos dos fármacos , Fatores de Tempo
20.
Am J Nurs ; 121(7): 24, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34156375

RESUMO

A rising number of cases of misuse and abuse of propylhexedrine (Benzedrex), an over-the-counter nasal decongestant, have been documented. Misuse of this drug can lead to serious and potentially fatal cardiac and psychiatric adverse effects.


Assuntos
Descongestionantes Nasais/efeitos adversos , Propilaminas/efeitos adversos , Humanos , Descongestionantes Nasais/administração & dosagem , Medicamentos sem Prescrição/efeitos adversos , Propilaminas/administração & dosagem , Propilaminas/farmacologia
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