The prevalence of high risk of obstructive sleep apnea in patients with allergic rhinitis.

BACKGROUND: Although allergic rhinitis (AR) has not been acknowledged as a strong risk factor for obstructive sleep apnea (OSA), several pathophysiological linkages between these two conditions have frequently been reported. However, epidemiological data relating to the prevalence of OSA in patients with AR remain scarce. OBJECTIVE: To investigate the prevalence of patients at high risk for OSA among patients with AR, and to determine the relationship between OSA and severity of AR. METHODS: Patients aged ≥ 18 years with a diagnosis of AR and positive skin prick test were recruited from the allergy clinic, Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand between October 2014 to November 2015. During routine follow-up, participants were asked to complete the STOP-Bang questionnaire and visual analog scale regarding AR symptoms, including their duration and severity. Patients with STOP-Bang score of ≥ 3 were considered as high risk for having OSA. RESULTS: Of the 120 AR patients (45 males, 75 females) included, there were 28 patients (19 males, 9 females) who had a STOP-Bang score of ≥ 3 (23.3%), especially for those who had longer duration of AR symptoms (low-risk/high-risk: 60/120 months, p = 0.01). However, no significant relationship was observed between ARIA classification and severity of nasal symptoms of AR for being high risk of OSA. CONCLUSIONS: The prevalence of high risk of having OSA in patients with AR was two times higher than that in general Thai population. Early screening and further management for these patients may improve treatment outcomes and quality of life.

The effect of steam inhalation on nasal obstruction in patients with allergic rhinitis.

BACKGROUND: Nasal obstruction is often impact on quality of life in allergic rhinitis (AR). The steam inhalation is one of widely used home remedies to soothe and open the nasal passages. Furthermore, steam inhalation may provide change in objective nasal airway assessment. OBJECTIVE: To compare the effect of steam inhalation on nasal obstruction between patients with AR and normal individuals, as well as the change in the cross-sectional area of the nasal cavity and in nasal airway resistance (NAR) between 2 groups. METHODS: A prospective comparative, parallel group study was conducted in AR and normal individuals. Steam with the temperature of 42-44°C was inhaled. Variables obtained before and after steam inhalation were compared. RESULTS: After steam inhalation, nasal symptom score, combined global symptoms, and Visual Analog scale (VAS) of combined global symptoms of AR patients showed statistically significant improvement. Whereas, normal individuals, there was statistically significant improvement only in sneezing and combined global symptoms. Meanwhile, the change of each measurement score, combined global symptoms, and VAS of the symptoms in those with AR were significantly higher than those of normal individuals. Total nasal airflow, NAR, volume, and mean minimal cross-sectional area of AR patients tended to better improve after steam inhalation. CONCLUSIONS: The steam inhalation significantly improved nasal obstruction in AR patients, but no statistical significant difference between both groups for any parameters. The different response between the 2 groups may be due to different nasal mucosa sensitivity to stimuli.

Pattern of allergic sensitization in chronic rhinitis: A 19-year retrospective study.

BACKGROUND: The pattern of allergic sensitization provides data for physicians to take appropriate care of allergic patients. OBJECTIVE: To analyze the long-term pattern of allergen skin prick test (SPT) sensitization at a single tertiary care hospital in Thailand. METHODS: Medical records of adult rhinitis patients during 1998 to 2017 were reviewed. Inclusion criteria were chronic rhinitis with positive SPT to at least one aeroallergen in the test panel. Outcome measures were SPT results, clinical symptoms, and their effect on patient quality of life (QoL). Descriptive statistics were used to demonstrate the pattern of sensitization. Multivariate linear regression was used to identify association between evaluated factors and patient QoL. RESULTS: Six thousand five hundred and seventeen adult patients were included in this study. Mean age was 36.4 & 13.8 years. A majority of patients (59.4%) had positive SPT, and 83.7% of those had polysensitization. Dermatophagoides pteronyssinus and sedge were the most common indoor (54.8%) and outdoor allergens (37.7%), respectively. Compared among the various periods of data collection over a 19-year period, there was no major change in the pattern of sensitization. Considering the most recent data from 2013-2017, the prevalence of sensitization increased from 66.8% to 73.7% (p < 0.001). Clinical symptoms, except sneezing and allergen sensitization, affect QoL of chronic rhinitis patients (p < 0.001). CONCLUSIONS: House dust mite and sedge are the most common indoor and outdoor allergens. There was no major change in the pattern of sensitization. Almost all allergic symptoms significantly affect QoL.

The effectiveness of oxymetazoline plus intranasal steroid in the treatment of chronic rhinitis: A randomised controlled trial.

BACKGROUND: The recommended drug for moderate to severe chronic rhinitis is intranasal steroids (INS). However, nasal congestion could be refractory and need additional treatments. OBJECTIVE: We sought to explore the benefit of oxymetazoline (Oxymet) plus INS on nasal congestion without inducing rhinitis medicamentosa. METHODS: We performed a 60-week, randomised, double-blind clinical trial in 50 patients, 18 years of age or greater, with chronic rhinitis who had used INS and cetirizine and still had nasal congestion. Subjects were randomised to receive 2 sprays of 0.05% Oxymet in each nostril twice daily or placebo for 4 weeks. All patients received 2 sprays of budesonide (100 µg/spray) in each nostril twice daily and 10 mg cetirizine once daily from entry throughout the study. Nasal symptom scores, nasal peak inspiratory flow (NPIF) and Rhinoconjunctivitis Quality of Life (Rcq) scores were measured. RESULTS: Oxymet significantly reduced nasal congestion in subjects with chronic rhinitis compared with placebo on the day of 15-28 and 29-42. In subjects with allergic rhinitis, nasal congestion scores in the Oxymet group were significantly reduced compared with those in the placebo group on days 4-7, days 8-14, days 15-28 and days 29-42. In the Oxymet group, post hoc analysis showed that subjects with allergic rhinitis significantly improved their nasal congestion scores compared to non-allergic individuals (N, allergic/non-allergic = 18/7, p < 0.05). The combination of INS and Oxymet was not associated with rhinitis medicamentosa. CONCLUSIONS: The combination of INS and Oxymet provides additional benefit compared to INS monotherapy in relieving nasal congestion in subjects with chronic rhinitis and allergic rhinitis without developing rhinitis medicamentosa.

A randomized study of temperature-controlled versus bipolar radiofrequency for inferior turbinate reduction.

UNLABELLED: The objective of this study is to compare outcomes of temperature-controlled radiofrequency (TCRF) and bipolar radiofrequency (BRF) for inferior turbinate reduction in patients with chronic rhinitis (CR). This was a prospective, randomized non-inferiority trial. Eighty-four adult patients with CR refractory to medication were randomized into two intervention groups: TCRF(42) or BRF(42). Primary outcomes consisted of patient-orientated visual analog scale (VAS; 0-10) of nasal obstruction at 4th postoperative week. Secondary subjective outcomes included VAS of nasal discharge, sneezing, hyposmia, and postnasal drip. Objective outcomes included crusting, mucociliary transportation time, minimal cross-sectional area, total nasal volume, and nasal airway resistance performed by blind assessors before and at 4th postoperative week and 1-year follow-up. Baseline and perioperative data showed no statistically significant difference between both groups, except for longer operative time in TCRF (481.5 ± 36.2 vs. 37.1 ± 3.0 s, p < 0.001) and slightly more crusts in BRF group (p = 0.04). Both intention-to-treat and per-protocol analyses, TCRF(39) versus BRF(41), revealed no significant difference among subjective and objective outcomes between two groups at 4th postoperative week. The 95% confidence intervals of mean differences of VAS scores of all subjective symptoms were within defined margin (-1.5 to 1.5), except for nasal discharge. At 1-year follow-up, there was still no significant difference in the outcomes. Minimal pain and minor bleeding without serious adverse effects from both interventions were reported. Both BRF and TCRF resulted in similar short-term outcomes, while less operative time was found in BRF group. Further studies, particularly, on cost-effectiveness should be conducted for better treatment selection. LEVEL OF EVIDENCE: 1b.

The correlation between intradermal testing and serum specific IgE to house dust mite in negative skin prick test allergic rhinitis adult patients.

BACKGROUND: Diagnosis of allergic rhinitis (AR) is based on history, physical examination, and skin prick test (SPT) while intradermal (ID) test can be performed to confirm the diagnosis in case of negative result of SPT. However, the ID test is not recommended for cat and timothy grass allergy because of its high false positive rate. As a result, the "quantitative" technique of serum specific IgE (sIgE) measurement might be helpful to diagnose AR with more confidence. OBJECTIVES: To evaluate the correlation between ID tests and sIgE in the diagnosis of house dust mite (HDM)-sensitive AR patients. METHODS: Patients with chronic rhinitis (CR) were recruited and SPT was performed. If SPT was negative, ID test and sIgE to HDM [Dermatophagoides pteronyssinus (Dp)] measurement were performed. RESULTS: Eighty-two patients with chronic rhinitis (CR), whose SPTs were negative for Dp, were included. There were 39 males (47.6%) and 43 females (52.4%) aged between 18 and 76 years old (mean age = 43.3 years). The ID test was positive in 13 patients (15.9%), and was negative in 69 patients (84.1 %). sIgE to HDM was positive ( ≥ 0.35 kUA/l) in 2 patients (2.4%). There was a fair to moderate correlation between the size of wheal of ID test and sIgE to HDM (r = 0.44, 95% confidence interval: 0.19 to 0.67, p < 0.01). CONCLUSION: ID test has a fair to moderate correlation with sIgE Dermatophagoides pteronyssinus and it can be used in CR patients with negative SPT where sIgE is not feasible.

Physical predictors for moderate to severe obstructive sleep apnea in snoring patients.

PURPOSE: This study aimed to identify physical findings that may predict the presence of moderate to severe obstructive sleep apnea (OSA) in snoring patients. METHODS: A total of 283 subjects (165 males and 118 females) were recruited, including 217 OSA patients and 66 patients with apnea-hypopnea index (AHI)<5 as a control group, diagnosed by level-1 polysomnography. Baseline data of patients including age, sex, weight, height, body mass index (BMI), neck circumference (NC), waist circumference (WC), neck-to-height ratio (NHtR), and waist-to-height ratio (WHtR) were recorded. Other physical parameters such as chin length (Chin1), thyromental distance, hyomental distance, cricomental distance, cricomental space (CMS), Friedman tongue position (FTP), and tonsils size were recorded by a single investigator who was blinded to the PSG results. RESULTS: The findings that were statistically different between the control group and moderate to severe OSA (AHI ≥ 15) included sex, BMI, NC, NHtR, WC, WHtR, Chin1, CM, and CMS (p<0.05). However, logistic regression analysis showed that only male gender and WHtR ≥ 0.55 were the independent predictors for AHI ≥ 15 with adjusted odds ratios of 6.6 and 3.1, respectively. CONCLUSION: Among snoring patients seeking medical consultation, male gender and WHtR of ≥ 0.55 were good predictors for moderate to severe OSA. No single head and neck finding reliably predicted this condition. In a situation with limited facilities, these data along with medical history may be helpful for prioritizing patients in order to achieve the optimal use of sleep investigation and treatment.

Clinical characteristics of 5 adult patients with rhinofacial entomophthoromycosis in Thailand.

Five patients [mean age: 36 years (range: 22-65)] were diagnosed with rhinofacial entomophthoromycosis at our center during the study period. All patients presented with painless cheek and nasal dorsum swelling with nasal obstruction. All pathology reports confirmed rhinofacial entomophthoromycosis, which is characterized by the Splendore-Hoeppli phenomenon. Conidiobolus coronatus was identified from fungal culture in all patients. All patients were successfully treated with various antifungals.

Prevalence of chronic rhinitis in Thai patients with obstructive sleep disordered breathing.

OBJECTIVE: To prospectively identify the prevalence of chronic rhinitis (CR) and findings from objective nasal airway evaluation in Thai patients with obstructive sleep disordered breathing (OSDB) in a sleep clinic. MATERIAL AND METHOD: Seventy patients, 44 males and 26females, with OSDB were recruited. All were asked to complete Epworth sleepiness scale (ESS), questionnaires regarding nasal symptoms including scores to assess the severity of CR, and objective nasal airway measurements. Nasal airway resistance (NAR) was measured by active anterior rhinomanometry and nasal volume and minimal cross-sectional area (MCA) were measured by acoustic rhinometry (before topical decongestion). RESULTS: Fifty-nine patients (84.3%) had a history of nasal obstruction, rhinorrhea, sneezing, and itching of either intermittent or persistent pattern, regardless of severity, for more than one month. Forty-six patients (65.7%) had active symptom of nasal obstruction. About 23% of patients had NAR higher than and 33% had MCA lower than 1 SD from the mean of normative values in healthy Asians. Both subjective and objective nasal parameters did not have a statistically significant correlation with the scores of ESS. CONCLUSION: A substantial proportion of patients with OSDB in the sleep clinic had co-existing CR symptoms and a tendency to be abnormal in objective nasal parameters when compared to general population. Careful history recording and a thorough evaluation of the nasal airway are, therefore, essential in these patients.

Health-related quality of life in Thai patients with obstructive sleep disordered breathing.

OBJECTIVE: To assess the health-related quality of life (HRQOL) of Thai patients with obstructive sleep disordered breathing (OSDB) and their responses to continuous positive airway pressure (CPAP) treatment. MATERIAL AND METHOD: Thirty-eight healthy volunteers, 35 primary snorers (PS), and 108 patients with obstructive sleep apnea (OSA) diagnosed with polysomnography (PSG) were asked to fill questionnaires including Thai version of Short Form-36 (SF-36), and Epworth sleepiness scale (ESS). Thirty-two subjects with OSA who had been using CPAP adequately were asked to complete SF-36 twice, before and three months after treatment initiation. RESULTS: The role-physical and general health dimensions of SF-36 in OSA patients and PS were significantly lower than healthy volunteers (p < 0.05). Other dimensions were not significantly different among groups of subjects. Nonetheless, the scores in all dimensions of SF-36 in OSA patients were lower than those of general population of Thailand, except for mental health. There were only weak but significant correlations between physical function, role-physical, general health, vitality, and role-emotional dimensions and ESS scores (r = 0.17-0.29). Most of PSG parameters, particularly apnea-hypopnea index, did not correlate with SF-36 scores except for a weak correlation between mean oxygen saturation and role-physical, mental health, and vitality dimensions. However there was a significant improvement in all dimensions of SF-36 after three months of adequate CPAP therapy (p < 0.01). CONCLUSION: Thai patients with OSDB had poorer HRQOL compared to healthy subjects and general population at least in some dimensions, and an effective CPAP use can improve them. However there was almost no relationship between HRQOL and PSG findings.

The improved quality process after implementation of the hemithyroidectomy care map.

OBJECTIVE: To report the improved quality process in service care of the patients undergoing hemithyroidectomy and the results of the care map implementation. MATERIAL AND METHOD: Descriptive analysis and retrospective chart reviews were performed in the patients who underwent hemithyroidectomy in the Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital before and after the care map implementation between January 2004 and December 2006. RESULTS: Hemithyroidectomy care map has been created with good cooperation of all members of our department in January 2005. Two hundred seventy nine patients, including 246 females (88%) and 33 males (12%) participated in this study. The care map was used in all patients. Hospital stay was reduced from five to eight days to less than four days in 93% of the patients. The estimated expenses of 97% of the patients differed from the true expense at less than 20%. Complications were minimized to the acceptable level by close supervision of the attending staffs. Incidence of vocal cord paralysis was reduced from 8.7% before the care map implementation to 2.4% and 2.3% in the first and second years. Hematoma was observed in three cases within 24 hours postoperatively and could not be prevented by drain insertion. Only minimal content was found in the drain after 48 hours. CONCLUSION: The improved quality process in hemithyroidectomy care received good cooperation from all members in our department. Effective resource utilization was achieved with maximal patients'benefit and satisfaction. Close supervision by attending staffs, meticulous surgical techniques, and adequate bleeding control are the keys of effective clinical care. Hospital stay is possibly reduced to one to two days by good pre-anesthetic care before admission and by avoiding or using drain only in selected cases for six to 48 hours.

Nasal Cavity Length or Analyzed Nasal Segment of Acoustic Rhinometry in Thai Adults.

Background: Nasal cavity length (NCL) is important for determining analyzed nasal segment (ANS) of acoustic rhinometry (AR). AR is a technique for nasal airway assessment which nasal cross-sectional areas and nasal volume (NV) are obtained. NCL or ANS is the important parameter to determine NV measured by AR. The ANS used to calculate NV in previous literatures vary from 4 to 8 cm. However, there has not been any study regarding NCL of Asians which is probably different from that of Western countries. Objectives: To measure NCL in Thai adults using nasal telescope and compared NCL between left and right sides as well as male and female as well as among age groups. Design: Prospective study. Methods: This study was performed on patients, aged 18-95 years, who underwent nasal telescopy under local anesthesia at the Department of Otorhinolaryngology, Siriraj Hospital. Baseline characteristics (sex and age) of patients were collected. NCL (from anterior nasal spine to posterior edge of nasal septum) of both nasal cavities was measured using rigid nasal telescope of 0 degree. Mean NCL length of both nasal cavities was calculated. Results: There were 1277 patients, with 498 (39%) male and 779 (61%) female. The mean ± standard deviation (SD) of NCL of male was 6 ± 0.6 cm whereas that of female was 5.7 ± 0.5 cm. There were no significant differences in NCL between left and right sides as well as among age groups in each gender (p > 0.05 all). However, male had significantly longer NCL compared with that of female (p < 0.001). The mean ± SD of NCL of total population was 5.9 ± 0.6 cm. Conclusion: The NCL of Thais was approximately 6 cm. These data are useful to determine ANS used to calculate NV when AR is performed. Plain Language Summaries: The length of nasal cavity (LNC) is important variable for acoustic rhinometry (AR) which is the instrument to measure nasal volume (NV). We use AR in clinical researches to diagnose and monitor the results of treatment of nose and sinus diseasesThe LNC used to calculate NV in previous studies vary from 4 to 8 cm. However, there has not been any study of LNC of Asians which is probably different from that of Western countriesWe measured LNC in 1277 Thai adults, aged 18-95 years, with 498 (39%) male and 779 (61%) female using nasal rigid endoscope and compared LNC between male and female.The average of LNC was 5.9 cm. Male had longer LNC compared with that female. The LNC of Thais was approximately 6 cm. These data are useful for AR to calculate NV.

Functional outcomes of sleep in Thai patients with obstructive sleep-disordered breathing.

PURPOSES: Quality of life assessment in obstructive sleep-disordered breathing (OSDB) is increasingly recognized, and the functional outcomes of sleep questionnaire (FOSQ) is a popular instrument. The objective of this study was to apply this questionnaire in Thai patients to assess its reliability, validity, and responsiveness properties. METHODS: A total of 223 subjects were recruited. The scores of FOSQ in 38 healthy volunteers and 40 primary snorers were compared with those of 108 obstructive sleep apnea (OSA) patients diagnosed by polysomnography. Seventy-two subjects answered the FOSQ twice at 2-4 weeks apart to check the test-retest reliability, and 37 patients with OSA who complied well with CPAP therapy answered them again after treatment at 3-6 months. All participants also filled the Epworth sleepiness scales (ESS) to check the concurrent validity. RESULTS: There were statistically significant differences in all FOSQ subscales including global scores between healthy volunteers (17.3 ± 2.1) and OSA patients (14.5 ± 2.9) (p < 0.001). The internal consistency of the questionnaire was excellent (Cronbach's alpha 0.95), and the test-retest reliability (intra-class correlation coefficients) was 0.70 in global scores. After adequate CPAP therapy, all FOSQ scores increased significantly (p < 0.001) There were significant correlations between all FOSQ scores except sexual relationship and ESS (r -0.48); however, these had only a weak relationship with AHI and minimal oxygen saturation. CONCLUSIONS: The FOSQ can be applied to Thai patients with OSDB with good reliability, validity, and responsiveness properties. It may be the first validated version of FOSQ in East Asian countries which is a very useful tool for future research.

Mastoid obliteration with postconchal soft tissue and postauricular pericranial flap.

OBJECTIVE: To report the technique and the result of mastoid obliteration with postconchal soft tissue and postauricular pericranial flap. MATERIAL AND METHOD: Retrospective chart reviews were performed in the patients who underwent mastoid obliteration after canal wall-down mastoidectomy by the first author in the Department of Otolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University between January 2004 and January 2008. RESULTS: Fifteen patients were included in the present series. All patients had final round dry cavities within six to eight weeks except one who had wet discharging cavity from accumulated keratin because of total flap atrophy. Some atrophic change at the distal part of the flap was found in five cases (33%) resulting in small pockets at attic and aditus area after a 6-month follow-up period. CONCLUSION: Postconchal soft tissue and postauricular pericranial flap were reliable for mastoid obliteration. The new cavity was finally round, dry, and healthy. It could be simply accessed, cleaned, and examined for recurrent disease during the follow-up period. Some shrinkage of the flap could be expected at the distal part after the 6-month follow-up period.

A randomized, prospective, double-blind study of the efficacy of dexpanthenol nasal spray on the postoperative treatment of patients with chronic rhinosinusitis after endoscopic sinus surgery.

OBJECTIVE: To assess the efficacy of dexpanthenol nasal spray compared with normal saline spray in the postoperative treatment of patients with chronic rhinosinusitis (CRS) who underwent endoscopic sinus surgery (ESS). MATERIALS AND METHOD: A prospective, randomized controlled study was conducted in CRS patients who underwent ESS. The enrolled patients had never been operated intranasally. These patients received either dexpanthenol or normal saline nasal spray intranasally four times a day for six weeks post-operatively. RESULTS: Fifty CRS patients were recruited in the present study. Age ranged from 23 to 63 years (means 43.4 +/- 11.2 years). Forty-four percent of patients were diagnosed as CRS without nasal polyps (NP) (CRSs NP) and 56% were CRS with NP (CRSw NP). Twenty-five cases were randomly assigned to use dexpanthenol nasal spray whereas the other 25 cases used normal saline nasal spray. The preoperative severity of CRS, determined by the computerized tomography (CT) scan scoring system of Lund-McKay was 13.9 +/- 6.2 in the dexpanthenol group and 13.6 +/- 6.9 in the normal saline group, which were not statistically different (p > 0.05). The endoscopic scoring was 10.2 +/- 2 in the dexpanthenol group and 10.7 +/- 3 in the normal saline group, which were not statistically different (p > 0.05). The mucociliary transit time improvement (time difference between pre- and post-treatment by nasal spray) was 8.4 +/- 3.3 minutes in the dexpanthenol group and 1.7 +/- 1.2 minutes in the normal saline group, which were statistically different (p < 0.05). CONCLUSION: The majority of the postoperative symptom scores and all of the endoscopic scores of the dexpanthenol group were not statistically different from those of the normal saline group. However, dexpanthenol nasal spray has superior efficacy compared with normal saline nasal spray on improvement of mucociliary clearance and nasal discharge in the postoperative care of CRS patients after ESS.

Epworth sleepiness scale in obstructive sleep disordered breathing: the reliability and validity of the Thai version.

PURPOSES: The objectives of this study are to test the reliability and validity of the Thai version of the Epworth sleepiness scale (ESS) and to assess the relationship between the ESS score and the severity of obstructive sleep disordered breathing. METHODS: A total of 228 subjects (149 males and 79 females) were recruited. In order to check the discriminant validity of the ESS, we included 32 healthy volunteers and 39 patients with primary snoring to be the control groups and 126 patients with obstructive sleep apnea (OSA) confirmed by full polysomnography to be the disease groups. The test-retest reliability was investigated in 71 subjects. To check the responsiveness properties of the questionnaire, we asked a separate group of 31 patients who were successfully treated with either continuous positive airway pressure (CPAP) or upper airway surgery to complete the ESS before and after treatment at 3-6 months. RESULTS: The internal consistency demonstrated by Cronbach's alpha coefficients for standardized item was 0.87 and a range from 0.84 to 0.86 if some items were deleted. The test-retest reliability was shown by intra-class correlation coefficients of 0.79. There was a statistically significant difference between the mean of the ESS scores of the control groups (6.1 ± 3.0) and the OSA patients (9.9 ± 5.3) (p < 0.001). The ESS scores decreased significantly after a successful treatment with both CPAP and surgery (p < 0.001); however, there was no statistically significant difference among different severities of OSA. CONCLUSIONS: Our Thai version of the ESS showed an excellent internal consistency and test-retest reliability. It is able to discriminate between control subjects and OSA patients and to assess the response of treatment; however, it has a weak relationship with the apnea-hypopnea index. Therefore, we recommend use it to combine with more comprehensive clinical evaluation in obstructive sleep disordered breathing patients.

In-vivo allergenic potency of Siriraj Mite Allergen Vaccine (SMAV) comparing with standardized vaccine in mite-sensitive patients.

BACKGROUND: The prevalence of allergic diseases, particularly asthma and allergic rhinitis, has increased tremendously in Thailand and worldwide. House dust mite (HDM) is the major IgE sensitizer among allergic children and adults. We have developed local standardized mite allergen extracts, Siriraj Mite Allergen Vaccine (SMAV) from Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df) from our source materials which were highly purified (99%). OBJECTIVE: To compare in-vivo allergenic potency of both SMAV Dp and Df with commercial standardized mite allergen vaccine by using skin prick testing in mite-sensitive individuals. METHODS: This was a double-blind, randomized, self controlled study comparing SMAV and commercial standardized mite allergen vaccine (Dp and Df) by using skin prick testing in mite-sensitive adult volunteers, 18-60 years of age. RESULTS: The study was performed in 54 adult volunteers (19 males, mean age 26.6 +/- 5.5 years old) who had positive skin test to commercial Dp and Df. Seventeen of them had no allergic disease. The most common allergic disease among the volunteers was allergic rhinitis (21/37). Mean wheal diameter of SMAV Dp and commercial Dp at the concentration of 10,000 and 5,000 AU/ml were equivalent but at the concentration of 2,500 AU/ml was inequivalent. Mean wheal diameter of SMAV Dp was significantly larger than commercial Dp at concentration of 2,500 AU/ml (p < 0.05). Mean wheal diameter of SMAV Df and commercial Df at all .3 concentrations were equivalent. There was no systemic side effect in all subjects. CONCLUSION: The study demonstrated that in mite-sensitive adults, SPT using SMAV Dp (10,000 AU) and Df (10,000 AU) had equivalent allergenic potency to the commercial comparator without any systemic side effect.

As-Needed Versus Regular Use of Fluticasone Furoate Nasal Spray in Patients with Moderate to Severe, Persistent, Perennial Allergic Rhinitis: A Randomized Controlled Trial.

BACKGROUND: Using intranasal corticosteroid (INCS) regularly is recommended for treating perennial allergic rhinitis. However, no studies have evaluated "as-needed" use. OBJECTIVE: To compare the efficacy between as-needed and regular use of INCS in patients with moderate to severe perennial allergic rhinitis. METHODS: In a 6-week randomized controlled trial, participants were assigned to either fluticasone furoate (FF) nasal spray, (27.5 µg) 2 sprays once daily for 1 week, followed by as-needed use (FF-as-needed) for 5 more weeks or 2 sprays once daily for 6 weeks (FF-regular). The primary outcome was a change in the total nasal symptom score (TNSS). The secondary outcomes were the change in nasal peak inspiratory flow, Rhinoconjunctivitis Quality of Life-36 Questionnaire score, and cumulative FF dose. RESULTS: In total of 108 patients, 53 and 55 patients were randomized to the FF-as-needed and FF-regular group, respectively. The difference in mean change in TNSS between the 2 groups was not significant at week 6 (1.21 points; 95% CI, -0.08 to 2.49; P = .066). The FF-regular group tended toward a greater improvement in TNSS. The FF-regular group had a higher mean change in nasal peak inspiratory flow than the FF-as-needed group at week 6 (-19.21 L/min; 95% CI, -33.54 to -4.89; P = .009). Both groups had similar improvement in Rhinoconjunctivitis Quality of Life-36 Questionnaire. The mean cumulative FF dose in the FF-as-needed group was 51% that of the FF-regular group. CONCLUSIONS: Both as-needed and regular use of INCS had similar improvement in TNSS and RCQ-36 score in patients with perennial allergic rhinitis. As-needed use had half of INCS exposure of the regular use.

Quality of life in patients with chronic rhinitis after radiofrequency inferior turbinate reduction.

OBJECTIVE: This prospective, before-and-after study was aimed to demonstrate the effectiveness of radiofrequency (RF) inferior turbinate reduction in patients with chronic rhinitis refractory to medication on quality of life. MATERIAL AND METHOD: From April 2007 to April 2008, there were 28 patients enrolled in the present study. The temperature-controlled radiofrequency (RF) was applied at inferior turbinate on both sides. To compare before and at the 8th weeks after RF treatment, the patients were given Rhinoconjuctivitis Quality of Life questionnaires (Rcq-36) and questionnaires using visual analog scales (0-10) to assess subjective symptoms such as the frequency and severity of nasal obstruction, nasal discharge, hyposmia, and sneezing. The acoustic rhinometry and active rhinomanometry were also done to evaluate objective outcomes. RESULTS: At the 8th week after RF treatment, the patients quality of life in every dimension of Rcq-36 and all symptoms revealed a significant improvement (p < 0.05). Particularly, the severity and frequency of nasal congestion were reduced from 6.8 +/- 2.5 and 6.3 +/- 2.5 to 2.6 +/- 2.2 and 2.5 +/- 2.1 respectively (p < 0.001). However, there was no statistically significant change in objective findings. All patients reported only minimal pain and no complication. CONCLUSION: This is the first study to show that radiofrequency inferior turbinate reduction can improve quality ofhlife ofthe patients with chronic rhinitis in all dimensions. It is a simple and minimal invasive procedure, and thus will be a good alternative treatment.

Choanal atresia.

Choanal atresia is caused by failure of resorption of the bucco-pharyngeal membrane during embryonic development. The atresia can be membranous or bony in nature, but is usually mixed in most cases. When the atresia is bilateral, newborns can have severe airway distress and cyanosis is alleviated by crying. Bilateral choanal atresia is managed with an oropharyngeal airway. Flexible nasal endoscopy and computed tomography can confirm the diagnosis. Surgery is the definitive treatment with two main approaches, namely transnasal or transpalatal. The transnasal route is currently the preferred procedure and can be performed in a minimally invasive fashion with endoscopic instrumentation. It is a safe and rapid procedure even in very young children, with no complications and a high rate of success. The use of a navigation system for surgical planning and intraoperative guidance and powered instrumentation can improve treatment outcome. The transpalatal approach is more invasive and reserved for failed endoscopic cases.