Folklore remedy (Canada fleabane) for soybean diarrhea; mule tail tea

Histamine Sensitivity in the Nasal Mucosa during Long-term Use of Xylometazoline in the Doubled Recommended Dose

It has been suggested that the severity of rhinitis medicamentosa is dependent on the length of time the drug has been used, on how frequently it is used, and on the amount administered. It has been reported that a 4-week use of oxymetazoline in the recommended dose induced a rebound swelling and an increased histamine sensitivity as a sign of rhinitis medicamentosa and nasal hyperractivity.

In order to study the impact of an increased amount of vasoconstrictor on the histamine sensitivity, nine healthy subjects had xylometazoline nasal spray in the doubled recommended dose (1.0 mg/mL; 0.28 mL in each nostril three times daily) for 30 days. After 10 days on the drug the histamine sensitivity was slightly increased, and after another 20 days the sensitivity was significantly increased compared to that before the start of the medication (P < 0.01). When comparing the results from this study with the corresponding ones from the oxymetazoline study, no difference in the histamine sensitivity was seen. One month after the medication was finished three subjects still had an increased sensitivity to histamine.

It was concluded that the doubled recommended dose of xylometazoline did not further increase the elevated histamine sensitivity seen following vasoconstrictor used in recommended dose. The results also indicate that the increased histamine sensitivity was not caused by the preservatives. Finally, the subjects achieved a drug-induced non allergic nasal hyperreactivity (NANH) that in some subjects persisted for a long time.

Sustained Use of Xylometazoline Nose Drops Aggravates Vasomotor Rhinitis

The effect of long-term treatment with nose drops on nasal obstruction was studied by measuring nasal airway resistance (NAR) in 12 patients with vasomotor rhinitis and in 10 healthy persons using anterior rhinomanometry. The dose-response effect on decongestion by xylometazoline was followed by decongestion induced by physical exercise. Measurements were performed before and after a 3-week treatment with nose drops containing xylometazoline. NAR at rest was significantly higher in the vasomotor rhinitis patient group than in the control group on the initial measurement, and the difference increased after the treatment period. No changes from before to after were found in the control group. Similar dose-response curves for xylometazoline were seen before and after the treatment period in both groups. Tolerance to xylometazoline apparently does not develop. Nose drops did not result in complete decongestion in patients with vasomotor rhinitis. These findings indicate that rebound congestion (rhinitis medicamentosa) develops in predisposed individuals, and interstitial edema of the nasal mucosa is a possible contributing pathophysiological mechanism.

Understanding the nasal airway: principles and practice

LEARNING OBJECTIVES

After studying this article, the reader should be able to: 1. Describe the soft-tissue, cartilaginous, and bony anatomy of the nose. 2. Describe the anatomy and function of the nasal valves. 3. Discuss the governing physiologic principles responsible for airflow dynamics. 4. Discuss the various functions of the nose. 5. Demonstrate an appropriate evaluation of the nasal airway. 6. Discuss the differential diagnosis of nasal obstruction. 7. Discuss appropriate management options for nasal airway obstruction. The nose is a complex, multifunctional organ that requires respect and understanding from the rhinoplasty surgeon. The etiologic and pathologic characteristics of each patient's nasal airway problem determine the treatment of the nasal airway. Frequently, medical management is sufficient without operative intervention. Recent advances have shown that nasal valves in airway patency may play a more important role than the septum. The rhinoplasty surgeon's understanding of the anatomy and physiology of the nasal airway, along with the causes of obstruction, can pave the way for a proper evaluation and appropriate management of nasal airway problems. Lack of understanding can result in misdiagnosis and mismanagement. This article outlines current concepts of medical and surgical management of nasal airway problems and discusses in detail the key concepts and principles in the practical management of the nasal airway.

Nasal airflow in health and disease

This review examines our present understanding of the physiology, pathophysiology and pharmacology of nasal airflow. The main aim of the review is to discuss the basic scientific and clinical knowledge that is essential for a proper understanding of the usefulness of measurements of nasal airflow in the clinical practice of rhinology. The review concludes with a discussion of the measurement of nasal airflow to assess the efficacy of surgery in the treatment of nasal obstruction. Areas covered by the review include: influence of nasal blood vessels on nasal airflow; nasal valve and control of nasal airflow; autonomic control of nasal airflow; normal nasal airflow; nasal cycle; central control of nasal airflow; effect of changes in posture on nasal airflow; effect of exercise on nasal airflow; effect of hyperventilation and rebreathing on nasal airflow; nasal airflow in animals; cerebral effects of nasal airflow; sensation of nasal airflow; sympathomimetics and sympatholytics; histamine and antihistamines; bradykinin; and corticosteroids.

Effect of oxymetazoline nose drops on acute sinusitis in the rabbit

This investigation was designed to evaluate the effect of the common topical nasal decongestant oxymetazoline hydrochloride on the early local tissue defense in an experimental bacterial infection. For that purpose, a bilateral infection of the maxillary sinus was induced in 14 rabbits. Nose drops (oxymetazoline) were instilled in one nasal cavity, and placebo in the other. After 48 hours, the degree of infection was judged by using a semiquantitative inflammatory score to evaluate histologic preparations of the maxillary sinuses. On the oxymetazoline-treated side, we found a significantly higher degree of inflammation. We conclude that oxymetazoline nose drops, commonly used in acute rhinitis and sinusitis, interfere with the normal defense mechanisms during bacterially induced sinusitis, possibly by a decrease in mucosal blood flow.

Management of allergic rhinitis: focus on intranasal agents

The clinical manifestations of allergic rhinitis are the result of an immune-mediated process after exposure of a sensitized individual to airborne allergens. The primary symptomatology includes nasal congestion, rhinorrhea, nasal and conjunctival pruritus, and sneezing. Principles of management include allergen avoidance, palliative therapy, immunotherapy, and pharmacotherapy. Oral decongestants stimulate alpha-adrenergic receptors in the nasal cavity, resulting in vasoconstriction and decreased edema. Oral antihistamines block histamine1 (H1) receptors, and may relieve rhinorrhea, sneezing, and nasal and conjunctival pruritus. Topical decongestants have a local effect on adrenergic receptors in the nasal mucosa, resulting in rapid, marked vasoconstriction. Intranasal corticosteroids inhibit mediator release from mast cells and basophils, and reduce edema of the nasal mucosa. Dexamethasone sodium phosphate, beclomethasone dipropionate, and flunisolide are currently available for intranasal administration. Cromolyn sodium inhibits allergen-induced degranulation and mediator release from sensitized cells, and is useful primarily as a prophylactic agent. Several agents, including the corticosteroids budesonide and flucortin butylester, the mast cell-stabilizing agent nedocromil sodium, the anticholinergic agent ipratropium bromide, and the H1 receptor antagonist levocabastine are being investigated for intranasal use in the management of allergic rhinitis.

Influence of topical phenylpropanolamine on tachyphylaxis and mucociliary clearance in the human nose

Topical nasal phenylpropanolamine in a 2.5 per cent solution (PPA) was used in an evaluation of the possible development of tachyphylaxis and of possible effects on the mucociliary system after one week of treatment in healthy humans. The tendency of PPA to produce tachyphylaxis was evaluated by rhinomanometrie measurements of nasal airway resistance after repeated dose-response provocations. The mucociliary transport time was tested with the saccharine-dye test. No reduced dose-response effect or change in mucociliary transport time was found with PPA, thus indicating that one week of treatment does not contribute to such adverse effects.