ArticleLiterature Review

Saline nasal irrigation. Its role as an adjunct treatment

March 2003
Canadian family physician Medecin de famille canadien 49:168-73

Source
PubMed

Authors:

To review clinical evidence on the efficacy of saline nasal irrigation for treatment of sinonasal conditions and to explore its potential benefits. Clinical trials, reviews, and treatment guidelines discussing nasal irrigation were obtained through a MEDLINE search from January 1980 to December 2001. Most trials were small and some were not controlled; evidence, therefore, is level II, or fair. Flushing the nasal cavity with saline solution promotes mucociliary clearance by moisturizing the nasal cavity and by removing encrusted material. The procedure has been used safely for both adults and children, and has no documented serious adverse effects. Patients treated with nasal irrigation rely less on other medications and make fewer visits to physicians. Treatment guidelines in both Canada and the United States now advocate use of nasal irrigation for all causes of rhinosinusitis and for postoperative cleaning of the nasal cavity. Nasal irrigation is a simple, inexpensive treatment that relieves the symptoms of a variety of sinus and nasal conditions, reduces use of medical resources, and could help minimize antibiotic resistance.

Nasal Irrigation as Treatment in Sinonasal Symptoms Relief: A Review of Its Efficacy and Clinical Applications

Article

Jan 2017

Nasal irrigations have been used for centuries without any scientific data to determine its efficacy. Despite their widespread use, much confusion exist about the mechanism of action, preparation, indications and therapeutic advantage of nasal irrigations. Anecdotal evidence and poorly controlled studies add to the confusion. Recent evidence provides strong scientific justification of the benefits and advantages of using nasal irrigations in sinonasal symptoms relief. The present review of the evidence based literature highlights its efficacy and clinical applications.

To print , Normal Saline, Nasal Irrigation During Nasal Surgery, JMSP

Article

Full-text available

Aug 2023

Sajad Younis Al-Helo

To assess the the efficacy the usage of normal saline irrigation in post operative cases of endoscopic sinus surgery

Intranasal delivery of mitochondria for treatment of Parkinson’s Disease model rats lesioned with 6-hydroxydopamine

Article

Full-text available

May 2021

The feasibility of delivering mitochondria intranasally so as to bypass the blood–brain barrier in treating Parkinson's disease (PD), was evaluated in unilaterally 6-OHDA-lesioned rats. Intranasal infusion of allogeneic mitochondria conjugated with Pep-1 (P-Mito) or unconjugated (Mito) was performed once a week on the ipsilateral sides of lesioned brains for three months. A significant improvement of rotational and locomotor behaviors in PD rats was observed in both mitochondrial groups, compared to sham or Pep-1-only groups. Dopaminergic (DA) neuron survival and recovery > 60% occurred in lesions of the substantia nigra (SN) and striatum in Mito and P-Mito rats. The treatment effect was stronger in the P-Mito group than the Mito group, but the difference was insignificant. This recovery was associated with restoration of mitochondrial function and attenuation of oxidative damage in lesioned SN. Notably, P-Mito suppressed plasma levels of inflammatory cytokines. Mitochondria penetrated the accessory olfactory bulb and doublecortin-positive neurons of the rostral migratory stream (RMS) on the ipsilateral sides of lesions and were expressed in striatal, but not SN DA neurons, of both cerebral hemispheres, evidently via commissural fibers. This study shows promise for intranasal delivery of mitochondria, confirming mitochondrial internalization and migration via RMS neurons in the olfactory bulb for PD therapy.

Nose ‐To ‐Brain Delivery of Mitochondria for Treatment of Parkinson’s Disease Model Rats With 6-Hydroxydopamine

Preprint

Full-text available

Oct 2020

Background Feasibility of mitochondrial organelle transport via the olfactory bulb route for Parkinson's disease (PD) therapy was evaluated in the unilateral 6-OHDA-lesioned rats due to the distinct difference based on payload properties. Methods An intranasal infusion with 200 μg of allogeneic mitochondria conjugated with Pep-1 (P-Mito) or not (Mito) was executed once a week at the ipsilateral side of lesioned brain for three months of treatments.Results A significant improvement of rotational and locomotor behaviors in PD rats was found in both mitochondria-treating groups in contrast to Sham group or Pep-1 group. There was more than 60% recovery survival of dopaminergic (DA) neurons in substantia nigra (SN) and striatum (ST) of lesioned sides compared to the intact sides in groups of Mito and P-Mito. Treatment effect in P-Mito group was higher in the P-Mito group than Mito group but not significant. The mechanism was associated with the restoration of mitochondrial function and attenuation of oxidative damage in lesioned SN. Notably, Pep-1 modification suppressed the plasma level of inflammatory cytokines induced by infused mitochondria. The 5-bromo-2-deoxyuridine-labelled tracks showed the mitochondrial penetrating into doublecortin-positive neurons of rostral migratory stream (RMS) along with the accessory olfactory bulb in ipsilateral side of lesion and it was expressed in striatal DA neurons, but not in SN, of two cerebral hemispheres via commissural fibers. Conclusion This study showed a promising approach of nose-to-brain delivery for mitochondrial transplantation by confirming the mitochondrial internalization via RMS neurons migration in olfactory bulb for therapeutic action of PD in rats.

Nasal Saline Irrigation for Sinonasal Disorders

Article

Full-text available

Nov 2007

Josefino Hernandez

Nasal saline irrigation is a simple easy-to-do procedure that has been used to treat sinus and nasal conditions for many years. Wingrave in his 1902 paper “The Nature of Discharges & Douches” discussed cleansing of the nasal passages as an important method of treating different nasal illnesses in the last part of the 19th century.1 Nasal saline irrigation has been used for such sinonasal conditions as atrophic rhinitis, rhinosinusitis and allergic rhinitis, among infants with nasal problems and patients who have undergone endoscopic sinus surgery. Past recommendations for use were based on anecdotal evidence such as reports of patients living near the sea, whose symptoms improved with natural seawater irrigation while swimming. The past two decades saw studies undertaken to support what has been in practice for many years. Taccariello studied 40 patients suffering from chronic sinusitis with 19 patients receiving traditional alkaline nasal douche and 21 patients receiving sterile sea water spray. Results showed that compared to the control group who received no treatment, douching per se improved endoscopic appearance and quality of life scores.2 Georgitis compared the use of nasal hyperthermia versus saline irrigation in patients with allergic rhinitis. Histamine levels fell with both forms of treatment with greatest declines seen with irrigation. Leukotriene C4 levels were significantly reduced by irrigation.3 Pediatricians have refrained from using oral and topical decongestants among infants. Excessive use of oral decongestants can result in cardiovascular side effects, while excessive use and sufficient absorption of topical decongestants can result in possible complications of CNS depression leading to coma and marked reduction in body temperature, especially in infants in whom these drugs should not be used.4 Nasal saline irrigation has become a good alternative. Another common use follows endoscopic sinus surgery, when the nasal cavity quickly becomes encrusted, and frequent cleaning and saline irrigation are needed for 4-8 weeks until the lining of the nose and sinuses has regenerated.5 Nasal saline irrigation moisturizes the nasal cavity and reduces dryness of the nasal mucosa. It has become important in clearing nasal crusts and thick mucous in patients with rhinosinusitis and has been known for its beneficial effect among patients with sinonasal problems. Saline solutions can be classified into isotonic or hypertonic, buffered or non-buffered. Preparations include powder, spray or mist forms; with and without preservative; and with and without dispenser. The number of available products in the market can make it difficult for the doctor to decide on what product to recommend for his suffering patient, ranging from inexpensive home-made preparations to very expensive imported solutions. Different studies will be presented which may help in this choice. Isotonic or hypertonic solution The main issue at hand is whether to use an isotonic or hypertonic solution. Traissac from the University ENT Hospital – Bordeaux, in a study of 410 patients using isotonic solution, showed the beneficial action on the nasal sinus mucosa in medical disease and after sugery.6 Tomooka (University of California, 2000) in a study of 211 patients using hypertonic saline solution, showed improvement in 23 of the 30 symptoms queried.7 Talbot, in 1997, demonstrated among 21 volunteers that 3% hypertonic saline solution decreased mucociliary saccharine transit times more than 0.9% normal saline, 3.1 minutes compared to 0.14 minutes less than baseline.8 This study was corroborated by Keojampa in 2004, demonstrating that buffered hypertonic saline improved saccharine clearance time more than buffered normal saline.9 Hypertonic saline solution decreases the viscosity of mucus which could have improved saccharine clearance time. However, it has been suggested that the saccharin dissolution method provides a less accurate assessment of mucociliary clearance against tagged insoluble particles, as the saccharin mixes between sol and gel layers of the mucociliary blanket and is not carried solely in the superficial gel layer.8 Boek from the University Hospital Utrecht studied the effect of different saline solutions on the ciliary beat frequency (CBF) of cryopreserved mucosa of the sphenoidal sinus measured by a photoelectric method. Results revealed that Locke-Ringer’s solution (LR) had no effect on the CBF, NaCI 0.9% had a moderately negative effect, NaCI 7% solution led to complete ciliostasis within 5 minutes (reversible after rinsing with LR), and 14.4% hypertonic solution had an irreversible ciliostatic effect. He concluded that LR is an isotonic solution with no effect on ciliary beat frequency.10 Therefore, it is probable that this solution is more appropriate than saline for nasal irrigation or antral lavage. This was further supported by the study of Min YG published in 2001, wherein isotonic and hypotonic solutions did not decrease ciliary beat frequency, but where ciliostasis was observed within a few minutes in the 3.0% and 7.0% solutions.11 Histologic changes showed disruption of nasal epithelial cells in vitro which could have resulted in decrease ciliary beat frequency in hypertonic solutions. Buffered or non-buffered solution The effect of pH on the rate of mucociliary clearance of the douching solution was also studied. One group was given hypertonic solution buffered to pH 8 and another group given non-buffered hypertonic solution.12 Results showed no difference in mucociliary clearance between solutions buffered to pH 8 and that which is non-buffered.12 In his paper, Taccariello noted that alkaline nasal douche improved endoscopic appearance but not the quality of life score, while sea water spray showed improved quality of life but not endoscopic appearance.2 Preparations Preparations for nasal saline irrigation in the market include powder which can be freshly prepared for use or ready-to-use spray or mist solutions which need preservatives to extend shelf life. Common preservatives are benzalkonium chloride, polyethylene glycol and propylene glycol. Bezalkonium chloride is an antibacterial preservative which may be potentially toxic to the mucosa. Krayenbuhl and Seppey (1995) compared application of a saline stream versus drops (passive saline instillation) among 104 patients who underwent intranasal surgeries. Stream patients required significantly fewer post-operative recovery days and visits to physicians. The recovery period with saline stream was 18.9 days versus 36.7 days using saline drops.5 Nasal saline preparations available in the local market include isotonic drops, isotonic and hypertonic sprays, and isotonic seawater sprays. Parsons in 1996 presented a recipe for patients to prepare their own nasal saline solution:8 Carefully clean and rinse a 1-quart glass jar. Fill the jar with tap water. Add 2 to 3 heaping teaspoons of “pickling/canning” salt. Add 1 rounded teaspoon of baking soda (pure bicarbonate). Stir and shake well before use. Store at room temperature. This will result in a 3% saline solution buffered to pH 7.6. If the mixture is too strong and results in a stinging effect in the nose, less salt (1 ½ tsp of salt) can be used. For children, it is best to start with a weaker salt water mixture which can be gradually increased in tonicity. Ordinary rock salt is used since iodine in iodized salt can be toxic to the nasal mucosa. A soft plastic catsup container can be used as a dispenser. The nose can be liberally irrigated 2-3 times per day. Nasal saline irrigation has been safely used by both children and adults with no documented serious side effects. Different studies have shown that both isotonic and hypertonic nasal saline irrigations have beneficial effects in many sinonasal conditions. The exact mechanism by which improvement is effected is unclear.7 Hypotheses for why nasal saline irrigation promotes improvement of nasal symptoms include the following: • improving mucociliary clearance • decreasing mucosal edema • decreasing inflammatory mediators • mechanically clearing nasal crusts and thick mucous The choice of which nasal saline solution to use depends on the physician and is mainly based on which studies he or she will believe in. Whether to recommend a saline solution prepared by the patient at home or saline solutions that are commercially available is really up to the doctor. Commercial solutions have the advantage of being sterile. Saline prepared at home is cheaper, but sterility may not be guaranteed and the percentage of tonicity may be variable. Although several studies have shown that hypertonic saline solutions improve saccharine transit time, other studies have likewise shown that hypertonic saline solutions affect ciliary beat frequency negatively. For this reason, isotonic saline solutions which do not affect ciliary beat frequency may be more appropriate than hypertonic saline solution for nasal irrigation. However, we cannot discount the mucolytic effect induced by the hyperosmolarity of hypertonic solutions which could have improved saccharine transit time. Further studies can be undertaken to finally determine which solution, isotonic or hypertonic, would be better to use as nasal saline irrigation for the different sinonasal disorders.

Efektivitas salin hipertonik terhadap waktu transpor mukosiliar dan skor gejala hidung penderita rinitis alergi

Article

Jan 2018

Latar belakang: Rinitis alergi (RA) adalah suatu penyakit inflamasi mukosa hidung yang diperantara oleh imunoglobulin E (IgE), setelah mukosa hidung terpapar alergen. Tujuan: Mengidentifikasi efektivitas cuci hidung salin hipertonik terhadap waktu transpor mukosiliar dan skor gejala hidung total (SGHT) pada penderita RA. Metode: Penelitian dilaksanakan pada bulan Juli hingga Desember 2016 di Poli Telinga Hidung Tenggorok – Bedah Kepala Leher Rumah Sakit Dr. Soetomo Surabaya. Uji klinis acak terkontrol pada 2 kelompok dengan desain control group in clinical trial. Pengambilan sampel dilakukan secara consecutive sampling. Uji korelasi yang digunakan adalah uji t berpasangan dan uji Wilcoxon. Hasil: Didapatkan sampel 42 penderita, yaitu 21 penderita pada kelompok loratadin, serta 21 penderita pada kelompok loratadin dan cuci hidung salin hipertonik. Didapatkan rerata penurunan transpor mukosiliar kelompok loratadin dan cuci hidung salin hipertonik lebih bermakna daripada kelompok loratadin (p=0,001). Penurunan transpor mukosiliar kelompok loratadin didapatkan rerata -2,30 (SD=2,77), kelompok loratadin dan cuci hidung salin hipertonik didapatkan rerata -6,27 (SD=3,91). Penurunan SGHT kelompok loratadin didapatkan rerata -2,48 (SD=1,72), sedangkan kelompok loratadin dan cuci hidung salin hipertonik didapatkan rerata -4,3 (SD=1,20). Kesimpulan: Penambahan cuci hidung salin hipertonik pada terapi loratadin lebih efektif dibandingkan terapi tunggal loratadin dalam menurunkan transpor mukosiliar dan SGHT pada penderita RA. Kata kunci: Loratadin, cuci hidung salin hipertonik, transpor mukosiliar, skor gejala hidung total, rinitis alergi ABSTRACT Background: Allergic rhinitis (AR) is a nasal mucous membrane inflamatory which mediated by Imunoglobulin E (IgE) after allergen exposure in nasal mucosa. Purpose: To identify the effectiveness of nasal hypertonic saline irrigation on reduction of mucociliary transport time (MCTT) and total nasal symptom score (TNSS) in AR patients. Methods: The was conducted from July until December 2016 in Oto Rhino Laryngology - Head and Neck Surgery of Dr. Soetomo Hospital Surabaya. The study was randomized controlled clinical trials on two groups, with the control group in clinical trial design. Paired t and Wilcoxon test was used as the correlation test. Results: There was 42 patients, 21 patients in loratadine group, and 21 patients in loratadine with hypertonic nasal saline group. The average of mucociliary transport time decrease of loratadine with hypertonic nasal saline group was more significant than loratadine group (p=0.001). The mean of decreasing mucociliary transport time in loratadine group was -2.30 (SD=2.77) and loratadine with hypertonic nasal saline group was -6.27 (SD=3.91). The mean of decreasing TNSS in loratadin group was -2.48 (SD=1.72), and loratadin with hypertonic nasal saline group was -4.3 (SD=1.20). Conclusions: The addition of hypertonic nasal saline in loratadine was more effective, compared to monotherapy of loratadine in decreasing mucociliary transport time and TNSS in patient with AR. Keywords: Loratadine, hypertonic nasal saline, mucociliary transport, total nasal symptom score, allergic rhinitis

Low-concentration hypochlorous acid nasal irrigation for chronic sinonasal symptoms: a prospective randomized placebo-controlled study

Article

Full-text available

Mar 2017
Eur Arch Oto Rhino Laryngol

Low-concentration hypochlorous acid (HOCl) is an endogenous antibacterial and antiviral agent. The purpose of this study was to evaluate the effectiveness of HOCl irrigation in patients with chronic rhinosinusitis (CRS) refractory to medical therapy. Forty-three adult patients (mean age 45.5 years) were enrolled in this study. They were randomly chosen to receive nasal irrigation with either low-concentration HOCl generated by a Salicid device (n = 21), or a placebo (saline; n = 22) for 8 weeks. The outcome measures were scores on the 20-Item SinoNasal Outcome Test (SNOT-20), rhinosinusitis disability index (RSDI), nasal endoscopic score, and bacterial cultures. The SNOT-20 scores were significantly lower in the HOCl group than in the placebo group after 2 weeks of treatment (p < 0.05) and remained lower after 4 weeks of treatment. With respect to the RSDI scores, there was a significant improvement in the HOCl group at 1 week after treatment and in both groups at 2 weeks after treatment (p < 0.05). There were no significant differences in the endoscopic scores between the two groups after the treatment. The bacterial culture rates were lower in the HOCl group than in the placebo group after 4 weeks of treatment, but this was not significant (p > 0.05). Our results showed that low-concentration HOCl irrigation resulted in a greater improvement in CRS symptoms as compared to saline irrigation.

Nasal hygiene in patients with end-stage renal disease

Article

Jan 2015

Efficacy of seawater for the treatment of allergic rhinitis: A randomized clinical trial

Article

Full-text available

Oct 2015

Objective: To evaluate the efficacy of diluted seawater (SW) nasal lavage and ingestion in the treatment of symptoms of allergic rhinitis, including nasal discharge, in children (2-6 years) compared with physiological “normal” saline solution (NS) as a control. Methods: Controlled, triple-blind, randomized clinical trial of 164 children with allergic rhinitis, drawn from schools and health centers located in areas with low socioeconomic status. Children were divided into two treatment groups: SW and NS. Clinical variables were evaluated at the beginning of the trial and at weeks 2 and 12. At the beginning and the end of the study an anthropometric growth check was performed. Results: 16 of the 164 children left the study early. There were 83 subject in the SW arm and 81 in the NS arm. In weeks 2 and 12, both groups achieved significant reductions in rhinorrhea (p

Patient compliance with medications, nasal douching, smoking cessation and long-term outcomes of surgical septorhinoplasty -a prospective series of 56 cases

Article

Full-text available

Sep 2024
ANN ROY COLL SURG

Introduction Septorhinoplasty addresses both functional and cosmetic concerns with the nose and has been shown to have consistent, long-term benefits for patients. Nasal irrigation and medication such as antimicrobials are prescribed postoperatively to improve outcomes. Patient compliance with these interventions and outcomes of surgery have not been described. We aim to describe what the effects of compliance with these interventions may be in long-term follow-up. Methods Patients undergoing septorhinoplasty were reviewed prospectively from 2015 to 2022. At time of operation, patients were prescribed medications, saline douching and given smoking cessation advice. Patients underwent rhinoplasty outcomes evaluation (ROE) preoperatively, at four weeks, and 3, 12, 24 and 36 months postoperatively. Compliance with postoperative interventions was measured at four weeks. Statistical tests were performed. Results A total of 56 patients underwent septorhinoplasty. Preoperative ROE scores were improved significantly at all stages of postprocedure follow-up (p<0.0001). Multiple linear regression found no significant differences in patients who were not compliant with medications (p>0.40), nasal douching (p>0.22), both medication and nasal douching (p>0.40), and a positive smoking status (p>0.11) at four weeks. At 3- and 24-months follow-up, there were no significant differences in ROE scores between compliant patients and those who were noncompliant with medications, nasal douching or both (p>0.13). Conclusions Our data represent the only series of patient-reported outcomes from septorhinoplasty patients where compliance with nasal irrigation, smoking cessation and antimicrobials is considered. Compliance with nasal irrigation, topical antimicrobials or smoking cessation did not influence postoperative ROE scores.

Antimicrobial efficacy, mode of action and in vivo use of hypochlorous acid (HOCl) for prevention or therapeutic support of infections

Article

Full-text available

Mar 2023

The objective is to provide a comprehensive overview of the rapidly developing field of the current state of research on in vivo use of hypochlorous acid (HOCl) to aid infection prevention and control, including naso-pharyngeal, alveolar, topical, and systemic HOCl applications. Also, examples are provided of dedicated applications in COVID-19. A brief background of HOCl’s biological and chemical specifics and its physiological role in the innate immune system is provided to understand the effect of in vivo applications in the context of the body’s own physiological defense mechanisms.

Bleeding Post Radiofrequency Ablation of Inferior Turbinate: A Case Study

Article

Jan 2023

Nasal obstruction is a troublesome condition and negatively impacts the quality of life. One of the most important causes is inferior turbinate hypertrophy. Radiofrequency submucosal tissue ablation is an effective technique used to reduce inferior turbinate volume. It is considered a safe, minimally invasive procedure with a low risk of complications. Most of the complications reported were minor such as pain, edema, sneezing, crustation, and bleeding. This study demonstrates a case of major bleeding as a complication of radiofrequency ablation of inferior turbinate aiming to reduce the incidence of such complication. The patient had major bleeding resulting in a drop in hemoglobin level, however, no surgical intervention was required, and he was managed conservatively.

Computational investigation of nasal surface coverage from squeeze bottle and Neti Pot saline irrigation flow

Article

Dec 2022
COMPUT METH PROG BIO

Background and objective: Nasal saline irrigation is a common therapy for inflammatory nasal and paranasal disease or for managing post nasal and sinus surgery recovery. Two common irrigation devices include the netipot and squeeze bottles, where anecdotally, these devices alleviate congestion, facial pain, and pressure. However, a quantitative evaluation of these devices’ performance and the fluid dynamics responsible for the irrigation distribution through the nose is lacking. This study tracked the liquid surface coverage and wall shear stresses during nasal saline irrigation produced from a Neti Pot and squeeze bottle. Methods: This study used transient computational fluid dynamics (CFD) simulations to investigate the saline irrigation flow field in a subject-specific sinonasal model. The computational nasal cavity model was constructed from a high-resolution computed tomography scan (CT). The irrigation procedure applied a head position tilted at 90° forward using an 80 ml squeeze bottle and 120 ml Neti Pot. Results: The results from a single sinonasal model demonstrated that the Neti Pot irrigation was more effective in delivering saline solution to the nasal cavity on the contralateral side of irrigation due to typically larger volumes but at the expense of reduced flow and shearing rates, as the flow entered under gravitational forces. The squeeze bottle irrigation provided greater surface coverage on the side of irrigation. Conclusions: The results from the single patient model, demonstrated the Neti Pot increased surface coverage in the paranasal sinuses. Reducing the jet diameter may aid the direct targeting of a specific region at the side of irrigation by preventing the impingement of the jet to the nasal passage surface and redirection of the flow. Evaluating this performance across a wider cohort of patients can strengthen the findings.

The Role of Seawater and Saline Solutions in Treatment of Upper Respiratory Conditions

Article

Full-text available

May 2022
MAR DRUGS

The history of saline nasal irrigation (SNI) is indeed a long one, beginning from the ancient Ayurvedic practices and gaining a foothold in the west at the beginning of the 20th century. Today, there is a growing number of papers covering the effects of SNI, from in vitro studies to randomized clinical trials and literature overviews. Based on the recommendations of most of the European and American professional associations, seawater, alone or in combination with other preparations, has its place in the treatment of numerous conditions of the upper respiratory tract (URT), primarily chronic (rhino)sinusitis, allergic rhinitis, acute URT infections and postoperative recovery. Additionally, taking into account its multiple mechanisms of action and mounting evidence from recent studies, locally applied seawater preparations may have an important role in the prevention of viral and bacterial infections of the URT. In this review we discuss results published in the past years focusing on seawater preparations and their use in clinical and everyday conditions, since such products provide the benefits of additional ions vs. saline, have an excellent safety profile and are recommended by most professional associations in the field of otorhinolaryngology.

A Novel Device for Blood Drainage after Le Fort I Osteotomy: Maxillary Sinus Ventilation Drainage (MSVD)

Article

Full-text available

Jan 2022

The purpose of this study is to present a novel maxillary sinus ventilation drainage (MSVD) device which facilitates blood drainage and nasal breathing after Le Fort I osteotomy. One hundred patients who underwent bimaxillary orthognathic surgery from January 2016 to June 2016 at the Department of Oral and Maxillofacial Surgery, Chung-Ang University Hospital were retrospectively selected and divided into two groups. MSVD was applied in 50 patients, who were allocated to the MSVD group, while the remaining 50 patients, in whom MSVD was not applied, were allocated to the non-MSVD group. All patients underwent a cone-beam computed tomography (CBCT) scan before and 2 days after surgery. CBCT was used to analyze middle meatus patency and the percentage of hematoma volume per entire maxillary sinus volume. Statistical comparisons between the two groups were performed using the Chi-squared and Mann–Whitney U tests to investigate the clinical effectiveness of MSVD. The MSVD group showed significantly higher maintenance ratio of the middle meatus patency and a higher percentage of maxillary sinus air volume (p < 0.05) than the non-MSVD group. MSVD facilitated nasal breathing after Le Fort I osteotomy by reducing hematoma inside the maxillary sinus and promoting middle meatal patency.

Liquid volume and squeeze force effects on nasal irrigation using Volume of Fluid modelling

Article

Full-text available

Dec 2021

For various sinonasal conditions, including chronic rhinosinusitis, saline irrigation is an accepted standard-of-care treatment. This study was aimed at determining the effect of increased irrigation volumes and greater squeeze force on mucosal irrigation. A sinonasal cavity computational model was reconstructed from high-resolution CT scans of a healthy, unoperated 25-year old female. Seven combinations of irrigation volumes (70, 150, 200, and 400 mL) and squeeze forces (ramp time 0.1, 0.5, and 1.0 s) at a fixed head tilt of 0 degrees to the horizontal (Frankfort position) were performed. Velocity, pressure, and wall shear stress, together with mapping of surface coverage and residual volumes at specific locations and time were demonstrated. Higher volume irrigation (400 mL) and greater squeeze force (ramp time 0.1 s) improved irrigation coverage on the ipsilateral and contralateral sinonasal surfaces and increased shear force (approximately 140 Pa). An increase in irrigation volume from 70 to 150 mL approximately doubled sinus surface coverage and from 70 to 200 mL tripled sinus surface coverage. A faster squeeze also contributed to increased sinus surface coverage but its effect was less influential. We infer that the greater irrigation volume and squeeze force improve therapeutic benefit in terms of lavage and distribution of topical medications.

Nasal manifestations in patients with chronic renal failure on hemodialysis

Article

Full-text available

Aug 2021

Maha Abdelmoneim Behairy

Background Patients with end‐stagerenal disease (ESRD) on regular hemodialysis (HD) show various otolaryngological manifestations owing to uremic toxins and electrolyte imbalance. Previous studies have reported epistaxis as the most common ENT manifestations of ESRD on HD as explained by bleeding tendency related to uremia or HD itself. Nasal crustation, septal perforation, and olfactory dysfunction were also observed in HD patients. Objective To evaluate the frequency of different nasal manifestations among nondiabetic prevalent HD patients. Patients and methods A cross‐sectional study was conducted in Ain Shams University Hospital from March 2019 till September 2019. It included 68 eligible nondiabetic patients with ESRD on regular HD more than 6 m. All patients were subjected to full history and clinical examination. CT nose and sinus was done only if indicated. Complete blood count and routine chemistry (blood urea nitrogen, serum creatinine, urea reduction ratio, calcium, phosphorus, parathyroid hormone, and iron profile) were done. Results Most patients did not give a past history of epistaxis (94.1%). Overall, 44.1% of the patients experienced dry nasal mucosa and pale inferior turbinates, and 10.3% of the patients had congested nasal mucosa. Crustations were founded in 7.4% of the patients, although they were found in nearly double percentage in nasal septum (14.7%). The nasal septum deviation and ulceration were found in 2.9% each. Only one (1.5%) patient had nasal septum perforation. The mean level of hemoglobin (g/dl) concentration was 10.4 (range, 6.8–15 g/dl). Conclusion Modern adequate HD techniques have reduced epistaxis in patients with ESRD. The most common ENT manifestations were dry nasal mucosa and pale inferior nasal turbinate and to a lesser extent crustations on both nasal septum and inferior nasal turbinate.

A Study on the Efficacy of Saline Nasal Irrigation in Chronic Rhinosinusitis

Article

Jul 2021

BACKGROUND The objective of this study was to test as to whether daily saline nasal irrigation improved sinus symptoms in adult subjects with chronic rhino sinusitis, and also study the safety of saline irrigation, incidence of any complication and improvement in quality of life in these patients. METHODS This was a prospective observational study conducted between two groups of patients at Government TD Medical College, Alappuzha. Patients who satisfied the criteria for diagnosing chronic rhino sinusitis were included in the study. The first group was given saline nasal irrigation with oral drug therapy while the second group was put on oral drugs alone. Each subject was given a pretested, structured questionnaire. Along with socio-demographic information, the questionnaire also contained queries of quality of life measure, compliance of nasal irrigation and adverse effects following its use. RESULTS The pre-treatment scores and post treatment scores were analysed and the results were statistically significant with P values of < 0.001 in all. 77 % of the patients in the saline irrigation group were strictly using saline nasal irrigation which meant a satisfactory compliance and the improvement in post treatment scores was statistically highly significant with a P value of < 0.001. Also there was a statistically significant difference between the mean pre-test and post test scores of the two groups with P value of < 0.001 and t value of 51.942 using the paired t test. CONCLUSIONS Chronic rhinosinusitis has a major negative impact on the healthcare and economy of not only the patients but also of the society. Saline nasal irrigation is an effective yet easy method of therapy in alleviating the symptoms of chronic rhinosinusitis and improving the quality of life in these chronic sufferers. KEY WORDS Chronic Rhinosinusitis, Saline Nasal Irrigation, Quality of Life, Economic Burden

Chemical and physical stability of selected drugs for aerosol therapy with Sirmione thermal water

Article

Full-text available

Jul 2021

In this work, we investigated the chemical and physical stability of ambroxol, beclomethasone dipropionate, budesonide, and N-acetylcysteine after dilution with Sirmione thermal water, stored in ampoules for aerosol, at room temperature. The chemical stability of all active drugs was evaluated by Ultra-High-Performance Liquid Chromatography tandem mass spectrometry (UHPLC/MS/MS). All samples were analyzed in triplicate at room temperature under normal fluorescent light at 0h, 1h, 6h, 12h, and 24 h. According to the Official Pharmacopoeia of the Italian Republic, the degradation of a molecule that exceeds more than 10% is considered unacceptable. After dilution with thermal water of Sirmione, ambroxol, beclomethasone dipropionate, budesonide, and N-acetylcysteine, were found to be physically stable over the entire study (degradation <3%) at room temperature without any loss of activity.

Stabilità e compatibilità di farmaci per aerosol terapia con acqua termale di Sirmione

Article

Full-text available

Jan 2021

Introduzione Le patologie respiratorie rappresentano la proble-matica più frequente con cui i professionisti sanitari sono chiamati a confrontarsi nella pratica clinica quo-tidiana. 1 In particolare circa un quarto dei consulti medici relativi all'assistenza primaria nei pazienti pediatrici riguarda problematiche respiratorie. 2 Tali affezioni rappresentano un importante capitolo di spesa, pubblica e privata. Secondo l'European Lung White Book, i costi diretti annuali europei della BPCO (assistenza sanitaria) sono stati di 23,3 miliardi di euro, mentre i costi indiretti (perdita di produzione) sono stati di 25,1 miliardi; le stesse cifre per l'asma erano rispettivamente di 19,5 miliardi e 14,4 miliardi di euro. I costi annuali per caso erano di 2100 euro per la BPCO e 3400 euro per l'asma. I costi indiretti hanno rappresentato rispettivamente il 52% e il 43% dei costi correlati alla BPCO e all'asma. 3,4 L'impatto non è, tuttavia, soltanto di carattere economico: nel paziente pediatrico patologie quali rinosinusiti, riniti, asma, e infezioni delle alte e basse vie respiratorie hanno risvolti sociali e implicazioni cliniche di estre-ma rilevanza. La morbosità per asma è un onere mag-giore per i bambini, le loro famiglie e la comunità. In Inghilterra il 69% dei genitori di bambini asmatici 204 Articoli originali GIFaC 2020; 34(4): 204-211 Gli autori hanno rilasciato dichiarazione di assenza di conflitto di interesse verso soggetti portatori di interessi in campo sanitario, conservata agli atti della segreteria del CURE. Riassunto. Le patologie respiratorie e allergiche sono in continuo aumento e hanno un impatto fortemente negati-vo sulla qualità di vita, in particolare della popolazione pediatrica. La via inalatoria rappresenta una modalità per la somministrazione di farmaci, che permette ai principi atti-vi di raggiungere direttamente il distretto nasale senza distribuzione sistemica, con elevato effetto terapeutico e diminuiti effetti indesiderati. L'acqua termale salso-bromo-iodica di Sirmione possiede azione mucolitica, disostruen-te, antisettica e idratante che la rendono idonea alla som-ministrazione tramite aerosol terapia, ma anche come vei-colo di farmaci ad uso inalatorio. Scopo del presente studio è la valutazione della stabilità, in contenitori per aerosol terapia, di N-acetilcisteina, ambroxolo, budesonide e beclometasone dipropionato ad uso inalatorio con acqua termale di Sirmione. La stabilità è stata valutata mediante cromatografia liquida ad elevata prestazione accoppiata a spettrometria di massa. I campioni, conservati a tempera-tura ambiente alla luce, sono stati analizzati al tempo 0 e successivamente a 1 ora, 6 ore, 12 ore e 24 ore. In accordo con Farmacopea Ufficiale della Repubblica Italiana, una degradazione del principio attivo superiore al 10% è consi-derata inaccettabile. Tutti principi attivi risultano stabili e compatibili con dispositivi per aerosol terapia per 24 ore (degradazione < 3%) a temperatura ambiente senza perdi-ta di attività. Parole chiave: Acqua termale di Sirmione, ambroxolo, beclometasone dipropionato, budesonide, N-acetilcisteina. Stability and compatibility of drugs for aerosol therapy with Sirmione thermal water Summary. Respiratory and allergic diseases increase continuously due to their strong and negative impact on the quality of life, particularly on the pediatric population. The inhalation route is used to administer corticosteroids and mucolytic agents because the nasal district is directly reached with a high therapeutic action and less side effects. The salso-bromo-iodic thermal water of Sirmione possesses mucolytic, unclogging and moisturizing action which make it suitable for administration by aerosol therapy, but also as a solvent for inhalation drugs. The aim of the present investigation is the evaluation of the stability, in aerosol therapy containers, of N-acetylcysteine, ambroxol, budes-onide and beclomethasone dipropionate after dilution with Sirmione thermal water. Stability was assessed by high performance liquid chromatography coupled with mass spectrometry. The samples, stored at room temperature under normal fluorescent light, were analysed at time 0 and subsequently at 1h, 6h, 12h and 24 hours. According to Official Pharmacopoeia of the Italian Republic, a degradation of the active drug that exceeds more than 10% was considered unacceptable. All active ingredients after dilution with thermal water of Sirmione are stable and compatible with aerosol therapy devices for 24 hours (degradation <3%) at room temperature without any loss of activity.

Larutan pencuci hidung salin isotonis tidak terbukti mempercepat waktu transpor mukosilia pada pasien dengan rinosinusitis akut di RSUP Sanglah, Bali, Indonesia

Article

Full-text available

Jan 2020

Background: Mucociliary clearance is a significant element of the defence system of the entire respiratory tract. Impairment of the mucociliary clearance serves as a medium for sinonasal infections. Saline nasal irrigation is believed to alleviated rhinosinusitis symptoms by clearing excess mucus, reducing congestion and remove infectious materials from the inspired air. This study aimed to determine the efficacy of mucociliary transport time of isotonic saline nasal solutions in patients with acute rhinosinusitis.Methods: An experimental study using pre- and post-test with control group design was conducted in this study. Mucociliary transport time was measured by the saccharine test on 20 acute rhinosinusitis patients before and after 7 daysâ€™ treatment with intranasal isotonic saline solutions and standard therapy (ciprofloxacin, pseudoephedrine/ triprolidine, ambroxol) for the case group and standard treatment for the control group. Data were analysed using SPSS version 20 for Windows.Result: The average mucociliary transport time before therapy was 35.5Â±10.7 minutes and 29.2Â±7.7 minutes for the case group and control group, respectively. The average mucociliary transport time after therapy was 22.9Â±8.7 minutes and 18.0 Â± 5.6 minutes for case group and control group, respectively. The mean difference mucociliary transport time before and after therapy was 11.0Â±7.5 minutes and 9.4Â±5.3 minutes for the case and control group, respectively (p=0.499).Conclusions: The addition of intranasal isotonic saline solutions in acute rhinosinusitis patients has the same effect of mucociliary transport time with oral medication with the antibiotic, decongestant, and mucolytic without intranasal isotonic saline solutions.Â Latar Belakang: Transpor mukosilia merupakan salah satu mekanisme pertahanan saluran pernapasan. Adanya gangguan pada sistem tersebut menjadi predisposisi terjadinya infeksi sinonasal. Larutan pencuci hidung dengan salin isotonis dipercaya dapat mengurangi gejala akibat rinosinusitis dengan cara membersihkan sekret, mengurangi odema dan mengeluarkan bahan-bahan berbahaya yang masuk bersama udara pernapasan. Tujuan penelitian ini adalah untuk menilai efektivitas waktu transpor mukosilia larutan pencuci hidung salin isotonis pada pasien rinosinusitis akut.Metode: Uji eksperimental dengan desai pre-post test dengan kontrol dilakukan pada penelitian ini. Waktu transpor mukosilia diukur menggunakan uji sakarin terhadap 20 pasien rinosinusitis akut sebelum dan 7 hari sesudah pemberian larutan pencuci hidung salin isotonis dan terapi standar (ciprofloxacine, pseudoephedrine/triprolidine, ambroxol) pada Kelompok Perlakuan dan terapi standar pada Kelompok Kontrol. Data dianalisis menggunakan SPSS versi 20 untuk Windows.Hasil: Rerata waktu transpor mukosilia sebelum perlakuan pada Kelompok Perlakuan adalah 35,5 Â± 10,7 menit dan 29,2 Â± 7,7 menit pada Kelompok Kontrol. Rerata waktu transpor mukosilia sesudah terapi adalah 22,9 Â± 8,7 menit dan 18,0Â±5,6 menit berturut-turut pada Kelompok Perlakuan dan Kelompok Kontrol. Median selisih waktu transpor mukosilia sebelum dan sesudah terapi adalah 11,0Â±7,5 menit pada Kelompok Perlakuan dan 9,4 Â± 5,3 menit pada Kelompok Kontrol (p=0,499).Kesimpulan: Penambahan larutan cuci hidung salin isotonis pada rinosinusitis akut memiliki efek waktu transpor mukosilia yang sama dengan pemberian antibiotika, dekongestan dan mukolitik tanpa larutan cuci hidung salin isotonis.

Original Article: Normal saline nasal irrigation in childhood allergic rhinosinusitis: Our experiences in a tertiary care teaching hospital of Eastern India

Article

Full-text available

Jun 2019

Background: Allergic rhinosinusitis (AR) is a common clinical disorder among pediatric patients. There are different modalities of the treatment for AR ranging from antihistamines, corticosteroids, and mast cell stabilizers in oral or topical formulations. Objective: The objective of the study was to find out the effect of nasal saline irrigation or saline spray for reducing the symptoms in childhood AR along with an oral antiallergic treatment. Materials and Methods: The present study is a prospective study of the children suffering from AR between December 2017 and January 2019. All the children were in the age group of 5–16 years. All were randomly divided into two groups. In Group I, nasal saline irrigation was done in 56 patients twice a day along with an oral antiallergic treatment. Group II or control group consists of 56 children of AR those received only oral antiallergic treatment. Follow-up was done at the 2nd, 4th, 6th, and 8th weeks after treatment and symptom scores were compared with previous clinical presentations. The data were analyzed by applying t-test. Results: Each group had 56 children with a mean age of 12.6 years in Group-I whereas 11.7 years in Group-II. The percentage disability scores (PDSs) at the beginning of the study were comparable in both the groups (83% vs. 88%). Both groups showed improvement in the PDS after treatment at the 2nd week; however, it was more in Group-I than in Group-II (p<0.001, paired t-test). Conclusion: Involvement of normal saline irrigation with oral antiallergic treatment in the present study provided satisfactory symptomatic relief in comparison with antiallergic treatment in pediatric patients suffering from AR.

Saline Nasal Douching Versus Decongestant Nasal Drops: A Comparative Study of Relative Efficacy in Post-Septal Surgery

Article

Full-text available

Jun 2018

Background and Objective: This study aimed to compare the relative efficacy of saline nasal douches versus topical nasal decongestant in post-operative septal surgery and to assess the feasibility and likely utility in post-operative septal surgery. Material and Methods: The study was a hospital-based prospective double-blind randomized controlled study. Over a period of 18 months, 120 patients following septal surgery were assigned to one of two groups-Group I: Saline nasal douching and Group II: Decongestant nasal drops (xylometazoline 0.1 %). The outcome measures recorded on the 5th and 10th postoperative days are nasal congestion, anosmia, facial pain, itching, crusts, edema, scarring and nasal discharge. On the 14th postoperative day, the patients underwent diagnostic nasal endoscopic examination by the operating surgeon and the findings were recorded on the proforma. Results: On the 5th postoperative day, group I patients were found to be symptomatically better than group II and this trend continued upto the 10th postoperative day, with group I patients reporting better symptomatic outcomes. Examination of the nasal cavities showed statistically significant differences between the two groups in terms of crusts, edema and scarring. Conclusion: Saline nasal douching appears to provide better alleviation of post-septal surgery symptoms (anosmia, facial pain and itching) than nasal decongestants as experienced by the patient in terms of VAS scores. There was no difference in alleviating nasal decongestion between the 2 groups.

Pengaruh cuci hidung dengan NaCl 0,9% terhadap peningkatan rata-rata kadar pH cairan hidung

Article

Jul 2017

Latar belakang: Pedagang kaki lima rentan terkena polusi udara. Hidung merupakan salahsatu organ pelindung tubuh terpenting dan menjadi target utama dari polusi udara. Polusi udara dapatmenurunkan kadar pH hidung dan menyebabkan sistem transpor mukosiliar hidung tidak bisa bekerjaoptimal. Terapi cuci hidung telah digunakan sejak berabad-abad lalu, untuk mengobati penyakit sinuskarena mencegah pembentukan krusta pada rongga hidung. Terapi cuci hidung juga dapat membersihkanpartikel-partikel debu dan polusi yang terperangkap di mukus hidung. Tujuan: Melihat pengaruh cucihidung dengan NaCl 0,9% terhadap peningkatan rata-rata kadar pH cairan hidung pada pedagang kakilima yang rentan terkena debu dan polusi udara.Metode: Penelitian ini bersifat pra-eksperimental denganone group pretest-posttest design. Populasi penelitian adalah seluruh pedagang kaki lima yang berjualan dikawasan kampus Universitas Sumatera Utara dan sampel adalah populasi yang memenuhi kriteria inklusidan eksklusi. Data hasil penelitian diolah dengan uji normalitas Kolmogorov-Smirnov dan dilanjutkandengan uji Wilcoxon.Hasil: Berdasarkan uji normalitas data Kolmogorov-Smirnov didapati nilai P pretest0,000 dan P posttest 0,001. Kedua data tersebut tidak terdistribusi normal, kemudian dilanjutkan denganUji Wilcoxon. Didapatlah hasil Wilcoxon dalam peningkatan kadar pH cairan hidung adalah peningkatanyang bermakna (p=0,000; p<0,05) dan memiliki peningkatan rata-rata pH cairan hidung yaitu sebesar0,0824.Kesimpulan: Terdapat peningkatan rata-rata kadar pH cairan hidung setelah dilakukan cucihidung dengan NaCl 0,9% sebanyak dua kali sehari, selama sepuluh hari pada pedagang kaki lima. Parapedagang kaki lima di lingkungan Universitas Sumatera Utara, dianjurkan untuk melakukan cuci hidungsetiap hari untuk menjaga higiene saluran napas.Kata kunci: pH cairan hidung, cuci hidung, polusi udara, pedagang kaki lima ABSTRACTBackground: Street vendors in Medan and other cities in Indonesia are prone to outdoor airpollution that may compromising the nose as well as the entire respiratory system. Outdoor air pollutantmay reduce nasal pH level causing an in-efficient mucociliary transport system. Nasal washing as oneof modality in personal hygiene aims to clean hazardous particles and pollutants trapped in the nasalmucous blanket. Purpose: This study aimed to find-out that average of pH levels of nasal fluid affectedby nasal washing using NaCl 0,9%. Method: The study design was a pre-experimental with one grouppretest-posttest design. Population of the study were all vendors in surrounding Universitas SumateraUtara, and the subjects were having 8 hours a day exposure to outdoor air pollutant without any evidenceof ongoing infectious inflammation. Research data processed by the normality test, Kolmogorov-Smirnovtest, and followed by Wilcoxon test. Result: Based on Kolmogorov-Smirnov test, result obtained P pretest0.000 and P posttest 0.001. Both were not distributed normally, and then followed by Wilcoxon Testwhich found a significant increase of pH level of nasal fluid (P<0.05) with average pH level of 0.0824.Conclusion: An increase in nasal fluid average pH levels was significantly observed after washing thenose using NaCl 0,9% solution twice a day for ten days. Street vendors in Universitas Sumatera Utarasurroundings are suggested to do daily nasal washing as their new life style to maintain personal hygiene.Keywords: Nasal fluid pH, nasal wash, air pollution, vendor

Nasalance measures outcome in vasomotor rhinitis patients after treatment with intranasal corticosteroids versus hypertonic saline irrigation

Article

Jan 2016

Saline irrigations following sinus surgery - A controlled, single blinded, randomized trial

Article

Dec 2016
Rhinology

Background: Chronic rhinosinusitis (CRS) is a common health problem. If medical treatment fails, endonasal sinus surgery is a valuable treatment option. A thorough postsurgical treatment is needed including, among others, nasal saline irrigations (NSI). In this prospective, controlled, single blinded, randomized trial, we aimed to evaluate efficacy of nasal saline irrigations following endonasal sinus surgery in CRS-patients with nasal polyps. Methodology: We examined patient's nasal symptoms, general quality of life and postoperative condition of the mucosa. We also investigated whether or not NSI reduced the number of missed workdays after surgery (MWD). Patients were randomized into an irrigation and non-irrigation arm. Results: Following treatment, mean nasal sum-score in the irrigation arm was 4.4 and in the non-irrigation arm it was 6.3. Accordingly, mean general sum-score in the irrigation arm was 2.5 and in the non-irrigation arm 4.8.Thus, nasal irrigation led to a more pronounced improvement of nasal and general symptoms than in the non-irrigation arm. No differences were observed in postoperative condition of mucosa or number of MWD. Conclusions: Nasal irrigation improves symptoms score after ESS in patients with CRSwNP.

Perbandingan Respons Klinis dan Efek Samping Semprot Hidung Salin Isotonik (Air Laut) dengan Tetes Hidung Salin Isotonik pada Anak Balita dengan Common Cold

Article

Full-text available

Nov 2016

Latar belakang. Keunggulan semprot hidung salin isotonik air laut pada anak balita dengan common cold masih kontroversi, dan studi pada anak balita masih sedikit. Tujuan. Membandingkan respons klinis dan efek samping semprot hidung salin (air laut) dan tetes hidung salin pada pasien dengan common cold, melalui a) penurunan skor gejala hidung, b) penurunan skor suhu tubuh, c) lama sakit, dan d) efek samping (epistaksis). Metode. Suatu opened-label randomized clinical trial, dilaksanakan di Puskesmas Kecamatan Kalideres dengan subjek anak berusia 12-60 bulan. Subjek diberikan semprot hidung salin air laut dan sirup parasetamol (kelompok eksperimen) atau tetes hidung salin dan parasetamol (kelompok eksperimen) atau hanya parasetamol (kontrol) berdasarkan alokasi random. Semprot hidung salin (air laut) diberikan 3 kali sehari 1 semprot tiap lubang hidung selama 7 hari, tetes hidung salin diberikan 3 kali sehari 2 tetes tiap lubang hidung selama 7 hari, dan parasetamol sirup diberikan 10 mg/kgbb tiap 4 jam bila suhu tubuh ≥38ºC. Penilaian skor gejala hidung, skor suhu tubuh, dilakukan sebelum dimulai pengobatan sampai dengan hari ke delapan. Lama sakit dan efek samping obat dinilai dari awal pengobatan sampai sembuh Hasil. Didapat 68 subjek yang memenuhi kriteria inklusi dirandomisasi menjadi kelompok eksperimen (semprot hidung salin air laut dan tetes hidung salin) atau kontrol. Pada hari kedelapan pengobatan, tidak terdapat perbedaan bermakna pada penurunan skor gejala hidung (p=0,976), skor suhu tubuh (p=0,884), dan lama sakit (p=0,805) antara ketiga kelompok penelitian. Tidak didapatkan efek samping berupa epistaksis. Kesimpulan. Pada anak balita dengan common cold yang diberikan semprot hidung salin (air laut) dibandingkan dengan tetes hidung salin dan kontrol tidak terdapat perbedaan bermakna pada respons klinis dan efek samping.

Comparison between the use of saline and seawater for nasal obstruction in children under 2 years of age with acute upper respiratory infection

Article

Full-text available

Jun 2016
TURK J MED SCI

Background/aim: The effectiveness of isotonic and hypertonic saline solutions used to open the nasal passage and improve clinical symptoms was compared in children under 2 years of age admitted with the common cold. Materials and methods: The study was performed as a randomized, prospective, and double-blind study. The study included 109 children. The children using saline (0.9%) and seawater (2.3%) as nasal drops (the patient group) and the control group (in which nasal drops were not administered) were compared. Seventy-four patients received nasal drops from package A (seawater) in single days and from package B (physiological saline) in double days. Results: The mean age of the patients was 9.0 ± 3.9 months and the numbers of boys and girls were 65 (59.6%) and 44 (40.4%), respectively. There was no significant difference between Groups A and B in terms of nasal congestion (P > 0.05). However, a significant difference was found between the control group and Groups A and B (P < 0.05). Conclusion: Relief was seen in nasal congestion, weakness, sleep quality, and nutrition with the use of both saline and seawater in children with the common cold. Seawater or saline drops may be added to standard treatment protocols.

Intractable Posterior Epistaxis due to a Spontaneous Low-Flow Carotid-Cavernous Sinus Fistula: A Case Report and a Review of the Literature

Article

Full-text available

Dec 2015

We report a case of a 90-year-old patient with intractable posterior epistaxis presenting as the only symptom of a nontraumatic low-flow carotid-cavernous sinus fistula. Purpose of this case report is to introduce low-flow carotid-cavernous sinus fistula in the differential diagnosis of intractable posterior epistaxis. We provide a literature review for the sequence of actions for the confrontation of posterior epistaxis. We also emphasize the significance of the radiological diagnostic and therapeutic procedures in the management of posterior epistaxis due to pathology of the cavernous sinus. The gold-standard diagnostic procedure of carotid-cavernous sinus fistula is digital subtraction angiography (DSA). DSA with coils is also the state-of-the-art therapy. By failure of DSA, neurosurgery or stereotactic radiosurgery (SRS) may be used as alternatives. SRS may also be used as enhancement procedure of the DSA. Considering the prognosis of a successfully closed carotid-cavernous sinus fistula, recanalization occurs only in a minority of patients. Close follow-up is advised.

Variations in peak nasal inspiratory flow among healthy students after using saline solutions

Article

Full-text available

Oct 2015
Braz J Otorhinolaryngol

Introduction: Nasal hygiene with saline solutions has been shown to relieve congestion, reduce the thickening of the mucus and keep nasal cavity clean and moist. Objective: Evaluating whether saline solutions improve nasal inspiratory flow among healthy children. Methods: Students between 8 and 11 years of age underwent 6 procedures with saline solutions at different concentrations. The peak nasal inspiratory flow was measured before and 30min after each procedure. Statistical analysis was performed by means of t test, analysis of variance, and Tukey's test, considering p<0.05. Results: We evaluated 124 children at all stages. There were differences on the way a same concentration was used. There was no difference between 0.9% saline solution and 3% saline solution by using a syringe. Conclusion: The 3% saline solution had higher averages of peak nasal inspiratory flow, but it was not significantly higher than the 0.9% saline solution. It is important to offer various options to patients.

चयनित शोधन-क्रियाओं (जलनेति, त्राटक, कपालभाति) का चिकित्सीय लाभों का वैज्ञानिक पक्ष

Article

Sep 2024

योग में शुद्धिकरण प्रक्रियाएं, जिन्हें अक्सर "षटकर्म" या "षटक्रिया" कहा जाता है, माना जाता है कि यह शरीर और दिमाग को शुद्ध करती है, जिससे समग्र स्वास्थ्य परिचायक है। षट्कर्मो द्वारा शरीर पर पड़ने वाले प्रक्रियागत मलहारी प्रभाव इन्हें चिकित्सीय दृष्टि से अति महत्त्वपूर्ण बनाते हैं। धौति, वस्ति, नेति, नौलि, त्राटक तथा कपालभाति इन सभी षट्कर्मो का प्रभाव शरीर के विभिन्न अन्तरङ्गों पर पड़ता है। तीन लोकप्रिय शुद्धिकरण तकनीकें जलनेति, त्राटक और कपालभाति हैं। यहां, हम इनमें से प्रत्येक अभ्यास के वैज्ञानिक पहलुओं और चिकित्सीय लाभों की व्याख्या करेंगे! षट्कर्मो के चिकित्सीय प्रभाव को वैज्ञानिक ढंग से समझने के लिए हमें चयनित षट्कर्मो को पृथक् रूप से लेकर इसके शरीर प्रक्रियागत (Physiological) प्रभावों को देखना होगा।

Safety and performance of narhinel 0.9% NaCl monodose and otrisal 0.74% NaCl monodose nasal saline sprays and nasal aspirators in the real-world setting: postmarket clinical follow-up study results

Article

Full-text available

Nov 2023
CURR THER RES CLIN E

Background Blocked or stuffy nose is a common and bothersome symptom of colds, particularly for young children who are unable to clear their noses on their own. Nasal saline solutions and nasal aspirators are designed to gently cleanse and remove blocking nasal secretions. Objective To assess the safety and performance of 2 monodose isotonic saline solutions (Narhinel 0.9% and Otrisal 0.74% sodium chloride; GSK Consumer Healthcare SARL, a Haleon company, Nyon, Switzerland) and 2 nasal aspirators with disposable hard- and soft-nozzle refills used as a standalone or combination treatment. Methods We conducted 2 observational, online questionnaire-based, postmarket clinical follow-up studies in Europeans who had used any of the devices ≥1 time in the past 6 months. Coprimary objectives were to confirm the safety and performance of the saline solutions (Narhinel and Otrisal, Study 1) and nasal aspirators (with hard- and soft-nozzle refills, Study 2). Safety was assessed via the proportion of patients reporting adverse events and/or device malfunctions while using the devices within the previous 6 months, and performance was assessed by satisfaction rated on a 5-point scale, with “satisfied” and “very satisfied” being the highest performance ratings. Results A total of 1136 (Study 1) and 1237 (Study 2) questionnaires were initiated by volunteer participants. Less than 2% of participants reported adverse events for any evaluated product in the previous 6 months. Most participants were “satisfied” or “very satisfied” with the devices for their intended use, with 78% to 91% of participants in the Narhinel arm, 73%–94% in the Otrisal arm, 71% to 95% in the soft-nozzle arm, and 71% to 80% in the hard-nozzle arm giving these ratings. Conclusions These data support the safety and performance of 2 monodose saline solutions (Narhinel and Otrisal) for nasal cleansing, nasal moisturization, and/or loosening nasal secretions, and of nasal aspirators (with hard- and soft-nozzle refills) for clearing a blocked nose and removing nasal secretions.

Nasal Toilet in Infants

Chapter

Sep 2023

Newborns and newborns must depend only on nose breathing; therefore, a healthy nasal passage is essential. Infants with nasal blockage may have feeding difficulties and dyspnea. Nasal saline rinse is an effective treatment for mucus-related nasal blockage [1]. In order to thin mucous, increase mucociliary clearance (MCC), decrease edema, and lessen antigen load in the nasal and sinus canals, it is thought that nasal saline irrigation (NSI) is effective [2, 3].KeywordsNasal toiletInfantSalineNasal blockageMucus

Marketing research of the range of medicinal products based on salts of natural origin

Article

Full-text available

Oct 2022

As a source of supply of a balanced complex of salts in pharmaceutical practice, sea water (MW), sea salt (MS), obtained by the method of ordinary evaporation, or salt solutions made from standardized raw materials are used. Deep seawater (SW), typically pumped from depths greater than 200 m, contains a wealth of trace elements, including magnesium, calcium, potassium, chromium, selenium, zinc, and vanadium. Due to this, SW has the potential of a source and raw material for the creation of medicinal products for human health. The purpose of the work was to research the assortment of preparations based on salts of natural origin and analyze the segment of such products on the pharmaceutical market of Ukraine as of June 2022. The research was conducted on the basis of data from the State Register of Medicinal Products of Ukraine, the Morion information search program, and the classification system of the ATS electronic resource Compendium.online. Methods of structural, statistical and graphic analysis were applied in the work, and their generalization and systematization was carried out. It was established that on the pharmaceutical market of Ukraine, the segment of medicines, medical products and cosmetics, the source of active substances of which is SW and/or SS, is represented by 150 trade names. It was determined that by type of registration, the most common are medical products (51%) and cosmetics (42%), only 7% of registered drugs are registered. Manufacturers use sea water obtained from the deep water basins of the Adriatic, Aegean, Mediterranean Seas, Atlantic Ocean, Kankal Bay, sea water of Gullmarsfjorden. Domestically produced drugs of the investigated market segment occupy a share of 57%. Among the importing countries, the leaders are Croatia (9%) and Poland (5%). The analysis of the nomenclature established that the most common medicinal form of the drugs are nasal sprays (78%). The obtained data show that as the active substance of saline solutions, manufacturers declare SS (56% of the nomenclature) and SW (53%), however, not all products contain information about the source of origin of SS/SW. It was determined that there are no products on the pharmaceutical market of Ukraine based on the SW and SS of the Black and Azov seas, which is the basis for research and the creation of new drugs of domestic production.

The Role of Seawater and Saline Solutions in Treatment of Respiratory Conditions

Preprint

Full-text available

Mar 2022

The history of saline nasal irrigation (SNI) is indeed a long one, beginning from the ancient Ayurvedic practices and starting to gain a foothold in the west at the beginning of 20th century. Today, there is a growing number of papers covering effects of SNI from in vitro studies to randomized clinical trials and literature overviews. Based on the recommendations of most of the European and American professional associations, seawater, alone or in combination with other preparations, has its place in treatment of numerous conditions of the upper respiratory tract (URT), primarily in chronic (rhino)sinusitis, allergic rhinitis, acute URT infections and postoperative recovery. Additionally, taking into account its multiple mechanisms of action and mounting evidence from recent studies, locally applied seawater preparations may have an important role in prevention of viral and bacterial infections of the URT. Therefore, in this review we discuss results published in the past years focused on the seawater preparations and their use in clinical and everyday conditions, since such products are superior to saline, have an excellent safety profile and are recommended by most professional associations in the field of otorhinolaryngology.

The Role of Seawater and Saline Solutions in Treatment of Respiratory Conditions

Preprint

Full-text available

Feb 2022

Bias in Pediatric Studies

Chapter

Full-text available

Jul 2005

Daniel Neuspiel

This NEW edition of the book, Weighing the Evidence: A Guide for Understanding Clinical Research, was developed by editors of AAP Grand Rounds, a journal of the American Academy of Pediatrics, to help medical professionals evaluate evidence-based

Nasal manifestations in patients with chronic renal failure on hemodialysis

Article

Jan 2021

Literature review of nasal lavage technique in paediatrics

Article

Apr 2021

Introduction Upper respiratory infections and bronchiolitis are among the most common pathologies in childhood. In paediatric patient care, the nasal lavage technique is widely used as it is recommended in various sinus pathologies. Objective To synthesise the available evidence on nasal lavage technique in paediatric patients. Methods Literature search in MEDLINE, EMBASE, CINAHL and COCHRANE PLUS databases, using the descriptors: paediatrics, respiratory tract infection, bronchiolitis, nasal lavage. Results Eleven articles were selected due to relevance and specificity. In the documents, the recommendations are structured in five sections regarding the LN technique. Conclusions We can recommend, based on scientific evidence, the use of sterile isotonic saline, low positive pressure with wide volumes using a disposable syringe. In the future, the aspects of volume to be used, material and position of the patient regarding the technique should be studied in depth.

Revisión narrativa de la técnica de los lavados nasales en pediatría

Article

Feb 2021

Resumen Introducción Las infecciones de vías respiratorias altas y la bronquiolitis son de las patologías más comunes en la infancia. Dentro de los cuidados del paciente pediátrico la técnica de los lavados nasales es muy utilizada a nivel mundial ya que está recomendada en varias patologías sinusales. Objetivos Sintetizar la evidencia disponible sobre la técnica de los lavados nasales en el paciente pediátrico. Métodos Búsqueda bibliográfica en bases de datos MEDLINE, EMBASE, CINAHL y COCHRANE PLUS, utilizando los descriptores: pediatrics, respiratory tract infection, bronchiolitis, nasal lavage. Resultados Se seleccionaron 11 artículos por su pertinencia y especificidad. En los documentos las recomendaciones se estructuran en cinco epígrafes respecto a la técnica de lavados nasales. Conclusiones Podemos recomendar según la evidencia científica el uso de suero salino isotónico estéril, la presión positiva baja con volúmenes amplios mediante jeringa desechable. En el futuro, se debería profundizar en el volumen de solución a irrigar, el material para realizar el lavado y la posición del paciente.

Joint Practice Parameters on the Management of Allergic Rhinitis

Article

Full-text available

Mar 2016

Introduction Allergic rhinitis is a common disease entity that may be easily misdiagnosed and mistreated. It is a global concern, affecting 10% to 25% of the population worldwide, that has to be controlled since it can be disabling affecting the quality of life of patients. The Philippine Society of OtolaryngologyHead and Neck Surgery is currently updating its 2006 guideline on Allergic Rhinitis. The Section of Rhinology, Department of Otorhinolaryngology together with the Section of Allergy and Immunology, Departments of Pediatrics and Internal Medicine, came up with practice parameters in the diagnosis and management of adult and pediatric patients suspected to have allergic rhinitis to guide clinicians in managing these patients. Locally, it is the first collaboration of otorhinolaryngologists and allergists. Scope of the Guideline This practice parameter was developed to guide general physicians, otorhinolaryngologists and allergists in the diagnosis and management of adult and pediatric patients with allergic rhinitis in an ambulatory care setting. Objectives This guideline aims to (1) assist general physicians, otorhinolaryngologists and allergists diagnose true allergic rhinitis; (2) evaluate current techniques and practices in diagnosing allergic rhinitis; and (3) describe treatment and management options for allergic rhinitis. Development process The Section of Rhinology of the Department of Otorhinolaryngology and Section of Allergy and Immunology of the Departments of Pediatrics and Internal Medicine of the UP-Philippine General Hospital convened a working group to create a consensus document to be used primarily for the Allergic Rhinitis Clinic, a joint clinic of the aforementioned sections in the Out-Patient Department of the UP-PGH, and to serve as a guide to general physicians, otorhinolaryngologists and allergists. The working group agreed to come up with an algorithm for the diagnosis and management of a patient with allergic rhinitis. Clinical questions were subsequently formulated based on the algorithm. The members then searched for relevant literature (including clinical practice guidelines, systematic reviews) in the National Library of Medicine’s PubMed database, Herdin database and unpublished local articles on allergic rhinitis. Appraisal of literature was done by an epidemiologist and evidence was presented and discussed within the working group. Applicability and availability of the diagnostic tests and therapeutic interventions were considered. All materials were assessed for relevance and further classified according to levels of evidence and grades of evidence based on guidelines. Recommendations were based on nominal approval of the working group. The document was then presented to stakeholders--consultants and residents of four clinical departments (Family Medicine, Internal Medicine, Otorhinolaryngology, Pediatrics), medical interns, medical students, nurses and patients. The opinions of the stakeholders were considered in the final draft.

Saline nasal irrigation for acute upper respiratory tract infections in infants and children: A systematic review and meta-analysis

Article

Feb 2020

Purpose Acute upper respiratory tract infections are the most common infections in infants and children. Saline nasal irrigation (SNI) is widely prescribed and recommended. We conducted a systematic review to assess the efficacy and safety of SNI in infants and children with acute rhinopharyngitis. Methods We searched CENTRAL, Medline, Embase and clinicalTrials.gov. Two authors selected randomized control trials (RCTs), including infants ≥ 3 months and children ≤ 12 years, comparing the use of isotonic saline solutions, whatever their mode of administration, with one therapeutic abstention, or a therapy deemed less important for nasal lavage. Trial quality was assessed independently by two authors, who, with a third author, extracted and analysed data. Statistical analysis was conducted using Comprehensive Meta-Analysis software. The standard difference in means (SMD) between groups and its 95% confidence interval were estimated. Results Four RCTs (569 participants) were included. The analysis showed a benefit of SNI for certain clinical rhinological symptoms (SMD = –0.29 [–0.45; –0.13]) but no significant improvement of respiratory symptoms (SMD= –0.19 [–0.70; 1.08]) or health status (SMD = –0.30 [–0.68; 0.07]). Its use appeared to limit the prescription of other treatments, whether local or systemic, and particularly antibiotics. Long-term use led to a decrease in the incidence of acute rhinosinusitis and its complications. SNI appeared to be a safe treatment. Conclusions SNI is beneficial for rhinological symptoms but not respiratory symptoms. Further research is needed to address the full benefits/risks of this treatment.

Représentation des parents de la toux du nourrisson, leurs attentes sur sa prise en charge. Enquête auprès des parents de nourrisson de moins de 24 mois

Thesis

Jun 2015

Ventaja Gaëlle

Introduction. L'offre des médications dans la prise en charge de la toux aiguë du nourrisson de moins de 24 mois, motif fréquent de recours des parents au médecin, s'est réduite avec la contre-indication par l'Afssaps, en 2010 et 2011, des diverses spécialités antitussives.Objectifs. Notre objectif était d'évaluer les attentes et craintes des parents de nourrissons tousseurs, de préciser leurs représentations de la toux, de quantifier le recours à l'automédication et le risque de demande de report de prescription vers d'autres classes médicamenteuses.Méthodes. Une enquête d'opinion, transversale, a été réalisée auprès des parents de nourrissons de moins de 24 mois. Un questionnaire à choix multiples leur a été proposé dans des crèches et centres de PMI. Les données recueillies ont été analysées de façon descriptive, puis par le test du chi2. La régression logistique nous a permis d'interpréter certains résultats obtenus.Résultats. Soixante-quatre pour cent des parents attendent du médecin un traitement pour faire cesser la toux. Pour la majorité des parents, les mesures hygiéno-diététiques sont bien intégrées (lavage de nez- considéré comme efficace pour le soulagement de la toux par 77% des parents, hydratation, éviction du tabac). Pour 33% des parents, les corticoïdes restent une alternative thérapeutique à viséeantitussive. Prés de la moitié (43%) des parents ont déjà demandé un traitement à leur médecin, le plus souvent suspensions nasales, corticoïdes et sérum physiologique. Concernant l'automédication, 30% des parents ont déjà donné un sirop ou un suppositoire antitussif sans ordonnance, dans le but de faire cesser la toux rapidement pour 66%. Ces parents paraissent plus inquiétés par la toux que les autres parents (p=0,0110, IC: 0.217 ; 1.751), comme ceux qui n'ont qu'un enfant (p=0.0029, IC : 0.120 ; 0.582).Conclusions. Notre étude suggère qu'une grande majorité des parents ont compris et acceptent les nouvelles recommandations. Mais environ un tiers des parents restent inquiets, démunis face à l'absence de traitement prescrit, ce qui les amènent à donner des sirops antitussifs sans ordonnance et à demander des traitements non indiqués. Il paraît indispensable d'informer les parents sur l'évolution naturelle de la toux du nourrisson, et de les éduquer sur les règles hygiéno-diététiques, pour diminuerle risque de report de prescription

Identification of Nasal Irrigation Bottle Contamination in Post Sinonasal Surgery

Article

Oct 2017

Nasal irrigation is an effective and cheap method in managing post sinonasal surgery patients. It works by improving ciliary clearance and performing mechanical debridement of the thick crust, decreasing mucosal edema and reducing the inflammatory mediators. Presence of nasal irrigation bottle contamination and its effect on patients have been studied. The aim of this study is to prospectively identify the risk of contamination in the nasal irrigation bottle, fluid from the bottle and to correlate with endoscopic findings from the patients who had underwent sinonasal surgery. Swabs will be taken from the nasal irrigation bottle and patient’s middle meatus before the surgery and at each post surgery visits (2 and 4 weeks). Patients will be advised to irrigate their nose three times per day post sinonasal surgery. During endoscopic examination of the patient’s nasal cavity at 2 and 4 weeks, any evidence of infection will be noted and documented. Additionally, a swab of fluid irrigated from the nasal cavity collected during the clinic follow-ups will also be taken. The specimens will be sent to the Microbiology laboratory for standard culture and sensitivity test. A total of 27 patients completed the study and were divided into case (n = 15) and control (n = 12) groups. The CFU (colony-forming unit) value of the bacteria cultured from the nasal cavity and the nasal irrigation bottle was statistically significantly (P = 0.00) increased from the baseline to the second week follow-up in both groups but not from the second week to the fourth week follow-up. The majority of the swabs from the nasal cavity of the patients and the nasal irrigation bottles were positively cultured for Pseudomonas sp. group. Other groups of bacteria that were cultured were Enterobacter sp., Coagulase Negative Staphylococcus (CONS) and Klebsiella sp. Endoscopically, there was no clinical evidence of infection found in the nasal cavity of the patients. The nasal irrigation bottle that was used in the post sinonasal surgery treatment and for alleviation of symptoms of sinonasal diseases was found to have bacterial contamination from the swabs taken from the bottle. However, despite this finding there was not clinical evidence of infection noted from the nasal endoscopic examination. A simple and effective method of cleaning the bottle would be helpful to reduce the bacterial contamination for this useful treatment method.

The acceptability and tolerability of nasal douching in children with allergic rhinitis: A systematic review

Article

Apr 2017
Int J Pediatr Otorhinolaryngol

Background Allergic rhinitis (AR) is a significant issue in children. Treatment options include allergen avoidance, pharmacotherapy and immunotherapy. The use of nasal saline douching (NSD) in children has recently gained acceptability. However, there is limited data regarding the acceptability and tolerability of NSD in children with AR. Methods A search was conducted using Medline and Embase databases from January 1946 until June 2015 on the use of NSD in children aged 4–12 years with AR. All publications identified that assessed the beneficial effects, acceptability and tolerability were included. Results 40 studies were analyzed. Data varied considerably in terms of saline solutions used, modality of application, participant numbers, study design, follow up and outcomes. Factors that appear to influence the acceptability and tolerability of NSD include parental and health professionals' preconceptions, and characteristics of the solution. Conclusions Nasal saline douching appears to be effective, being accepted and tolerated in the majority of children (78–100%). NSD has a significant positive impact on the quality of life in children with allergic rhinitis. When used as an adjunctive treatment having mainly a cleansing property, NSD potentiates the effects and may reduce the dose required of AR medications. Among the principal factors that influence the acceptability and tolerability of NSD are the child's age, delivery system and method, and tonicity. Nasal saline douching provides an accessible, low cost, low morbidity, easy to use treatment in children with allergic rhinitis.

Représentation parentale de la toux du nourrisson et attentes sur sa prise en charge

Article

Mar 2016

Background: Providing medications for the management of acute cough in infants less than 24 months, a frequent reason for medical consultation, has recently been reduced by the contraindication of various antitussive specialties in France. Objectives: The objective of this study was to assess the expectations and fears of coughing infants' parents, to determine their representations of coughing, and to quantify the use of self-medication and the risk of a deferral requests to prescribe other drug classes. Methods: An opinion and cross-survey was carried out with parents of infants under 24 months of age. A multiple-choice questionnaire was proposed to them in day care centers and Mother and Infant Welfare centers. The data collected were analyzed descriptively and using the Chi(2) test. Logistic regression enabled us to interpret some of the results. Results: Sixty-four percent of parents expect an antitussive treatment from the doctor. For most parents, lifestyle modifications are well integrated (nasal irrigation, considered effective cough relief, hydration, smoking cessation). For 33 % of parents, corticosteroids are an alternative therapy to stop cough. Nearly half (43 %) of parents have sought treatment from their doctor, usually nasal suspensions, corticosteroids, and saline irrigation. Regarding self-medication, 30 % of parents have already given cough syrup or an antitussive suppository without a prescription, in order to stop the cough rapidly for 66 % of them. These parents seem more worried by coughing than other parents (P=0.0110, CI: 0.217; 1.751) as did those who had only one child (P=0.0029, CI: 0.120; 0.582). Conclusions: This study suggests that a large majority of parents understand and accept the new recommendations. But one-third of parents are still worried, not knowing what to do without prescribed medications, which led them to give nonprescription cough syrups and ask for inappropriate treatments. It seems essential to inform parents about the natural history of infant coughing and educate them on lifestyle rules to reduce the risk of deferral prescription.

Physiotherapy in rehabilitation of breathing pattern disorders

Chapter

Dec 2014

Dinah Bradley

Comparing hypertonic saline and xylometazoline in allergic rhinitis

Article

Full-text available

Jan 2015

Otite media acuta in età pediatrica. Linea guida regionale

Technical Report

Full-text available

May 2015

Vergleich von Carboxymethylcellulose (Rapid Rhino(R)-Sinu-Knit) und "keiner Nasentamponade" nach endoskopischer Nasennebenhöhlenchirurgie

Article

Nov 2006

K.G. Kastl

Clinical Study and Literature Review of Nasal Irrigation

Article

Full-text available

Jul 2000
LARYNGOSCOPE

Objectives/hypothesis: Nasal disease, including chronic rhinosinusitis and allergic rhinitis, is a significant source of morbidity. Nasal irrigation has been used as an adjunctive treatment of sinonasal disease. However, despite an abundance of anecdotal reports, there has been little statistical evidence to support its efficacy. The objective of this study was to determine the efficacy of the use of pulsatile hypertonic saline nasal irrigation in the treatment of sinonasal disease. Study design: A prospective controlled clinical study. Methods: Two hundred eleven patients from the University of California, San Diego (San Diego, CA) Nasal Dysfunction Clinic with sinonasal disease (including allergic rhinitis, aging rhinitis, atrophic rhinitis, and postnasal drip) and 20 disease-free control subjects were enrolled. Patients irrigated their nasal cavities using hypertonic saline delivered by a Water Pik device using a commercially available nasal adapter twice daily for 3 to 6 weeks. Patients rated nasal disease-specific symptoms and completed a self-administered quality of well-being questionnaire before intervention and at follow-up. Results: Patients who used nasal irrigation for the treatment of sinonasal disease experienced statistically significant improvements in 23 of the 30 nasal symptoms queried. Improvement was also measured in the global assessment of health status using the Quality of Well-Being scale. Conclusions: Nasal irrigation is effective in improving symptoms and the health status of patients with sinonasal disease.

Inhalation of hypertonic saline aerosol enhances mucociliary clearance in asthmatic and healthy subjects

Article

Full-text available

May 1996

Hyperosmolarity of the airway surface liquid (ASL) has been proposed as the stimulus for hyperpnoea-induced asthma. We found previously that mucociliary clearance (MCC) was increased after isocapnic hyperventilation (ISH) with dry air, and we proposed that the increase related to transient hyperosmolarity of the ASL. We investigated the effect of increasing the osmolarity of the ASL on MCC, by administering an aerosol of concentrated salt solution. MCC was measured using 99mTc-sulphur colloid, gamma camera and computer analysis in 12 asthmatic and 10 healthy subjects on three separate days, involving administration of each of the following: 1) ultrasonically nebulized 14.4% saline; 2) ultrasonically nebulized 0.9% saline; and 3) no aerosol intervention (control). The (mean +/- SD) volume of nebulized 14.4% saline was 2.2 +/- 1.2 mL for asthmatics and 3.2 +/- 0.7 mL for healthy subjects. This volume was delivered over a period of 5.4 +/- 1.3 and 6.4 +/- 0.7 min for asthmatic and healthy subjects, respectively. The airway response to 14.4% saline was assessed on a separate visit and the fall in forced expiratory volume in one second (FEV1) was 22 +/- 4% in the asthmatic and 3 +/- 2% in the healthy subjects. Compared to the MCC with the 0.9% saline and control, the hypertonic aerosol increased MCC in both groups. In asthmatic subjects, MCC of the whole right lung in 1 h was 68 +/- 10% with 14.4% saline vs 44 +/- 14% with 0.9% saline and 39 +/- 13% with control. In healthy subjects, MCC of the whole right lung in 1 h was 53 +/- 12% with 14.4% saline vs 41 +/- 15% with 0.9% saline and 36 +/- 13% with control. We conclude that an increase in osmolarity of the airway surface liquid increases mucociliary clearance both in asthmatic and healthy subjects. These findings are in keeping with our previous suggestion that the increase in mucociliary clearance after isotonic hyperventilation with dry air is due to a transient hyperosmolarity of the airway surface liquid.

A Clinical Trial of Hypertonic Saline Nasal Spray in Subjects With the Common Cold or Rhinosinusitis

Article

Jan 1998
Arch Fam Med

P. Adam

A practical guide for the diagnosis and treatment of acute sinusitis

Article

Apr 1997

To develop guidelines for the diagnosis and management of acute sinusitis. Diagnostic clinical criteria and imaging techniques, the role of antimicrobial therapy and duration of treatment, and the role of adjunct therapy, including decongestants, glucocorticosteroids and nasal irrigation. Improved accuracy of clinical diagnosis, better utilization of imaging techniques and rational use of antimicrobial therapy. A MEDLINE search for relevant articles published from 1980 to 1996 using the MeSH terms "sinusitis," "acute sinusitis," "respiratory infections," "upper respiratory infections," "sinusitis" and "diagnosis," "sinusitis" and "therapy," "sinusitis" and "etiology," and "antimicrobial resistance" and search for additional articles from the reference lists of retrieved articles. Papers referring to chronic sinusitis, sinusitis in compromised patients and documented nonbacterial sinusitis were excluded. The evidence was evaluated by participants at the Canadian Sinusitis Symposium, field in Toronto on April 26-27, 1996. A hierarchical evaluation of the strength of evidence modified from the methods of the Canadian Task Force on the Periodic Health Examination was used. Strategies were identified to deal with problems for which no adequate clinical data were available. Recommendations arrived at by consensus of the symposium participants were included. Increased awareness of acute sinusitis, accurate diagnosis and prompt treatment should reduce costs related to unnecessary investigations, time lost from work and complications due to inappropriate treatment. As well, physicians will be better able to decide which patients will not require antimicrobial therapy, thus saving the patient the cost and potential side effects of treatment. Clinical diagnosis can usually be made from the patient's history and findings on physical examination only. Five clinical findings comprising 3 symptoms (maxillary toothache, poor response to decongestants and a history of coloured nasal discharge) and 2 signs (purulent nasal secretion and abnormal transillumination result) are the best predictors of acute bacterial sinusitis (level I evidence). Transillumination is a useful technique in the hands of experienced personnel, but only negative findings are useful (level III evidence). Radiography is not warranted when the likelihood of acute sinusitis is high or low but is useful when the diagnosis is in doubt (level III evidence). First-line therapy should be a 10-day course of amoxicillin (trimethoprim-sulfamethoxazole should be given to patients allergic to penicillin) (level I evidence) and a decongestant (level III evidence). Patients allergic to amoxicillin and those not responding to first-line therapy should be switched to a second-line agent. As well, patients with recurrent episodes of acute sinusitis who have been assessed and found not to have anatomic anomalies may also benefit from second-line therapy (level III evidence). The recommendations are based on consensus of Canadian and American experts in infectious diseases, microbiology, otolaryngology and family medicine. The guidelines were reviewed independently for the advisory committee by 2 external experts. Previous guidelines did not exist in Canada.

Balanced physiological saline in the treatment of chronic rhinitis

Article

Jan 1987
Rhinology

The effects of a special balanced physiological saline on nasal symptoms of 93 patients with chronic rhinitis were studied. The main diagnoses of the patients were allergic rhinitis, atrophic rhinitis and ozaena, rhinitis sicca, chronic sinusitis, nasal polyposis and postoperative condition after nasal surgery. The tested solution was administered by a simple metered dose pump. 85 (91%) of the patients reported beneficial effects of the tested solution on nasal symptoms. In addition, 22 (71%) of those patients who used continuous anti-allergic medication, mainly intranasal steroids, reported that the tested solution improved the efficacy of their ordinary drug. So the tested solution proved to be beneficial in humidifying atrophic or otherwise dry mucosa, douching crusty nose and as adjuvant therapy in the treatment of allergic rhinitis.

Therapeutic Agents in the Medical Management of Sinusitis

Article

Sep 1993
Otolaryngol Clin

Richard L. Mabry

Surgical approaches to the management of sinus disease have undergone a significant change over the past decade. The rhinologist must appreciate that the medical management of sinusitis also has been radically altered during the past 10 years by the development of newer and better pharmacotherapeutic agents for the treatment of sinusitis. These agents are best employed as part of an ordered approach to treatment with a full knowledge of their proper applications and potential drawbacks.

Nasal Hyperthermia and Simple Irrigation for Perennial Rhinitis

Article

Nov 1994

John W. Georgitis

Local nasal hyperthermia or inhalation of heated water vapor is often recommended as a home remedy for various rhinitis disorders such as the common cold and allergic rhinitis. Inhaled heated vapor treatments and simple saline solution nasal irrigation were investigated for their effect on inflammatory mediator production in nasal secretions. Three treatments were given for nasal irrigation: heated water particles (large particle water vapor) at 43 degrees C, heated molecular water vapor (molecular water vapor) at 41 degrees C, and simple saline solution nasal irrigation. Nasal washes were done before each treatment (baseline), immediately after treatments, and at 30 min, 2, 4, and 6 h. Histamine, prostaglandin D2, and leukotriene C4 (LTC4) concentrations were measured in nasal secretions and compared with baseline values. Thirty symptomatic patients with active perennial allergic rhinitis underwent three treatments at weekly intervals. Nasal histamine concentrations fell substantially with the nasal irrigation (p < 0.01 immediately posttreatment and at 30 min; p < 0.05 at 2, 4, and 6 h). Large particle vapor also reduced histamine concentrations for up to 4 h posttreatment compared with baseline values (p < 0.05). Alternatively, molecular water vapor did not alter nasal histamine concentrations. Surprisingly, the three treatments did not alter prostaglandin D2 concentrations over the 6 h. Leukotriene C4 concentrations fell briefly after the large particle treatment but did not with the molecular water vapor. With saline solution irrigation, LTC4 concentrations in nasal secretions were lower than baseline at 30 min to 4 h after a treatment (p < 0.05). This study demonstrated the usefulness of large particle vapor treatment and saline solution irrigation in reducing inflammatory mediators in nasal secretions and indirectly supports the clinical efficacy of these treatments for chronic rhinitis.

The Efficacy of Various Irrigation Solutions in Removing Slime-Producing Staphylococcus

Article

Nov 1994
J ORTHOP TRAUMA

To determine which type of irrigation solution and which method of irrigation most effectively removes slime-producing Staphylococcus from implant surfaces, we performed experimental washings of bacteria-coated stainless steel screws with various solutions delivered by bulb syringe or by jet lavage. The quantity of bacteria remaining on the screw surface was determined after irrigation with 1 L of saline, 1 L of antibiotic solutions, or 1 L of saline containing a liquid soap. Antibiotic solutions tested included bacitracin, neomycin, and polymyxin/neomycin. We found that the use of power irrigation increased the removal of bacteria by a factor of at least 100 over bulb syringe irrigation of the same volume, no matter which solution was used. This effect ranged from a 100-fold improvement for neomycin, to a 285-fold effect for the polymyxin solution. The addition of antibiotic drugs to the irrigation solution had no significant effect on bacterial removal, and none of the antibiotic solutions were statistically different from saline alone in the amount of bacteria removed from the screws. The addition of a liquid soap solution dramatically increased the amount of bacteria removed by irrigation, reducing the residual bacteria per screw from a colony count of 3.5 x 10(4) for polymyxin (the best of the antibiotic solutions), to 4.38 x 10(3). This difference was statistically significant as judged by Student's t test, with p = 0.01. We have concluded that the use of power irrigation improves the ability to clean this pathogenic bacteria from metallic surfaces, and that the addition of antibiotic drugs to the irrigation solution does not.(ABSTRACT TRUNCATED AT 250 WORDS)

Local hyperthermia and nasal irrigation for perennial allergic rhinitis: Effect on symptoms and nasal airflow

Article

Oct 1993
Ann Allergy

John W. Georgitis

Local hyperthermia or inhalation of heated water vapor is often recommended as a home remedy for various nasal disorders such as the common cold and allergic rhinitis. With technical advances in vapor generation, water can be heated to a range of 41 degrees C to 43 degrees C with variation in particle size. The effect of inhaled heated vapor treatments was studied in patients with perennial rhinitis for changes in nasal airflow and patient perception of symptoms. Thirty symptomatic patients underwent three treatments at weekly intervals: (1) a large particle heated water vapor at 43 degrees C for 20 minutes with a particle size of 4 to 8 microns, (2) a molecular water vapor at 41 degrees C for 20 minutes which is a vapor phase, and (3) nasal irrigation. Nasal airflow increased after both vapor treatments at four and six hours (P < .05) whereas airflow decreased after simple nasal irrigation treatment. Rhinitis symptoms improved after vapor treatments but not with nasal irrigation. Patients preferred the molecular water vapor treatment over the large particle vapor treatment and nasal irrigation by 2:1 margin. This study demonstrated the usefulness of heated vapor treatments in improving rhinitis symptoms and nasal airflow.

Endoscopic Sinus Surgery

Article

Sep 1993
Otolaryngol Clin

Dale H. Rice

Successful endoscopic sinus surgery requires a thorough knowledge of the anatomy of the paranasal sinuses and, in particular, the lateral nasal wall. This article discusses a variety of topics relating to endoscopic sinus surgery, including physiology, patient evaluation, several surgical techniques, postoperative care, and complications.

Inflammatory diseases of the sinuses:physiology. Clinical applications

Article

Sep 1993
Otolaryngol Clin

Physiologic principles form the foundation upon which rational medical and surgical decisions are based. Over the years, a growing understanding of the physiology of the nose and sinuses has evolved, allowing us to better treat our patients with sinonasal disease. As clinicians, we are challenged to keep abreast not only of advances in therapeutic options but also of advances in physiology. In this manner, we may employ the new therapies with both skill and intelligence.

Comparative Randomised Clinical Study of Tolerability and Efficacy of Rhinomer® Force 3 versus a Reference Product in Post-Operative Care of the Nasal Fossae after Endonasal Surgery

Article

Mar 1996

Twenty-eight patients undergoing rhinologic surgery were enrolled in a clinical study to compare two post-operative cleansing preparations. Patients were asked to wash their nasal fossae for 1 month, either with Rhinomer, a cleansing preparation of isotonic, sterile, undiluted sea water, presented in slightly pressurised bottle with neither CFC nor preservative, or with Prorhinel, a marketed solution containing an antiseptic agent. Patients were randomly allocated to treatment beginning 2 days after surgery. Nasal status was assessed by symptoms (blocking nose, rhinorrhoea, sneezing, itching and impaired smell) and rhinologic endoscopy (colour of the nasal mucosa, swelling of the mucosa, secretions, presence of crusts or pus). Patients attended control visits on days 9, 15 and 30 following surgery. They were asked to record symptom intensity and use of a rescue medication (Vibrocil, dimetindene 0.25 mg and phenylephrine 2.5 mg/ml) on a diary card. Twenty-six of 28 patients were eligible for efficacy analysis, 14 in the Rhinomer group and 12 in the Prorhinel group, In both groups, intensity of complaints decreased markedly over the study period. No severe adverse drug reactions were reported in either treatment. Evoked complaint frequency was comparable between groups, but patient's and physician's opinion on tolerability was significantly different between treatments, in favour of Rhinomer. In addition, the test preparation was found to be easier to use than Prorhinel. The weekly average frequency of use of the rescue medication was not significantly different between treatments. When both patients and physicians were asked about treatment efficacy, they expressed an opinion significantly more favourable to Rhinomer than to the reference drug. In this study, Rhinomer has shown efficacious results that justify its use in washing of the nasal cavities following endonasal surgery.

Management of post-ethmoidectomy crust formation: Randomized single-blind clinical trial comparing pressurized seawater versus antiseptic/mucolytic saline

Article

Apr 1996
Rhinology

This study compared the efficacy of mechanical nasal lavages with pressurized seawater versus nasal irrigations with saline plus benzododecinium (antiseptic) plus oleosorbate (mucolytic). Twenty patients agreed to participate in a randomized, single-blind clinical trial. All patients underwent endoscopic endonasal ethmoidectomy for nasal polyps. The packing was removed after 48 h and patients were asked to start the same day nasal lavages three times a day. Clinical evaluations were performed: (1) by weighing residual nasal crusts and secretions after 21 +/- 2 days; and (2) by using visual analogue scales to daily record symptom scores. Data are presented as mean +/- SEM. T-test statistics for two independent groups were applied. The mean residual crust and secretion weights were 1,756 +/- 688 mg and 1,033 +/- 422 mg in the pressurized seawater group, 932 +/- 414 mg and 1,222 +/- 435 mg in the antiseptic-mucolytic saline group. No statistical differences were found. Sample size calculations showed that 100 subjects in each group would be necessary to confirm a 700-mg reduction in residual crusts in the antiseptic/mucolytic saline group (power = 0.80; two-sided type-I error = 0.05). Daily symptom score curves were similar in both groups and allowed us to give a description of post-operative complaints. The role of antiseptic, mucolytic and mechanical lavages in preventing post-ethmoidectomy crust formation is discussed.

Chronic Sinusitis: A Medical or Surgical Disease?

Article

Mar 1996
Otolaryngol Clin

David S. Parsons

Chronic sinusitis in children who do not have other underlying medical problems is a medically treatable disease, and surgery is not required often. Allergies, environmental factors, and gastroesophageal reflux are the three most important contributing causes of chronic sinusitis in children. Chronic sinusitis is not a primary infectious disease.

Preventing the Emergence of Antimicrobial Resistance: A Call for Action by Clinicians, Public Health Officials, and Patients

Article

Oct 1997

The Medical Management of Rhinosinusitis

Article

Oct 1997

The management of rhinosinusitis depends on a number of variables related to the duration and severity of symptoms in the individual patient. Furthermore acute rhinosinusitis is managed differently than chronic rhinosinusitis. Because a variety of conservative and pharmacologic interventions are available, the physician can find it difficult to develop a cohesive and logical approach to treatment. An understanding of the pathophysiology, microbiology, and natural history of rhinosinusitis is necessary to formulate the best treatment plan for the individual patient.

A Clinical Trial of Hypertonic Saline Nasal Spray in Subjects with the Common Cold or Rhinosinusitis

Article

Jan 1998
Arch Fam Med

To determine whether hypertonic saline nasal spray relieves nasal symptoms and shortens illness duration in patients with the common cold or acute rhinosinusitis. Randomized trial with 2 control groups. Two family practice clinics. One hundred forty-three adult patients with a cold or sinus infection. Patients with allergic rhinitis, symptoms for more than 3 weeks, or other respiratory diagnoses were excluded, as were those who had used topical decongestants. Hypertonic saline or normal saline spray 3 times a day or observation. Subjects completed a 7-day symptom checklist that included a well-being question ("Do you feel back to normal?"). Nasal symptom score (sum of scores for nasal congestion, rhinorrhea, and headache) on day 3 and day of well-being (day of symptom resolution). Data were collected for 119 subjects. No difference was found in either primary outcome when hypertonic saline was compared with either normal saline or observation. Mean day of well-being was 8.3 (95% confidence interval [CI], 6.9-9.7), 9.2 (95% CI, 6.9-11.43), and 8.0 (95% CI, 6.7-9.3) days in the hypertonic saline, normal saline, and observation groups, respectively. Day 3 mean nasal symptom score was 3.8 (95% CI, 3.0-4.5) for hypertonic saline, 3.7 (95% CI, 2.9-4.5) for normal saline, and 4.1 (95% CI, 3.5-4.7) for observation. Only 44% of the patients would use the hypertonic saline spray again. Thirty-two percent noted burning, compared with 13% of the normal saline group (P = .05). Hypertonic saline does not improve nasal symptoms or illness duration in patients with the common cold or rhinosinusitis.

Treatment with hypertonic saline versus normal saline nasal wash of pediatric chronic sinusitis

Article

Jun 1998
J ALLERGY CLIN IMMUN

Chronic sinusitis (CS) is a common disease in children, especially those with allergies, that is caused by impaired drainage from the sinuses. Hypertonic NaCl solution has been shown to increase mucociliary clearance and ciliary beat frequency. We performed a randomized double blind study to compare the effect of nasal wash with hypertonic saline (HS) (3.5%) versus normal saline (NS) (0.9%) on CS. Thirty patients with CS aged 3 to 16 years were studied. They were randomly divided into two treatment groups matched by age and severity of the disease. Each individual was treated with either HS or NS for 4 weeks. All patients were evaluated by two clinical scores (cough and nasal secretions/postnasal drip [PND]) and by a radiology score at the beginning of the study and after 4 weeks. The HS group improved significantly in all scores (average +/- SD): cough score, from 3.6 +/- 0.51 to 1.6 +/- 0.74; nasal secretion/PND score, from 2.86 +/- 0.35 to 1.6 +/- 0.74; and radiology score, from 8.06 +/- 1.28 to 2.66 +/- 1.04. The NS treatment group showed significant improvement only in the PND score (from 2.66 +/- 0.49 to 1.53 +/- 0.83) but no significant change in both the cough score (from 3.53 +/- 0.52 to 3.33 +/- 0.49) and the radiology score (from 8.13 +/- 1.25 to 7.86 +/- 0.91). Clinical observation 1 month after the end of the study showed no change compared with the end of the study in both groups. HS nasal wash is an efficient treatment of CS.

Acute sinusitis: A cost-effective approach to diagnosis and treatment

Article

Dec 1998
AM FAM PHYSICIAN

Lyle Fagnan

Acute bacterial sinusitis usually occurs following an upper respiratory infection that results in obstruction of the osteomeatal complex, impaired mucociliary clearance and overproduction of secretions. The diagnosis is based on the patient's history of a biphasic illness ("double sickening"), purulent rhinorrhea, maxillary toothache, pain on leaning forward, pain with a unilateral prominence and a poor response to decongestant therapy. Radiographs and computed tomographic scans of the sinuses generally are not useful in making the initial diagnosis. Since sinusitis is self-limited in 40 to 50 percent of patients, the expensive, newer-generation antibiotics should not be used as first-line therapy. First-line antibiotics such as amoxicillin or trimethoprim-sulfamethoxazole are as effective in the treatment of sinusitis as the more expensive antibiotics. Little evidence supports the use of adjunctive treatments such as nasal corticosteroids and systemic decongestants. Patients with recurrent or chronic sinusitis require referral to an otolaryngologist for consideration of functional endoscopic sinus surgery.

Rhinosinusitis - Current concepts in evaluation and management

Article

Feb 1999
MED CLIN N AM

Sinusitis is one of the most common health complaints leading to a physician office visit in the United States. Recently standardized terminology with diagnostic parameters are outlined. Following this is a detailed discussion of the basics of relevant history and physical examinations, laboratory and radiology testing, the appropriate selection of pharmacotherapy, and the indications for surgical intervention.

[Nasal washing with Physiomer ... 10 years later: 1988-1998]

Article

Feb 1999
Rev Laryngol Otol Rhinol

The authors present the story of Physiomer. It began in 1988 in Goemar's 'Laboratory of the Sea', with an original idea of making a product manufactured from sea water and transforming it into an isotonic solution, while preserving all the elements of natural sea water, specially the trace elements and the alkaline PH. Scientific analysis has shown that the chemical composition of the product is true to the original, and that it has a positive action on cellular growth in respiratory tract mucosa in experimental culture, and it is very well tolerated. Clinical tests using nasal washings have confirmed beneficial action on the nasal and sinus mucosa in medical disease and after surgery. Tests have been carried out on 410 cases, 344 of which were treated with Physiomer, and on 199 cases after surgery on the nose or sinuses. Physiomer nasal washings have proved their value. It now remains for all the potential qualities of sea water to be demonstrated, using other preparations or other combinations.

The effect of pH of douching solutions on mucociliary clearance

Article

Sep 1999

The effect of the pH of hypertonic saline nasal douching solutions on mucociliary clearance was studied in order to investigate the common notion that such solutions should be buffered alkaline. Thirty normal subjects were included in a randomised controlled crossover trial. Mucociliary clearance was measured by the saccharin clearance time. There was no difference in mucociliary clearance after douching with a non-buffered solution and a solution buffered to pH 8. However both solutions significantly improved mucociliary clearance compared to the baseline (P < 0.001) probably on account of their hypertonicity.

Gysin C, Alothman GA, Papsin BC.. Sinonasal disease in cystic fibrosis: clinical characteristics, diagnosis, and management. Pediatr Pulmonol 30: 481-489

Article

Dec 2000

Cystic fibrosis is an autosomal recessive genetic disorder that causes dysfunction of exocrine glands, and has several clinical manifestations. Among those, sinonasal involvement is almost universal, with or without chronic sinusitis and/or nasal polyposis. This review will detail the pathophysiologic changes of the sinonasal mucosa, and the clinical manifestations, diagnosis, and treatment. Developmental anatomic abnormalities, which are identified radiologically, will also be demonstrated. Medical management is the first treatment for patients with cystic fibrosis, but effective treatment of sinonasal disease in cystic fibrosis relies heavily on surgery. In the past, nasal polyposis was the main indication for surgery, and consisted mostly of polypectomy alone. This procedure was associated with a high recurrence rate. The development of functional endoscopic sinus surgery has contributed to decreasing the morbidity of sinonasal surgery and the recurrence of nasal polyposis in cystic fibrosis. The evolution of the surgical techniques will be discussed and a review of the literature will be provided.

The Pupil. Anatomy, Physiology and Clinical Applications.

Article

Feb 2001
BRIT J OPHTHALMOL

J P DIAMOND

The Pupil. Anatomy, Physiology and Clinical Applications. Irene E Loewenfeld. £180; Pp 2223. Oxford: Butterworth-Heinemann, 1999. ISBN 0750671432. This text represents a lifetime body of work for Professor Irene Loewenfeld. Perhaps more accurately, it represents a greater part of two lifetimes' work; having been commenced in the mid-1950s as a collaborative project with Professor Otto Lowenstein at the Columbia-Presbyterian Medical Center in New York. Following Otto Lowenstein's death in 1965, Irene Loewenfeld continued writing, eventually publishing through Wayne State University Press in 1993. Presented in two volumes, the first includes the text and runs to 1645 pages, divided into five sections, …

Nasal Irrigation for the Alleviation of Sinonasal Symptoms

Article

Aug 2001

To determine the effect of nasal irrigation on sinonasal symptoms. A total of 150 adult subjects with chronic sinusitis symptoms were recruited from the community and assigned to 1 of 3 treatment groups: nasal irrigation with bulb syringe, nasal irrigation with nasal irrigation pot, or control treatment with reflexology massage. Groups 1 and 2 performed daily hypertonic saline irrigation with 1 device for 2 weeks and then with the other device for 2 weeks. Group 3 performed reflexology massage daily for 2 weeks. Prospective data collected included pretreatment Medical Outcomes Study Short Form, pretreatment and posttreatment Rhinosinusitis Outcomes Measure, daily medication use, subjective treatment efficacy, and preference of irrigation method. There was a significant and equivalent improvement in Rhinosinusitis Outcomes Measure 31 score after 2 weeks of intervention in each treatment group; 35% of subjects reported decreased use of sinus medication. Daily nasal irrigation using either a bulb syringe, nasal irrigation pot, and daily reflexology massage were equally efficacious and resulted in improvement in the symptoms of chronic sinusitis in over 70% of subjects. Medication usage was decreased in approximately one third of participants regardless of intervention.

Efficacité de Rhinomer Force 3 dans les suites opératoires de la chirurgie endonasale

Jan 1995
1-4

M Krayenbuhl
Seppey

Krayenbuhl M, Seppey M. Efficacité de Rhinomer Force 3 dans les suites opératoires de la chirurgie endonasale. Rev Med Suisse Romande 1995;115(3):1-4.

Rhinomer pour la thérapie de la pathologie rhinosinusale

Jan 1995
20-4

M Seppey
M Krayenbuhl
D Simmen
M J Buvelot
Pelloni

Seppey M, Krayenbuhl M, Simmen D, Buvelot J-M, Pelloni R. Rhinomer pour la thérapie de la pathologie rhinosinusale. ORL Highlights 1995;2(2):20-4.

Defining the public health impact of drug-resistant Streptococcus pneumoniae: report of a working group

1-14

Centres

Centres for Disease Control. Defining the public health impact of drug-resistant Streptococcus pneumoniae: report of a working group. MMWR Morb Mortal Wkly Rep 1996;45:1-14

Traitement combiné de la sinusite aiguë avec Rhinomer et Zinat

M Seppey
Krayenbuhl

Seppey M, Krayenbuhl M. Traitement combiné de la sinusite aiguë avec Rhinomer et Zinat. ORL Highlights 1998;5(4):3-6

Saline nasal irrigation. Its role as an adjunct treatment

Abstract

No full-text available

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