Nasal allergy and leukotriene. 2. Kinetics of peptide leukotrienes and inflammatory cells in nasal lavage fluid after antigen challenge

The purpose of this study is to clarify the role of peptide leukotrienes (LTs) on the onset of characteristic hyperreactive nasal symptoms of nasal allergy by observing the time course of the correlation among degrees of nasal symptoms, and by observing the amount of chemical mediators and the number of inflammatory cells in the nasal lavage fluid after nasal antigen challenge in subjects with Japanese cedar pollinosis during off season. Sneezing was terminated within 10 minutes and nasal discharge within 2 hours. However, time course change of the percent increase of nasal airway resistance showed dual response consisting of immediate and late phase responses. The peak of the former was seen at 30 minutes and the latter was at 7 hours after provocation. The significant increase of eosinophils in the nasal lavage fluid was observed during both the immediate and the late phase responses, but during the late phase response, the increase was more prominent. Basophilic cells definitely increased during the late phase response. The amount of LTs in the nasal lavage fluid increased significantly during both the immediate and the late phase responses. In contrast, the level of histamine increased significantly only during the immediate phase response. Considering that LTs, especially LTD4, has potent and persistent effect on causing swelling of nasal mucosa, LTs may play important role in causing nasal obstruction during both the immediate and the late phase responses after antigen challenge. On the other hand, the role of histamine may be confined to cause the hyperreactive nasal symptoms during the immediate phase response.(ABSTRACT TRUNCATED AT 250 WORDS)     

Nasal decongestant effect of oxymetazoline in the common cold: an objective dose-response study in 106 patients

Oxymetazoline has been used as decongesting nosedrops for more than 25 years but so far no objective dose-response study of the drug has been published. In this double-blind clinical trial the decongestant effect on the nasal mucosa by the doses and concentrations traditionally used of oxymetazoline were studied. In 106 men with acute infectious rhinitis, a significant dose-response relationship was found when the decongestant effect was measured objectively by anterior rhinomanometry and subjectively by symptom scores. The concentration and volumes of the drug recommended from clinical experience seem to be adequate.     

联合应用白三烯受体拮抗剂治疗小儿变应性 鼻炎的临床观察

目的探讨联合应用白三烯受体拮抗剂治疗小儿中、重度变应性鼻炎(allergic rhinitis, AR)的临床疗效。方法随机将62例中、重度AR患儿分为常规治疗组和联合治疗组,每组患者各31例,常规治疗组用第二代抗组胺药口服、鼻用糖皮质激素喷鼻治疗;联合治疗组在常规治疗组的基础上加用孟鲁司特钠咀嚼片口服,两组患者疗程均为4周。对两组患儿在治疗前、治疗4周结束时及治疗结束后3个月鼻部症状视觉模拟量表(VAS)评分及总有效率进行比较。 结果①鼻部症状VAS评分每组患者治疗前与治疗4周结束时、治疗结束后3个月分别比较差异均具有统计学意义(P均<0.05);治疗4周结束时、治疗结束后3个月,联合治疗组和常规治疗组分别比较,差异均有统计学意义(P均<0.05);②总有效率:治疗4周结束时、治疗结束后3个月,联合治疗组（总有效率为96.67%、90.00%）和常规治疗组（总有效率83.33%、73.33%）分别比较,差异均有统计学意义(P均<0.05);常规治疗组治疗4周结束时和治疗结束后3个月总有效率比较,差异具有统计学意义(P<0.05),而联合治疗组差异则无统计学意义 (P>0.05)。结论白三烯受体拮抗剂联合鼻用糖皮质激素和第二代抗组胺药治疗小儿中、重度AR可以增强和巩固疗效。     

Nasal mucosal temperature and the effect of acute infective rhinitis

Nasal mucosal temperature was measured in 71 healthy subjects with an electronic thermometer. No correlation was found between the nasal mucosal temperature and age or sex. An increased mucosal temperature was found in patients with acute rhinitis, an effect which is supposed to assist in the defence system against microorganisms. When measuring nasal mucosal temperature over a 7-h period at the same time as nasal airway resistance, there was no correlation between these factors, indicating that the temperature is independent of the state of the capacitance vessels.     

The effect of the leukotriene antagonist pranlukast on pediatric acute otitis media

ObjectiveConventional treatment for acute otitis media mainly targets bacteria with antibiotics, neglecting to control for mediators of inflammation. Mediators of inflammation, such as leukotrienes, have been identified in patients with acute otitis media (AOM) or subsequent secretory otitis media (SOM). They can cause functional eustachian tube dysfunction or increase mucous in the middle ear, causing persistent SOM following AOM. The objective of the present study was to evaluate whether or not administration of pranlukast, a widely used leukotriene C4, D4, and E4 antagonist, together with antibiotics could inhibit the progression to SOM.MethodsChildren with AOM, who were from two to 12 years old, were randomly divided into two groups as follows: a control group in which 50 patients received antibiotic-based conventional treatment according to guidelines for treating AOM proposed by the Japan Otological Society (version 2006); and a pranlukast group, in which 52 patients were administered pranlukast for up to 28 days as well as given conventional treatment. Cases were regarded as persistent SOM when a tympanogram was type B or C2 four weeks after treatment was initiated.ResultsTwo patients in the pranlukast group and 3 patients in the control group were excluded because they relapsed AOM within 28 days after initial treatment. Therefore, the analysis included 50 and 47 subjects in the pranlukast and control groups, respectively. The percentage of patients diagnosed with persistent SOM (22.0%) was significantly smaller in the pranlukast group compared with the control group (44.7%) (p = 0.018, chi-squared test).ConclusionThe results indicate that combined treatment of AOM with antibiotics and a leukotriene antagonist to control inflammation is useful for preventing progression to persistent SOM.     

Nasal obstruction and sleep-disordered breathing: the effect of supine body position on nasal measurements in snorers

OBJECTIVE: Nasal obstruction is considered to be a potential etiological factor in sleep-disordered breathing. However, a significant correlation between nasal measurements and obstructive sleep apnea has not been demonstrated so far. The aim of this study was to investigate the relationships between nasal resistance, nasal volumes and selected sleep parameters using nasal measurements performed in both seated and supine positions. We also investigated whether snoring patients in our clinical sample showed increased positional or decongestive nasal mucosal changes. MATERIAL AND METHODS: Forty-one snoring men on a waiting list for correction of nasal obstruction underwent polysomnography, anterior rhinomanometry and acoustic rhinometry. Nineteen non-snoring control subjects were also recruited. Nasal measurements were performed in a seated position, after lying down in a supine position and, after decongestion of nasal mucosa, in a seated position again. RESULTS: In the overall patient group, nasal volume at a distance 2-4 cm from the nares in the supine position correlated inversely with apnea-hypopnea index (AHI) (r = -0.32, p < 0.05) and oxygen desaturation index (ODI) (r = -0.49, p < 0.05). In the non-obese patients, total nasal resistance measured in a supine position correlated with AHI (r = 0.50, p < 0.05) and ODI (r = 0.58, p < 0.05) and supine nasal volumes were also inversely correlated with ODI. No significant correlations were found between baseline nasal measurements performed in a seated position and sleep parameters. Postural or decongestive changes in nasal measurements were not increased in snoring patients compared with control subjects. CONCLUSION: The relationship found between nasal measurements and sleep parameters suggests that nasal obstruction does augment airway collapse.     

Middle ear fluid histamine and leukotriene B4 in acute otitis media: effect of antihistamine or corticosteroid treatment

OBJECTIVE: Two potent mediators of acute inflammation, histamine and leukotriene B4 (LTB4), have been shown to play important roles in the pathogenesis and clinical course of acute otitis media (AOM) in children. The purpose of this study was to evaluate the ability of adjuvant drugs, antihistamine and corticosteroid, in reduction of the levels of histamine and LTB4 in the middle ear and their ability to improve outcomes of AOM. METHODS: Eighty children with AOM (aged 3 months to 6 years) were enrolled in a prospective, randomized, double-blind, placebo controlled study. All children received one dose of intramuscular ceftriaxone and were randomly assigned to receive either chlorpheniramine maleate (0.35 mg/kg per day) and/or prednisolone (2 mg/kg per day) or placebos three times a day for 5 days. Tympanocentesis was performed at enrollment and after 5 days of adjuvant drug treatment. MEFs were collected for bacterial and viral studies and histamine and LTB4 levels. The subjects were followed for the duration of middle ear effusion or up to 3 months. RESULTS: Histamine or LTB4 levels in the MEF after 5 days of treatment were not significantly reduced by adjuvant drug treatment. However, subjects receiving corticosteroid had a lower rate of treatment failure during the first 2 weeks and shorter duration of middle ear effusion. CONCLUSIONS: Five day of antihistamine or corticosteroid treatment does not reduce the levels of histamine or leukotriene B4 in the MEF of children with AOM. Positive clinical outcomes of AOM cases associated with corticosteroid treatment needs to be confirmed in a larger clinical trial of children with intact tympanic membranes, who do not receive tympanocentesis.     

Role of Vascular Reflex in Nasal Mucosal Swelling in Nasal Allergy

Objective: In patients with nasal allergy, antigen challenge on the unilateral nasal mucosa results in nasal secretion not only in the ipsilateral but also in the contralateral nasal cavities that can be inhibited almost completely by premedication with atropine sulfate. The present study was performed to elucidate if centrally mediated vascular reflex induced by antigen challenge plays a role in nasal mucosal swelling in subjects with nasal allergy. Methods: Variations of mucosal swelling and mucosal blood flow in the ipsilateral and the contralateral nasal cavities after unilateral antigen challenge were evaluated by acoustic rhinometry and laser Doppler flowmetry in 20 patients with perennial nasal allergy. Results: Unilateral antigen challenge caused ipsilateral and contralateral nasal mucosal swelling in 17 and 13 patients, respectively. Incidence of contralateral nasal mucosal swelling after unilateral antigen challenge was significantly higher compared with that after control disc challenge (P < .001). In 10 patients in whom unilateral antigen challenge caused bilateral nasal mucosal swelling, significant swelling of the nasal mucosa lasted for more than 30 minutes in the ipsilateral nasal cavity after antigen challenge compared with only 15 minutes in the contralateral nasal cavity. Peak values of contralateral mucosal swelling were 45.3% of those of ipsilateral nasal mucosa. Conclusions: Centrally mediated vascular reflex is partially involved in the onset of nasal mucosal swelling observed after antigen challenge in subjects with nasal allergy. However, nasal mucosal swelling that persists and proceeds even 20 minutes after antigen challenge is caused by the direct effects of chemical mediators on the nasal vasculature.     

Nasal Obstruction and Sleep-disordered Breathing: The Effect of Supine Body Position on Nasal Measurements in Snorers

Objective --Nasal obstruction is considered to be a potential etiological factor in sleep-disordered breathing. However, a significant correlation between nasal measurements and obstructive sleep apnea has not been demonstrated so far. The aim of this study was to investigate the relationships between nasal resistance, nasal volumes and selected sleep parameters using nasal measurements performed in both seated and supine positions. We also investigated whether snoring patients in our clinical sample showed increased positional or decongestive nasal mucosal changes. Material and Methods --Forty-one snoring men on a waiting list for correction of nasal obstruction underwent polysomnography, anterior rhinomanometry and acoustic rhinometry. Nineteen non-snoring control subjects were also recruited. Nasal measurements were performed in a seated position, after lying down in a supine position and, after decongestion of nasal mucosa, in a seated position again. Results --In the overall patient group, nasal volume at a distance 2-4 cm from the nares in the supine position correlated inversely with apnea-hypopnea index (AHI) ( r = &#109 0.32, p <0.05) and oxygen desaturation index (ODI) ( r = &#109 0.49, p <0.05). In the non-obese patients, total nasal resistance measured in a supine position correlated with AHI ( r =0.50, p <0.05) and ODI ( r =0.58, p <0.05) and supine nasal volumes were also inversely correlated with ODI. No significant correlations were found between baseline nasal measurements performed in a seated position and sleep parameters. Postural or decongestive changes in nasal measurements were not increased in snoring patients compared with control subjects. Conclusion --The relationship found between nasal measurements and sleep parameters suggests that nasal obstruction does augment airway collapse.     

Role of the External Nasal Dilator in the Management of Nasal Obstruction

The aim of this study is to evaluate the effect of an external nasal dilator in patients with nasal obstruction secondary to mucosal congestion (n = 33) or to septal deviation in the nasal valve area (n = 28). A group of subjects with healthy nasal cavities was tested also (n = 51). Acoustic rhinometric and rhinomanometric nasal measurements were performed with and without the dilator and before and after topical decongestion of the nasal mucosa. A visual analog scale was employed to evaluate the subjective sensation of nasal obstruction. Objective measurements showed that the external dilator increased the minimum cross-sectional area and decreased the nasal resistance significantly in all three groups (P < 0.01). The effect was more impressive in patients with septal deviation (P < 0.001). Subjective assessments reflected patency in all subjects except those in the mucosal swelling group (P = 0.06). From this study the authors conclude that the external nasal dilator offers an effective, nonsurgical therapeutic approach in the management of septal deviation that obstructs the nasal valve area. Although patients with nasal obstruction secondary to mucosal congestion showed objective improvement with the nasal dilator, these changes were not accompanied by a sensation of enhanced patency.     

Functional Roles of Nasal Nitric Oxide in Nasal Patency and Mucociliary Function

The purpose of this study was twofold: (i) to clarify whether it is possible to change the amount of nasal nitric oxide (NO) artificially; and (ii) to confirm that the artificially altered nasal NO has biological properties such as vasodilatation and mucociliary function. We measured nasal NO and nasal airway resistance (NAR) in healthy subjects before and after topical administration of sodium nitroprusside (SNP), an NO donor. We also measured nasal NO and saccharin transport time after administration of SNP or L-N G -nitroarginine methylester (L-NAME), a NO synthase inhibitor. In addition, we examined the effect of SNP and L-NAME on nasal NO and saccharin transport time after pretreatment with flutropium bromide (FB), an anticholinergic agent. Administration of SNP elicited increases in nasal NO and NAR in a dose-dependent manner. Nasal NO decreased significantly after topical administration of L-NAME. Saccharin transport time, an indicator of mucociliary function, was shortened after topical administration of SNP and prolonged after administration of L-NAME. Moreover, these phenomena were observed even after pretreatment with FB. These results suggest that artificially altered nasal NO may affect NAR and mucociliary function.     

Nasal endoscope in posterior epistaxis: a preliminary evaluation

The findings of a preliminary, prospective evaluation of the role of endoscopy in the management of adult posterior epistaxis are presented. A cohort of patients managed by the endoscopic technique was compared with a control group managed by the traditional methods of nasal packing or epistaxis balloons. The endoscope allowed visualization and direct treatment of previously undiagnosed posterior bleeding points. Patients managed by the endoscopic technique had a significantly shorter duration of in patient stay than those managed by traditional methods.     

Nasal antral windows in children: a retrospective study

A retrospective study of 39 patients with 46 sets of bilateral nasal antral windows was undertaken to assess the effect of this procedure on chronic sinusitis in children. All patients had symptoms of sinusitis for at least 3 months with plain radiographic documentation of maxillary sinus disease. Only medical failures were surgical candidates. Forty percent of the patients were improved at 1 month, but the success rate at 6 months decreased to 27%. It was necessary to repeat the nasal antral window procedure because of recurrent or persistent sinusitis in 7 of 39 patients. An additional 11 patients required endoscopic ethmoidectomy and maxillary antrostomy. Based on this experience, the nasal antral window procedure does not appear to be effective in treating chronic sinusitis in children.