羟甲唑啉在小儿鼻内镜手术中的应用

目的:探讨羟甲唑啉(商品名:达芬霖)在小儿鼻内镜手术中的应用价值。方法:观察鼻内镜手术中应用羟甲唑啉对患儿的脉搏、血压的影响,出现反跳的时间及术中出血量的多少。结果:在羟甲唑啉应用前后,72例患者的脉搏及血压变化差异均无统计学意义(均P>0.05),降低鼻血流量约50%,作用持续时间长达6h。结论:羟甲唑啉作为鼻黏膜血管减充剂和麻醉辅助药可常规用于小儿鼻内镜手术,且安全、有效。     

慢性鼻窦炎鼻内窥镜手术前后鼻粘膜观察

目的：观察慢性鼻窦炎（chronic sinusitis,CS)鼻内窥镜手术（endoscopic sinus surgery,ESS)前后鼻粘膜的组织形态及功能变化。方法：（1）对32例CS患者手术前后进行糖精试验和鼻粘膜光镜观察，并与健康对照进行比较；（2）对10例CS患者手术后与2例健康对照组进行鼻粘膜扫描电镜和透射电镜观察。结果：（1）CS术前与对照组比较，糖精试验时间明显延长（P＜0．001），。术后较术前明显缩短（P＜0．001）；（2）光镜观察：CS术前出现炎性细胞浸润，水肿、鼻肉形成和病理性腺体，与对照组比较差异有显著性（P＜0．01）；术后炎性细胞浸润，水肿和息肉形成明显减轻，与健康对照组比较差异无显著性（P＞0．05）；但病理性腺体术后无明显减轻；（3）电镜观察：CS术前鼻粘膜超微结构受到破坏，术后4个月后基本恢复正常。结论：本实验提示：（1） CS鼻粘膜的正常结构和纤毛清除功能到破坏；（2）ESS术后4个月鼻粘膜的结构和纤毛清除功能较术前明显改善，基本恢复正常，（3）ESS术后鼻粘膜中病理性腺体的恢复可能需更长的时间。     

鼻渊舒口服液结合内镜鼻窦手术治疗复发性鼻窦炎鼻息肉

目的 观察鼻渊舒口服液结合内镜鼻窦手术治疗复发性鼻窦炎／鼻息肉的临床效果。方法68例患者随机分为试验组和对照组，试验组术前1周和术后1月（围手术期）服用鼻渊舒口服液，两组其它治疗措施相同包括内镜鼻窦手术。随访6个月后，以鼻内镜检查结果为标准，比较两组疗效。结果试验组34例中，23例治愈，7例好转，4例无效，有效率为88．2％；对照组34例中，16例治愈，6例好转，12例无效，有效率为64、7％。经1。检验,x^2=5．23，P〈0．05，两组疗效差异有显著性意义。结论鼻渊舒口服液结合内镜鼻窦手术能显著提高复发性鼻窦炎／鼻息肉的治疗效果，鼻渊舒口服液在围手术期的治疗中有重要作用。     

内镜鼻窦手术治疗慢性鼻-鼻窦炎临床结局的主客观评估

目的评估内镜鼻窦手术治疗慢性鼻．鼻窦炎的主客观临床结局并构建临床实用性的主客观结局评估体系。方法通过前瞻性队列研究，对120例慢性鼻-鼻窦炎患者术前和术后12个月的临床结局进行视觉模拟量表（visual analog scale，VAS）、医学结局研究简表36项（medical outcome study short-form 36-items，SF-36）和鼻腔鼻窦结局测试20条（sino-nasal outcome test-20，SNOT-20）等症状与生存质量的主观评估，以及内镜下黏膜形态、纤毛功能与组织病理学等客观评估。数据统计采用t检验、Х^2检验和Spearman相关分析处理手术前后主客观结局的变化及其相互关系。结果①术后12个月，VAS、SF-36和SNOT-20整体评分较术前明显改善（P〈0．01），其中85．96％、77．19％和83．33％的个体三项主观指标评分分别较术前改善，同时改善的比例为72．28％；手术前后各个时期，三种主观指标评分均具相关性（P值均〈0．01），其中SNOT-20兼性作用最大。②术后12个月，内镜下黏膜形态、纤毛功能和组织病理学整体评分较术前明显改善（P值均〈0．05），其中86．84％、86．81％和75．57％的个体三种客观指标评分分别较术前改善，同时改善的比例为71．85％；手术前后各个时期，三种客观指标评分均具相关性（P值均〈0．05），其中内镜下黏膜形态兼性作用最大。③SNOT-20与内镜下黏膜形态同时评估显示：术后12个月74．56％的患者主客观评分升降结局一致，而25．44％的患者主客观结局不一致，其中伴发鼻息肉患者更容易出现这种差异性（P〈0．05）。④手术前后不同时期，SNOT-20与内镜下黏膜形态评分均无相关性（P〉0．05），但前10位条目总分与内镜下黏膜形态评分具有相关性（0．18≤r≤0．42，P〈0．05），而后10位条目总分与之不相关（P〉0．05）。结论①内镜鼻窦手术可有效改善慢性鼻-鼻窦炎患者术后的症状、生存质量、内镜下黏膜形态、纤毛功能及组织状态等临床结局；②构建以SNOT-20和内镜下黏膜形态评估为主体的主客观结局评估体系，简约可靠，合理有效，具有临床实用性。     

影像导航鼻内镜系统在鼻内翻性乳头状瘤、鼻窦骨瘤中的应用

目的通过影像导航行鼻腔内翻性乳头状瘤、鼻窦骨瘤鼻内镜手术,与传统鼻内镜手术在手术时间、麻醉时间及出血量和复发率、并发症等方面进行比较分析。方法73例鼻腔内翻性乳头状瘤、鼻窦骨瘤患者被分成导航组与非导航组,导航组采用影像导航下鼻内镜手术,非导航组采甩传统鼻内镜手术。分析两组在手术时间、麻醉时间、出血量、并发症及术后疗效等情况。结果导航组与非导航组患者在麻醉时间比较差异无统计学意义（P=0．287）,在手术时间、出血量比较差异有统计学意义（P〈0．05）。鼻腔内翻性乳头状瘤导航组与非导航组Ⅰ＋Ⅱ级复发率比较差异无统计学意义,而在Ⅲ＋Ⅳ级中复发率比较差异有统计学意义（P=0．043）。鼻窦骨瘤中非导航组有1例复发,导航组未见复发病例。鼻腔内翻性乳头状瘤中,导航组与非导航组鼻内并发症比较差异有统计学意义（P〈0．05）,Ⅰ＋Ⅱ级鼻内并发症导航组与非导航组的发生率比较无显著差异（P〉0．05）,而在Ⅲ＋Ⅳ级中鼻内并发症的发生率比较有显著差异（P〈0．05）。在鼻窦骨瘤中导航组与非导航组鼻内并发症比较差异有统计学意义（P〈0．05）。结论对于鼻窦骨瘤及Ⅲ＋Ⅳ级鼻腔内翻性乳头状瘤,影像导航引导下鼻内镜术优于常规鼻内镜手术,尤其是在术前评价和确保术中的安全性有重要辅助作用,且肿瘤切除更彻底,复发概率更低。     

鼻内镜手术对慢性鼻-鼻窦炎鼻息肉患者临床症状和生活质量的影响

目的探讨鼻内镜手术方式对慢性鼻-鼻窦炎鼻息肉患者症状和生活质量（quality of life, QOL）的影响。方法通过医学结局研究简表36项健康调查(medical outcome study short-form 36-items healt 和 survey, MOS SF-36,简称 SF-36)和鼻腔鼻窦结局测量20条(sino-nasal outcome test-20, SNOT-20)对60例慢性鼻-鼻窦炎鼻息肉患者术前、术后1个月和术后6个月进行随访调查与评估,并从中选取多组鼻窦炎鼻息肉的患者采取不同范围的手术来评估手术方式对改善患者症状和生活质量的影响。结果经鼻内镜手术治疗,患者术后一个月SF-36量表的生理角色、心理健康、情感角色、总体健康等部分维度以及SNOT-20量表的20个条目总分与5大条目总分等指标均开始出现明显好转(P＜0．05),术后2～6个月上述指标则无显著提高(P＞0．05)。术后6个月症状与QOL状态较术前均全面改善,而手术方式对患者症状和QOL状态影响则无统计学意义（P＞0.05）。结论慢性鼻-鼻窦炎鼻息肉患者鼻内镜手术后6个月内症状基本缓解,生活质量基本恢复常态,改良鼻内镜手术对慢性鼻-鼻窦炎鼻息肉患者症状和生活质量的改善与传统鼻内镜手术基本相同。     

Haller气房解剖特点和临床意义

目的：了解Hailer气房解剖特点和临床意义。方法：对252例疑似慢性鼻窦炎的患者行鼻窦冠状CT检查，了解Hailer气房的解剖特点；对鼻窦炎患者行鼻内镜手术，术后随访以了解Hailer气房与疗效的关系。结果：252例患者中有89例出现Hailer气房，总发生率为35％，其中单侧58例，发生率为23％，双侧31例，发生率为12％，双侧发生率较低，而且有明显不对称性，包括大小和左右发生率；252例中慢性鼻窦炎168例，存在Hailer气房53例，比较非慢性鼻窦炎组与慢性鼻窦炎组，差异无统计学意义（P〉0．05），提示鼻窦炎发生与Hailer气房无必然联系；术后随访发现Hailer气房残存有13例，无效8例，无Hailer气房残存的40例中无效6例，两者比较差异有统计学意义（P〈0．01），提示鼻内镜手术疗效与Hailer气房有关，是复发原因之一。结论：Haller气房具有个体差异及不对称性的特点，不是鼻窦炎的必然病因，熟悉Hailer气房的解剖特点可能是提高鼻内镜手术疗效的关键因素之一。     

鼻息肉组织中一氧化氮与肿瘤坏死因子-α的表达及其相关性研究

目的：探讨一氧化氮(NO)与肿瘤坏死因子-α(TNF-α)在鼻息肉组织中的表达的相关性及其在鼻息肉形成过程中的作用。方法：应用化学比色法和放射免疫法对33例鼻息肉患者(鼻息肉组)的息肉、黏膜和血清标本及10例鼻中隔偏曲患者(对照组)的黏膜和血清标本进行NO和TNF-α的检测。结果：鼻息肉组的息肉和黏膜中的NO及TNF-α水平明显高于对照组的黏膜，其差异有极显著性意义(P＜0．01)，两组血清标本差异无显著性意义(P＞0．05)；鼻息肉组的息肉和黏膜中NO与TNF-α之间呈明显负相关(r＝一0．411，P＜0．05和r＝一0．476，P＜0．01)；息肉和黏膜中的TNF-α水平呈明显正相关(r＝0．808，P＜0．01)。结论：鼻息肉组织中有较高水平的NO及TNF-α的存在，且二者之间存在负反馈关系，提示NO与TNF-α在鼻息肉形成过程中有重要作用。     

鼻内镜下等离子射频消融术对合并鼻窦炎的小儿腺样体肥大患者疗效及鼻腔黏膜纤毛清除功能的影响

目的 探讨鼻内镜下等离子射频消融术治疗小儿腺样体肥大并鼻窦炎的临床疗效及对鼻腔黏膜纤毛清除功能的影响。 方法 选取腺样体肥大并鼻窦炎患儿96例,随机平均分为两组,对照组采用普通手术切除法,观察组采用低温等离子射频消融法,对比两组患者的手术时间、术中出血量、鼻内镜下评分下降幅值,采用糖精试验测定手术前后鼻腔黏膜纤毛传输速率(MTR)。 结果 两组患者的临床疗效比较差异无统计学意义(P>0.05)。两组患者的手术时间、术中出血量及鼻内镜下评分下降幅值比较,差异有统计学意义(P<0.05)。与手术前比较,对照组患者手术后MTR差异无统计学意义(P>0.05),观察组患者手术后MTR差异有统计学意义(P<0.05);与治疗组比较,观察组患者手术后MTR差异有统计学意义(P<0.05)。 结论 鼻内镜下等离子射频消融术治疗小儿腺体肥大并鼻窦炎的术中出血量少、手术时间短且对患者鼻腔黏膜纤毛清除功能影响不明显,临床疗效显著。     

慢性肥厚性鼻炎4种术式特点及下鼻甲黏膜的超微结构观察

目的：探讨治疗慢性肥厚性鼻炎4种不同术式的手术特点及下鼻甲黏膜超微结构的变化。方法：88例慢性肥厚性鼻炎患者行鼻内镜下鼻甲黏膜下成形术（A组），30例行下鼻甲部分切除术（B组），36例行射频消融下鼻甲减容术（C组），10例行下鼻甲硬化剂注射术（D组）。分别比较A、B、C3组术式治疗慢性肥厚性鼻炎的有效率、手术特点及术前、术后下鼻甲黏膜超微结构特征。结果：术后随访4～6个月，A、B、C3组的有效率分别为97．4％、100．0％和93．4％，差异无统计学意义（均P〉0．05）。A组和C组术式优点突出，下鼻甲黏膜纤毛结构保存较好。结论：鼻内镜下鼻甲黏膜下成形术和射频消融下鼻甲减容术是治疗慢性肥厚性鼻炎较好的手术方法。     

羟甲唑啉鼻喷剂改善伴鼻阻塞OSAHS患者行nCPAP顺应性

目的 探讨羟甲唑啉鼻喷剂对伴鼻阻塞的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者行经鼻持续气道正压通气(nCPAP)的疗效,明确伴鼻阻塞OSAHS患者改善鼻腔阻力提高nCPAP顺应性的意义。方法 将确诊存在鼻阻塞性病变的OSAHS患者随机分为试验组30例(nCPAP治疗前使用羟甲唑啉喷雾剂)和对照组30例(常规使用nCPAP治疗),采用嗜睡评价量表(Epworth)、治疗压力滴定对nCPAP治疗前后睡眠情况进行分析。结果 伴鼻阻塞的OSAHS患者羟甲唑啉喷雾后nCPAP治疗过程中的睡眠情况均较对照组改善,顺应性、依从性差异有统计学意义。结论 羟甲唑啉鼻喷剂提高伴鼻阻塞的OSAHS患者nCPAP治疗顺应性,通过治疗有望获得患者对nCPAP治疗依从性的提高。     

Oxymetazoline solutions inhibit middle ear pathogens and are not ototoxic

OBJECTIVES: This study was performed to explore the antimicrobial activity of two commercially available oxymetazoline hydrochloride preparations against the common pathogens of otitis media and to demonstrate the lack of ototoxicity of these agents and of United States Pharmacopeia (USP) oxymetazoline in a standard animal model. METHODS: Disc diffusion assays and minimum inhibitory concentration studies against American Type Culture Collection reference strains of common middle ear pathogens were used to evaluate the antimicrobial activity of oxymetazoline solutions and fluoroquinolone drops, and outer hair cell counts were performed on scanning electron micrographs of guinea pig basal cochlear segments after chronic exposure to oxymetazoline solutions and positive and negative controls. RESULTS: Oxymetazoline nasal spray and eyedrops had activity against all species tested except Haemophilus influenzae and Pseudomonas aeruginosa. The USP oxymetazoline had limited antimicrobial activity. Oxymetazoline nasal spray, oxymetazoline eyedrops, and USP oxymetazoline had ototoxicity profiles indistinguishable from that of the saline solution control. CONCLUSIONS: Commercially available oxymetazoline solutions are active against several of the common pathogens of otitis media. This antimicrobial activity is not due to oxymetazoline, and is more likely due to preservatives present in the solutions. The solutions tested are not ototoxic to guinea pig outer hair cells. Oxymetazoline solutions are potential substitutes for broad-spectrum antibiotic drops after tympanostomy tube placement.     

Effects of oxymetazoline on isolated rat’s tracheal smooth muscle

Oxymetazoline is often used as a decongestant in rhinitis patients who are suffering from nasal obstruction. It is used as a nasal drop or spray solution. The effect on nasal mucosa in vitro or in vivo is well known. However, the effect of the drug on tracheal smooth muscle has rarely been explored. During administration of the drug to the nose, it might affect the trachea via inhalation. We used our preparation to test the effectiveness of oxymetazoline on isolated rat’s tracheal smooth muscle. A 5 mm long portion of rat trachea was submersed in 30 ml Kreb’s solution in a muscle bath at 37°C. Changes in tracheal contractility in response to the application of parasympathetic mimetic agents were measured using a transducer connected to a Pentium III computer equipped with polygraphy software. The following assessments were performed: (1) effect on tracheal smooth muscle resting tension; (2) effect on contraction caused by 10⁻⁶ M methacholine as a parasympathetic mimetic; (3) effect of oxymetazoline on electrically induced tracheal smooth muscle contractions. Addition of parasympathetic mimetics to the incubation medium caused the trachea to contract in a dose-dependent manner. Addition of oxymetazoline induced a significant relaxation response when the preparation was up to 10⁻⁴ M. At the same concentration, the drug also could inhibit EFS induced spike contraction. Oxymetazoline had negligible effect on the basal tension of trachea as the concentration increased. The degree of drug-induced tracheal contraction or relaxation was dose-dependent. The study indicated that high concentrations of oxymetazoline might actually antagonize cholinergic receptors of the trachea.     

Vascular effects of topical oxymetazoline on human nasal mucosa

Oxymetazoline, a derivative of imidazoline, is a widely used nasal decongestant. In contrast to other topical decongestants related to phenylephrine, sympathomimetic amines, it also induces a reduced nasal mucosal blood flow. The purpose of the present investigation was to evaluate the duration of effect of oxymetazoline on nasal airway resistance and mucosal blood flow. During the eight hours of study, the blood flow was reduced by 30-40 per cent in six hours. A similar decongestant effect of about 30 per cent was found during the same interval. The pharmacological profile of oxymetazoline seems questionable, since a reduced nasal mucosal blood flow might not be of value in the treatment of upper airways infections.     

盐酸羟甲唑啉对慢性鼻窦炎离体钩突黏膜纤毛细胞纤毛摆动频率的短期影响

目的 观察不同浓度盐酸羟甲唑啉对体外培养的人钩突黏膜纤毛细胞纤毛运动的影响.方法采用组织块培养法,观察在加有羟乙基哌嗪乙磺酸[4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid,HEPES]的Hank平衡盐溶液(Hank balanced salt solution,HBSS)、0.25、0.50、1.00和2.00g/L的盐酸羟甲唑啉作用下,体外培养人鼻腔纤毛细胞的纤毛摆动频率(ciliarybeat frequency,CBF),并进行配对分析.结果 ① CBF在HBSS中20 min内无显著性变化(F=0.098,P=1.00);②0.25g/L盐酸羟甲唑啉组在20 min内与加药前CBF无明显变化,差异无统计学意义(F=0.124,P=1.00);③0.50g/L盐酸羟甲唑啉组与1.00g/L盐酸羟甲唑啉组类似,CBF轻微升高,并在1～2min内达到高峰,保持3～4min后,CBF开始缓慢下降,在测量最后达到最低值,但0.50g/L盐酸羟甲唑啉组与加药前相比,差异无统计学意义(F=2.94,P=0.05);1.00g/L盐酸羟唑啉组较加药前CBF降低,加药16 min后,差异有统计学意义(F=3.78,P=0.00);④2.00g/L盐酸羟甲唑啉组CBF在最初3min保持稳定,然后持续下降,差异有统计学意义(F=5.69,P=0.00);⑤各组在加药后的最大增加值,差异无统计学意义(F=0.85,P=0.50);加药后的最大下降值在1.00和2.00g/L的CBF明显降低,差异有统计学意义(F=23.74,P=0.00).结论 0.25～2.00g/L的盐酸羟甲唑啉对体外培养的人鼻腔纤毛细胞的纤毛运动存在一定浓度依赖性的抑制作用,且随着药物浓度的增加,抑制作用逐渐增强;0.50g/L盐酸羟甲唑啉可能更适用于临床应用.     

应用羟甲唑啉鼻喷剂观察鼻阻塞对阻塞性睡眠呼吸暂停低通气综合征患者的影响

目的探讨羟甲唑啉鼻喷剂对伴鼻阻塞的阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的影响,明确鼻阻塞在OSAHS发病中的意义。方法 53例存在鼻阻塞性病变的OSAHS患者,采用鼻声反射比较羟甲唑啉喷雾鼻腔前、后的差异性,PSG监测比较羟甲唑啉喷雾鼻腔前、后的主要指标差异。结果伴鼻阻塞的OSAHS患者羟甲唑啉喷雾鼻腔前、后鼻声反射检测指标：鼻腔最小横截面积（nasal minimal cross-sectional area,NMCA）和鼻阻力（nasal airway resistance,NAR）,包括NMCA（L）、NMCA（R）、NAR（L）、NAR（R）,差异有显著统计学意义,PSG监测指标中最长呼吸暂停时间、平均脉搏血氧饱和度差异有统计学意义,AHI、最低动脉血氧饱和度差异无统计学意义。结论羟甲唑啉鼻喷剂对伴鼻阻塞的OSAHS患者有一定疗效,证实鼻阻塞在OSAHS发病中起一定作用;对存在鼻阻塞性病变的OSAHS患者,鼻通气手术应纳入整个OSAHS治疗计划中。     

Effect on the Nasal Mucosa of Long-Term Treatment With Oxymetazoline,Benzalkonium Chloride,and Placebo Nasal Sprays

A parallel, randomized, double-blind study was performed in 30 healthy subjects to investigate the effects on the nasal mucosa of a 1-month treatment with nasal sprays. Ten subjects received oxymetazoline nasal spray; 10 subjects used a nasal spray containing the preservative benzalkonium chloride, and the others were treated with a placebo nasal spray. The three variables that were studied-nasal mucosal swelling, symptom scores, and nasal reactivity-were estimated by histamine challenge before and after 28 days of treatment. Rhinostereometry was used to measure nasal mucosal swelling and nasal reactivity. After 28 days of use, benzalkonium chloride spray alone induced an increase in nasal mucosal swelling. At the end of the month, the score for nasal stuffiness was significantly higher for the group treated with oxymetazoline than for those treated with benzalkonium chloride. Oxymetazoline nasal spray induced a pronounced increase in nasal reactivity, which was significantly greater than that induced in the placebo group. Long-term use of placebo and benzalkonium chloride nasal sprays also caused an increase in nasal reactivity, but not to the same extent as with the nasal sprays containing oxymetazoline. The authors concluded that long-term use of oxymetazoline induces a sensation of nasal stuffiness, which may be due to unconscious exaggeration of the degree of nasal stuffiness, induced nasal hyperreactivity, or a combination of both. These factors are probably the main reasons for the prolonged use of nasal decongestive sprays and the development of rhinitis medicamentosa. Benzalkonium chloride induces mucosal swelling, which explains why the presence of this preservative in a decongestant spray aggravates rhinitis medicamentosa. Laryngoscope, 106:605-609, 1996     

Effect of oxymetazoline nasal spray on intraocular pressure and retrobulbar hemodynamics

OBJECTIVES: To determine the effect of oxymetazoline nasal spray on intraocular pressure and retrobulbar hemodynamics in patients with open-angle glaucoma and to compare the results with those measured in healthy control participants. STUDY DESIGN: Controlled, prospective clinical trial. SETTING: University hospital. METHODS: Thirty patients with open-angle glaucoma and 30 healthy volunteers as controls were topically self-administered oxymetazoline nasal spray three times a day (one spray in each nostril of 0.05% concentration) for 5 days continuously. MAIN OUTCOME MEASURES: Intraocular pressure and retrobulbar hemodynamics were measured in glaucomatous and normal eyes at baseline and at the end of oxymetazoline application . RESULTS: Oxymetazoline nasal spray lowered intraocular pressure significantly in both the glaucoma group (p = .02) and the control group (p = .001) after 5 days of treatment. The systemic parameters in the glaucoma and control groups (systolic blood pressure, p = .14 and p = .17; diastolic blood pressure, p = .18 and p = .49; and pulse rate, p = .06 and p = .50, respectively) did not show statistically significant differences during the study period. Additionally, except with a significant decrease in the resistivity index of the central retinal artery in the glaucoma patients (p = .001), oxymetazoline nasal spray did not result in any significant changes in the retrobulbar hemodynamics in both the glaucoma and control groups. CONCLUSIONS: This study showed that a 5-day treatment with oxymetazoline nasal spray reduced intraocular pressure in both healthy controls and patients with glaucoma under treatment. In addition, it had no significant adverse effects on the retrobulbar hemodynamics.     

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.     

The effects of treatment with oxymetazoline on the lysozyme content of nasal fluid

Lysozyme is a protein with bacteriostatic properties secreted by nasal submucosal glands and which is a normal constituent of nasal fluid. The secretion of lysozyme is increased after rhinovirus inoculation¹ 1 IGarashi Y., SKoner D.P., DOyle W.J. and lysozyme may form an important component of respiratory defence against secondary bacterial infection. The effects of oxymetazoline on lysozyme are not known. This randomized controlled study investigates the effect of topical oxymetazoline on the total protein and lysozyme content of nasal fluid. Thirty healthy volunteers were randomized to receive either a normal saline nasal spray (placebo) or oxymetazoline 0.05% w/v in saline. Nasal lavage was performed on all subjects prior to the application of the spray and again 10 min later. The lavage collected was assayed for lysozyme (turbidometry) and total protein (Bradford). There was a significant decrease in both the lysozyme and total protein content of nasal lavage after application of oxymetazoline when compared with placebo (P < 0.05 Mann-Whitney U test). Oxymetazoline is known to cause vasoconstriction of both resistance and capacitance vessels in the nasal mucosa, and the decrease in lysozyme and total protein content of the nasal lavage after application of oxymetazoline may be due to a reduction in blood flow to nasal glands. One may speculate that the consequences of this are a decrease in the ability of the nose to defend itself against bacteria and we would suggest that this is a further reason for caution in the use of this medication.