The relationship between particle deposition in the anterior nasal passage and nasal passage characteristics.

The objective of this study was to examine the effects of nasal passage characteristics on anterior particle deposition during cyclical breathing. Forty healthy, nonsmoking, adult subjects participated in this study. Nasal passage characteristics such as nostril length, width, angle, ellipticity, and minimum nasal cross-sectional area were measured. The subjects inhaled a polydisperse radioactively tagged aerosol (mass median aerodynamic diameter = 5.4 microns, geometric standard deviation [GSD] = 1.3) into the nose and exhaled through the mouth. The amount of radioactivity in the nose was measured immediately after inhalation and thereafter for 54 minutes. At 52.5 minutes, subjects wiped the accessible portion of the anterior nose to remove any remaining activity. The difference in activity at 52 and 54 minutes was used as a measure of activity removed during the nose wipe. Percentage of activity in the nasal passage at 52 minutes and percentage of activity removed with the nose wipe were considered surrogates for particles deposited in the anterior nasal passage. A multiple regression analysis showed that the degree of ellipticity of the nostrils was significantly related to particle deposition in the anterior nasal passage. These results suggest that ellipticity of the nostrils may be a determinant of the amount of particle deposition in the anterior nasal passage.     

Merocel高分子止血膨胀材料在老年鼻出血患者鼻腔填塞中的效果观察

目的观察Merocel高分子止血膨胀材料在老年鼻出血患者鼻腔填塞中的应用效果。方法使用Merocel高分子止血膨胀材料对48例患者(Merocel组)进行鼻腔填塞,以凡士林纱对53例患者(对照组)进行鼻腔填塞,比较两组的局部疼痛、睡眠障碍发生情况、止血效果及抽出时出血量、黏膜愈合情况。结果两组的局部疼痛、睡眠障碍发生情况及出血量均有显著性差异(P<0.01)。结论Merocel高分子止血膨胀材料在鼻腔填塞中的疗效肯定,安全有效,通过适当护理,将大大减少鼻腔填塞的痛苦。     

Maximal nasal inspiratory flow rate: Its use in assessing the effect of pseudoephedrine in vasomotor rhinitis

Summary The maximal nasal inspiratory flow rate has been used as an objective test to assess the effect of pseudoephedrine in patients with vasomotor rhinitis. In a double blind trial oral pseudoephedrine (60 mg) was shown to produce a significant increase in maximal nasal flow when compared with the effect of a placebo. The improvement seen after pseudoephedrine was comparable to that seen after the installation of ephedrine nose drops.     

Treatment of posttraumatic nasal deformity

This paper surveys 57 consecutive cases of posttraumatic rhinoplasty. The commonest cause of injury was sporting activities. Thirty-seven percent of patients had additional non traumatic nasal problems. Ninety-four percent considered the nasal appearance and airway after surgery to be either satisfactory or significantly improved. There were no serious complications. It is concluded that this type of surgery is effective in improving the appearance and function of the traumatised nose while preaccident nasal pathology may usually be helped simultaneously.     

The nasal airways response in normal subjects to oxymetazoline spray: randomized double-blind placebo-controlled trial

AIMS: The effects of a single dose of oxymetazoline nasal spray on nasal patency have been compared with placebo using three separate measuring systems in normal subjects. METHODS: The study was a placebo-controlled, randomised double-blind crossover trial. Subjects without ear, nose or throat disease and with resting nasal airways resistance >0.15 Pa s cm-3 were selected so that a fall in airways resistance could be detected. Nasal airways resistance (NAR) was measured by NR6-2 rhinomanometer. Acoustic rhinometry (SR-2000 rhinometer) provided the sum of the minimum cross-sectional areas (tMCA) and volume (tVOL) of the left and right nasal cavities. Symptoms of congestion were assessed on a visual analogue scale (CON, range 0-100). Measurements were made for 60 min before and for 120 min after bilateral administration of oxymetazoline nasal spray (0.9 mg) or placebo (0.9% saline). Crossover occurred 7-21 days later. Results for all measures were analysed as change from average baseline value by trapezoidal AUC, and statistical significance was tested by 2-way anova. RESULTS: NAR, tMCA, tVOL and CON did not change after placebo, but NAR and CON fell and tMCA and tVOL increased significantly at all timepoints after oxymetazoline. NAR_AUC, tVOL_AUC, tMCA_AUC were significantly different between placebo and oxymetazoline (P<0.001) as was CON_AUC (P=0.012). The day-to-day intraindividual repeatability of baseline NAR tMCA and tVOL was <10%. CONCLUSIONS: Normal subjects can be used to detect the effects of nasally vasoactive drugs with a variety of complementary systems, with the advantages of easy subject recruitment and low variability.     

Characterization of deposition from nasal spray devices using a computational fluid dynamics model of the human nasal passages.

Many studies suggest limited effectiveness of spray devices for nasal drug delivery due primarily to high deposition and clearance at the front of the nose. Here, nasal spray behavior was studied using experimental measurements and a computational fluid dynamics model of the human nasal passages constructed from magnetic resonance imaging scans of a healthy adult male. Eighteen commercially available nasal sprays were analyzed for spray characteristics using laser diffraction, high-speed video, and high-speed spark photography. Steadystate, inspiratory airflow (15 L/min) and particle transport were simulated under measured spray conditions. Simulated deposition efficiency and spray behavior were consistent with previous experimental studies, two of which used nasal replica molds based on this nasal geometry. Deposition fractions (numbers of deposited particles divided by the number released) of 20- and 50-microm particles exceeded 90% in the anterior part of the nose for most simulated conditions. Predicted particle penetration past the nasal valve improved when (1) the smaller of two particle sizes or the lower of two spray velocities was used, (2) the simulated nozzle was positioned 1.0 rather than 0.5 or 1.5 cm into the nostril, and (3) inspiratory airflow was present rather than absent. Simulations also predicted that delaying the appearance of normal inspiratory airflow more than 1 sec after the release of particles produced results equivalent to cases in which no inspiratory airflow was present. These predictions contribute to more effective design of drug delivery devices through a better understanding of the effects of nasal airflow and spray characteristics on particle transport in the nose.     

Capsaicin sensitive sensory neurons mediate the response to nasal irritation induced by the vapour phase of cigarette smoke

Cigarette-smoke exposure in awake guinea-pigs induced reproducible nose wipings with the fore-paws. This behaviour was used as a model to study the mechanisms underlying the irritant effect of cigarette smoke. The nose wipings upon smoke exposure were abolished after local anaesthesia of the nasal mucosa, which indicates that this response was due to activation of nasal protective reflexes. Removal of the particulate phase of the smoke including nicotine using a Cambridge filter only slightly reduced the wiping response, and nicotine-free cigarettes also induced marked irritation. This suggests that irritant chemicals in the vapour phase of the smoke caused this effect. Systemic capsaicin pretreatment, which is known to cause a functional impairment of chemosensitive C-fibre afferents, abolished the nose wiping behaviour seen upon smoke exposure. Local pretreatment of the nasal mucosa with capsaicin also significantly reduced the number of smoke-induced nose wipings. It is concluded that smoke-induced irritation, as indicated by nose wipings, is primarily due to activation of capsaicin-sensitive sensory nerves in the nasal mucosa by vapour-phase components.     

鼻内镜下治疗中老年人顽固性鼻出血的临床分析

目的：总结鼻内镜下治疗中老年人顽固性鼻出血的临床经验。方法对鼻内镜下治疗顽固性鼻出血患者312例的临床资料进行回顾性分析。结果出血部位主要是鼻腔上部的中鼻甲前端对应的鼻中隔面与嗅裂区,其次是鼻腔后部的中鼻甲后端与中鼻道、下鼻甲后端与下鼻道,鼻腔前部的鼻中隔利特尔区出血较少。经鼻内镜下射频止血或膨胀海绵区域性填塞治疗后,治愈310例,无效2例,总有效率99．4％。随访3个月,无复发病例。结论对于中老年人顽固性鼻出血,经鼻内镜下射频止血或膨胀海绵区域性填塞治疗,方法简单且疗效确切,值得推广应用。     

Histamine H3 receptor activation inhibits neurogenic sympathetic vasoconstriction in porcine nasal mucosa

Histamine release from mast cells is a primary mediator of rhinorrhea, nasal mucosal swelling, increased secretion, sneezing, pruritis and congestion that occur in allergic rhinitis. It is well known that histamine H(1) receptor antagonists inhibit the itch and rhinorhea, but do not block the allergic nasal congestion. A growing body of evidence shows that in addition to histamine H(1) receptors, activation of H(3) receptors may contribute to the procongestant nasal actions of histamine. Activation of the prejunctional histamine H(3) receptor modulates sympathetic control of nasal vascular tone and resistance. The present study was conducted to further characterize the role of histamine H(3) receptors on neurogenic sympathetic vascular contractile responses in isolated porcine nasal turbinate mucosa. We presently found that the histamine H(3) receptor agonist, (R)-alpha-methylhistamine (10-1000 nM), inhibited electrical field stimulation-induced sympathetic vasomotor contractions in a concentration-dependent fashion. Pretreatment with either of the selective histamine H(3) receptor antagonists, thioperamide and clobenpropit, blocked the sympathoinhibitory effect of (R)-alpha-methylhistamine in porcine turbinate mucosa. The effect of compound 48/80, an agent that elicits the release of endogenous histamine from mast cells on nasal sympathetic contractile responses, was also tested. The action of compound 48/80 to release mast cell-derived histamine in the nose mimics many of the nasal responses associated with allergic rhinitis, extravascular leakage and decreased nasal patency. We presently found that compound 48/80 also inhibited the electrical field stimulation-induced sympathetic response. Pretreatment with the H(3) receptor antagonist clobenpropit blocked the sympathoinhibitory action of compound 48/80 on sympathetic contractile responses in nasal mucosa. Taken together, these studies indicate that histamine H(3) receptors modulate vascular contractile responses by inhibition of noradrenaline release from sympathetic nerve terminals in nasal mucosa. It is further suggested that histamine H(3) receptors may play a role in the regulation of vascular tone and nasal patency in allergic nasal congestive disease.     

Nasal tumours in rats after severe injury to the nasal mucosa and prolonged exposure to 10 ppm formaldehyde

To study the significance of damage to the nasal mucosa for the induction of nasal tumours by formaldehyde in rats, a long-term inhalation study was conducted in which male rats with severely damaged or undamaged nose were exposed 6 h/day for 5 days/week to 0, 0.1, 1.0 or 10 ppm formaldehyde vapour for 28 months, or for 3 months followed by a 25-month observation period. The damage to the nasal mucosa was induced by bilateral intranasal electrocoagulation. The total number of rats used was 720, 480 with damaged and 240 with intact nose. Compound-related degenerative, inflammatory and hyperplastic changes of the nasal respiratory and olfactory mucosa were invariably observed when rats with intact nose were exposed to 10 ppm but not when exposed to 1.0 or 0.1 ppm formaldehyde. Nasal electrocoagulation increased the incidences of formaldehyde-induced rhinitis, hyper- and metaplasia of the respiratory epithelium, and degeneration and hyper- and metaplasia of the olfactory epithelium. In addition, exposure to 10 ppm formaldehyde for 28 months produced nasal squamous cell carcinomas in rats with damaged nose (15/58) but not in rats with intact nose. Three months of exposure to 10 ppm formaldehyde or exposure to 0.1 or 1.0 ppm formaldehyde for 28 months had no such effect. It was concluded that severe damage to the nasal mucosa may contribute to the induction of nasal tumours by formaldehyde.     

The biopharmaceutical aspects of nasal mucoadhesive drug delivery

Nasal drug administration has frequently been proposed as the most feasible alternative to parenteral injections. This is due to the high permeability of the nasal epithelium, allowing a higher molecular mass cut‐off at approximately 1000 Da, and the rapid drug absorption rate with plasma drug profiles sometimes almost identical to those from intravenous injections. Despite the potential of nasal drug delivery, it has a number of limitations. In this review, the anatomy and physiology of the nasal cavity, as well as ciliary beating and mucociliary clearance as they relate to nasal drug absorption, are introduced. The rationale for nasal drug delivery and its limitations, some factors that influence nasal drug absorption, and the experimental models used in nasal drug delivery research are also reviewed. Nasal mucoadhesion as a promising method of nasal absorption enhancement is discussed, and factors that influence mucoadhesion, as well as safety of nasal mucoadhesive drug delivery systems are reviewed in detail. Nasal drug administration is presently mostly used for local therapies within the nasal cavity. Anti‐allergic drugs and nasal decongestants are the most common examples. However, nasal drug administration for systemic effects has been practised since ancient times. Nasally‐administered psychotropic drugs by native Americans, the use of tobacco snuffs, and nasal administration of illicit drugs such as cocaine are all well known (Illum & Davis 1992). Nowadays, the nasal cavity is being actively explored for systemic administration of other therapeutic agents, particularly peptides and proteins (Illum 1992; Edman & Bjork 1992), as well as for immunization purposes (Lemoine et al 1998). To better understand the basis for nasal drug absorption and factors that can influence it, a brief review of the anatomy and physiology of the nose is appropriate.     

The effect of platelet activating factor on nasal hypersensitivity

Summary Platelet activating factor (PAF) is known to have a wide range of biological activities. In the lower airways PAF has been suggested as the biochemical mediator partly responsible for the bronchial hyperreactivity which is a feature of asthma. In order to study whether PAF has a similar effect in the upper airways, we carried out a double blind, placebo-controlled cross-over study in twelve patients with strictly seasonal allergic rhinitis. The study was performed in pollen-free winter months.26 µg PAF or placebo was sprayed into each nasal cavity 8 h and 1 h before a nasal allergen challenge. The nasal response to PAF and the allergen challenge that followed was monitored by repeated measurements of nasal expiratory peak flow rate and symptom scores.PAF induced only minor changes in nasal patency and nasal symptoms as compared to placebo. However, pretreatment with PAF induced an increase in responsiveness of the nasal vasculature to the allergen challenge that followed. This was registered as a small, but statistically significant increase in the symptom scores for nasal blockage, from 1.7 (0.3; SEM) after placebo pretreatment to 2.4 (0.36; SEM) after PAF (p<0.05). A similar trend was also noted for the measurements of nasal peak flow. The other response parameters, sneezes and secretion, remained identical.These results suggest that PAF may play a role in human nasal hyperreactivity, but it appears that PAF is not a major mediator involved in the induction of this phenomenon.     

Anatomy, physiology and function of the nasal cavities in health and disease

In studying drug absorption from the nasal mucous membrane, it is essential to have a clear understanding of anatomy and physiology of the nose, and how it relates to the characteristics of the delivery system used. The human nose is characterized by an individually varying shape and caliber, which might interfere with standard recommendations of intranasal medication. It is also of significance that there is a tendency for reflex- induced and profuse watery hypersecretion from glands, and for quick and considerable changes of mucosal thickness due to the presence of large venous sinusoids. These are factors which can interfere with pharmacokinetics. Also mucociliary transport rate has to be taken into consideration, as the drug is removed from the absorptive mucous membrane within 30 min. Intranasal drug distribution has been poorly studied in relation to nasal anatomy and pathology. In contrast to common believe, nasal inflammation does not seem to increase drug absorption. On the contrary, blockage, sneezing and rhinorrhoea might preclude the absorption.     

曲安奈德喷雾剂对变应性鼻炎的作用

目的研究曲安奈德鼻腔局部给药对实验性变应性鼻炎动物模型的治疗作用及对组胺致大鼠鼻气道阻力增加的缓解作用。方法以实验性变应性鼻炎模型豚鼠和组胺致鼻气道阻力增加模型大鼠为试验对象 ,以豚鼠鼻腔分泌物量、喷嚏次数、搔鼻次数、鼻组织学及大鼠鼻气道阻力为指标 ,全面考察曲安奈德喷雾剂对变应性鼻炎的作用。结果曲安奈德鼻喷雾剂 (5 0、10 0、2 0 0 μg·kg-1,对卵蛋白致敏实验性变态反应性鼻炎豚鼠模型的各种变应性鼻炎的症状和体症均有明显改善作用 ;与模型对照组比较 ,各给药组动物鼻腔分泌物量、喷嚏次数、抓鼻次数明显减少 ,并可对抗组胺所致大鼠鼻气道阻力的增加。结论曲安奈德鼻喷雾剂鼻腔局部给药对实验性变应性鼻炎有显著改善作用     

Rate of Staphylococcus aureus nasal carriage in immunocompromised patients receiving haemodialysis treatment

Specimens from the nose and throat were collected from 28 long-term haemodialysed patients. Staphylococcus aureus strains were isolated from sixteen patients who been on haemodialysis for over 113 months. Cytokine levels, as well as full blood cell differential counts and cell surface antigens were determined in these patients. The serum concentration of TGF-beta was significantly higher in patients carrying Staphylococcus aureus. CD14 and HLA-DR molecule expression on monocytes, as well as NK cell percentage was significantly different in S. aureus carriers. Our preliminary results suggest that immune status imbalance in haemodialysed patients could be related to the high incidence of S. aureus nasal carriage and infections.     

83例原发性鼻腔癌放射治疗的临床疗效分析

目的通过回顾性分析，寻找鼻腔癌最佳治疗方案和影响预后的因素。方法对83例鼻腔癌单纯外照射治疗进行回顾性分析，放疗方式采用60Co机外照射，以鼻前野为主野，颞颌野为辅野，剂量为40-80Gy，颈部加预防照射。结果83例鼻腔癌中生存10年以上的有30例，生存率为36．1％，死于局部复发21例，死于转移19例。结论鼻腔癌的治疗方案应根据分期，病理类型来选择，以便获得较好疗效。早期病例可行单纯放疗，晚期病例应以综合治疗为主。分化差的鼻腔癌应选择放疗加化疗，而鳞癌，腺癌应以放疗加手术的综合治疗为宜。     

表皮生长因子治疗鼻中隔粘膜糜烂性鼻出血

目的：观察表皮生长因子治疗鼻中隔粘膜糜烂性鼻出血的疗效。方法：治疗组６２例（男性２９例，女性３３例；年龄３５±ｓ６ａ）用０．２％表皮生长因子明胶海绵敷贴在鼻中隔的糜烂面上，并用该药液滴鼻，每次４滴，ｑｉｄ×１０ｄ。对照组３０例（男性１４例，女性１６例，年龄３２±５ａ）用０．２５％氯霉素明胶海绵敷贴，并用此药滴鼻，每次４滴，ｑｉｄ×１０ｄ。结果：治疗组出血停止，鼻腔干燥，刺痛感消失，粘膜恢复正常的平均天数及复发率均低于对照组（Ｐ＜０．０１），未见不良反应。结论：表皮生长因子可作为治疗鼻中隔粘膜糜烂性鼻出血的满意制剂。     

鼻可乐在鼻咽癌放疗后鼻腔冲洗的效果评价

目的探讨鼻咽癌放疗后鼻腔冲洗的临床效果。方法将我院2010年1月至2011年3月收治的96例鼻咽癌放疗患者随机分为观察组和对照组,每组48例,对照组采用常规药物冲洗,观察组采用鼻可乐冲洗,两组均治疗7～8周,比较两组患者鼻臭、鼻塞、鼻出血的发生率。结果观察组在鼻臭、鼻塞、鼻出血的发生率均少于对照组,（P〈0.05）。结论应用鼻可乐鼻腔冲洗能够显著降低鼻咽癌放疗后的并发症,值得临床推广。     

Mometasone furoate sinus implant – a new targeted approach to treating recurrent nasal polyp disease

ABSTRACT

Introduction: Chronic rhinosinusitis (CRS) is a broad heterogeneous inflammatory disorder of the nose and paranasal sinuses, resulting from the dysfunctional interplay between host immunity, defective epithelial barrier, and environmental factors. CRS with nasal polyps (CRSwNP) is considered a more severe clinical phenotype with greater burden of symptoms and higher relapse rate, especially with comorbid asthma or aspirin sensitivity. Available treatment options after endoscopic sinus surgery (ESS) – systemic corticosteroids or revision surgery – have significant risks and limitations.

Areas covered: Bioabsorbable, steroid-eluting implants have been studied extensively for the ability to dilate and re-establish sinus patency by the localized, controlled delivery of topical corticosteroids to diseased sinonasal lining and nasal polyps. This review provides a comprehensive, up to date analysis of the literature regarding a novel, office-based, mometasone furoate (MF) sinus implant that may treat patients with recurrent CRSwNP after ESS.

Expert commentary: Clinical evidence has demonstrated the safety and efficacy of steroid-eluting implant in the reduction of polyp size, symptom burden, and the need for revision sinus surgery. MF sinus implants may play an important role in the management of patients with recurrent polyposis after sinus surgery.     

牙槽裂取髂骨用于鼻堤及鼻翼基底凹陷畸形

目的 通过单侧牙槽突裂及梨状孔基底部手术植骨前后的观察,探讨鼻外形矫治的临床效果。方法 手术前、后拍摄轴位、矢状位CT软组织像,分别测量健侧与患侧软组织及骨组织高度及观察外形满意度。结果通过观察,36例中其中34例患者行牙槽突裂植骨手术6个月后随访,鼻孔宽度和高度均有变化,鼻堤及鼻外侧脚凹陷畸形明显改善,手术后患者面部形态满意。结论 牙槽突裂患者行鼻基底植骨,明显改善鼻堤及鼻翼凹陷畸形,为发育不良的上颌骨梨状孔缺损植骨稳定后鼻堤及鼻外侧脚畸形进一步整复打下基础。