Pathophysiology of chronic daily headache

Despite no clear explanation of the mechanism underlying chronic daily headache, sensitization of central nociceptive neurons is one possibility. Either prolonged activation of peripheral nociceptors or any factors that can alter the endogenous pain control system can trigger this process. A decrease in platelet serotonin has been observed in patients with chronic tension-type headache as well as migraine patients with medication-induced headache. It was also shown that chronic analgesic exposure led to changes in the serotonin content and the density of the 5-HT_2A receptor in the cerebral cortex. The plasticity of the serotonin-dependent pain control system may facilitate the process of sensitization and results in the development of chronic daily headache.     

Involvement of Pro‐Nociceptive 5‐HT2A Receptor in the Pathogenesis of Medication‐Overuse Headache

(Headache 2010;50:185‐197) Objectives.— To determine the involvement of 5‐HT_2A (5‐HT_2A) receptor in the process of trigeminal plasticity induced by chronic analgesic exposure and in the process of inflammatory‐induced thermal hyperalgesia. Background.— Derangement in 5‐HT_2A serotonin receptor has been reported to implicate in pathogenesis of medication‐overuse headache. No clear explanation concerning the precise roles of these receptors in the process. Methods.— Wistar rats were daily administered with paracetamol (200 mg/kg) for 30 days. On the next day, ketanserin, a 5‐HT_2A antagonist, or saline was given prior to cortical spreading depression (CSD) induction. Electrocorticogram, cortical blood flow, Fos and 5‐HT_2A‐immunoreactivity in cortex and trigeminal pathway were studied. In the other experiment, complete Freund's adjuvant was injected into the rat hind paw to induce tissue inflammation. Three days later, ketanserin was given and noxious heat was applied to both inflamed and noninflamed paws. The response between 2 sides was compared by measuring paw withdrawal latency. Results.— Chronic paracetamol exposure led to an increase in CSD frequency and CSD‐evoked Fos expression in cerebral cortex indicating the increase in neuronal excitability. Prolonged medication exposure also facilitated trigeminal nociception as evident by an increase in CSD‐evoked Fos expression in trigeminal nucleus caudalis. The expression of 5‐HT_2A receptor in cerebral cortex and trigeminal ganglia was enhanced by chronic paracetamol administration. Pretreatment with ketanserin significantly attenuated these effects. The second experiment showed that ketanserin was able to lengthen the paw withdrawal latency in the inflamed side but did not alter nociceptive response in the noninflamed side. Conclusion.— These findings suggest that up‐regulation of pro‐nociceptive 5‐HT_2A receptor is an important step in the process of cortical hyper‐excitation and nociceptive facilitation induced by chronic analgesic exposure.     

Pharmacokinetically enhanced amoxicillin/clavulanate (2,000/125 mg) in acute bacterial rhinosinusitis caused by Streptococcus pneumoniae, including penicillin-resistant strains

We evaluated the efficacy of a new pharmacokinetically enhanced formulation of amoxicillin/clavulanate (2,000/125 mg) twice daily for the treatment of acute bacterial rhinosinusitis (ABRS) caused by Streptococcus pneumoniae, particularly penicillin-resistant S pneumoniae (PRSP; penicillin minimum inhibitory concentrations [MICs]: > or = 2 microg/ml. A total of 2,482 patients received study medication (safety population). Of these, 2,324 were clinically evaluable (efficacy population), and 1,156 of them had at least one pathogen isolated at screening (bacteriology population). S pneumoniae was isolated from 371 patients in the bacteriology population, including 37 with PRSP. Follow-up in the bacteriology population on days 17 through 28 revealed that amoxicillin/clavulanate therapy was successful in 345 of 371 patients with S pneumoniae infection (93.0%) and in 36 of 37patients with PRSP infection (97.3%), including 7 of 8 patients (87.5%) whose amoxicillin/clavulanic acid MICs were 4/2 microg/ml or higher. Pharmacokinetically enhanced amoxicillin/clavulanate was generally well tolerated, as only 2.2% of patients withdrew because of adverse events. This agent represents a valuable new therapeutic option for the empiric treatment of ABRS, particularly in areas where antimicrobial-resistant pathogens (including beta-lactamase-positive organisms) are prevalent, and for the treatment of patients who are at increased risk of infection with PRSP.     

Otolaryngic allergy. The last half-century.

The American Academy of Otolaryngic Allergy (AAOA) celebrated 1991 as its 50th anniversary. This article reviews the last 50 years in otolaryngology and examines the lives of such prominent individuals as F. Hansel, H. Rinkel, G. Shambaugh, R. Williams, and others. The development of the Academy from a small group of individuals to its present status is presented.     

Effect of serotonin depletion on nitric oxide induced cerebrovascular nociceptive response

The study was conducted to investigate the effect of serotonin depletion on nitric oxide-induced meningeal vascular response and cerebrovascular nociception. Nitroglycerin was infused i.v. to control and serotonin-depleted rats. Pial circulation was monitored by intravital fluorescent videomicroscopy and Fos immunoreactivity trigeminal nucleus caudalis neurons was used as an indicator for the cerebrovascular nociception. The results showed that the degree of nitric oxide-induced pial microvascular dilatation was significantly greater in the serotonin-depleted group than the control. The number of nitric oxide-evoked Fos-immunoreactive cells between the two groups remained comparable. The results suggest that though depletion of serotonin can facilitate the vascular response to nitric oxide it does not alter the nitric oxide-induced craniovascular nociceptive response.     

Perilymph fistula

Perilymph fistula occurs when endolymph and perilymph mix, or when perilymph leaks into the middle ear space. Sensorineural hearing loss and/or vertigo may result. This paper reviews the pertinent anatomy and physiology of the inner ear, clinical presentations, diagnosis, treatment, and prognosis as a guide for the clinician.