Premedication Methods in Nasal Endoscopy: A Prospective, Randomized, Double-Blind Study

OBJECTIVES: To identify the optimal pharmacological method of preparing patients for nasal endoscopy. METHODS: Twenty healthy volunteers were enrolled in this prospective, randomized, double-blind study. Four types of medications were applied in their nostrils with binary combinations of spray bottles on four different days in a random order: placebo (normal saline [NS]+NS), decongestant (NS+oxymetazoline), anesthetic (NS+lidocaine), and decongestant plus anesthetic (oxymetazoline+lidocaine). Rigid nasal endoscopy was performed 10 minutes after spray application. The volunteers evaluated the discomfort caused by each spray application, and nasal pain scores due to the passage of the endoscope. The physicians quantified nasal decongestion using a visual analogue scale. Endoscopy duration as well as pulse and mean blood pressure (MBP) before spray application, 10 minutes after the application, and immediately after endoscopic examination were also recorded. RESULTS: The discomfort caused by lidocaine was significantly higher than that caused by the other sprays (P<0.001). The lowest pain score related to endoscopy was obtained for oxymetazoline+lidocaine (P<0.001). Nasal decongestion was best achieved with NS+oxymetazoline (P<0.001). Endoscopy duration was the shortest for oxymetazoline+ lidocaine (P<0.05). Statistically significant MBP changes were only seen with the application of NS+oxymetazoline (P<0.05). However, neither MBP nor pulse rate change was significant clinically. CONCLUSION: Application of decongestant and anesthetic sprays together seems to be the best method of pharmacological preparation of patients for nasal endoscopy.

Arnica montana and blood loss, surgical field bleeding and operative time in endoscopic sinus surgery: A Randomized-controlled trial

@#<p><strong>OBJECTIVE:</strong>To determine the association of Arnica montana and blood loss, surgical field bleeding and operative time in endoscopic sinus surgery among adults with chronic rhinosinusitis with nasal polyposis.</p> <p><strong>METHODS:</p></strong> <p><strong>Design:</strong> Single-blinded Randomized Controlled Trial</p> <p><strong>Setting:</strong> Tertiary government hospital</p> <p><strong>Participants:</strong> Forty-one (41) adults aged 19-76 years old with chronic rhinosinusitis with nasal polyposis and meeting inclusion criteria were randomly divided into two groups, Arnica and control. The former took 5 sublingual Boiron® Arnica montana 30C pellets, 12 hours then 1 hour prior to surgery; the latter did not. Both groups had routine oxymetazoline and lidocaine-epinephrine decongestion. Intraoperative blood loss, surgical field bleeding quality and operative time were assessed by blinded surgeons and anesthesiologists. </p> <p><strong>RESULTS:</strong> Mean estimated blood loss was 187ml (SD 100.14) for controls versus 72ml (SD 12.59) for the Arnica group; (p < 0.05). Mean operative time was 3.55 hours (SD 1.25) for controls and 3.44 hours (SD 1.57) for the Arnica group; (p=0.9). Surgical field bleeding was graded slight with 75% needing occasional suctioning (grade 2) and 25% needing frequent suctioning (grade 3) in the Arnica group, versus moderate bleeding with more frequent suctioning (grade 4) in 71% and slight bleeding but needing frequent suctioning (grade 3) in 29% of controls.</p> <p><strong>CONCLUSION:</strong> In this randomized clinical trial, Arnica montana was associated with less blood loss and less surgical field bleeding compared to controls, but there was no difference in mean operative times.  Arnica montana may be effective in reducing blood loss and improving surgical field quality during endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis.</p> <p> </p>

Correlação entre a resistência nasal e diferentes parâmetros da rinometria acústica em crianças e adolescentes com e sem rinite alérgica / Correlation between nasal resistance and different acoustic rhinometry parameters in children and adolescents with and without allergic rhinitis

Rinometria acústica e rinomanometria são importantes técnicas de avaliação da função nasal. Ainda não está definido em que extensão suas variáveis se correlacionam. OBJETIVO: Avaliar as relações entre a resistência nasal (RN) e parâmetros da rinometria acústica em crianças e adolescentes com rinite alérgica e controles. MÉTODO: Vinte pacientes com rinite alérgica e 20 controles foram avaliados. RN, volumes (V4, V5, V2-5) e menores áreas transversais (MC1, MC2) foram mensurados em três momentos: basal, após indução de obstrução nasal e após descongestionante tópico. RESULTADOS: No grupo rinite, a RN se correlacionou significantemente com todos os volumes (V5: r = -0,60) e com MC2. Nos controles, MC1 foi o parâmetro com melhor correlação com a RN no momento basal (r = -0,53) e após descongestionante. Na análise conjunta dos dados, V5 foi o que apresentou as melhores correlações, no momento basal (r = -0,53), quando obstruído (r = -0,58) e após descongestionante (r = -0,46). CONCLUSÕES: Nossos dados demonstram haver correlação negativa e significante entre os valores de rinometria acústica e RN. Em geral, os volumes apresentaram melhor correlação com a RN do que as menores áreas transversais. V5 foi a variável com melhor correlação no grupo com rinite alérgica e na análise conjunta.

Acoustic rhinometry and rhinomanometry are important tests used to assess nasal function. The degree to which the parameters of these tests are correlated is yet to be established. OBJECTIVE: This paper aimed to study the correlations between nasal resistance (NR) and acoustic rhinometry parameters in children and adolescents with allergic rhinitis and controls. METHOD: Twenty patients with allergic rhinitis and 20 controls were enrolled. NR, volumes (V4, V5, V2-5), and minimal cross-sectional areas (MC1, MC2) were measured in three moments: baseline, after induction of nasal obstruction and after topical decongestant administration. RESULTS: Patients with allergic rhinitis had significant correlation between NR and all volumes (V5: r = -0.60) and with MC2. Among controls, MC1 was the parameter with the strongest correlation with NR at baseline (r = -0.53) and after decongestant administration. In the combined analysis, V5 had the highest correlation coefficients at baseline (r = -0.53), after obstruction (r = -0.58) and after decongestant (r = -0.46). CONCLUSIONS: Our data showed that NR and acoustic rhinometry parameters have negative and significant correlations. Nasal volumes are, in general, better correlated than minimal cross-sectional areas. V5 was the parameter with the highest correlation in the rhinitis group and in the combined analysis.

Síndrome do balonamento apical secundário ao uso abusivo de descongestionante nasal / Apical ballooning syndrome secondary to nasal decongestant abuse / Síndrome del abombamiento apical secundario al uso abusivo de descongestionante nasal

Descrevemos um caso típico de síndrome do balonamento apical em uma paciente octogenária com alteração eletrocardiográfica, de contratilidade do ventrículo esquerdo, e que apresentou recuperação da função ventricular. A paciente é portadora de rinite alérgica e fez uso excessivo de descongestionante nasal horas antes do episódio da dor.

We describe a typical case of apical ballooning syndrome in an octogenarian female patient with left ventricular wall motion abnormality on electrocardiography, whose ventricular function returned to normal. The patient has allergic rhinitis and had used nasal decongestant excessively a few hours prior to the episode of pain.

Describimos un caso típico de síndrome de abombamiento apical en una paciente octogenaria con alteración electrocardiográfica, de contractilidad del ventrículo izquierdo, y que presentó recuperación de la función ventricular. La paciente es portadora de rinitis alérgica y hace uso excesivo de descongestionante nasal horas antes del episodio del dolor.

Effects of oxymetazoline hydrochloride on ex vivo human nasal cilia movement measured with high-speed digital microscopy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of oxymetazoline hydrochloride on ex vivo human nasal cilia movement.</p><p><b>METHODS</b>Ciliary beat frequency (CBF) of cultured human nasal epithelial cells was measured by high-speed digital microscopy in HBSS and oxymetazoline hydrochloride of different concentrations in 20 minutes. RESULTS; CBF of cultured nasal epithelial cells in HBSS and 0.25 g/L oxymetazoline hydrochloride did not show significant changes in 20 minutes (F = 0.098, P = 1.00). However, in 0.50 g/L and 1.00 g/L oxymetazoline hydrochloride, CBF increased slightly in 3 -4 minutes and reached the apex, then decreased gradually. At the end of observation, CBF showed no significant difference in 0.50 g/L, (F = 2.94, P = 0.05) but there was a significant lower CBF in 1.00 g/L. In the first 3 minutes, the CBF in 2.00 g/L oxymetazoline hydrochloride was stable, and then slowed gradually. After 16 minutes, there was significant difference. In initial, the highest normalized CBF of each group showed no significant difference. However, the lowest normalized CBF of 1.00 and 2.00 g/L oxymetazoline hydrochloride showed a significant difference with HBSS, 0.25 and 0.50 g/L oxymetazoline hydrochloride.</p><p><b>CONCLUSIONS</b>Oxymetazoline had a concentration-dependent inhibitory effect on cultured human nasal CBF from 0.25 to 2.00 g/L. The inhibitory effect increased with the concentration going up. Oxymetazoline hydrochloride of 0.50 g/L might be the optimal choice for clinical application.</p>

Exposiçäo aguda a derivados imidazolínicos em crianças / Acute exposure to imidazoline derivatives in children

OBJETIVOS: Estudar a exposiçäo aguda a derivados imidazolínicos em crianças com idade inferior a 15 anos, atendidas no período de janeiro de 1994 a dezembro de 1999. MÉTODOS: Neste estudo retrospectivo foram avaliadas 72 crianças com idades entre dois meses e 13 anos, mediana de dois anos (25 por cento a 75 por cento; um a três anos), expostas a nafazolina (n = 48), fenoxazolina (n = 18), oximetazolina (n = 5) e tetrizolina (n = 1); por via oral (n = 46), nasal (n = 24) ou desconhecida (n = 2). RESULTADOS: No total, 57 crianças desenvolveram manifestações clínicas: sonolência (n = 34), sudorese (n = 20), palidez (n = 17), hipotermia (n = 16), bradicardia (n = 13), extremidades frias (n = 9), agitaçäo (n = 7), taquicardia (n = 6), vômitos (n = 34), respiraçäo irregular e apnéia (n = 5), miose/midríase (n = 4), sendo a nafazolina (n = 47), a fenoxazolina (n = 5) e a oximetazolina (n = 4) os princípios ativos mais envolvidos. O início das manifestações clínicas foi rápido, iniciando-se, em 32/57 crianças, até duas horas após a exposiçäo. Somente medidas de suporte foram empregadas, com uma criança necessitando de ventilaçäo mecânica após exposiçäo à nafazolina. Na maioria dos pacientes, o quadro clínico remitiu até 24 horas após a exposiçäo (n = 39/57). Näo houve evoluçäo letal. Pacientes expostos à nafazolina (n = 47/48) apresentaram maior freqüência de manifestações clínicas de intoxicaçäo em comparaçäo com aqueles expostos à fenoxazolina (n = 5/18) (p < 0,001). Comparando-se a freqüência de pacientes que desenvolveram manifestações clínicas de acordo com a via de exposiçäo (oral, n = 34/46; nasal, n = 21/24), näo foi encontrada uma diferença estatisticamente significante (p = 0,31). CONCLUSÕES: Na maioria dos casos de exposiçäo a derivados imidazolínicos, principalmente à nafazolina e em crianças com menos de três anos de idade, ocorreu, independentemente da via (oral ou nasal), o aparecimento precoce de manifestações clínicas de intoxicaçäo, destacando-se as depressöes neurológica, cardiovascular e respiratória, que regrediram até 24 horas após a exposiçäo

Perfil das intoxicaçöes por medicamentos utilizados no tratamento das rinites na cidade de Säo Paulo / Intoxication by medicines for treatment of rhinitis in Säo Paulo

0s autores fazem revisäo da literatura sobre a farmacologia dos medicamentos usados no tratamento das rinites e analisam os casos de intoxicaçöes pelos mesmos (antialérgicos, descongestionantes, vasoconstritores nasais, antígenos respiratórios) notificados ao Centro de Controle de Intoxicaçöes (CCI-Jabaquara) do Hospital Municipal Dr. Arthur Ribeiro de Saboya e ao Centro de Assistência Toxicológica (CEATOX) na cidade de Säo Paulo durante o segundo semestre de 1996. Foram encontrados 177 casos de intoxicaçöes por esses fármacos, correspondendo a 2,66 por cento do total de intoxicaçöes notificadas aos dois serviços naquele período. Análise da distribuiçäo dos casos segundo sexo e idade mostrou predomínio de intoxicaçöes na populaçäo pediátrica (94 por cento das intoxicaçöes por antígenos respiratórios) e no sexo feminino (75 por cento das intoxicaçöes por antialérgiocos). Estudo das circunstâncias das intoxicaçöes revelou prevalência da ingestäo acidental para todos os grupos de medicamentos. Säo propostas medidas para prevenir as intoxicaçöes na utilizaçäo de medicamentos para o tratamento das rinites

Permeabilidade nasal em crianças e adolescentes / Nasal in children and adolescents

A rinomanometria anterior ativa foi considerado o método de escolha para avaliaçäo da permeabilidade nasal em crianças e adolescentes que apresentavam obstruçäo nasal e foram submetidos a algum tipo de cirurgia para sua correçäo. Desta maneira, pode ser realizado, uma comparaçäo objetiva entre os resultados pré e pós-operatórios

Alteraciones histopatológicas de la mucosa nasal por el empleo de vasoconstrictores tópicos: estudio experimental / Histological modifications of the nasal mucosa using topical vasoconstrictor: an experimental study

Existen muchos descongestivos nasales y su empleo en ocasiones es indiscriminado, posiblemente por la publicidad y disponibilidad de los mismos, ya que son drogas que no requieren prescripción médica; sin embargo son escasos los reportes en relación a los cambios histológicos de la mucosa nasal por el empleo de estos fármacos. Se realizó un estudio prospectivo, comparativo y experimental, en 47 ratones, en los cuales se observaron las alteraciones histológicas de la mucosa nasal ocasionadas por fenilefrina, oximetazolina y solución fisiológica al cabo de cinco días, cuatro y ocho semanas. A los cinco días se observó que la oximetazolina ocasionó mayores cambios histológicos que la fenilefrina. A las cuatro semanas el grupo de fenilefrina presentó mayores alteraciones que el de oxometazolina, y a las ocho semanas los cambios fueron similares en ambos grupos. En los ratones que recibieron solución fisiológica, se identificaron cambios estructurales importantes en las tres etapas del estudio

A clinical comparison of budesonide nasal aerosol, terfenadine and a combined therapy of budesonide and oxymetazoline in adult patients with perennial rhinitis.

The efficacy of budesonide, terfenadine and a combination of budesonide and oxymetazoline in the treatment of perennial rhinitis was evaluated by a double blind, parallel group study. Adult patients with perennial rhinitis were randomized into three groups. Group 1 patients received budesonide nasal aerosol 400 micrograms/day for 21 days and oxymetazoline nasal drops for the first three days. Group 2 and 3 patients received budesonide 400 micrograms/day and terfenadne tablet 60 mg twice/day respectively. Nasal symptoms were assessed by the patients before and daily during the treatment period using a simple scoring system. One hundred and forty-two patients were recruited and 130 completed the study. Budesonide, but not terfenadine, significantly reduced all nasal symptoms from baseline (p less than 0.05). Terfenadine could significantly relieve the nasal blockage (p less than 0.05) more than other nasal symptoms. Budesonide with or without oxymetazoline nasal drops provided a better control of nasal symptoms than terfenadine (p less than 0.05). Budesonide with oxymetazoline for the first three days showed a faster relief of nasal blockage than budesonide alone (p less than 0.05). Mild and transient adverse effects were encountered in all three groups. It is concluded that nasal symptoms of perennial rhinitis are more adequately controlled by budesonide than by terfenadine.

Vascular desensitisation--possible role of prostaglandins.

Prolonged exposure to noradrenaline (NA) brings about an increase in the release of prostaglandin (PG)-like material from rat aortic strip. The release is greater with oxymetazoline while methoxamine decreases it. These effects are blocked by yohimbine and prazosin respectively. Pretreatment with 6-OHDA or reserpine diminishes the release of PG-like material. Barium chloride, a non-specific spasmogen, does not affect the release significantly. It appears therefore that the source of PG-like material is presynaptic and that its release mechanism is linked to an alpha 2 (alpha 2) adrenoceptor. It is proposed that this release of PG-like material contributes to the development of desensitisation in vascular tissue.

Oxymetazolina, um novo descongestionante ocular. / Oxymetazoline, a new ocular descongestant

Quarenta voluntarios normais participaram neste estudo. Difosfato de histamina a 0,0075% produz um modelo experimental adequado da hiperemia ocular. Oxymetazonina, um derivado da imidazolina, mostrou-se um descongestionante ativo e seguro nas concentracoes de 0,01% e 0,05%