The International Study of the Allergic Rhinitis Survey: outcomes from 4 geographical regions

BACKGROUND: Allergic rhinitis (AR) is a global health problem and is characterised by one or more symptoms, including sneezing, itching, nasal congestion and rhinorrhea. OBJECTIVE: We investigated the features of AR and the physician's approach to the management of AR patients in four geographical regions. METHODS: In this cross-sectional study, a questionnaire survey concerning AR was completed by Honorary and Corresponding Members of the Italian Society of Rhinology from different countries among 4 world geographical regions—Asia, Europe, the Americas, and Africa. RESULTS: The prevalence of AR was reported to be 15%–25%. Children and adolescents, as well as young adults, were the age groups more affected by AR with comorbidities of asthma, sinusitis, conjunctivitis, and nasal polyposis. Nasal symptoms of AR were more intense in the spring (51.92%) and autumn (28.85%). The most common aero-allergens were pollen and mites (67.31%), animal dander and pollutants (23.08%), and fungal allergens (21.15%). Allergen-specific immunotherapy was prescribed for both perennial and seasonal allergens (32.69%) via sublingual swallow (46.15%) and subcutaneous (32.69%) routes. For the AR patients, the most prescribed drugs were intranasal corticosteroids (86.54%) and oral H₁-antihistamines (82.69%). CONCLUSION: A network of experts can improve our knowledge concerning AR epidemiology, and together with guidelines, could assist practitioners and otolaryngologists in standardising the diagnosis and treatment of AR.

Internal laryngocele: unusual onset in a 91-year-old female patient

While internal laryngoceles rarely cause major clinical complaints, they may lead to airway obstruction and require emergency intervention on rare occasions. We report a 91-year-old patient who was referred to the Ear, Nose and Throat Clinic of the Policlinico Santa Maria alle Scotte, Siena, Italy, in 2017 due to recurrent episodes of severe dyspnoea. A flexible nasopharyngolaryngoscopic examination revealed an internal laryngocele of approximately 1.5 cm in diameter that moved up and down the glottic plane, occasionally invading the subglottic space during inspiration and impeding airflow. This caused cyanosis and dyspnoea so severe that an emergency tracheotomy was considered. Luckily, after considerable effort, the patient was able to cough, causing the mass to move above the vocal plane and allowing normal breathing. The laryngocele was subsequently removed via laryngomicrosurgery. Although the incidence of internal laryngoceles is quite rare, physicians should consider this potentially life-threatening condition among patients with dyspnoea

Nasal allergy and otitis media a real correlation?

The correlation between middle ear pathology and nasal allergy has been debated for almost 30 years. This study aimed to evaluate the relationship between otitis media with effusion [OME] and persistent allergic rhinitis symptoms versus intermittent rhinitis in children. The study included 100 atopic children [52 boys, 48 girls] aged 5-9 years with otological symptoms who were patients of the University of Siena Hospital, Italy. Ear, nose and throat evaluations, tympanometry, skin prick tests [SPTs], mucociliary transport time [MCTt] and Eustachian tube function tests were performed. The SPTs revealed 50 children sensitised to Dermatophagoides pteronyssinus, 34 to grass pollen and 16 toParietaria. Of all patients, mild symptoms were intermittent in 19 children and persistent in 18; moderate/severe symptoms were intermittent in 22 and persistent in 41. Tubal dysfunction was present in 25 children, whereas middle ear effusion was present in 45 children undergoing myringotomy. The MCTt was slower in the persistent group [21 +/- 2 mins] versus the intermittent group [16 +/- 2 mins] with a significant difference [P <0.01]. Mean eosinophil cationic protein [ECP] values in the middle ear effusions of children who had undergone myringotomy were 251 +/- 175.2 micro g/L, and mean ECP blood values were 25.5 +/- 16.3 micro g/L, with significant differences [P < 0.001]. There was a significant association between OME, delayed MCTt, ECP values in middle ear effusion and persistent symptoms of allergic rhinitis. These results suggest a direct involvement of the middle ear mucosa as a target organ in persistent forms

Atomized Nasal Douche: Our Experience

BACKGROUND AND OBJECTIVES: A recently proposed apparatus for the treatment of nasal inflammatory affections is the atomized nasal douche. The aim of the paper was to assess the efficacy of the atomized nasal douche in patients affected by acute or chronic rhinopathy. MATERIALS AND METHODS: We selected 60 adult patients: They were subdivided into two groups and each group consisted of 15 patients suffering from vasomotor rhinitis and 15 patients affected by acute rhinitis. The former underwent atomized nasal douche and the latter underwent nasal lavages with saline solution. We performed bacterial cultures of the nasal swab and the secretions drawn from the nasal cavity, a rhinomanometric test, an assessment of the symptomatologic score before and after the treatment in all the patients. RESULTS: At the end of treatment, there was a reduction or complete disappearance of the bacterial colonies in 23 of the 30 patients treated with the atomized nasal douche, while in the control group the same result occurred in only 10 of the 30 patients. CONCLUSION: Our results confirm that the atomized nasal douche performs an efficacious lavage of the nasal cavity, representing a good support for the treatment of inflammatory processes of the nose.

Atomized Nasal Douche: Our Experience

BACKGROUND AND OBJECTIVES: A recently proposed apparatus for the treatment of nasal inflammatory affections is the atomized nasal douche. The aim of the paper was to assess the efficacy of the atomized nasal douche in patients affected by acute or chronic rhinopathy. MATERIALS AND METHODS: We selected 60 adult patients: They were subdivided into two groups and each group consisted of 15 patients suffering from vasomotor rhinitis and 15 patients affected by acute rhinitis. The former underwent atomized nasal douche and the latter underwent nasal lavages with saline solution. We performed bacterial cultures of the nasal swab and the secretions drawn from the nasal cavity, a rhinomanometric test, an assessment of the symptomatologic score before and after the treatment in all the patients. RESULTS: At the end of treatment, there was a reduction or complete disappearance of the bacterial colonies in 23 of the 30 patients treated with the atomized nasal douche, while in the control group the same result occurred in only 10 of the 30 patients. CONCLUSION: Our results confirm that the atomized nasal douche performs an efficacious lavage of the nasal cavity, representing a good support for the treatment of inflammatory processes of the nose.