Key nasal symptoms predicting a positive skin test in allergic rhinitis and patient characteristics according to ARIA classification.

OBJECTIVE: To find predicting symptom(s) in patients with a positive skin test, and identify patient characteristics according to ARIA classification. MATERIAL AND METHOD: Four hundred and thirty four rhinologic patients were retrospectively studied. Nasal obstruction, rhinorrhea, itching, sneezing, and smell dysfunction were assessed. Patients were also classified according to the ARIA guideline. RESULTS: Of 434 patients, 277 (63.8%) were skin prick test positive. There was no statistical difference in sex, but the mean age of the positive skin test group was lower than that in the negative group (p < 0.05). Intermittent or persistent symptoms and total symptom score were not significantly different. Severe nasal itching was more common in the positive group (p = 0.04). The impact of symptoms was similar between the two groups, except for self-reported comorbidity, which was higher in the negative group (p = 0.039). CONCLUSION: There were no predicting symptoms and no difference in the symptom characteristics for the patients with positive skin test.

Comparison on the efficacy of dexpanthenol in sea water and saline in postoperative endoscopic sinus surgery.

OBJECTIVE: To compare the efficacy of dexpanthenol spray and saline irrigation in the postoperative care of sinusitis patients following endoscopic sinus surgery (ESS). MATERIAL AND METHOD: One hundred twenty eight sinusitis patients undergoing ESS were randomly allocated to receive dexpanthenol spray (Mar plus) or saline irrigation twice a day for 4 weeks after the operation. Total nasal symptom score, crusting, infection, compliance, and patient satisfaction were evaluated at 1, 2-3, 4-6, and 12 weeks. Mucociliary clearance was assessed with the saccharin test before ESS and at the last visit. One hundred ten patients remained at the present study termination. Chi-square test and Mann-Whitney U test were employed. RESULTS: Total nasal symptom score, mucociliary clearance, and infection improved in both groups after the operation. The dexpanthenol group resulted in a better mucociliary clearance than saline irrigation (9.93 +/- 6.04 vs. 12.38 +/- 9.32 min, p = 0.43). Saline irrigation resulted in a greater reduction of post nasal drip than dexpanthenol at the first visit (74% vs. 87%, p = 0.04). Compliance and patient satisfaction were comparable. CONCLUSION: The efficacy of dexpanthenol was comparable to nasal saline irrigation in the postoperative care of sinusitis patients following endoscopic sinus surgery. Dexpanthenol is an alternative treatment, which may be useful in young children and complicated cases.

Invasive fungal rhinosinusitis in Maharaj Nakorn Chiang Mai Hospital.

BACKGROUND: Invasive fungal rhinosinusitis, a rare infection, is a life threatening disease. Delay in diagnosis may consequently lead to high morbidity and mortality. OBJECTIVE: Encourage early detection and proper management of invasive fungal rhinosinusitis. MATERIAL AND METHOD: Medical records, radiological, and pathological reports of five patients who were diagnosed as invasive fungal rhinosinusitis were reviewed retrospectively. RESULTS: Four in five cases of invasive fungal rhinosinusitis, confirmed by pathological study, had successful treatment. One patient had intracerebral hemorrhage that may be associated with the disease spreading. Disease extension was evaluated by CT paranasal sinus in all cases, but it usually did not have classic bony erosion. CONCLUSION: Curing infection, correcting underlying conditions, and working up fungal infection should be carried out as early as possible, because morbidity and mortality depend on disease extension and host status.

Comparative efficacy of wheal-and-flare suppression among various non-sedating antihistamines and the pharmacologic insights to their efficacy.

BACKGROUND AND OBJECTIVE: Non-sedating antihistamines (loratadine, fexofenadine, and cetirizine) have been widely used in Thailand. This study examined the time-of-onset and compared the 95% inhibitory effect of these agents on histamine-induced cutaneous reaction so as to understand the diversity of their efficacy. PATIENTS AND METHOD: Thirty-one atopic patients were randomized into 4 treatment groups, placebo (n = 7), loratadine (n = 8), fexofenadine (n = 8), and cetirizine (n = 8). They were pricked with histamine every 30 min for 4 hrs. The percentage change of the wheal/flare area was calculated. RESULTS: All active treatments showed wheal suppression superior to placebo after 210 min for loratadine (P = 0.04); 90 min for fexofenadine (P = 0.009); and 60 min for cetirizine (P = 0.02), while flare suppression was significantly marked after 150 min (P = 0.0008) for loratadine; 90 min for fexofenadine (P = 0.0001), and 60 min for cetirizine (P = 0.006). All drugs except loratadine demonstrated a 95% suppression of wheal superior to the placebo (P = 0.001 for fexofenadine; P = 0.0001 for cetirizine). Only fexofenadine exhibited a 95% suppression of flare statistically superior to placebo (P = 0.02). Discrepancies among the effects of these 3 antihistamines were also detected. DISCUSSION AND CONCLUSION: All antihistamines tested repressed the wheal-and-flare area superbly over the placebo within 4 hours. Cetirizine exerted the fastest onset, and it also appeared to be the most efficacious inhibitor. The heterogeneity of their efficacy probably stems from their diverse physicochemical properties, which have also been discussed.

Entomophthoromycosis in Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To review documented entomophthoromycosis patients at Maharaj Nakorn Chiang Mai Hospital from 1985 to 2001. MATERIAL AND METHOD: A retrospective review was performed at Maharaj Nakorn Chiang Mai Hospital from 1985 to 2001. Eight cases of entomophthoromycosis were found between 1988 and 1993, with five patients diagnosed as subcutaneous zygomycosis, I GI entomophthoromycosis and 2 rhinofacial zygomycosis. RESULTS: The subcutaneous zygomycosis group was composed of 5 female patients, aged 7- 77 years. They presented with a painless subcutaneous mass, which was solitary or multiple and most commonly found on the extremities. The duration of disease was between 3 months to 5 years. The cultures grew Basidiobolus ranarum. A case of GI entomophthoromycosis was seen in a 34 year old man, who presented with dyspepsia, multiple intraabodminal masses and peritonitis. Two cases of conidiobolomycosis (rhinofacial zygomycosis) were seen. These two patients were male, 26 and 39 years old, and they presented with unilateral nasal obstruction from a mass at the inferior turbinate. The cultures grew Conidiobolus coronatus. CONCLUSION: Entomophthoromycosis in the northern part of Thailand is rare. The disease should be differentially diagnosed by a chronic painless tumor. The patients in this review responded very well to the recommended therapy.