Posterior nasal neurectomy in treatment of intractable rhinitis: A preliminary series

Objective@#To evaluate the efficacy and safety of posterior nasal neurectomy on the treatment of nasal congestion, rhinorrhea, sneezing, and post-nasal discharge in intractable rhinitis patients.@*Methods@#Design: Preliminary case series. Setting: Tertiary University Medical Center. Participant: Ten (10) patients with intractable rhinitis underwent endoscopic posterior nasal neurectomy in both sides. Symptoms were compared pre- and post-operatively one month and one year after surgery using Visual Analog Scale (VAS) scores. Endoscopic pre- and one-month post-operative Lund-Mackay scores were also compared.@*Results@#All four mean nasal symptom scores were reduced significantly at 1-month follow-up for nasal congestion (1.5 ± 1.08 vs 4.1 ± 0.5687, p = .00001), rhinorrhea (0.7 ± 0.823 vs 3.4 ± 0.966, p = .00001) post-nasal discharge (0.9 ± 0.994 vs 2.4 ± 1.5, p = .03), and sneezing (1.1 ± 0.738 vs 3 ± 0.943, p = .02). Mean endoscopic scores were also reduced significantly at one month, from 12.9 ± 2.55 to 4.2 ± 3, p = 0.0001.In the 6 patients that followed up at 1-year, post-operative mean nasal symptoms were still significantly better for congestion (0.6667 ± 0.8165 vs 4 ± 0.632, p = 0.00001), rhinorrhea (0.6667 ± 0.5164 vs 3.67 ± 1.033, p = .001), post-nasal discharge (0.1667 ± 0.40825 vs 2.17 ± 1.835, p = .033), sneezing (0.5 ± 0.54772 vs 3.17 ± 0.983, p = 0.0001). Mean post-operative VAS nasal scores and endoscopic scores were well associated (Correlation Coefficient -.648, p = .048).@*Conclusion@#Posterior nasal neurectomy could be considered as a safety and effective way to treat intractable rhinitis patients in Vietnam.

Evidences for Local Allergic Rhinitis

Local allergic rhinitis is defined as a localized allergic reaction of the nasal mucosa in the absence of systemic atopy. Its main pathophysiological mechanism can be summarized as: 1) increased specific immunoglobulin E in the nasal fluid, and 2) Th2 allergic mechanism localized in the nasal mucosa. In patients whose result of a skin prick test is totally negative for all antigens, practitioners could diagnose local allergic rhinitis using a nasal provocation test. Oral antihistamines and intranasal steroids can be an effective treatment. Subcutaneous immunotherapy can also be helpful. Further study is essential to further elucidate the detailed pathophysiologic mechanism and set up global standard diagnostic criteria.

Prescribing Patterns of Codeine among Children under Aged 12 in Korea

OBJECTIVE: Codeine may result in death or respiratory depression in children, particularly who are rapid metabolizer of CYP2D6, therefore it should be used cautiously among children under 12 years of age. This study was to investigate the prescribing pattern of codeine among children according to the age group, prescribed diagnosis, type of medical service and medical specialties. METHOD: We used Korea Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) database. Study subjects included inpatients or outpatients, who were prescribed codeine between January, 1, 2011 and December, 31, 2011. Contraindicated use of codeine was defined as the use of codeine at least one times under aged 12. Age groups were sub-classified according to the <2 years, 2-4 years, 5-8 years, and 9-11 years. Frequently prescribed diagnosis (ICD-10), type of medical service, and medical specialties were also described among codeine users under aged 12. RESULTS: Codeine users were 6,411 inpatients (9,958 prescriptions), and 3,397 outpatients (6,258 prescriptions), respectively. Codeine prescription under 12 years of age were 2.1% (210 prescriptions) among inpatients, and 12.3% (776 prescriptions) among outpatients (p-value<0.05). Outpatient prescriptions of codeine under 12 aged were issued mostly from primary care clinics and frequent diagnosis were unspecified bronchopneumonia (51.6%), and vasomotor rhinitis (23.7%). CONCLUSION: This study found prescribing of codeine under 12 aged is common in outpatient and primary clinics. Nationwide and community-based efforts should be needed to reduce inappropriate prescribing among children.

Vitamin D serum levels in children with allergic and vasomotor rhinitis / 소아과

PURPOSE: In addition to regulating calcium and phosphorus homeostasis and bone metabolism, vitamin D is known as an immune modulator. Recently, there has been increased worldwide interest in the association between low levels of vitamin D and allergic diseases. The purpose of this study was to assess the relationship between serum vitamin D levels and allergic/vasomotor rhinitis (AR/VR) in children. METHODS: This study included 164 patients. The sample included 59 patients with AR, 42 patients with VR, and 63 controls. Their ages ranged from 0 to 16 years. We examined the levels of 25-hydroxyvitamin D, Immunoglobulin E, specific IgE, and eosinophil cationic protein; peripheral blood eosinophil count; and the results of a skin prick test. RESULTS: Serum 25-hydroxyvitamin D levels were 19.0+/-8.5 ng/mL in the AR group, 25.5+/-10.9 ng/mL in the VR group, and 26.9+/-10.7 ng/mL in the control group. After adjustment for body mass index and season at the time of blood sampling, vitamin D levels in the AR group were lower than those of the VR group (P=0.003) and control group (P<0.001). Vitamin D levels were inversely correlated with Immunoglobulin E levels (r=-0.317, P<0.001). AR patients with food allergy or atopic dermatitis did not have lower levels of 25-hydroxyvitamin D than AR patients without these diseases. CONCLUSION: This study demonstrates a possible relationship between vitamin D levels and allergic rhinitis in Korean children.

Symptomatic differences between allergic and nonallergic rhinitis in children

PURPOSE: Children and adolescent have high prevalences of allergic rhinitis (AR) and nonallergic rhinitis (NAR) as well as adult. The purpose of this study was to assess the symptomatic differences between AR and NAR in children. METHODS: This study included 138 patients with 2 or more of rhinitis symptoms, including rhinorrhea, nasal obstruction, nasal itching, and sneezing for over 1 hour on most days who visited Kyungpook National University Children's Hospital between March 2013 and June 2014. The levels of total IgE, specific IgE, eosinophil cationic protein, peripheral blood eosinophil count, and the skin prick test were carried out. All the patients or parents were asked to fill out a rhinitis symptom questionnaire and contents were rechecked by physician during the consultation. The symptoms of rhinorrhea, sneezing, nasal itching, nasal obstruction and eye itching were checked. Family history and comorbidity were also evaluated. RESULTS: Ninety-one patients were diagnosed with AR, 47 patients with NAR. Their age ranged from 1 to 16 years. AR patients had more sneezing, nasal pruritus and eye symptoms than NAR patients (P=0.003, P=0.036, and P=0.003, respectively). CONCLUSION: This study shows that the several symptomatic differences may help to diagnose the AR. It will be helpful in establishing diagnostic and treatment plans for rhinitis patients before allergic tests.

Diagnosis and clinical characteristics of patients with non-allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore a step-by-step exclusive diagnosis and analyze the clinical characters of non-allergic rhinitis (NAR).</p><p><b>METHODS</b>Patients with symptoms (nasal itching, sneezing, rhinorrhea, nasal congestion) were selected to take four-step exclusive diagnosis for NAR and we tried to eliminate the false NAR and retain the true NAR. First step was to exclude the patients who were not suitable for skin prick test (SPT, such as during pregnancy, breastfeeding, asthma, oral antihistamine medication in 7 day, severe skin diseases). The second step was to exclude the patients with positive SPT and the third step was to exclude the patients with 1 level or above of specific sero-immunoglobulin E (sIgE). The fourth step was to exclude the patients with infection rhinitis, clear abnormal nasal structure, drug-induced rhinitis, nasal neoplasm. The remained patients were finally diagnosed as NAR and who were further differential diagnosed as vasomotor rhinitis (VMR) or non-allergic rhinitis with eosinophilia syndrome (NARES) according to the eosinophilia counts in nasal secretion and venous blood. The common characters of patients with NAR were analyzed and their symptoms and quality of life were evaluated by visual analogue scale (VAS) and rhino-conjunctivitis quality of life questionnaire (RQLQ) separately.</p><p><b>RESULTS</b>One thousand four hundred and thirty-seven patients were included after first step exclusion and 735 cases with negative SPT were remained after second step exclusion. Of 735 patients, 302 were tested in vitro for sIgE and 93 cases with 0 level of sIgE and total IgE were remained after third step exclusion. Sixty-two patients were finally diagnosed as NAR after fourth step exclusion. The NAR diagnosis rate was 51.15% (735/1 437) with negative SPT alone and the NAR diagnosis rate was 29.06% (93/302) with combination of negative SPT and sIgE. Of 62 patients with NAR, 47 patients (75.81%) were diagnosed as VMR and 15 cases (24.19%) as NARES. There were 23 males and 39 females in the 62 patients aged 11 - 77 years. The history was 11-47 months. The biggest numbers of patients with VMR or NARES were among 41-50 years. Their onset ages were among 21-30 years in both two groups. VAS scores of nasal congestion in VMR patients were the highest with significant difference among nasal symptoms (F = 3.958 0, P = 0.009 1). VAS scores of sneezing in NARES patients were the highest but without significant difference among nasal symptoms. There were no difference in seven domain scores of RQLQ and the total mean scores between VMR group and NARES group but the nasal symptoms got the highest scores with significant difference among the seven domains in each group (VMR group, F = 9.771 2, P = 0.000 0;NRAES group, F = 3.226 9, P = 0.006 2).</p><p><b>CONCLUSIONS</b>SPT combined with sIgE may exclude much more patients with AR. Females with NAR are much more than males. Patients with NAR aged 21-30 years. The characters of NAR are helpful to improve our knowledge about NAR. VAS and RQLQ may be a suitable tool in assessment of NAR.</p>

Diagnosis of Allergic Rhinitis / 대한내과학회지

Rhinitis is divided into allergic and non-allergic rhinitis. Non-allergic rhinitis includes inflammatory rhinitis, such as non-allergic rhinitis with eosinophilia syndrome (NARES) and infective rhinitis, and non-inflammatory rhinitis, such as vasomotor rhinitis and idiopathic rhinitis. Allergic rhinitis is diagnosed based on the presence of allergen-specific IgE and the documentation of relationship between the allergen and symptoms in patients with typical rhinitis symptoms, such as rhinorrhea, nasal obstruction, itchiness and/or sneezing. Local allergic rhinitis can be considered for differential diagnosis. Allergic rhinitis should be differentiated from non-allergic rhinitis by using skin prick test, serum specific IgE test, nasal cytology and/or allergen nasal provocation test. Allergic rhinitis should be differentiated from structural nasal diseases, such as septal deviation and nasal polyps. Rhinitis is frequently accompanied by paranasal sinusitis, which should be recognized in clinical practice. Management strategies differ between allergic and nonallergic rhinitis. In addition to pharmacotherapy, allergen avoidance and allergen-specific immunotherapy can be tried in patients with allergic rhinitis. Thus, the exact diagnosis is very important for the effective treatment in allergic rhinitis. The diagnostic tests for allergic rhinitis are reviewed.

Diagnosis of Allergic Rhinitis / 대한내과학회지

Rhinitis is divided into allergic and non-allergic rhinitis. Non-allergic rhinitis includes inflammatory rhinitis, such as non-allergic rhinitis with eosinophilia syndrome (NARES) and infective rhinitis, and non-inflammatory rhinitis, such as vasomotor rhinitis and idiopathic rhinitis. Allergic rhinitis is diagnosed based on the presence of allergen-specific IgE and the documentation of relationship between the allergen and symptoms in patients with typical rhinitis symptoms, such as rhinorrhea, nasal obstruction, itchiness and/or sneezing. Local allergic rhinitis can be considered for differential diagnosis. Allergic rhinitis should be differentiated from non-allergic rhinitis by using skin prick test, serum specific IgE test, nasal cytology and/or allergen nasal provocation test. Allergic rhinitis should be differentiated from structural nasal diseases, such as septal deviation and nasal polyps. Rhinitis is frequently accompanied by paranasal sinusitis, which should be recognized in clinical practice. Management strategies differ between allergic and nonallergic rhinitis. In addition to pharmacotherapy, allergen avoidance and allergen-specific immunotherapy can be tried in patients with allergic rhinitis. Thus, the exact diagnosis is very important for the effective treatment in allergic rhinitis. The diagnostic tests for allergic rhinitis are reviewed.

Therapeutic effect of endoscopic vidian neurectomy on moderate-severe persistent allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of endoscopic vidian neurectomy in the management of moderate-severe persistent allergic rhinitis, and to explore its possible mechanism.</p><p><b>METHODS</b>One hundred and ninety-one patients with moderate-severe persistent allergic rhinitis were divided into three groups: endoscopic vidian neurectomy was carried out in 71 patients (group A), partial inferior turbinectomy and/or septal-plasty in 39 patients (group B), and 81 patients were as control (group C). The life quality was assessed at 6 month, 1 year and 3 years after operation using rhinoconjunctivitis quality of life questionnaire (RQLQ) and visual analogue scale (VAS).</p><p><b>RESULTS</b>Among 191 cases, one hundred and forty-five cases had complete follow-up documents. The average score of RQLQ and VAS score (x(-) ± s) were significantly decreased at the time of 6 months (0.84 ± 0.41, 2.55 ± 1.57), 1 year (0.91 ± 0.43, 2.63 ± 1.71) and 3 years (1.03 ± 0.46, 2.81 ± 1.75) after endoscopic vidian neurectomy than scores before operation (2.25 ± 0.49, 7.34 ± 1.11), F = 115.45, 133.09, respectively, P < 0.001, and also significantly lower than scores in patients in group B or control group at the same period after treatment. By patient's self-evaluation, the ratio of greatly-improved, improved and not-improved was respectively, 65.5% (38 cases), 24.1% (14 cases), 10.4% (6 cases), and significantly higher in patients in group A than in patients in group B (U = 237.0, P < 0.001) and group C (U = 246.0, P < 0.001). There was no severe complication in all patients observed.</p><p><b>CONCLUSION</b>Endoscopic vidian neurectomy is an effective and safe technique in the management of moderate-severe persistent allergic rhinitis.</p>

Postnasal Drip Syndrome

Postnasal drip syndrome is one of the most common causes of chronic cough, and is caused by a variety of conditions including vasomotor rhinitis, allergic rhinitis, nasal polyps and chronic sinusitis. Postnasal drip syndrome is diagnosed based on clinical symptoms, and patients may complain of tickles or drainage of liquid in the back of the throat. Cobblestoning of the nasal or oropharyngeal mucosa may be observed upon physical examination. However, in many patients cough may be the only symptom of postnasal drip syndrome. Confirmation of the diagnosis may depend on the resolution of symptoms after treatments with antihistamines and intranasal or systemic corticosteroids.

Unilateral ethmoidal polyps

To know the etiology and incidence of unilateral ethmoidal polyps. Descriptive. ENT department Allied Hospital Faisalabad. From Jan 2007 to June 2009. The patients were admitted through ENT out patient department. The data was collected on the basis of history, physical examination, investigations, management and follow up. Out of 200 patients between 05 years to 60 years of age suffering from ethmoidal polyps the incidence of unilateral ethmoidal polyps was 35% and that of bilateral ethmoidal polyps was 65%. The 57% of patients having unilateral ethmoidal polyps were male and 43% female. The highest incidence of unilateral ethmoidal polyps was seen during second decade of life 43%.The incidence of unilateral ethmoidal polyps and bilateral ethmoidal polyps was 1.6 and 03 cases per month respectively. The most common presenting symptom was unilateral nasal obstruction [100%] in cases of unilateral ethmoidal polyps. The most common associated disease in patients with unilateral ethmoidal polyps was deflected nasal septum [71%]. Transantral ethmoidectomy was carried out in majority of patients [43%]. The most common etiology held to be responsible for unilateral ethmoidal polyps was Vasomotor rhinitis [57%]. The unilateral ethmoidal polyps are not uncommon in young adults and the etiological factors are same as that for bilateral ethmoidal polyps

Comparative study of efficacy of mucosal electrocautry versus submucosal diathermy for the treatment of inferior turbinate hypertrophy of nose

To compare the efficacy of submucosal electrocautry versus submucosal diathermy for the surgical treatment of inferior turbinate hypertrophy of nose and to analyze the outcome of both treatment options. Retrospective study was done in 100 cases at the department of otorhinolaryngology, head and neck surgery department JPMC and PMCH Nawabshah, form January 2007 to July 2008. The patients suffering from inferior turbinate hypertrophy were included in this study having ages between 20 to 35 years. Demographic data were obtained from the patient files at the Hospital and were complied for result. Among one hundred patients which were evaluated and surgically treated, 30 cases were of allergic rhinitis, 28 cases of vasomotor rhinitis, 22 cases were of chronic hypertrophic rhinitis and rest of 20 cases had mild septal deviation. The results were evaluated for the patients, pre-, post-operative symptoms and clinical findings. Submucosal diathermy was found more successful in relieving the patients' symptoms and decreasing the size of the inferior turbinates as compared to mucosal electrocautry

Evaluation of nasal patency in patients with vasomotor rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To measure the nasal patency in patients with vasomotor rhinitis (VMR) and healthy controls and to assess its correlation with visual analogue scale (VAS).</p><p><b>METHODS</b>A total of 105 patients with VMR and 71 healthy controls were included in this study. By using nasal rhinomanometry, the pressure-flow curve and got total nasal resistances of 75 Pa and 150 Pa were measured. By means of acoustic rhinometry, the area-distance curve before and after using nasal vasoconstrictor substance was obtained, got the nasal minimum cross-sectional area (MCA), then calculated nasal congestion index (NCI). The outcomes of nasal resistance and acoustic rhinometry in two groups were compared. The correlation between VAS and nasal patency of VMR was evaluated.</p><p><b>RESULTS</b>The correlation between the outcomes with nasal resistance and acoustic rhinometry and VAS of nasal symptom showed no statistical significance in VMR patients (all P > 0.05). MCA before and after decongestion showed no difference (Z value were -1.541 and -0.626, each P > 0.05), NCI had statistic differences in two groups (Z = -2.707, P < 0.05). Nasal resistance of 75 Pa had statistic differences in two groups (Z = -4.334, P < 0.05), 150 Pa showed no difference (Z = -1.314, P > 0.05).</p><p><b>CONCLUSIONS</b>Vasomotor rhinitis is one of the most common non-allergic rhinitis. Subjective symptoms has no correlation with objective nasal patency tests. In clinical practice, comprehensive evaluation of subjective symptoms and objective test results of the patient is required.</p>

Comparison of risk factors between patients with non-allergic rhinitis and allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate and describe the differences in age, sex, seasonality distribution, and related environmental factors between patients with non-allergic rhinitis (NAR) and allergic rhinitis (AR).</p><p><b>METHODS</b>One hundred and eleven patients with NAR and 112 patients with AR were enrolled in this study. All patients were first diagnosed in outpatient department between January and August 2010. Questionnaires were distributed to all participants to record the general information, medical history, and the factors relevant to symptom onset. Statistical analysis was performed using a SPSS13.0 software.</p><p><b>RESULTS</b>The proportion of patients with NAR increased with age, compared to patients with AR. The peak age was 21 - 30 years old in patients with NAR, whereas 11 - 20 years old in patients with AR. In adults more than 18 years old, the average age (years, x(-) ± s) of patients with NAR (38.6 ± 14.5) was significantly higher than those with AR (32.8 ± 13.0; t = 2.58, P = 0.024). NAR was more likely to be males before 30 years old, while after 30 years old, it likely to be female predominance. The same case occurred in AR subjects but in their 20 years old. NAR was symptomatically worse in winter (χ(2) = 27.57, P = 0.000), whereas AR worse in spring (χ(2) = 13.75, P = 0.003). The cases of NAR were significantly more than those of AR during the winter season (χ(2) = 12.34, P = 0.000). Among the disease-related environmental factors, living or working place near the traffic artery had 1.94-fold increased risk for development of NAR compared with AR; however, living or working in ground floor or sunshine time less than 2 h per day had 1.77- or 1.91-fold increased risk for development of NAR compared with NAR. Subjects with personal or family history of allergic disease had 2.14 to 4.06-fold increased risk for development of AR compared with NAR. The self-reported predisposing factors in NAR patients were mainly including temperature shift (56.3%), common cold (52.8%), climate change (32.4%), and strong odors (31.1%). However, there were no significant differences in these nonspecific triggers between NAR and AR (all P > 0.05).</p><p><b>CONCLUSION</b>There are significant differences in the distribution of age, sex and seasonality, personal and family history of allergic disease, and some environmental factors relevant to the onset of symptom between patients with NAR and AR.</p>

Clinical characteristics in patients with non-allergic rhinitis and allergic rhinitis: preliminary analysis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare and analyze the clinical characteristics in patients with hyperreactive non-allergic rhinitis (HNAR) and allergic rhinitis (AR).</p><p><b>METHODS</b>A questionnaire survey on AR and HNAR patients between January and August 2009 was conducted. The clinical data of 298 AR patients and 100 HNAR patients were analyzed, including gender, age distribution, seasonal, clinical symptom and induced factors.</p><p><b>RESULTS</b>The number of male patients was more than female in AR, while in NAR, the number of female patients was more than male (χ(2) = 6.415, P = 0.01). The highest morbidity age in AR was teenagers, aged between 10 - 19 (χ(2) = 12.772, P = 0.00), while in HNAR, the highest morbidity age was middle-aged and youth, aged between 30 - 39 (χ(2) = 51.533, P = 0.00). The main onset seasons in AR was autumn, while there was no seasonal diversity in HNAR. The main allergen in AR was mugwort and ragweed, consistent with the vegetative cover characteristic in Jilin province. The main classification of AR was moderate-severe persistent (χ(2) = 123.991, P = 0.00), while the main classification of HNAR was moderate-severe intermittent (χ(2) = 97.420, P = 0.00). The clinical symptoms were significantly different between AR and HNAR except rhinocnesmus (all P < 0.05). There was consistency about non-specificity induced factors in AR and HNAR (all P > 0.05).</p><p><b>CONCLUSIONS</b>There were significant differences between AR and HNAR in sex, age, classification and seasons. The severity of clinical symptoms in AR was higher than that in HNAR except sneezing and gasping. There was consistency about induced factors in AR and HNAR.</p>

Effects of the General Anesthesia and the Rose Position on the Change of the Inferior Turbinate Size

BACKGROUND AND OBJECTIVES: Enlargement of the inferior turbinates can be caused by allergic rhinitis, vasomotor rhinitis, or emotional responses. However, the effects of general anesthesia and the Rose position on the enlargement of the turbinates are unknown. The aim of this study is to evaluate the effects of general anesthesia and the Rose position on the size of the inferior turbinates and nasal passage. MATERIALS AND METHODS: Fifty patients undergoing tonsillectomy with or without adenoidectomy or snoring surgery without nasal pathology from February, 2007 to July, 2007 at a university hospital were included in the study. The size of the inferior turbinates was measured under the following conditions:1) pre-anesthesia in the supine position;2) post-anesthesia in the supine position;3) post- anesthesia, lying in the Rose position, and 4) at the end of the operation 30 to 50 minutes after anesthesia, with endoscopic nasal photographs. Using an acoustic rhinometry, the minimal cross-sectional area of the nasal cavity was, during conditions one and four, listed above, simultaneously. RESULTS: The size of the inferior turbinates was increased statistically in condition three, post-anesthesia, lying in the Rose position, and condition four, at the end of surgery 30 to 50 minutes after anesthesia, compared to condition one, pre-anesthesia lying in the supine position. In addition, the minimal cross-sectional area of the nasal cavity was decreased in condition one compared to condition four. CONCLUSION: The size of the inferior turbinates was influenced by general anesthesia and the Rose position, presumably due to engorgement of the venous sinuses and/or mucosal edema.

Efficacy evaluation of polysaccharide nucleic acid-fraction of BCG on vasomotor rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the efficacy and safety of polysaccharide nucleic acid-fraction (BCG-PSN) in the treatment of vasomotor rhinitis.@*METHOD@#Sixty patients were randomly divided into BCG-PSN group (n = 30) and control group (n = 30). The patients in BCG-PSN group were administered with BCG-PSN 1.0 mg twice a week for two months, and intranasal azelastine was used if needed. The patients in control group were administered with intranasal azelastine solely twice a day, which could be decreased with the symptom relief. Follow-up was 6 months. Symptom and medication scores were recorded. Side effects were registered.@*RESULT@#The symptom and medication scores of BCG-PSN group were significantly lower than that of control group (P 0.05), while the medication score of BCG-PSN group was still much lower than that of control group (P < 0.01). No serious adverse events were reported in BCG-PSN group except for local pain on the injection place in one patient.@*CONCLUSION@#BCG-PSN is effective and safe in the treatment of vasomotor rhinitis.

The expression of serum IL-10,12,13,16 in patients with allergic rhinitis and vasomotor rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the role of serum IL-10, 12, 13, 16 in patients with allergic rhinitis and vasomotor rhinitis.@*METHOD@#The serum levels of IL-10, 12, 13, 16 were measured by ELISA in 30 cases of allergic rhinitis, 25 cases of vasomotor rhinitis and 20 healthy people.@*RESULT@#The level of IL-12 in allergic rhinitis was (170.33 +/- 90.58) ng/L, which was significantly lower than that of normal controls [(376.69 +/- 140.70) ng/L, P < 0.01]. The levels of IL-13 and IL-16 in allergic rhinitis were (408.51 +/- 189.68) ng/L and (151.53 +/- 63.56) ng/L, which were significantly higher than those of normal controls [(151.92 +/- 85.08) ng/L, (60.65 +/- 32.45) ng/L, P < 0.01]. There were no significant difference of levels of IL-10, 13, 16 between vasomotor rhinitis and normal controls, while the level of IL-12 in vasomotor rhinitis was lower than that of normal controls [(196.03 +/- 96.31) ng/L vs. (376.69 +/- 140.70) ng/L, P < 0.01]. It was suggested that IL-10 had positive correlation with IL-12 (r = 0.73, P < 0.01), and IL-13 had positive correlation with IL-16 (r = 0.94, P < 0.01).@*CONCLUSION@#The imbalance of IL-12, IL-13 and IL-16 play crucial roles of regulation in the onset and developing of allergic rhinitis. Further research is needed on the role of IL-12 in vasomotor rhinitis.

Therapeutic effect of vadian neurectomy under the nasal endoscope on the vasomotor rhinitis / 中南大学学报(医学版)

OBJECTIVE@#To explore the therapeutic effect of vadian neurectomy under the nasal endoscope on the vasomotor rhinitis.@*METHODS@#Anatomic measurements of vadian canal in 14 cadavers were carried out, and vadian neurectomy under the nasal endoscope was performed on 51 patients with vasomotor rhinitis.@*RESULTS@#Anatomic measurements showed vadian canal was located behind the sphenoid-palatine hole, and its external orifice was shaped as infundibular. The vertical diameter was (3.5+/-0.9) mm and the horizontal diameter was (2.9+/-0.5) mm. The distance to the rotundum foramen and nasal septum was (6.1+/-1.2) mm and (10.5+/-5.9) mm. Longitudinal axes of the vadian canal was (27.0+/-9.6) degrees with the horizontal plane, and (7.8+/-2.5) degree with the sagittal plane. Among the 51 patients, 41(80.4%) patients showed complete response and 3(5.9%) partial response at the 5-year follow-up.@*CONCLUSION@#Vadian neurectomy under nasal endoscope is an effective technique for vasomotor rhinitis.

Clinical Efficacy of Intranasal Azelastine Hydrohloride Spray in Korean Vasomotor Rhinitis Patients

Background & Objectives: Vasomotor rhinitis (VMR) is a chronic non-allergic rhinitis without the increased Ig E level and eosinophilia. Azelastine hydrochloride is a second generation anti-histamine medication with anti-inflammatory properties that inhibits the synthesis of inflammatory materials. There are reports that azelastine hydrochloride can be effective in the treatment of VMR. Therefore, this study examined the clinical efficacy of intranasal azelastine hydrochloride spray in comparison with placebo for the treatment of VMR. MATERIALS AND METHOD: This study was a prospective double blind randomized test. The subjects consisted of 84 VMR patients. Among them, 54 patients were treated with intranasal azelastine hydrochloride for 4 weeks and 30 patients with intranasal normal saline. Following the treatment, an analysis of the symptom score was performed in order to compare the treatment effects between the study group and the control group. RESULTS: In the study group, the symptom score was significantly improved in the areas of sneezing (1.38 to 0.72), rhinorrhea (1.57 to 0.76), nasal obstruction (1.76 to 1.01) and postnasal drip (1.43 to 0.65). In the control group, however, the symptom score was significantly improved in a single area of rhinorrhea (1.73 to 0.65). Patients in the study group, thus, displayed greater improvements in the areas of sneezing, rhinorrhea, nasal obasturction and postnasal drip comparative to the control group. Consequently, the study group patients were more satisfied with their quality of life than those of the control group. CONCLUSION: Azelastine chloride is a useful medicine for the treatment of VMR, especially in controlling sneezing, rhinorrhea, nasal obstruction and postnasal drip.