The value of Ems Mineral Salts in the treatment of rhinosinusitis in children. Prospective study on the efficacy of mineral salts versus xylometazoline in the topical nasal treatment of children.

UNLABELLED: The treatment of rhinosinusitis seen in the light of uncertain pathogenesis and variable symptoms is under discussion and ranges from the administration of antibiotics, decongestants and anti-allergic agents to no treatment. In this randomized, prospective, double-blind and controlled study the effect of a 14-day treatment (1-2 sprays into each nostril t.d.) with either isotonic Ems Mineral Salts (EMS) solution (Siemens & Co., Bad Ems, Germany) or xylometazoline solution (0.05%) was tested in children (n=66) aged 2-6 years. MAIN OUTCOMES: the degree of mucosal inflammation, nasal patency, general state of health, condition of the middle ear, auditory function as well as an assessment of complaints by the parents. With the exception of the hearing defects, all parameters showed a clear improvement in both treatment groups at the end of the observation period (p>0.001). The hearing defects showed only a trend towards improvement. At the end of the study no differences between the treatment groups could be determined. However, at the intermediate examination after the first 7 days of treatment more favourable results were seen in the group treated with EMS. No undesired medicinal effects were observed, although in 7 out of 34 cases the nasal spray was improperly used in the group treated with xylometazoline. The results of the study show that there is no difference in efficacy between an exclusive treatment by EMS solution in children aged 2-6 years and a treatment with xylometazoline, but with the distinction that with EMS the length of use was not restricted, there were not the potential side effects of nasal decongestants, and there was no contraindication in the newborn and infants.

Prospective randomized investigation for evaluation of postoperative changes in the microbial climate of paranasal mucosa by the use of different dissoluting techniques during postoperative care.

Endonasal dissolution by the use of NaCl-solution is a common postoperative treatment of the nasal mucosa after endonasal surgery. These procedure involve for example endonasal shower and sterilized solutions. The contamination of nasal shower in case of unprofessional cleaning after treatment was an argument against this technique in earlier discussions. The danger of such an infection should be avoided by the use of sterilized solution. Therefore the dependence of nasal microbial climate on different nasal dissoluting techniques was investigated by the use of such named endonasal shower (Siemens und Co, Bad Ems, Germany) in comparison with sterilized solution (Rhinomer, Zyma SA, Nyon, France). Microbial cultures were investigated of 80 patients after endonasal surgery (53 m, 27 f; 31 +/- 21 age). Surgery was done for the treatment of chronic polypous sinusitis. Pre-, intra- and postoperative samples were taken in 640 cases to proceed microbial cultures. Material was transferred with the use of a Port-A-Cul-transport medium and preparation of the microbial cultures was done during the first four hours. As a result 895 bacterial clones were cultivated. These consisted of 87% aerob and 13% anaerob bacteria. Staphylococcus aureus (39%) and members of the family of Enterobactericae (30%) were the most common microbes. There was neither an evidence for postoperative microbes on the nasal mucosa nor a correlation between the dissoluting technique and the postoperative outcome. The use of sterilized solutions for the postoperative care of endonasal mucosa does not cause an additional worthful effect on neither the postoperative microbial climate nor the outcome in comparison to endonasal shower.

Alpha 1-receptors at pre-capillary resistance vessels of the human nasal mucosa.

The aim of the present study was to further characterise the alpha-adrenoceptors in pre-capillary arteries of the human nasal mucosa. Mucosa was obtained from patients undergoing endonasal surgery. From the isolated conchae small arteries (diameter: 90-220 microns) were dissected, avoiding any direct traumatisation. The arteries were mounted to a Mulvany-Halpern wire myograph allowing isometric registration of the vessel constriction. Receptor subtypes were characterised using the agonists noradrenaline, phenylephrine and oxymetazoline, and the antagonists prazosine and yohimbine. The EC50 values of the three agonists were in the micromolar range, whereas the Emax values differed. When maximal responses to the agonists were expressed as a percentage of a potassium-induced constriction, values for noradrenaline, phenylephrine and oxymetazoline amounted to 110%, 78% and 21%, respectively. The agonist effects were almost completely blocked by the alpha 1-receptor antagonist prazosine, whereas yohimbine, the alpha 2-receptor antagonist, did not affect the agonist responses. From these results it is concluded that the adrenoceptors in pre-capillary arteries of the mucosa in human central concha are of the alpha-type. Since the decongestive effect of alpha 2-receptor agonists is beyond any doubt, this subtype of the adrenoceptor must be present on the venous capacitance vessels.

[Effect of postoperative endonasal mucous membrane care on nasal bacterial flora: prospective study of 2 irrigation methods with NaCl solution after paranasal sinus surgery]. / Der Einfluss der postoperativen endonasalen Schleimhautpflege auf die nasale Bakterienflora: Prospektive Untersuchung zweier Spülverfahren mit NaCl-Lösung nach Nasennebenhöhlenchirurgie.

BACKGROUND: Endonasal irrigation with saline solution is a widely used constituent of mucosal care after sinus surgery. This procedure could explain a repeatedly observed phenomenon: contamination of the endonasal mucosa by facultative skin pathogens from the palm during paranasal sinus irrigation. METHOD: For this reason the effect of nasal rinses with saline solution on the endonasal bacterial flora was investigated (use of so-called nasal douche [Siemens & Co., Bad Ems] compared to rinsing by hand). In 36 patients (23 m., 13 f., 36 +/- 19.5 years of age) with chronic sinusitis, a total of 288 swabs was collected before, during, and after surgery. The collected specimens were transferred to a Port-A-Cul transport medium and processed within four hours. RESULTS: Two hundred sixty-six cultures of 325 bacterial strains were aerobic (82%), while 59 were anaerobic (18%). Staphylococcus aureus (33%) and representatives of the Enterobacteriaceae family (31%) were the most common enriched germs. The number of times that enterobacteriaceae could be isolated was significantly (p < 0.05) lower (13%) when a nasal douche was used than when irrigation was done using the palm (38%). An irrigation technique-related effect was found on neither the spectrum of the pathagonic organisms nor the wound healing process. CONCLUSION: The frequent isolation of enterobacteria in nasal swabs of individuals rinsing by hand constitutes the difference between irrigation by nasal douche and by hand in the postoperative care of the endonasal mucosa. These pathogens can sustain the paranasal sinus system.

[Epithelioid sarcoma of the parotid region]. / Epitheloides Sarkom der Parotisregion.

BACKGROUND: Epithelioid sarcoma has been described in 1970 by Enzinger as a separate tumor entity. It is a rare soft-tissue tumor mostly found in the distal extremities in young adults. The head and neck region is only very infrequently affected. PATIENT AND RESULT: We report the rare case of a manifestation of an epithelioid sarcoma in the area of the right parotid gland in a 72-year-old patient. Only two more cases with a similar tumor entity and location have been described in the international literature. The patient underwent total parotidectomy, radical neck dissection, and postoperative radiotherapy two years ago and has been free of recurrence since then. CONCLUSIONS: Epithelioid sarcomas of the head and neck are very rare tumors. They are treated by radical local tumor removal, neck dissection, and postoperative radiotherapy. Prolonged postoperative follow-up is necessary since recurrences can occur after up to more than 15 years.