Evaluation of threshold criteria for the nasal histamine challenge test in perennial allergic rhinitis.

Nasal reactivity to histamine was determined in patients with perennial allergic rhinitis and in control subjects. A histamine titration method delivered by a metered dose pump was used. Stuffiness, itching, and the number of sneezes were recorded, nasal secretions measured, and nasal airway resistance was recorded by active anterior rhinomanometry. Increased nasal reactivity to histamine was observed among rhinitic patients and inversely correlated with the severity of nasal symptoms. A 3-fold increase of post-saline nasal airway resistance (NAR) best differentiated the nasal responses to histamine in rhinitic patients from those in control subjects. A histamine dose of < or = 2.5 microg provoked a 3-fold increase in NAR, strongly suggesting moderate or severe symptomatic rhinitis in most cases. Nasal provocation techniques might be a useful tool for objectively assessing disease severity and response to treatment in perennial allergic rhinitis.

Intracranial complications of suppurative otitis media: 13 years' experience.

Among 24,321 patients with otitis media treated at the Otolaryngology Department of Chiang Mai University Hospital from 1978 through 1990, 87 patients had 140 central nervous system complications (0.36%). Multiple complications existed simultaneously in almost 45% of the patients. The group developing the complications were mainly in their second decade of life. Meningitis occurred in 43 patients, brain abscess in 29, perisinus abscess in 23, lateral sinus thrombosis in 16, and extradural abscess in 12 patients. The most striking symptoms and signs were increasing otorrhea, visible cholesteatoma and/or granulations, fever, headache and otalgia, and vestibular symptoms. Proteus mirabilis, Pseudomonas aeruginosa, and staphylococcal organisms were found in almost 80% of patients. Overall mortality was 18.4% with brain abscess being the main cause (31%). Epidemiologic presentation, clinical features, and results of treatment for each disease are compared and contrasted to those of previous studies.

Extracranial and intracranial complications of suppurative otitis media. Report of 102 cases.

During the eight-year period, 1983-1990, 102 cases of intracranial (IC) and extracranial (EC) complications from 17 144 suppurative otitis media were reviewed. The prevalence of each complication was 0.24 and 0.45 per cent respectively. Facial paralysis, subperiosteal abscess and labyrinthitis were the common complications among the EC group, while meningitis and brain abscess were common in the IC group. Twenty five per cent of the EC group and 44 per cent of the IC group had more than two complications. The reliable warning signs and symptoms for IC complications were fever, headache, earache, vestibular symptoms, meningeal signs and impairment of consciousness. Proteus spp., Pseudomonas aeuruginosa and Staphylococcus spp. were the commonest organisms isolated from both groups. Cholesteatoma and granulation/polyp in the middle ear/mastoid were the major findings in both patient groups. Mortality rate in the IC group was 18.6 per cent. Morbidity rate in each group was 14.3 per cent (EC) and 27.9 per cent (IC) respectively. Epidemiological presentations, clinical features and the result of treatment are discussed.

Facial paralysis following blunt head injury.

Schirmer's test is not a reliable test to localize the level of facial nerve damage. From our results of Schirmer's test (greater than 30%), 53.3 per cent of the cases had facial nerve damage below the geniculate ganglion. Conservative treatment is recommended for delayed palsy.