Nasal pathophysiology and its relationship to the female ovarian hormones.

The influence of the female ovarian hormones on nasal physiology has been the subject of ongoing research, especially over the last 20 years, yet their role remains unclear. This review looks at the evidence to date from the studies that have looked at the different physiologic and therapeutic scenarios in which the ovarian hormones are raised. It also examines the current pathophysiologic links between the hormonal surges and nasal congestion and the missing links that need to be addressed in future studies.

The effect of female hormone manipulation on nasal physiology.

BACKGROUND: This study was performed to establish whether the ovarian hormone beta-estradiol has any influence on nasal physiology when manipulated during in vitro fertilization treatment. METHODS: Women undergoing in vitro fertilization (IVF) treatment at the Assisted Conception Unit, Leicester Royal Infirmary, were recruited. Nasal peak inspiratory flow rate, acoustic rhinometry, anterior rhinomanometry, mucociliary clearance, olfactory thresholds, quality of life, and serum 17-beta-estradiol levels were measured at each visit. Subjects were studied at the beginning of their IVF treatment and then at one or two additional occasions while they received synthetic follicule-stimulating hormone with a final set of results taken at the end of their treatment. RESULTS: Results were analyzed using paired t-tests. There was no statistical difference between any of the data sets for any of the variables during the process of IVF treatment. CONCLUSION: Increasing levels of beta-estradiol that occur in IVF treatment cause no significant effect on nasal physiology in contrast to the effects seen during pregnancy.

Does the use of the combined oral contraceptive pill cause changes in the nasal physiology in young women?

BACKGROUND: Changes in nasal physiology have been observed during pregnancy and the menstrual cycle. The role of female hormones in these changes is unclear. The aim is to investigate the effect of the modern combined oral contraceptive pill (COCP). METHODS: Eleven women were recruited from a family planning clinic. Anterior rhinoscopy, peak inspiratory flow rate, acoustic rhinometry, anterior rhinomanometry, mucociliary clearance time, and rhinitis quality-of-life questionnaire (RQLQ) scores were recorded at days 1 and 14 pre- and post-COCP. RESULTS: Increased nasal obstruction midcycle pre-COCP, with significant differences for anterior rhinoscopy (p = 0.001) and peak inspiratory flow rate (p = 0.022), was found. No statistical difference was shown between pre- and post-COCP results apart from day 1 anterior rhinoscopy findings (p = 0.05). CONCLUSION: The modern COCP has no significant effect on nasal physiology.

Comparison of subjective perception with objective measurement of olfaction.

OBJECTIVE: To see if nasal peak inspiratory flow rate and subjective sense of smell had any correlation with olfactory thresholds. STUDY DESIGN AND SETTING: A cohort study of 186 normal volunteers was recruited from among staff and visitors at a university hospital. Olfactory thresholds were detected for each subject (103 with eucalyptol and 83 with phenethyl alcohol), along with nasal peak inspiratory flow (PIFR). Subjective sense of smell, along with nasal symptoms, mood, and alertness, were recorded on visual analogue scores. RESULTS: Subjective perception of smell had no correlation with olfactory thresholds detected (P = 0.4057) and the other subjective measures also had no correlation. There was a significant relationship of PIFR to thresholds in the group tested with phenethyl alcohol (P = 0.002). CONCLUSION: As with the sensation of nasal patency, the self-assessment of a subject's sense of smell has poor correlation with their actual olfactory ability. SIGNIFICANCE: A patient's history cannot be relied upon when determining their olfactory ability and formal testing should be performed. EBM RATING: A-1b.

Canalicular adenoma of the parotid gland.

Canalicular adenomas are a rare form of benign tumour that occur in salivary glands, occurring mainly in the upper lip and minor salivary glands of the buccal mucosa. The authors report the fifth case and the first in the otorhinolaryngological literature of a canalicular adenoma of the parotid gland. Its specific histological features are difficult to detect on fine needle aspiration and its multifocal nature can lead to recurrence and this must be considered in the clinical management.

Sildenafil and nasal obstruction.

OBJECTIVE: Sildenafil (Viagra; Pfizer), a phosphodiesterase inhibitor, promotes penile erection through increased intracellular cyclic guanine monophosphate (a second messenger) in response to nitric oxide (a first messenger) release following sexual stimulation. Nitric oxide is involved in nasal vasodilation, secretion, and mucociliary clearance. The aim of this study was to assess the effect of sildenafil on nasal patency. DESIGN: Pilot study. SETTING: Teaching hospital. METHODS: Nasal patency was assessed by a visual analogue score and by measurement of the peak nasal inspiratory flow (PNIF) in five subjects before and after administration of sildenafil. MAIN OUTCOME MEASURES: Visual analogue score and PNIF. RESULTS: There was a significant increase in the subjective sensation of nasal obstruction (p = .003; -9.6 +/- 2.7, -15.4 to -3.7 [mean +/- SEM, 95% CI) and a significant reduction of PNIF (p < .001; 70.7 +/- 13.2, 43.1 to 98.3). CONCLUSIONS: This pilot study suggests that nasal patency may be reduced following the administration of sildenafil. The role of phosphodiesterase inhibitors in nasal physiology merits further investigation.