Congestion In Adults Research Articles

A real-world study of quality of life following treatment with xylometazoline hydrochloride in individuals with common cold.

The common cold is a frequent, acute, and mild upper respiratory human disease. Nasal congestion has been considered the most bothersome symptom in the common cold, impacting quality of life (QoL). Topical decongestants containing steroids benefit QoL in allergic rhinitis, but no published research has assessed the impact of topical decongestants on QoL in the common cold. To evaluate the effects of xylometazoline hydrochloride 0.1% (Otrivin, GSK Consumer Healthcare SARL, Switzerland) for up to 7 days on QoL in participants with nasal congestion associated with the common cold. This was a decentralized, longitudinal, open-label study. The study enrolled 136 participants (⩾18 years) with early symptoms of the common cold, of which 102 were included in the modified intention-to-treat (mITT) population. Within 24 h of study product receipt, participants confirmed a 'plugged nose' and ⩾1 other common cold symptom. Primary endpoints were Wisconsin Upper Respiratory Symptom Survey-21 (WURSS-21) total score, total and individual symptom scores, and total QoL score. Secondary endpoints were additional QoL scores. Exploratory and post hoc analyses included median days to resolution for each QoL factor and analyses of five QoL categories. Consistent improvements in symptoms and QoL were seen in the mITT population. From day 1, improvements were seen in the 'plugged nose' symptom (p = 0.0023), WURSS-21 total QoL score, and all individual QoL scores (p < 0.0001 for all). After the last dose needed, significant improvements were seen in sleep quality (73%), vitality (76%), physical activity (71%), social activity (80%), and sensation (81%). No serious or unexpected adverse events were reported. This study is the first to demonstrate in a real-life setting that treating nasal congestion in adults with xylometazoline hydrochloride 0.1% during the common cold positively impacts QoL factors relevant to daily living [Otrivin: Quality of Life (QoL) Impact in a Real-World Setting; https://clinicaltrials.gov/study/NCT05556148].

The Use and Efficacy of Oral Phenylephrine Versus Placebo Treating Nasal Congestion Over the Years on Adults: A Systematic Review.

Nasal congestion is a common issue stemming from various factors such as allergies and anatomical variations. Allergic rhinitis frequently leads to nasal congestion. The pathophysiology involves inflammation, swelling, and mucus production in the nasal mucosa. Multiple treatments are available, including oral phenylephrine, an over-the-counter or prescription option. However, the effectiveness and safety of phenylephrine have been subjects of debate. This systematic review aims to provide an updated perspective on the efficacy of oral phenylephrine versus placebo in addressing nasal congestion in adults. We conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a systematic review involving searches on PubMed, Cochrane, and Scopus databases. Inclusion/exclusion criteria were defined to identify high-quality studies. The focus was on randomized controlled trials (RCTs) and case-control studies published in English between 1998 and 2023, involving adult populations. The interventions compared oral phenylephrine with placebo or standard care, with outcomes centering on changes in nasal congestion symptoms and nasal airway resistance. We identified four articles that met the criteria. These studies exhibited varied designs and populations. The findings consistently indicated that phenylephrine was not more effective than a placebo in relieving nasal congestion.This systematic review demonstrates that oral phenylephrine did not offer substantial relief from nasal congestion compared to a placebo in adults. The studies featured diverse designs, yet the prevailing conclusion was that phenylephrine's efficacy was limited. Safety assessments showed no life-threatening adverse events, with common side effects including headaches and mild discomfort. In summary, this systematic review indicates that oral phenylephrine is not significantly more effective than a placebo in alleviating nasal congestion in adults. Clinicians should explore alternative treatment options, considering the review's limitations. Additional research may be needed to clarify the role of oral phenylephrine in managing nasal congestion.

Mastoid fluid signal in acute cerebral venous thrombosis is is associated with increased clot burden

PurposeMastoid air cell abnormalities in the form of hyperintense T2 fluid signal have been reported in cases of acute Cerebral Venous Thrombosis (CVT) without otologic infection and have been hypothesized to be a result of venous congestion rather than infectious mastoiditis. The aim of this study was to investigate a link between the spectrum of mastoid abnormalities and clot burden in patients with acute CVT. MethodsA retrospective study of adult patients admitted to the National Institute of Mental Health and Neurosciences between 2016 and 2023 who were diagnosed with acute CVT and had no clinical evidence of active or recent ear infections was conducted. Pre- and post-contrast MR Images were analyzed to identify the dural sinuses and/or cerebral veins involved and the presence of fluid signal in the mastoid. Fluid signal in the mastoid was graded from 0 to 3 as described by Shah et al- no fluid signal (grade 0), thin curvilinear hyperintensities (grade 1), thick crescenteric hyperintensities (grade 2), and complete hyperintensity (grade 3). Clot Burden Score (CBS) was calculated by assigning one point for each sinus involved, one point for extension of thrombus into the intracranial Internal Jugular Vein (IJV), one point for thrombosis of cortical veins and one point for thrombosis of deep cerebral veins. ResultsA total of 89 patients with acute CVT were included in the final analysis. Median time from presentation to MRI was 2 days (range 0–13). 51 patients (57.3%) had fluid signal in the mastoid air cells on T2-weighted images, of whom 33 showed mucosal contrast enhancement. Higher grade of fluid signal in the mastoid was present ipsilateral to the side of venous thrombosis in 59 out of 60 patients with posterior fossa CVT. CBS was significantly different between patients with different grades of fluid signal (p = 0.002). Grade 2–3 fluid signal was associated with higher clot burden (CBS > 3) in both the entire study population (n = 89) – OR = 8.281, 95 %CI: 2.758–24.866 (p < 0.001) and among patients with posterior fossa CVT – OR = 4.375, 95 %CI: 1.320–14.504 (p = 0.016). Among patients with posterior fossa CVT, grade 2–3 fluid signal was associated with left sided transverse and/or sigmoid sinus thrombosis – OR = 5.600, 95 %CI: 1.413–22.188 (p = 0.014), and extension of thrombosis into the IJV – OR = 4.606, 95 %CI: 1.162–18.262 (p = 0.030). ConclusionT2 fluid signal in the mastoid is associated with venous congestion in adults with acute CVT without evidence of otologic infection. Moderate-to-severe T2 fluid signal in the mastoid air cells is associated with increased clot burden.

Do nasal saline rinses improve severity of acute sinus congestion in adults with seasonal allergies?

Keyhani, Javad MD; Thibodeau, Chelsea DO; Feng, Emily MD; Ferri-Huerta, Rita MD Author Information

The effectiveness of subcutaneous furosemide for symptoms related to congestion in adults with heart failure: A limited systematic review

Heart failure is a major cause of morbidity and mortality worldwide (Bui et al., 2010, Savarese and Lund, 2017 and Metra, and Teerlink, 2017). It usually progresses, leading to repeated hospital admissions and significant symptom burden for patients (Beattie and Johnson MJ, 2012). Therapeutic options to achieve diuresis are of extreme importance for symptom relief. Subcutaneous furosemide might be a useful medication and its use is increasing in heart failure, especially in the field of palliative medicine (Beattie and Johnson MJ, 2012). Limited systematic review, searching five databases. We included only randomized controlled trials (RCTs), for their higher level of evidence. Study design was evaluated including inclusion and exclusion criteria, method and site of recruitment, blinding. We also evaluated population characteristics, intervention and comparison, primary and secondary outcomes, adverse effects and follow-up. The data will be analyzed using narrative synthesis. Fifteen articles, of which 3 were included, reporting on eligible RCTs, all published in 2018. Studies found that subcutaneous furosemide might be an effective option to achieve therapeutic plasma doses, better than oral furosemide. Studies found no statistical difference in diuresis in comparison with oral or intravenous furosemide or in hospitalization rates between groups, which suggests that subcutaneous furosemide might prevent acute hospital admissions. No major adverse events were reported. There are few studies and the evidence suggests that subcutaneous furosemide may be a therapeutic option for patients with heart failure requiring parenteral diuresis. However, the evidence to date at the time of the systematic review is limited and as such this therapeutic approach is off license and currently requires more evidence. L’insuffisance cardiaque est une cause majeure de morbidité et de mortalité dans le monde (Bui et al., 2010, Savarese et Lund, 2017 et Metra, et Teerlink, 2017). Elle progresse généralement, entraînant des hospitalisations répétées et une charge de symptômes importante pour les patients (Beattie et Johnson MJ, 2012). Les options thérapeutiques pour réaliser la diurèse sont extrêmement importantes pour le soulagement des symptômes. Le furosémide sous-cutané pourrait être un médicament utile et son utilisation augmente dans l’insuffisance cardiaque, en particulier dans le domaine de la médecine palliative (Beattie et Johnson MJ, 2012). Revue systématique limitée, recherche dans cinq bases de données. Nous n’avons inclus que des essais contrôlés randomisés (ECR), pour leur niveau de preuve plus élevé. La conception de l’étude a été évaluée, y compris les critères d’inclusion et d’exclusion, la méthode et le site de recrutement, et l’aveuglement. Nous avons également évalué les caractéristiques de la population, l’intervention et la comparaison, les résultats primaires et secondaires, les effets indésirables et le suivi. Les données seront analysées à l’aide d’une synthèse narrative. Quinze articles, dont 3 inclus, rendant compte des ECR éligibles, tous publiés en 2018. Les études ont montré que le furosémide sous-cutané pourrait être une option efficace pour obtenir des doses plasmatiques thérapeutiques, mieux que le furosémide oral. Les études n’ont trouvé aucune différence statistique dans la diurèse chez une comparaison avec le furosémide par voie orale ou intraveineuse ou dans les taux d’hospitalisation entre les groupes, ce qui suggère que le furosémide sous-cutané pourrait empêcher les hospitalisations aiguës. Aucun événement indésirable majeur n’a été signalé. Il existe peu d’études et les preuves suggèrent que le furosémide sous-cutané peut être une option thérapeutique pour les patients souffrant d’insuffisance cardiaque nécessitant une diurèse médicamenteusement facilitée. Cependant, les preuves à ce jour au moment de l’analyse de la littérature sont limitées et, à ce titre, cette approche thérapeutique est hors autorisation de mise sur le marché (AMM) et nécessite actuellement plus de preuves.

A Controlled, Randomized Clinical Study to Verify the Efficacy and Safety of a New Hypertonic Solution (Narlisim) in Nasal Congestion in Adults Affected by Common Cold

Background: Nasal congestion is the main symptom of common cold. Symptomatic treatment with nasal decongestant seems to be the only treatment option. We managed a study to assess the efficacy of Narlisim, a developed nasal spray, on nasal congestions in common cold. Materials and methods: In this study, sixty adult patients with common cold were included. Thirty patients were treated with Narlisim nasal spray, and 30 patients with isotonic nasal spray. The primary outcome was the assessment of the speed of relief of nasal congestion; the secondary outcome was the assessment of nasal congestion and nasal secretion symptoms by a 0–100% rating Visual analog score (VAS) scale on 5 items at baseline and after 5, 10, 15, 20, 25 and 30 minutes from treatment. Results: VAS score progressively reduced for all investigated symptoms in both groups; a statistically significant higher mean reduction at each time point was recorded in the study group compared to controls (p<0.001). Conclusions: Our results suggest that Narlisim may be a promising medical device to control nasal congestion and rhinitis in common cold thanks to its nasal washing, hypertonic city, and low pH and osmo protection properties.

Nasal decongestants in monotherapy for the common cold.

Nasal decongestants in monotherapy for the common cold.

Nasal congestion: algorithm for the diagnosis and treatment in children and adults

Nasal congestion in adults and children remains a major challenge in otorhinolaryngology. Nasal breathing difficulty is one of the most common complaints of patients visiting otorhinolaryngologists. The main causes of nasal congestion are acute upper respiratory tract viral infections, manifested, for example, by acute rhinitis. [1]

Oral Phenylephrine HCl for Nasal Congestion in Seasonal Allergic Rhinitis: A Randomized, Open-label, Placebo-controlled Study

Phenylephrine hydrochloride (PE HCl) is widely used for the treatment of nasal congestion, but efficacy at the 10-mg dose is not known for certain. The Food and Drug Administration has requested that sufficiently powered, multicenter, dose-ranging studies be conducted to assess the efficacy and safety of PE HCl. To evaluate subjective nasal congestion symptom relief and safety of 4 different doses of PE HCl immediate-release 10-mg tablets and placebo in adults with seasonal allergic rhinitis (SAR). This multicenter, phase 2, parallel, open-label trial randomized 539 adults with SAR (but otherwise healthy) to 7 days of treatment with either PE HCl 10-mg tablets at fixed doses of 10, 20, 30, or 40 mg or placebo. The primary efficacy end point was the mean change from baseline over the entire treatment period in daily reflective nasal congestion score. Other efficacy end points and safety were also evaluated. None of the PE HCl treatment groups had a statistically significant change from baseline in instantaneous or reflective nasal congestion scores compared with the placebo group. PE HCl was well tolerated at doses of up to 30 mg. At least 1 treatment-emergent adverse event was experienced by 18.4% of the participants, the most common being headache (3.0%). PE HCl, at doses of up to 40 mg every 4 hours, is not significantly better than placebo at relieving nasal congestion in adults with SAR. The phenylephrine section of the Food and Drug Administration monograph on over-the-counter cold, cough, allergy, bronchodilator, and antiasthmatic products should be revised accordingly.

Comparison of two oral probiotic preparations in a randomized crossover trial highlights a potentially beneficial effect of Lactobacillus paracasei NCC2461 in patients with allergic rhinitis

BackgroundThere is promising but conflicting evidence to recommend the addition of probiotics to foods for prevention and treatment of allergy. Based on previous studies with fermented milk containing Lactobacillus paracasei NCC2461, we aimed to compare the effect of a powder form of the latter probiotic with the effect of a blend of Lactobacillus acidophilus ATCC SD5221 and Bifidobacterium lactis ATCC SD5219 in patients with allergic rhinitis.MethodsA double-blind, randomized, cross-over study, involving 31 adults with allergic rhinitis to grass pollen, was performed outside the grass pollen season (registration number: NCT01233154). Subjects received each product for 4-weeks in two phases separated by a wash-out period of 6 to 8 weeks. A nasal provocation test was performed before and after each 4-week product intake period, and outcome parameters (objective and subjective clinical symptoms; immune parameters) were measured during and/or 24 hours after the test.ResultsOut of the 31 subject enrolled, 28 completed the study. While no effect was observed on nasal congestion (primary outcome), treatment with NCC2461 significantly decreased nasal pruritus (determined by VAS), and leukocytes in nasal fluid samples, enhanced IL-5, IL-13 and IL-10 production by peripheral blood mononuclear cells in an allergen specific manner and tended to decrease IL-5 secretion in nasal fluid, in contrast to treatment with the blend of L. acidophilus and B. lactis.ConclusionsDespite short-term consumption, NCC2461 was able to reduce subjective nasal pruritus while not affecting nasal congestion in adults suffering from grass pollen allergic rhinitis. The associated decrease in nasal fluid leukocytes and IL-5 secretion, and the enhanced IL-10 secretion in an allergen specific manner may partly explain the decrease in nasal pruritus. However, somewhat unexpected systemic immune changes were also noted. These data support the study of NCC2461 consumption in a seasonal clinical trial to further demonstrate its potentially beneficial effect.

Colds, flu and coughing: a review of over-the-counter nasal therapies in general practice

Nasal congestion due to the common cold occurs because of dilation of the blood vessels, leading to swelling of the nasal mucosal epithelium. This narrows nasal passages, which are further blocked by increased mucus production. Nasal sprays and drops are often recommended for the treatment of rhinorrhoea and nasal congestion associated with the common cold. This brief review discusses over-the-counter nasal therapies that are used to relieve rhinorrhoea and nasal congestion in adults and children.

WITHDRAWN: Nasal decongestants for the common cold.

The common cold is a major and recurrent cause of morbidity, on average affecting children and adults two or more times each year. Nasal congestion is its commonest symptom and many therapies are marketed for its relief. There is no meta-analysis of controlled clinical trials on the effects of nasal decongestants in the common cold. To assess the efficacy of nasal decongestants at reducing the symptom of nasal congestion in adults and children with the common cold and to identify possible adverse effects associated with their use. In this updated review in 2006, the following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2006, issue 3); MEDLINE (January 1996 to September 2006); OLDMEDLINE (1951 to 1965); EMBASE (1980 to Week 36, 2006). We contacted known principal investigators and pharmaceutical companies. Randomised, placebo controlled trials of single-active oral and topical nasal decongestants in adults and children suffering from common cold. Two review authors (DT, GJL) independently extracted data. All outcomes variables were continuous. Subjective outcomes were normalised to a common scale and a weighted mean difference (WMD) was calculated. A standardised mean difference (SMD) was calculated for the objective outcomes. Seven studies in adults, but none in children, fitted all inclusion criteria. There was a small but statistically significant 6% decrease in subjective symptoms after a single dose of decongestant compared with placebo. This was supported by a significant decrease in nasal airways resistance. With repeated doses, nasal decongestants produce a very small statistical benefit of 4% over three to five days, again supported by a decrease in nasal airways resistance. Two studies provided safety data for this meta-analysis, showing a relatively small number of adverse events and only a small increased risk of insomnia with pseudoephedrine compared to placebo. A single oral dose of nasal decongestant in the common cold is modestly effective for the short term relief of congestion in adults, and these drugs also provide benefit in some individuals after regular use over three to five days. Adverse events in adults are rare and mild. There is insufficient data on the use of these medications in children and therefore they are not recommended for use in children younger than 12 years of age with the common cold.

Mometasone furoate monohydrate nasal spray for the treatment of nasal congestion in allergic rhinitis

Allergic rhinitis (AR) affects an estimated 20–40 million Americans annually. It is a multifaceted condition comprising a range of symptoms, including nasal congestion, arguably the most bothersome symptom. Of the various types of medications available for the treatment of AR, intranasal corticosteroids are considered the most effective. Mometasone furoate nasal spray is an intranasal corticosteroid with anti-inflammatory properties. It is indicated for the treatment of the nasal symptoms of seasonal AR and perennial AR in adults and children, for the prophylaxis of nasal symptoms of seasonal AR and for the treatment of nasal polyps. Numerous clinical trials have demonstrated that mometasone furoate nasal spray effectively relieves nasal congestion in adults and children with AR, while providing excellent safety and tolerability.

Review: a single dose of nasal decongestant reduces congestion in the short term in adults with the common cold; insufficient evidence exists on the effectiveness of repeated doses

Taverner D, Latte J, Draper M. Nasal decongestants for the common cold. Cochrane Database Syst Rev 2004;(3):CD001953. Q Are nasal decongestants effective for reducing the symptom of nasal congestion in...

Nasal decongestants for the common cold.

The common cold is a major and recurrent cause of morbidity, affecting children and adults two or more times each year. Nasal congestion is its commonest symptom and many therapies are marketed for its relief. There is no meta-analysis of controlled clinical trials on the effects of nasal decongestants in the common cold. To assess the efficacy of nasal decongestants at reducing the symptom of nasal congestion in adults and children with the common cold and to identify possible adverse effects associated with their use. In updating this review in 2004, the following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2004) which contains the Cochrane Acute Respiratory Infections Group's specialised register; MEDLINE (January 1996 to February week 1 2004); EMBASE (1996 to February week 7 2004); and Current Contents (February 2004). We handsearched review citations from other references and contacted known principal investigators and pharmaceutical companies. Randomised controlled trials with placebo of single-active oral and topical nasal decongestants in adults and children suffering from common cold. Data were independently extracted by two reviewers (DT and GJL). All outcomes variables were continuous. Subjective outcomes were normalised to a common scale and a weighted mean difference (WMD) was calculated. We calculated a standardised mean difference (SMD) for the objective outcomes. Five studies involving 286 adults were included, none in children. There was a significant 13% decrease in subjective symptoms after decongestants were compared with placebo. This was supported by a significant decrease in nasal airways resistance. Repeated doses of nasal decongestant were not significantly better than placebo at relieving symptoms of nasal congestion. A single dose of nasal decongestant in the common cold is moderately effective for the short term relief of congestion in adults, while there is no evidence available to show benefit after repeated use over several days. There is insufficient data on the use of these medications in children and therefore they are not recommended for use in young children with the common cold.

A single dose of nasal decongestant in the common cold is moderately effective for the short-term relief of congestion in adults

A single dose of nasal decongestant in the common cold is moderately effective for the short-term relief of congestion in adults

Nasal decongestants for the common cold.

The common cold is a major and recurrent cause of morbidity, affecting children and adults two or more times each year. Nasal congestion is its commonest symptom, and many therapies are marketed for its relief. There is no meta-analysis of controlled clinical trials on the effects of nasal decongestants for the common cold. To assess the efficacy of nasal decongestants at reducing the symptom of nasal congestion in adults and children with the common cold and to identify possible adverse effects associated with their use. MEDLINE, EMBASE and Current Contents were searched up to May 1999. Searching the Cochrane Acute Respiratory Infections Group's trials register, following the review citation trail from other references and contacting known principal investigators and pharmaceutical companies was also done. Randomised, placebo controlled trials of single-active oral and topical nasal decongestants in adults and children suffering from the common cold. Data were independently extracted by two reviewers (DT and LB). All outcomes variables were continuous. Subjective outcomes were normalised to a common scale and a weighted mean difference (WMD) was calculated. A standardised mean difference (SMD) was calculated for the objective outcomes. Four studies in adults, but none in children, fitted all inclusion criteria. There was a significant 13% decrease in subjective symptoms after decongestant compared with placebo. This was supported by a significant decrease in nasal airways resistance. Repeated doses of nasal decongestant were not significantly better than placebo at relieving symptoms of nasal congestion. A single dose of nasal decongestant in the common cold is moderately effective for the short term relief of congestion in adults, while there is no evidence available to show benefit after repeated use over several days. These medications are not recommended for use in young children with the common cold.

STENOSIS OF THE AQUEDUCT OF SYLVIUS

In 1760, Morgagni published some rather pertinent views on the subject of hydrocephalus. Among his many speculations appears one that is singularly appropriate:1 Indeed the greatest part of observers do not allow the disorder to be a hydrocephalus when the head is not enlarged. Yet there is not the least doubt, but that when a large quantity of water is by degrees collected in the cranium, a tumor of the head must infallibly arise therefrom, if it were possible for the bones to yield to the extension, as they do in young creatures: nor can it be doubted, but some of the causes, which give rise to the congestion of water in the heads of tender infants, are the same that give rise to the congestion in adults.... Suppose, for instance, either such a structure or constitution of the pineal gland, that it can transmit no water. This eighteenth