Intranasal Decongestants Research Articles

Rhinitis Control and Medication Use in a Real-World Sample of Patients With Persistent Rhinitis or Rhinosinusitis: A Community Pharmacy Study

BackgroundLittle is known about rhinitis control in real-life, nor about the contribution of treatment-related and patient-related factors. ObjectiveThis study aimed to examine the level of rhinitis control and rhinitis medication utilization in patients with persistent rhinitis, and to identify predictors of rhinitis control. MethodsA cross-sectional observational study was conducted in patients with persistent rhinitis recruited in community pharmacies. Participants completed the Rhinitis Control Assessment Test (RCAT), and a questionnaire on patient/rhinitis characteristics, and rhinitis medication use. A visual analogue scale (VAS) for nasal symptoms was also completed. Pharmacy dispensing data was used to calculate adherence to intranasal glucocorticoids. Nasal spray technique was evaluated using a standardized checklist. Predictors of rhinitis control were explored using a linear regression model. ResultsA total of 1514 patients, recruited in 215 pharmacies, participated in the study (mean age 48.7 years, 62% female). Almost 60% exhibited suboptimal rhinitis control (RCAT ≤ 21/30). A 50mm cut-off on the VAS yielded 78.1% sensitivity to identify suboptimal rhinitis control. Participants most frequently used intranasal glucocorticoids (55.6%) and intranasal decongestants (47.4%). Only 10.3% of current nasal spray users demonstrated perfect technique. More than half (54.8%) of glucocorticoid users were identified as underadherent. Female sex, self-reported nasal hyperreactivity, active asthma, and use of oral/intranasal decongestants or nasal saline were identified as predictors of worse rhinitis control. ConclusionSuboptimal rhinitis control was common in this real-life sample of persistent rhinitis patients. Improving use of rhinitis medication may be key to increase disease control.

The Effectiveness of High-Intensity Focused Ultrasound in Treating Nasal Obstruction Caused by Inferior Turbinate Hypertrophy: A Clinical Study.

Background Nasal obstruction due to inferior turbinate hypertrophy is a common medical complaint among ENT clinic patients, which can significantly affect thepatient's quality of life, and some are compelled to use topical intranasal decongestants. Conservative management is the first line of treatment; however, surgical reduction of the inferior turbinate becomes necessary if the symptoms persist after three months of treatment. The optimal surgical technique is controversial. High-intensity focused ultrasound (HIFU) is a minimally invasive surgical option that targets tissue volume precisely and minimally impacts surrounding tissue. This study aimed to assess the effectiveness and safety of HIFU in treating patients suffering from nasal obstruction due to inferior turbinate hypertrophy. Methods This prospective study was conducted from February to December 2016. The study lasted over six months. Patients with a history of allergic and non-allergic rhinitis participated in this study. It included 43 patients who had been experiencing chronic nasal obstruction due to bilateral inferior turbinate hypertrophy and had not shown improvement after three months of medical treatment. The patients underwent Ultrasound Volumetric Tissue Reduction (UVTR) surgery using the D & A Ultrasurgdevice (Diamant Medical Equipment Ltd., Amman, Jordan) under local anesthesia.The effectiveness, safety, and tolerance of HIFU were assessed subjectively for six months using a well-designed questionnaire utilizing a visual analog scale (VAS) and nasal endoscopy after the surgery. Results The study included 43 patients, 22 male and 21 female, aged 13 to 65 years. The study found that 40 (93%) patients showed significant improvement in nasal obstruction within a month of the surgery. However, three (7%) patients continued to experience persistent nasal obstruction even after six months of follow-up. The procedure was well-tolerated, with low rates of complications after surgery and reasonable pain control. During the surgery, 20(46.5%) patients reported mild pain described as a pressure-like sensation, and 10 out of 43 patients (23%) required paracetamol after the procedure. Four patients (9.3%) had mild bleeding, which was treated with an ultrasound nasal probe without nasal packing. All patients experienced crusting of the nasal cavity during the first week, but no crustation was observed after the first month. There were no reported cases of synechia among the patients. Conclusion This study confirms that HIFU treatment is a reliable and effective treatment for improving short-term nasal obstruction caused by inferior turbinate hypertrophy. The procedure is easily applied and well-tolerated in outpatient clinics.

Pharmacists' Attitudes Towards Long-Term Use of Nasal Decongestants: A Cross-Sectional Study.

Rhinitis medicamentosa is a nonallergic inflammation of the nasal mucosa caused by topical decongestants overuse. It mainly affects young and middle-aged adults. Therefore, the aim of this study was to investigate the attitudes of pharmacists regarding the utilization of over-the-counter intranasal decongestants. An online cross-sectional study was conducted from November 2021 to January 2022. The target population of the study included pharmacists who work in community pharmacies in Saudi Arabia. Binary logistic regression analysis was used to identify predictors of having positive attitude towards controlling the use of decongestant. A total of 220 participants were included in this study. Around 15.0% of them reported that ND come with a physician prescription. The majority of the participants (87.3%) reported that the less than 5 days is the maximum safe duration for the use of NDs. Overall, the study participants demonstrated moderately positive attitude towards controlling the use of decongestant with a mean attitude score of 2.5 (standard deviation: 1.2) out of 5; which represents 50.0% of the maximum score. Binary logistic regression analysis identified that pharmacists aged 31-40 years were two-folds more likely to have positive attitude towards controlling the use of decongestant compared to others (p<0.05). Around 45.9% of them reported that they recommend other over-the-counter treatments like nasal irrigation, nasal steroids, or antihistamine if they see a patient with RM asking for ND with or without prescription. The majority of pharmacists in Saudi Arabia demonstrated sufficient awareness and understanding on the adverse effects associated with the excessive use of NDs. Rhinitis medicamentosacan be avoided by appropriate measures, highlighting the importance of raising awareness about the excessive use of decongestants among healthcare professionals and patients alike.

Complete Resolution of Fungal Ball Sinusitis with Medical Management Only: Case Series with Literature Review

Abstract Fungal ball (FB) is non-invasive type of fungal sinusitis. It might present with facial pain or pressure, nasal obstruction, secretions, or decreased sense of smell, depending on the size and location of the sinus that is involved. In this series, we aim to share our experience in treating cases of FB with medical treatment only. Medical records data collected from three different centers for four patients diagnosed with FB were discussed in this case series. Four cases, with two males and two females, were reported in this series. Patient ages ranged from 19 to 51 years old. The most common complaint was nasal obstruction and nasal discharge. Computed tomography (CT) showed a heterogenous mass in the maxillary sinus for three cases with one of them involved the concha bullosa. Also, in one case the mass involved sphenoid sinus with expansion over the posterior sphenoidal septum. Two patients received intranasal steroids, one received additional oral steroids, and one received only intranasal decongestant drops. Within one to six months, all patients reported the complete resolution of their symptoms. Repeated CT showed the complete resolution of the FB in all four cases. Surgical resection of FB remains the mainstay of management. However, trials using medical treatment can be used to waive the surgical option in some cases where there is no urgent indication for surgical intervention.

New Nasal Spray for Migraine Headaches

Zavegepant (Zavzpret), a nasal spray, is approved to treat adults with acute migraine with or without aura. It should not be used as a preventative.The most common adverse effects of zavegepant are taste disorders, nausea, nasal discomfort, and vomiting. Hypersensitivity reactions are also possible.Patients should avoid coadministration with intranasal decongestants, as these can decrease zavegepant absorption.

The effectiveness of essential oils in the treatment of acute viral rhinosinusitis

Introduction. Acute respiratory viral infections are the most widespread diseases, accounting for up to 90% of all infectious pathology, which supports the relevance of optimizing the treatment of acute viral rhinosinusitis.Aim. Evaluate the dynamics of clinical symptoms of acute viral rhinosinusitis, which arose as part of an acute respiratory infection, when supplementing therapy with the drug Respero Myrtol (Pol-Boskamp GmbH and Co.KG, Germany), the active ingredient of which is myrtol standardized 120 mg in 1 capsule.Materials and methods. The dynamics of clinical symptoms of 20 cases of acute viral rhinosinusitis in comparison groups was analyzed. Traditional treatment of patients included taking propionic acid derivatives, ascorbic acid, intranasal use of decongestants and irrigation of the nasal cavity with isotonic saline solutions. Patients who have received traditional treatment are defined as a “standard therapy group”. To assess the effectiveness of therapy using standardized myrtol, 20 cases of acute viral rhinosinusitis against the background of acute respiratory viral infections with a similar severity were analyzed, in which patients received outpatient therapy with Respero Myrtol 2 capsules 3 times a day for 7 days in addition to the above treatment (the “myrtol therapy” group). The dynamics of the disease assessed: the number of days of disability before recovery, the period of normalization of body temperature in feverish patients, the need for vasoconstrictive intranasal agents after the seventh day of therapy, the period of complete relief of pain syndrome, the period of normalization of night sleep, the number of cases of bacterial superinfection and the need for systemic antibacterial therapy.The results. In the observed patients, the quality of sleep was restored faster, the pain syndrome was stopped earlier, less often there was a need for systemic antibiotics and prolonged use of intranasal decongestants. The disease proceeded with fewer days of disability.Conclusion. The study results have been shown to report the clinical efficacy of Respero Myrtol essential oils in the outpatient treatment of patients with acute rhinosinusitis.

Подходы к ведению ребенка с острым риносинуситом: взгляд педиатра

Acute rhinosinusitis (ARS) is common in children and most often occurs in upper respirato-ry tract infections. Meanwhile, a disease duration of more than 7–10 days suggests a bacterial infec-tion and requires a change in the treatment approach to sinusitis. Any local condition preventing normal sinus drainage (i.e., inflammation) predisposes the patient to infection. ARS diagnosis is difficult because of the overlap between its clinical manifestations and symptoms of other common diseases, strong dependence on the subjective perception of symptoms by parents, and difficulties in physical examination of the child. The disease history, nature of symptoms, and duration are the basis for establishing a clinical diagnosis. In most patients, ARS resolves spontaneously, and in an uncomplicated course, antibiotics are not indicated. Intranasal steroids, irrigations, decongestants, and mucolytics are used as adjuvant therapy. However, data supporting the efficacy of these adju-vant therapies in children are scarce, and no strong formal recommendations on their use are avail-able. This paper discusses the key issues of ARS diagnosis and management in pediatric practice. KEYWORDS: acute rhinosinusitis, ARS, children, diagnosis, treatment, decongestants, acetyl-cysteine, tuaminoheptane sulfate. FOR CITATION: Kolosova N.G., Shatalina S.I. Management approach to acute rhinosinusitis: a pediatrician's perspective. Russian Medical Inquiry. 2023;7(8):537–542 (in Russ.). DOI: 10.32364/2587-6821-2023-7-8-11.

The effectiveness of using a homeopathic preparation containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with nasal obstruction in vasomotor and chronic subatrophic rhinitis

Introduction. In recent years, the world has seen an increase in the number of patients with difficulty in nasal breathing due to nasal obstruction, one of the causes of which are functional disorders of the nasal mucosa in various forms of rhinitis. Frequent use of intranasal decongestants among the population further contributes to the lack of effectiveness of conservative treatment and the need for surgical correction to restore free nasal breathing. This article discusses the possibility of using a homeopathic preparation containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with nasal obstruction in vasomotor and chronic subatrophic rhinitis to stop the clinical manifestations of the disease and improve the quality of life of patients. Аim. Тo evaluate the effectiveness of a drug containing calendula, witch hazel, aesculus, menthol and zinc oxide in patients with vasomotor and chronic subatrophic rhinitis in the complex treatment of nasal obstruction. Мaterials and methods. The study involved 48 adult patients of both sexes, aged 20 to 50 years, diagnosed with vasomotor (idiopathic) rhinitis in 24 and chronic subatrophic rhinitis in 24 patients. The studied preparation containing calendula, witch hazel, esculus, menthol and zinc oxide was smeared on the mucous membrane of the nasal cavity by laying gauze turundas for 5 minutes, 3 times a day, while the course of treatment was 10 days. The efficacy and safety of the drug was assessed by the dynamics of the severity of subjective symptoms, objective clinical data during control examinations by an otorhinolaryngologist in points, as well as by the presence of side effects in the treatment of the disease. Results. Results of the study showed a pronounced positive trend in the form of relief of subjective complaints and the main clinical manifestations of the disease, accompanied by an improvement in the quality of life in patients in both groups examined during treatment. Side effects were not observed in patients in both study groups. Conclusions. Based on the results of the study, conclusions were drawn about the efficacy and safety of using a complex homeopathic preparation containing calendula, witch hazel, esculus, menthol and zinc oxide in an adult group of patients with nasal obstruction, which makes it possible to recommend it for widespread use for the complex treatment of nasal syndrome. obstruction in vasomotor and chronic subatrophic rhinitis, as well as other forms of rhinitis accompanied by nasal obstruction syndrome.

An Observational Study of Quality of Life in Patients of Allergic Rhinitis in a Tertiary Health Care Centre of South Gujarat.

Allergic rhinitis (AR) refers to an IgE-mediated inflammation following exposure to allergen. Often deemed as a minor inconvenience rather than a disease, AR impairs the QOL. Medical treatment has a beneficial effect. To evaluate the QOL in patients of AR. Patients of AR with ≥ 18 years age, receiving treatment in our department are included. Pre and Post treatment VAS (Visual Analogue Scale) and RSDI (Rhinosinusitis Disability Index) are compared to know the effect of disease and treatment on QOL. The patients of PAR (Persistent Allergic Rhinitis) had a greater impact on QOL. In PAR, a combination of INCS (Intranasal Corticosteroids) + oral antihistaminics result in significant reduction in VAS & RSDI scores. In IAR (Intermittent Allergic Rhinitis), Oral antihistaminics monotherapy was most effective in reducing itching while Oral antihistaminics + 1 week of intranasal decongestant was most effective in reducing sneezing, running nose and nasal blockage. Oral antihistaminics + LTRA (Leukotriene Receptor Antagonist) was most effective in reducing physical RSDI score. Oral antihistaminics + 1 week of intranasal decongestantwas most effective in reducing functional and emotional RSDI score. Functional RSDI scores had improved much higher than emotional and physical scores. All these observations were statistically significant. AR does affect the QOL while pharmacotherapy helps in improving the overall QOL. Oral antihistaminic alone or in combination with local decongestant/LTRA in IAR cases while INCS + oral antihistaminic in PAR cases are significantly effective in controlling symptom scores and QOL.

Оценка эффективности дренирования околоносовых пазух назальным катетером в лечении острого бактериального риносинусита

There are various ways to treat acute bacterial rhinosinusitis (ABRS), the main one being systemic antibiotic therapy (SAB), which seems logical today. However, the role of the method of active noninvasive drainage of the paranasal sinuses (PNS) with a nasal catheter (NC) in the treatment of this disease is not yet completely clear. Based on the pathogenesis of acute sinusitis, there are good reasons to use it as a possible treatment option. However, clinical studies are needed to confirm the effectiveness of the method. Objective. To evaluate the effectiveness of drainage of the paranasal sinuses with a nasal catheter in the treatment of acute bacterial rhinosinusitis. Materials and methods. Adult patients with ABRS were divided into 2 groups of 50 people. In the first group, SAB, irrigation of the nasal mucosa with saline, and intranasal decongestants were prescribed, in the second group, in addition to similar treatment, the procedure for draining PNS using NC was performed. The quality of life and the severity of sinonasal symptoms were assessed using the SNOT-16; the severity of the endoscopic picture, according to the modified Lund–Kennedy score (m-LK). In addition, in the second group, complications, duration of manipulation, and pain during the procedure were assessed according to the VAS (visual analogue scale). Results. The use of NC statistically significantly (p &lt; 0.05) reduces the severity of the disease according to the SNOT-16 and on the m-LK score on days 5–6 relative to treatment without NC, although this decrease is small. More long-term results in the groups do not differ (p &gt; 0.05). In the second group, facial pain stopped faster than in the first group (p &lt; 0.05). The severity of pain during the procedure with a catheter was 2,0 [1,0; 3,0] points, the procedure time was 12,0 [12,0; 13,0] minutes, complications were observed in 12% of cases. Conclusion. Treatment of OBRS with SAB in combination with NC is effective, well tolerated as well as relatively safe, but it does not affect the outcome of the disease compared to treatment with antibiotics alone. Given the effectiveness of the NC procedure with respect to facial pain, this procedure is indicated as an adjunct to the SAB in the presence of this symptom.

Safety of topical administration of nasal decongestants and vasoconstrictors in paediatric nasal surgery – A systematic review

ObjectivesTopical intranasal decongestants are essential in nasal surgery to improve operative field. There are concerns regarding safety in paediatric population. Data on safety and safe dosage are limited. This systematic review evaluated the literature on safety and dosage of intranasal decongestant in paediatric population. MethodsWe performed a systematic search of PubMed, EMBASE, Cochrane library for relevant articles. Quality assessment was done on included articles. ResultsA total of 10 articles were included: five case reports; three observational studies; and two randomised control trials. Decongestants evaluated were phenylephrine, oxymetazoline, epinephrine, xylometazoline, and cocaine. In total, 209 patients were included. Side effects reported included bradycardia, tachycardia and hypertension. These were mostly self-limiting and of no clinical compromise to the patients. A total of 4/209 (1.9%) of patients required treatment for these reported effects. No mortality was reported in the included studies. ConclusionIn the paediatric population, the literature suggests that when delivered in a pre-specified, controlled dosage, the haemodynamic effects of phenylephrine, oxymetazoline, xylometazoline are minimal and of no clinical significance. There is scope for further studies to establish safe dosage in the paediatric population given the paucity of current literature.

Heterogeneity of the pharmacologic treatment of allergic rhinitis in Europe based on MIDAS and OTCims platforms.

The practice of allergology varies widely between countries, and the costs and sales for the treatment of rhinitis differ depending on practices and health systems. To understand these differences and their implications, the rhinitis market was studied in some of the EU countries. We conducted a pharmaco-epidemiological database analysis to assess the medications that were being prescribed for allergic rhinitis in the years 2016, 2017 and 2018. We used the IQVIA platforms for prescribed medicines (MIDAS®- Meaningful Integration of Data, Analytics and Services) and for OTC medicines (OTC International Market Tracking-OTCims). We selected the five most important markets in the EU (France, Germany, Italy, Poland and Spain). Intranasal decongestants were excluded from the analyses because they are rarely prescribed for allergic rhinitis. For both Standard Units (SU) and costs, France is leading the other countries. In terms of SU, the four other countries are similar. For costs, Poland is lower than the three others. However, medication use differs largely. For 2018, in SU, intranasal corticosteroid is the first treatment in Poland (70.0%), France (51.3%), Spain (51.1%) and Germany (50.3%), whereas the Italian market is dominated by systemic antihistamines (41.4%) followed by intranasal corticosteroids (30.1%). Results of other years were similar. There are major differences between countries in terms of rhinoconjunctivitis medication usage.

Местная терапия в лечении пациентов с острым риносинуситом

Acute rhinosinusitis is one of the most common diseases in the world, characterized by acute inflammatory processes in the nasal cavity and paranasal sinuses, lasting less than 4 weeks. According to statistics, in Russia, this disease is recorded in 6–15% of the population annually, in European countries in every seventh person, while there is a tendency to an increase in the incidence. Acute viral rhinosinusitis has the highest incidence among all rhinosinusitis and occurs in most patients in a mild form, however, untimely treatment of inflammation of the nasal mucosa can lead to obstruction of the natural anastomoses, impaired physiological ventilation and drainage of the paranasal sinuses, stagnation of secretions with further development acute bacterial rhinosinusitis. The overuse of local vasoconstrictor drugs (intranasal decongestants) leads to the development of drug-induced rhinitis, long-term imbalance of autonomic innervation of the nasal mucosa and edema, called "rebound syndrome". In the article we consider the issues of etiology, pathogenesis, features of the course of rhinosinusitis. The principles of differential diagnosis of viral and bacterial rhinosinusitis are stated, taking into account the latest recommendations and research in this area. The features of the use of the most frequently used topical preparations in acute rhinosinusitis in the practice of an ENT doctor have been analyzed.

Role of decongestants in a complex therapy of acute infectious rhinitis

Nowadays the problem of treating of acute respiratory viral infections, primarily manifested with the clinical picture of acute rhinitis, remains an important problem due to the high prevalence and variety of etiological factors of this disease. Pathogenesis of rhinitis, regardless of the etiology, includes the swelling of the nasal mucosa, the increase in nasal secretion, which blocks nasal breathing and significantly reduces the quality of life. In uncomplicated forms of acute infectious rhinitis, symptomatic treatment is traditionally used, including the elimination therapy and drugs for reducing the nasal mucosa swelling. Topical decongestants have a sympathomimetic effect, affect α1- and α2-adrenergic receptors and help to eliminate swelling of the nasal mucosa and improve nasal breathing, and as a result, restore the patency and aerodynamics of the airways, recover the drainage function of the paranasal sinuses and auditory tube. To date, the pharmaceutical market offers many intranasal decongestants that differ in the duration of exposure, frequency of use, the occurrence of side effects or adverse events. The article shows the pharmacological and pharmacokinetic characteristics of the drug xylometazoline, highlights the results of Russian and foreign studies that demonstrate the efficacy and good tolerability of xylometazoline with a short-term topical course of treatment. The conclusion is made about a good profile of the efficacy and safety of the drug and confirmed that in compliance with the recommendations for the frequency and duration of application, xylometazoline could be recommended for use in a complex symptomatic treatment of acute rhinitis in adults and children.

Rhinitis 2020: A practice parameter update

This comprehensive practice parameter for allergic rhinitis (AR) and nonallergic rhinitis (NAR) provides updated guidance on diagnosis, assessment, selection of monotherapy and combination pharmacologic options, and allergen immunotherapy for AR. Newer information about local AR is reviewed. Cough is emphasized as a common symptom in both AR and NAR. Food allergy testing is not recommended in the routine evaluation of rhinitis. Intranasal corticosteroids (INCS) remain the preferred monotherapy for persistent AR, but additional studies support the additive benefit of combination treatment with INCS and intranasal antihistamines in both AR and NAR. Either intranasal antihistamines or INCS may be offered as first-line monotherapy for NAR. Montelukast should only be used for AR if there has been an inadequate response or intolerance to alternative therapies. Depot parenteral corticosteroids are not recommended for treatment of AR due to potential risks. While intranasal decongestants generally should be limited to short-term use to prevent rebound congestion, in limited circumstances, patients receiving regimens that include an INCS may be offered, in addition, an intranasal decongestant for up to 4 weeks. Neither acupuncture nor herbal products have adequate studies to support their use for AR. Oral decongestants should be avoided during the first trimester of pregnancy. Recommendations for use of subcutaneous and sublingual tabletallergen immunotherapy in AR are provided. Algorithms based on a combination of evidence and expert opinion are provided to guide in the selection of pharmacologic options for intermittent and persistent AR and NAR.

Rhinitis medicamentosa

One type of non-allergic non-infectious rhinitis is represented by a heterogeneous group of rhinitis medicamentosa, which can be divided into several pathogenetic types. The most common rebound nasal congestion associated with the use of topical decongestants. Excessive use of intranasal decongestants leads to a decrease in the number of alpha-adrenoreceptors on the surface of cell membranes and uncoupling their connection with the G-protein and the development of tachyphylaxis. To prevent the development of rebound nasal congestion caused by topical decongestants, it is important to limit the frequency of their use. In most cases, the duration of the use of vasoconstrictor drugs should be limited to 5-7 days, according to Patient information leaflets for the drugs. However, in patients who have had a history of episodes of rebound nasal congestion, which develops including the previously indicated periods, the duration of decongestant therapy should be limited to 3 days. Rhinitis associated with local inflammation is caused by the intake of acetylsalicylic acid (ASA) or other non-steroidal anti-inflammatory drugs. Currently, the so-called "aspirin triad" is well known - a combination of bronchial asthma, rhinosinusitis (often polyposis) and intolerance to ASA. Neurogenic rhinitis develops due to the use of drugs that violate vascular tone, for example, antihypertensive drugs or type 5 phosphodiesterase inhibitors. Drug-induced rhinitis has a significant impact on the patient's quality of life: nasal congestion, rhinorrhea, secondary night apnea, insomnia as a result of nasal breathing disturbances, headaches, irritability, weakness after sleepless nights disturb patients to a large extent. Timely diagnosis and withdrawal of a provocative drug, the use of topical corticosteroids in case of severe rhinitis are the basis of the treatment of rhinitis medicamentosa. In severe cases, there is a need, including surgical treatment, such as, for example, submucosal laser destruction of the lower nasal concha.

Visual Vignette

Case Presentation: A 41-year-old female presented with a 4-month history of right-sided nasal congestion and copious clear drainage. Her symptoms were attributed to seasonal allergies and treated with intranasal glucocorticoids and decongestants. Despite medical therapy, her symptoms persisted, and a computed tomography scan of the sinuses was obtained. Imaging demonstrated a fluid-attenuating lesion extending through the sellar region and into the right sphenoid sinus and nasopharynx via a skull base osseous defect (Fig. 1 A and B). Beta-2 transferrin testing of her rhinorrhea sample was positive, reflecting a cerebrospinal fluid (CSF) leak. Magnetic resonance imaging of the brain confirmed the presence of a pseudomeningocele advancing through the sellar region into the right nasal cavity (Fig. 1 C), with resultant partially empty sella, flattening of the posterior sclera, and prominent fluid-filled optic nerve sheaths. No clinical or biochemical evidence of pituitary dysfunction was noted on further evaluation. Lumbar puncture was performed and notable for an opening pressure of 34 cm of water. What is the diagnosis?

Influence of Intranasal Drugs on Human Nasal Mucociliary Clearance and Ciliary Beat Frequency.

The nasal mucociliary clearance system, which comprises epithelial cilia and mucus from goblet cells, is an important intrinsic defense mechanism of the upper respiratory tract. Intranasal drugs and additives can have a detrimental effect on ciliary activity and mucociliary clearance, and thus impact the integrity of nasal defense mechanisms. This article discusses the current literature on the effects of different classes of intranasal drugs including intranasal corticosteroids, antihistamines, decongestants, antimicrobials and antivirals, as well as various drug excipients and nasal irrigation solutions on human nasal mucociliary clearance and ciliary beat frequency. Available data indicate that some intranasal formulations tend to hamper nasal ciliary function and mucociliary clearance. Therefore, it is of great importance to assess the effects of intranasal drugs and additives on mucociliary function before they are recommended as therapy for different nasal conditions.

EXERCISE INDUCED RHINITIS: A PREVALENT BUT ELUSIVE DISEASE

Introduction Exercise induced rhinitis is defined as inflammation of the nasal passages leading to rhinorrhea, sneezing, congestion or nasal itching related to physical activity. Although abundant research exists regarding exercise induced asthma, urticaria, and anaphylaxis, as well as allergic rhinitis, little is understood regarding exercise induced rhinitis. Exercise induced rhinitis has been displayed in indoor and outdoor athletes with and without nasal allergy. Similarities exist between the nasal mucosa and the bronchial airways, suggesting similar mechanisms of inflammation between exercise induced asthma and rhinitis. These include airway dehydration, hyperpnoea, fluid hyperosmolarity, neutrophilic inflammation, histamine release and mast cell degranulation. Case Description This case involved a 37-year-old female who presented with rhinitis during exercise. Her symptoms included nasal congestion and discharge, sneezing, and itchy nose, and exam revealed edematous nasal turbinates. Her symptoms were only mildly improved with daily oral Cetirizine and nasal Fluticasone. Allergy testing revealed IgE of 13kU/L (Ref: <=214kU/L), with environmental and food allergens showing no significant elevations in specific IgE levels, suggesting a non-allergic etiology. She was started on a trial of nasal Azelastine to be used prior to exercise, which provided relief of symptoms. Discussion Currently, no standardized method of diagnosis or treatment of exercise induced rhinitis exists. Suggested treatment strategies include intranasal corticosteroids, decongestants, and antihistamines, however, each have side effects that can interfere with exercise. Further research is indicated to explore the mechanism, evaluation, and treatment of exercise induced rhinitis as a distinct entity to ensure the safety and success of affected athletes. Exercise induced rhinitis is defined as inflammation of the nasal passages leading to rhinorrhea, sneezing, congestion or nasal itching related to physical activity. Although abundant research exists regarding exercise induced asthma, urticaria, and anaphylaxis, as well as allergic rhinitis, little is understood regarding exercise induced rhinitis. Exercise induced rhinitis has been displayed in indoor and outdoor athletes with and without nasal allergy. Similarities exist between the nasal mucosa and the bronchial airways, suggesting similar mechanisms of inflammation between exercise induced asthma and rhinitis. These include airway dehydration, hyperpnoea, fluid hyperosmolarity, neutrophilic inflammation, histamine release and mast cell degranulation. This case involved a 37-year-old female who presented with rhinitis during exercise. Her symptoms included nasal congestion and discharge, sneezing, and itchy nose, and exam revealed edematous nasal turbinates. Her symptoms were only mildly improved with daily oral Cetirizine and nasal Fluticasone. Allergy testing revealed IgE of 13kU/L (Ref: <=214kU/L), with environmental and food allergens showing no significant elevations in specific IgE levels, suggesting a non-allergic etiology. She was started on a trial of nasal Azelastine to be used prior to exercise, which provided relief of symptoms. Currently, no standardized method of diagnosis or treatment of exercise induced rhinitis exists. Suggested treatment strategies include intranasal corticosteroids, decongestants, and antihistamines, however, each have side effects that can interfere with exercise. Further research is indicated to explore the mechanism, evaluation, and treatment of exercise induced rhinitis as a distinct entity to ensure the safety and success of affected athletes.

Topical nasal decongestant oxymetazoline (0.05%) provides relief of nasal symptoms for 12 hours.

Nasal congestion, often referred to as stuffy nose or blocked nose is one of the most prevalent and bothersome symptoms of an upper respiratory tract infection. Oxymetazoline, a widely used intranasal decongestant, offers fast symptom relief, but little is known about the duration of effect. The results of 2 randomized, double-blind, vehicle-controlled, single-dose, parallel, clinical studies (Study 1, n=67; Study 2, n=61) in which the efficacy of an oxymetazoline (0.05% Oxy) nasal spray in patients with acute coryzal rhinitis was assessed over a 12-hour time-period. Data were collected on both subjective relief of nasal congestion (6-point nasal congestion scale) and objective measures of nasal patency (anterior rhinomanometry) in both studies. A pooled study analysis showed statistically significant changes from baseline in subjective nasal congestion for 0.05% oxymetazoline and vehicle at each hourly time-point from Hour 1 through Hour 12 (marginally significant at Hour 11). An objective measure of nasal flow was statistically significant at each time-point up to 12 hours. Adverse events on either treatment were infrequent. The number of subjects who achieved an improvement in subjective nasal congestion scores of at least 1.0 was significantly higher in the Oxy group vs. vehicle at all hourly time-points on a 6-point nasal congestion scale. This study shows for the first time, that oxymetazoline provides both statistically significant and clinically meaningful relief of nasal congestion and improves nasal airflow for up to 12 hours following a single dose.