Nose Blowing Research Articles

DEVELOPMENT OF A NEW DETECTOR SYSTEM TO EVALUATE POSITION AND ACTIVITY OF PLUTONIUM PARTICLES IN NASAL CAVITIES.

Plutonium dioxide (PuO2) is used to fabricate a mixed oxide fuel for fast breeder reactors. When a glove box containing PuO2 fails, such as by rupture of a glove or a vinyl bag, airborne contamination of plutonium (Pu) can occur. If a worker inhales PuO2 particles, they will be continually irradiating their lung tissue with alpha particles, and this could cause lung cancer. The nasal smear and nose blow methods are useful for checking workers for PuO2 intake in the field. However, neither method can evaluate the quantitative activity of Pu. No alpha-particle detector that can be used for direct measurements in the nasal cavity has been developed. For direct and quantitative measurement, it is required that a shape of the detector should be a fine bar which inserts itself in the nose to measure the accurate activity of Pu. Therefore, we developed a nasal monitor capable of directly measuring the activity of Pu in the nasal cavity to estimate the internal exposure dose of a worker. Prismatic-shaped 2 × 2 acrylic light guides were used to compose a detector block, and a ZnS(Ag) scintillator was adhered to the surface of these light guides. Silicon photomultiplier (SiPM) arrays with 8 × 8 channels were used as a photodetector. Actual PuO2 particles were measured using the nasal monitor. The nasal monitor could be directly inserted in the nasal cavities, and the activity distribution of Pu was obtained by the nasal monitor. The average efficiencies in 4-pi were 11.4 and 11.6% for the left and right nasal cavities, respectively. The influence of gamma and beta rays from Cesium-137 (137Cs) Strontium-90 (90Sr) on the detection of the alpha particles of Pu was negligible. The difference in the measured Pu activity between the ZnS(Ag) scintillation counter and the nasal monitor was within 4.0%. Therefore, it was considered that the developed nasal monitor could be used in direct Pu determination to estimate the internal exposure dose of workers.

Familial misophonia or selective sound sensitivity syndrome : evidence for autosomal dominant inheritance?

IntroductionMisophonia is a recently described, poorly understood and neglected condition. It is characterized by strong negative reactions of hatred, anger or fear when subjects have to face some selective and low level repetitive sounds. The most common ones that trigger such aversive reactions are those elicited by the mouth (chewing gum or food, popping lips) or the nose (breathing, sniffing, and blowing) or by the fingers (typing, kneading paper, clicking pen, drumming on the table). Previous articles have cited that such individuals usually know at least one close relative with similar symptoms, suggesting a possible hereditary component.ObjectiveWe found and described a family with 15 members having misophonia, detailing their common characteristics and the pattern of sounds that trigger such strong discomfort.MethodsAll 15 members agreed to give us their epidemiological data, and 12 agreed to answer a specific questionnaire which investigated the symptoms, specific trigger sounds, main feelings evoked and attitudes adopted by each participant.ResultsThe 15 members belong to three generations of the family. Their age ranged from 9 to 73 years (mean 38.3 years; median 41 years) and 10 were females. Analysis of the 12 questionnaires showed that 10 subjects (83.3%) developed the first symptoms during childhood or adolescence. The mean annoyance score on the Visual Analog Scale from 0 to 10 was 7.3 (median 7.5). Individuals reported hatred/anger, irritability and anxiety in response to sounds, and faced the situation asking to stop the sound, leaving/avoiding the place and even fighting. The self-reported associated symptoms were anxiety (91.3%), tinnitus (50%), obsessive-compulsive disorder (41.6%), depression (33.3%), and hypersensitivity to sounds (25%).ConclusionThe high incidence of misophonia in this particular familial distribution suggests that it might be more common than expected and raises the possibility of having a hereditary etiology.

Nasal vestibulitis: etiology, risk factors, and clinical characteristics: A retrospective study of 118 cases

BackgroundNasal vestibulitis (NV) is a common infection; however, scant data is available in the literature as it pertains to NV. We aim to describe the clinical characteristics of NV in respect to its potential complications. MethodsA retrospective chart review of 118 NV cases admitted to a tertiary medical center between 2008 and 2015. ResultsIdentified risk factors for NV included nasal hair plucking (n=15, 14.41%), nose blowing (n=10, 9.32%), nose picking (n=9, 8.47%) and nose piercing (n=5, 3.39%). Twelve patients (10.17%) were diabetic, and 3 patients were immunosuppressed. Mid-facial cellulitis was observed in the majority of patients (78.81%), and abscess of the nasal vestibule was observed in almost half (48.30%). Cultures were taken from 33.33% of patients demonstrated MSSA as the most common isolate (81.25%). No complications were observed. ConclusionEven in complicated cases of NV requiring admission, the risk of major complications is extremely low.

A Case of Bilateral Pneumoparotid Improved with Conservative Treatment

이하선 기종은 이하선 종대의 원인 중 매우 드문 질환으로, 이하선의 종창과 통증 등의 증상을 나타낸다. 이하선 기종은 유리 부는 직공이나 관악기 연주자 등 여러 구강 내 압력이 증가하는 상황에서 이하선 내로 공기가 들어가 발생할 수 있다. 저자들은 최근 습관적인 볼 부풀리기로 유발된 양측 이하선 기종 환자를 경험하고, 이에 대해 습관 교정을 통한 보존적 치료로 호전되었기에 문헌 고찰과 함께 보고하고자 한다.Pneumoparotid is defined as the presence of air within the parotid gland or duct. Pneumoparotid is an extremely rare cause of parotid gland swelling. Pneumoparotid can be induced by air insufflation from oral cavity into the intraparotid salivary ducts, in condition like nose blowing, blowing up balloons, during extubation after general anesthesia while receiving positive pressure, rapid decompression while scuba diving, chronic attempts to suppress cough, and glassblowers. It can also be self-induced, and the literature contains an increasing number of reports involving pediatric and adolescent patients who induce parotid insufflation to avoid school or gain attention. Here, we report a case of pneumoparotid caused by habitual cheek inflating and improved with conservative treatment.

Autologous intratympanic blood patch for presumed perilymphatic fistulas.

To assess an alternative to bed rest and surgery for suspected perilymphatic fistulas using intratympanic blood injections. A review was conducted of patients' history, physical and audiometric data, before and after treatment by intratympanic blood injections performed from 2009 to 2015. Twelve ears were identified, with trauma associated with air travel, water sports or nose blowing. Ten of these cases had hearing loss, six had vestibular symptoms. Four cases had audiological and vestibular symptoms, two had vestibular symptoms only, and six had audiological symptoms only. Time-to-treat varied from 1 day to 30 days. Magnetic resonance imaging scans were obtained for five cases. Ten cases received steroids. Six out of seven cases showed improvement of hearing loss. Five cases showed positive fistula test results, four with documented resolution. Seven cases had full resolution of all symptoms, four had near-full resolution and one had no improvement. Intratympanic blood injections offer an effective alternative to conservative or surgical therapy. Advantages include sooner time-to-treat, lower financial costs and decreased psychosocial burdens. It allows a more flexible and liberal use of a potential definite treatment for perilymphatic fistula.

Orbital emphysema after nose blowing

A 33-year-old male presented with a sudden onset of left periorbital swelling and painless erythema over left lower eyelid after vigorous nose blowing (Figure 1a). There was no history of paranasal sinusitis, no trauma to the nose or face and no history of facial or nose surgery. Ophthalmologic examination revealed mild left congested conjunctiva with normal extraocular movements and visual acuity. Flexible fiberoptic rhinoscopy was unremarkable. Computed tomography (CT) scan showed orbital …

Persistent nasal symptoms and mediator release after continuous pollen exposure in an environmental challenge chamber

BackgroundImmediate- and late-phase reactions are associated with nasal symptoms of patients with allergic rhinitis. ObjectiveTo examine the symptoms and mediators released after continuous allergen exposure in an environmental challenge chamber (ECC). MethodsFifteen patients with Japanese cedar pollinosis were enrolled in this study and continuously exposed to cedar pollen at a concentration of 8,000 grains/m3 for 3 hours in an ECC. Nasal function tests were performed, and nasal secretions were collected before pollen exposure (0 hour), immediately after exiting the ECC (3 hours), and 6 hours after exiting the ECC (9 hours). Symptom scores were recorded every 30 minutes in the ECC and every 3 hours after exiting the ECC. The frequency of sneezing and nose blowing also was monitored. ResultsThe severity of symptoms in the ECC peaked approximately 2 hours after the beginning of pollen exposure and continued more than 6 hours after leaving the ECC. Concentrations of histamine, tryptase, interleukins 5, 3, 33, and 31, and substance P increased over time, whereas that of nasal fractional exhaled nitric oxide decreased. ConclusionVarious mediators are released during continuous allergen exposure, which subsequently induce persistent nasal symptoms. Effective treatment is required to control the intense inflammation observed after allergen exposure.

A Case of Perilymphatic Fistula Misdiagnosed as Benign Paroxysmal Positional Vertigo

Perilymphatic fistula (PLF) is an uncommon disease characterized by abnormal leakage of the perilymph from the inner ear into the middle ear. The symptoms of PLF include sudden-onset hearing loss, tinnitus, ear fullness, and vertigo resulting from inner-ear trauma, stapedial surgery or barotrauma such as valsalva, and nose blowing. As nystagmus can be induced by the affected-ear in down position, benign positional paroxysmal vertigo (BPPV) should be considered for differential diagnosis. About 40-50% of PLF patients have experienced spontaneous healing, but surgical repair should be considered when the hearing symptom and dizziness are not alleviated or are aggravated within a few days. Reported herein, with a review of the relevant literature, is a case of PLF initially misdiagnosed as BPPV but where successful fistula repair was finally achieved.

Bilateral Sequential Pneumolabyrinth Resulting from Nose Blowing.

Pneumolabyrinth describes a condition with entrapped air in the labyrinth and usually occurs in temporal bone fractures that involve the otic capsule. While sporadic cases of bilateral pneumolabyrinth have been reported, cases lacking head trauma are very rare. We report the case of a 43-year-old man who had sudden hearing loss bilaterally after blowing his nose at an interval of 1 year. Although conservative management for the right ear and exploratory tympanotomy with sealing of the possible site of perilymphatic leakage in the left ear were performed, hearing outcome was poor in both ears. To our knowledge, this is the first case of bilateral pneumolabyrinth occurring as a result of nose blowing.

Spontaneous Subcutaneous Orbital Emphysema Following Nose Blowing

Spontaneous Subcutaneous Orbital Emphysema Following Nose Blowing

Needle decompression in a patient with vision-threatening orbital emphysema

Orbital emphysema is a condition resulting from trapping of air in loose subcutaneous or orbital tissues from the paranasal sinuses. This condition commonly seen in patients with a history of periorbital trauma or surgery, especially following sneezing or nose blowing. It usually has a benign and self-limited course. However, the entrapped orbital air can cause a substantial increase in pressure with restricted ocular motility or vascular compromise and become severe enough to cause visual impairment. We herein present the case of a patient who developed severe orbital emphysema after blunt trauma followed by sneezing and was successfully treated with needle decompression of intraorbital air. Emergency needle decompression resulted in an improvement in vision and intraocular pressure.

Hapşırma Sonrası Spontan Subkutanöz Orbital Amfizem

Mersin University Faculty of Medicine, Department of Emergency Medicine, MERSIN Mersin Toros State Hospital, Department of Emergency Medicine, MERSIN Yuzuncu Yil University Faculty Of Medicine, Department of Plastic And Reconstructive Surgery, VAN Cukurova Medical Journal 2015;40(1):193-194. A previously healthy 55-year-old man presented to the emergency department with a sudden onset of mild pain in the right eye and swelling after an episode of sneezing. He denied diplopia or any other visual changes after the swelling took place, but had difficulty opening his eyes from ptosis and swelling of the upper eyelid. There was no history of sinusitis, facial trauma or previous surgery. Furthermore, he did not have any symptoms related to dental or upper respiratory tract infections, insect bites, or open wounds. Vital signs of the patient were normal. On physical examination, there was mild ecchymosis, periorbital swelling, ptosis associated with crepitus on palpation in the around of the right eye (mostly in the right upper eyelid) without localized heat or tenderness (Figure. 1). An ophthalmologist as urgently consulted after reviewing physical examination findings. On ophthalmologic examination, the visual acuity, pupillary light reactions, extraocular movements, and the funduscopic examination were normal. Other systems examinations were also normal. CT revealed subcutaneous air right superior orbit without fracture in the orbit (Figure. 2). The patient was managed conservatively with non-steroidal antiinflammatory drug, and advised avoidance of nose blowing, sneezing or perform activities that might elevate sinus pressures. He was discharged for the outpatient treatment and followed-up during two weeks. Two week later, on follow-up, the subcutaneous emphysema gradually resolved without any complications. Orbital emphysema is an uncommon condition in the absence of facial trauma, previous surgery, insect bites, open wounds or sinusitis. In rare instances, it is observed after spontaneous, atraumatic causes such as nose blowing, sneezing or during air travel. These conditions (such as sneezing) may lead to a sudden increase in intranasal pressure, causing the defect in the lamina papyracea and subsequently allowing air to enter the surrounding orbital tissue (orbital emphysema). In most patients, orbital emphysema usually resolves in a week or 2, without adverse sequelae. Patients should be counseled to avoid activities that raise intranasal pressure such as nose blowing, sneezing, diving in pools, and flying on airplanes. All patients should have close follow-up and careful observation with pyhicians. In conclusion, orbital emphysema may occur spontaneously after unexpected events such as sneezing in the absence of trauma. The aim of this presentation is to bring awareness to physicians of this uncommon condition, and a relatively simple Editore Mektup / Letter to the Editor

Effectiveness of Second-Generation Antihistamine for the Treatment of Morning Symptoms Observed in Patients with Perennial Allergic Rhinitis: Comparison Study of Bepotastine Besilate versus Olopatadine Hydrochloride

Objective: The aim of the present study was to examine circadian rhythm-based treatment strategies with the intension of improving the pharmacotherapy for morning symptoms with perennial allergic rhinitis. We investigated the effects of two second generation antihistamines, with different pharmacokinetic parameters, bepotastine besilate and olopatadine hydrochloride, for the treatment of morning symptoms. Methods: Twenty-four subjects with perennial allergic rhinitis were recruited for this study. They were randomly allocated to either a bepotastine group (n=10) or an olopatadine group (n=14). During the 1-hour period after waking up in the morning, the patients counted and recorded the number of sneezes and nose blowing. PNIF was also measured. The study participants took the allocated medicine twice a day. They continued recording their nasal symptoms and PNIF after awakening for 10 to 14 days. Results: In both group, taking bepotastine and olopatadine, the mean sneezing count and the mean nose blowing count were well suppressed. However, a significant change in the nasal congestion score was not observed throughout the study. Especially in olopatadine group, PNIF increased from day 2 onward and a significant increase was observed for the following 10 days. Conclusion: The worsening of nasal symptoms after awakening that is associated with perennial allergic rhinitis has a significant impact on the quality of life of patients. Two second-generation antihistamines, bepotastine besilate and olopatadine hydrochloride, were effective for the treatment of these morning symptoms. The measurement of Peak Nasal Inspiratory Flow (PNIF) value might lead to a favorable self-evaluation of nasal symptom and treatment effects. Some guidance regarding the taking of medicine from Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation the viewpoint of chronotherapy might improve the satisfaction of patients with the results of pharmacotherapy.

Correlation between Nasal Nitric Oxide and Quality‐of‐Life Improvements after Sinus Surgery

Objectives: Analyze the correlation between preoperative nasal nitric oxide (nNO) level, its postoperative change, and symptom scores in patients with chronic rhinosinusitis (CRS). Methods: We collected pre- and postoperative 3 and 6 months nNO level for patients who received bilateral endoscopic sinus surgery. They were classified according to existence of nasal polyps (NPs) and allergy test. Subjective symptoms were provided as Sino-Nasal Outcome Test-22 (SNOT-22) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Associated medical parameters were analyzed. Results: Fifty-four patients completed the follow-up, including 16 CRS without NPs (CRSsNPs) and 38 CRS with NPs (CRSwNPs). Allergic patients had higher preoperative nNO level ( P = .042), but existence of NPs didn’t make any difference. The nNO level correlated well with computed tomography score ( P = .001), endoscopy score ( P < .001), and current smoking ( P = .038). Baseline nNO correlated with postoperative 3-month improvement in nose blowing ( P = .029) and nasal discharge ( P = .007) in CRSwNPs. In nonallergic patients, higher baseline nNO had better improvement in olfaction ( P = .039) and nasal discharge ( P = .035). Postoperative 3 month nNO change had significant correlation with improvement of olfaction only in CRSwNPs ( P = .036). The nNO change in postoperative 6 month had no correlation with any individual symptom score change in either group. Conclusions: Baseline nNO was significantly correlated to some of the symptom improvements in CRSwNPs and nonallergic group within 3 months postoperatively. Postoperative 3 month nNO change related to olfaction improvement in CRSwNPs group; however, no significant correlation could be detected in the 6-month period after surgery.

Orbital Emphysema as a Rare Complication of Septorhinoplasty: A Case Report

Orbital emphysema following rhinoplasty is an extremely rare complication. Only one case of sub-dermal emphysema was reported in the English literature following rhinoplasty directly in post-operative period and one reported case of sudden orbital emphysema during septorhinoplasty operation. A 29 year old male underwent open septorhinoplasty. Surgery was un eventful and no nasal packs were placed after surgery. Hours after surgery he developed right orbital swelling following forceful nose blowing and sneezing. CT scan showed extensive right orbital and peri-orbital emphysema extending to the right infra-temporal fossa. Emphysema was gradually resolving without any complications and disappeared completely on the 10th day post-operatively. Keywords: Orbital emphysema, complication, septorhinoplasty, osteotomy. Read more →

Mechanisms for acute corneal hydrops and perforation.

Acute corneal hydrops (ACH) and perforation in corneal thinning diseases are the consequences of exposure to distending intraocular pressure (IOP) forces that are in excess of corneal resistance to them. Apart from thinning, resistance to these forces may be reduced by disease-related tissue changes, such as corneal scarring, which could lower resistance to IOP. Eye rubbing trauma has sometimes been found to be associated with ACH and perforation. This association is not surprising given that the combination of rubbing-related mechanical tissue trauma and the associated increased distending stress of higher IOP seem likely to increase the risk of complications. Many cases of ACH and perforation are described as spontaneous, but this classification may be the consequence of not considering the multiple potential mechanisms for IOP elevation such as coughing, sneezing, nose blowing, and sneeze suppression in addition to those related to eye rubbing/wiping/massaging/touching as well as changes in body orientation, strenuous exercise, and wearing swimming goggles for example. Classification of ACH or perforation as spontaneous may lead patients to assume that nothing can be done to avoid these complications. Patients with corneal thinning diseases who are counseled regarding the potential precipitating mechanisms for IOP elevation will have the opportunity of reducing exposure to them and the risk of the associated complications. In addition, when ACH or perforation occur, faster resolution of edema and wound healing may depend on reducing potentially exacerbating exposures to mechanisms for IOP elevation.

Specific IgE for wheat in tear fluid of patients with allergic conjunctivitis

Context: Allergy to hydrolyzed wheat protein in facial soap has become a major social issue in Japan. It has been reported that the most frequent early symptoms of allergy to hydrolyzed wheat protein in soap are allergic conjunctivitis and rhinitis, while wheat-dependent exercise-induced anaphylaxis can be induced by long-term use.Objective: We evaluated the relation between tear fluid levels of specific IgE for wheat and the features of allergic conjunctivitis.Methods: A prospective, non-randomized, cross-sectional study was conducted in 103 patients with moderate to severe allergic conjunctivitis (allergic group) and 20 age- and sex-matched healthy control subjects (control group). Specific IgE for wheat was measured in tear fluid with an immunochromatography assay, and a skin prick test (SPT) was also performed. Symptoms (sneezing, rhinorrhea, nasal obstruction, ocular itching, and lacrimation) were assessed in each subject along with the activities of daily living (ADL) score and the total ocular symptom score for allergic conjunctivitis. A severity score (0, 1, 2, or 3) was assigned for various changes of the palpebral and bulbar conjunctiva, as well as for limbal and corneal lesions associated with allergic conjunctivitis.Results: The IgE positive rate and specific IgE score were both higher in the allergic group than in the control group (71.8% versus 40.0% and 1.9 ± 0.7 versus 1.4 ± 0.5). A positive SPT for wheat was also more frequent in the allergic group than in the control group (6.8% versus 0.0%). Within the allergic group, patients with a positive SPT had higher specific IgE scores than patients with a negative SPT (3.3 ± 0.5 versus 1.8 ± 0.6, p < 0.001). In the allergic group, the wheat IgE level in tear fluid was correlated with the severity of allergic conjunctivitis symptoms, including ocular itching (r = 0.665), tearing (r = 0.672), and the total ocular symptom score (r = 0.204). Wheat IgE in tear fluid was also correlated with the severity of rhinitis symptoms, including sneezing (r = 0.610), nose blowing (r = 0.640), and nasal obstruction (r = 0.677). Furthermore, the tear fluid wheat IgE score was correlated with five objective features of allergic conjunctivitis (p < 0.05).Conclusions: These results suggest that wheat allergy may be involved in the development of allergic conjunctivitis.

Medial Orbital Wall Fracture Caused by Forceful Nose Blowing

Medial Orbital Wall Fracture Caused by Forceful Nose Blowing

Abstract T P175: Symptoms and Signs of Cerebrovascular Ischemia in the New England Medical Center Patent Foramen Ovale Registry

Objective: To evaluate the frequencies of symptoms and signs in patients with cryptogenic strokes in the setting of patent foramen ovale (PFO). Methods: We conducted a retrospective case series of cryptogenic stroke patients at the NEW England Medical Center, with proven PFO. The patients' records were reviewed for: 1) Activity at time of symptoms, 2) symptoms, 3) physical exam finding. Results: The study included 148 men (58%) and 109 women (42%). The average age was 52 years. The most frequent activity at the time of symptoms onset were lifting weights (30%), bending (34%), coughing/ sneezing/ nose blowing (16%), intercourse (7%), vomiting (5%). A history of prolonged immobility was present in 31% of patients. The most frequent presenting symptoms were unilateral weakness (46%), dysarthria (17%), unilateral numbness (11%), unsteady gait (10%), visual field defect (9%), diplopia (8%), vomiting (6%). The most frequent signs were normal exam (52%), unilateral weakness (14%), visual field deficits (13%), ataxia (4%), neglect/ inattention (2%), Babinski (3%), nystagmus (2%), unsteady gait (1%). Conclusion: We report our experience with cryptogenic stroke in patients with proven PFO. The disparity in frequencies of the signs and symptoms at the time of presentation raises the possibility of including these variables in an algorithm for predicting PFO in the setting of cryptogenic stroke.

Barotraumatic Subcutaneous Orbital Emphysema after Nose Blowing: Case Report

Orbital subcutaneous emphysema is defined as the abnormal presence of air within the periorbital soft tissue. It occurs generally as a result of blunt or penetrating facial trauma. Spontaneous barotraumatic emphysema is a very rare entity that generally results due to a sudden increase in the intraorbital pressure. If there is not an obvious visual acuity loss even with high ocular pressure, it is generally managed conservatively. However prolonged elevation of intraorbital pressure may cause an irreversible, ischemic visual loss secondary to an ischemic optic neuropathy or an acute central retinal artery occlusion.Emergency decompression may be required. Here we are presenting a patient with barotraumatic orbital subcutaneous emphysema, occurring after forceful nose blowing who was managed conservatively without any complications.