Postnasal Drip Research Articles

Acute respiratory viral infections: Consensus on rational therapy

There are diseases for which people turn to specific specialists, but there are also a number of ones that are treated by doctors of different specialties. Therapists, infectious disease specialists, otolaryngologists, and pulmonologists diagnose and treat acute respiratory viral infections. But the same specialists often have to deal with the outcomes of an acute process – postnasal drip and post-infectious cough, which decreases the quality of life and exhaust patients. However, in case when the correct diagnosis is made, there are treatment regimens that allow to achieve quick relieve subjective and objective symptoms, as well as clinical cure of the disease escaping the use of antibacterial therapy. The efficient therapy agreement of the otolaryngologist and pulmonologist is that for various causes of cough, herbal medicine is the best choice.

Epidemiological investigation of allergic rhinitis in children aged 6-12 years in Bayannur City, China.

Allergic rhinitis (AR) is an inflammatory condition of the nasal mucosa triggered by exposure to non-harmful substances. Over the past decade, the prevalence of AR in Chinese children has been steadily increasing. However, detailed epidemiological data on AR in children from Bayannur City are lacking. This study randomly selected six primary schools in Bayannur City. Electronic questionnaires were distributed via the web, and parents and children completed the questionnaires by scanning the two-dimensional code within a designated timeframe. Statistical analysis was performed on the collected data. A total of 4,754 valid responses were obtained. The self-reported prevalence of AR among children in Bayannur city was 39.79%. Multivariate analysis revealed that male gender, belonging to an ethnic minority, a history of food or drug allergies, frequent antibiotic use (≥3 times per year in the past two years, with each course lasting ≥3 days), and residence in urban or pastoral areas was associated with an increased prevalence of AR in children. The proportion of children experiencing moderate to severe AR hat impacted their studies or daily life was 48.78%. Chronic AR was reported in 56.71% of cases. Among AR patients with other allergic conditions, the incidence rates were as follows: bronchial asthma 35.99%, upper airway cough syndrome (UACS) 64.32%, secretory otitis media (SOM) 22.41%, obstructive sleep apnea hypopnea-syndrome (OSAHS) 49.58%, allergic dermatitis (AD) 48.72%, and allergic conjunctivitis (AC) 85.20%. The prevalence of AR was 50.30% in urban areas, 13.733% in rural areas and 20.90% in pastoral areas. Seasonal effects on AR prevalence were notably significant in urban and pastoral regions. The prevalence of AR among children in Bayannur city was 39.80%. Of those with AR, 48.72% experienced significant impacts on their learning or daily life, while only 14.80% had no other allergic conditions. There were significant variations in the prevalence and onset of AR among children between urban, agricultural and pastoral areas.

AYURVEDIC MANAGEMENT OF CHRONIC ALLERGIC RHINITIS W.S.R TO PRATISHYAYA: A CLINICAL CASE STUDY.

Chronic allergic rhinitis is a common nasal condition characterized by persistent inflammation of the nasal membranes triggered by allergens. Allergic rhinitis, often called hay fever, inflammation, and discomfort, signif-icantly impacts the quality of life. In Ayurvedic classics, this condition is associated with Pritishyaya, which is mentioned in Nasagata roga. Objective: This study aims to explore the Ayurvedic management of chronic rhini-tis, with a focus on understanding and treating the five types of Pritishyaya, i.e. Vataja, Pittaja, Kaphaja, Rakta-ja, Sannipataja. Methods: A clinical case study involved a patient with chronic rhinitis. Symptoms such as nasal congestion, rhinorrhea, sneezing, watery eyes, and post-nasal drip were evaluated and notably aggravated by certain factors, including curd (yogurt) consumption, exposure to cold environments (such as air conditioning), and exposure to dust, etc. The patient’s condition was classified according to Ayurvedic principles, and a tai-lored treatment regimen, including dietary changes, herbal remedies, and lifestyle adjustments, was implement-ed. Results: The treatment led to significant improvements in the patient’s symptoms, including reduced nasal congestion and discharge, decreased sneezing, and enhanced overall comfort. The personalized approach proved effective in addressing the specific type of Pritishyaya. Conclusion: The study highlights the efficacy of Ayur-vedic treatments in managing chronic rhinitis and emphasizes the importance of individualized care. The find-ings support integrating Ayurvedic methods into contemporary clinical practice and suggest further research to explore their broader applicability.

Effect of N-acetylcysteine aerosol inhalation on serum levels of inflammatory factors and immune function in children with upper airway cough syndrome

Effect of N-acetylcysteine aerosol inhalation on serum levels of inflammatory factors and immune function in children with upper airway cough syndrome

Multidisciplinary team discussion based on etiological treatment improves refractory chronic cough outcomes

BackgroundRefractory chronic cough (RCC) causes significant impairments in the life quality of patients. Further research into the identification of etiologies and development of the treatment schedules for RCC is needed. Patients and methodsWe established an multidisciplinary team (MDT) clinic, by integrating respiratory medicine, otorhinolaryngology, and gastroenterology departments, to investigate cough etiologies and the effectiveness of treatment. The therapeutic effect was assessed quantitatively using the Cough Visual Analog Scales (VAS), Leicester Cough Questionnaire (LCQ), and Reflux Symptoms Index (RSI) scores. ResultsIn total, 213 patients attending the MDT outpatient clinic were examined, and 115 patients with RCC were included for analysis. The RCC diagnosis rate among the outpatient was 88.7%. Common causes of RCC included gastroesophageal reflux cough (63.5%), upper airway cough syndrome (UACS) (43.5%), and cough variant asthma (CVA) (14.8%). After an average treatment period of 2.17 ± 1.06 weeks (wk), 73.9% of the patients had partial cough remission, and 6.1% had complete cough remission. The cough VAS score before and after treatment was 6.11 ± 2.02 vs. 3.66 ± 2.22 (P < 0.05), respectively; LCQ total score before and after treatment was 10.24 ± 3.11 vs. 13.16 ± 3.59 (P < 0.05), respectively; and RSI score before and after treatment was 15.82 ± 7.01 vs. 10.71 ± 6.64 (P < 0.05), respectively. ConclusionThe etiologies of most patients with RCC could be identified in the MDT clinic, and the cough-related symptoms of a significant number of patients with RCC improved in a short period.

Merocel versus a new septal clip with splint in post septal surgery cases: a prospective study

Septoplasty is one of the most frequently performed surgical procedures in otorhinolaryngology to overcome nasal obstruction. Following septal surgery, nasal packs are commonly inserted by surgeons to support and appose septal flaps the types of which depend on the preference and experience of the surgeon.Background We conducted a study to compare the Merocel sponge with that of a newly developed septal clip with the splint in patients who underwent septoplasty or submucosal resection to find out which one is better. A total of 50 patients were included in the study over a period of 3 years. Patients were divided into 2 groups of 25 each where group M is for patients receiving Merocel after surgery and group C is for patients receiving septal clips with splints.Aim The aim of this study was to assess and compare the effects of a Merocel pack on nasal functions with that of the septal clip and their eventual complications and outcome in the post-operative period.Results The main observations that were found in both groups in the immediate postoperative period were (1) pain (2) nasal obstruction (3) sleep disturbance (4) headache (5) epiphora (6) dryness of mouth and (7) postnasal drip. Pain was mild to moderate in the case of group M (MPS was 2.4) and moderate to severe degree in the case of group C (MPS was 5.7).Nasal obstruction was more common in Merocel group patients. Sleep disturbance, headache, epiphora, post-nasal drip, and dryness of mouth were also more in the Merocel group. After pack removal in both groups, the nasal examination was done to see crusts, vestibulitis, and septal ulcers. All these findings were more in the septal clip with the splint group.Conclusions It was observed that Merocel nasal packing causes significant morbidity and discomfort in the immediate post-operative period as compared to septal clips. It is also expensive. The new septal clips with splints can be used as an effective alternative to Merocel for approximation of flaps after septal surgery.

Sinus Irrigation with N-Acetylcysteine after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Preliminary Report of a Single-Blind Randomized Controlled Trial.

Nasal irrigation is crucial following endoscopic sinus surgery (ESS), especially for managing chronic rhinosinusitis (CRS). This study assessed the effectiveness of N-acetylcysteine (NAC) irrigation during the post-ESS period of patients with CRS without nasal polyposis. In this prospective, single-blind randomized controlled trial, 49 patients (NAC, n = 24; saline, n = 25) undergoing ESS were assigned to receive either NAC or saline irrigations twice daily for a month. The preoperative and postoperative assessments conducted included Lund-Macka (LM) and Lund-Kennedy (LK) endoscopic scores, the Nasal Obstruction Symptom Evaluation (NOSE) scale, and the Sino-Nasal Outcome Test-20 (SNOT-20). At 2 weeks, 1 month, and 3 months after the operation, endoscopic findings and symptoms were evaluated. Both groups showed no differences in age, sex, LM and LK scores, NOSE scale, and SNOT-20 preoperatively. In terms of the endoscopic findings regarding the sinonasal mucosa after ESS, the NAC group had slightly lower scores 2 weeks, 1 month, and 3 months after the operation, but this difference was not statistically significant. The NAC group showed significant improvement in VAS scores, namely, postnasal drip (1.0, p = 0.041), smell dysfunction (0.8, p = 0.003), and crust (1.5, p = 0.034), compared to the control group's scores of 2.6, 4.7, and 3.6, respectively, 2 weeks after the operation, although no significant differences were observed in VAS scores for any symptoms 1 and 3 months after the operation. NAC was well tolerated, and no adverse events were reported. NAC irrigation showed benefits over saline irrigation in terms of improving postnasal drip, smell dysfunction, and crust after ESS for CRS without nasal polyposis in the immediate postoperative period.

Growth rate, impact of smoking and management of incidentally found paranasal sinus osteomas

ObjectiveTo build upon existing literature regarding growth rate of asymptomatic, incidentally found paranasal sinus (PNS) osteomas, evaluate potential factors associated with growth rate and present an argument for how to follow up. MethodsAt our institution, EPIC SlicerDicer was used to screen imaging studies using keyword ‘osteoma’ and included patients with at least 2 imaging studies 6 months apart that both demonstrated a PNS osteoma(s). Imaging studies with the largest time interval were selected. Non-PNS osteomas were excluded. Results47 patients that fit this criterion with a median duration of interval imaging of 35.9 months. Growth rate was measured to be 0.39 mm/year in the cephalocaudal direction and 0.45 mm/year in the mediolateral direction, together averaging 0.42 mm/year. Increases in growth rate additionally did not appear to impact the likelihood of developing conditions including nasal polyposis or chronic sinusitis and symptoms such as sinus pressure, headache, postnasal drip, or congestion. Those with interval scans >36 months were found to have a slower growth rate than those with closer interval scans. Furthermore, former smokers and current smokers had significantly greater growth rates than nonsmokers. ConclusionGiven their slow growth rate, we conclude that select lesions likely do not require follow-up. If there is concern that growth could cause an obstructive complication, such as blocking the frontal outflow tract, we argue a single scan at one year is appropriate. If there is additional growth on this scan, surveillance scans up to 3 years could be performed to assess stability. Lastly, while there was a significant growth rate for smokers compared to non-smokers, the slow growth rate is unlikely to influence management.

Case report of an unusual allergic reaction to a routine skin prick test performed in an outpatient clinic: Diagnosis, management, and knowledge gaps.

The skin prick test (SPT) is a standard procedure in allergy/immunology clinics, crucial for evaluating conditions like allergic rhinitis and food allergies. As a cornerstone in investigating immunoglobulin E-mediated allergy, it plays a vital role in diagnosing allergies, including those triggered by common dust mites like Dermatophagoides pteronyssinus, Dermatophagoides farinae, Euroglyphus maynei, and Blomia tropicalis. Despite its widespread use, adverse reactions to SPT are uncommon (15 per 100,000 patients), though the procedure is not entirely risk-free. This article presents a clinical case involving a 17-year-old female who experienced a moderately delayed allergic reaction 120 minutes post-SPT, managed effectively with subsequent symptom resolution. The patient, with a history of persistent rhinorrhea, itchy nose, eyes, and postnasal drip, sought consultation due to worsening symptoms. Diagnostic measures, including patient-reported outcomes and SPT with a standard aeroallergen panel, revealed sensitization to various allergens. Post-test, the patient reported ocular pruritus, left eyelid swelling, and moderate rhinorrhea, persisting for about 24 hours. On the subsequent medical visit, the patient received rupatadine and deflazacort, leading to symptom resolution within 3 hours. This article delves into a systemic allergic reaction post-SPT, emphasizing the 2 main stages of type I hypersensitivity reactions. While the acute phase involves mast cell-driven mediators within 15 minutes, the delayed phase (4-8 hours) includes de novo cytokine release. Vigilance regarding symptom onset and differentiation between mild and severe reactions is crucial. Notably, the absence of specific waiting time guidelines post-SPT underscores the need for reporting to enhance understanding and subsequent management. Performing these procedures in specialized centers with qualified professionals is essential for effectively managing potential anaphylactic reactions. Addressing these knowledge gaps will contribute to enhanced patient safety during diagnostic procedures.

Features of Importance in Nasal Endoscopy: Deriving a Meaningful Framework.

Critical components of the nasal endoscopic examination have not been definitively established for either the normal examination or for clinical disorders. This study aimed to identify concordance among rhinologists regarding the importance of examination findings for various nasal pathologies. A consortium of 19 expert rhinologists across the United States was asked to rank the importance of findings on nasal endoscopy for 5 different sinonasal symptom presentations. An online questionnaire was distributed in July 2023. The questionnaire utilized JotForm® software and featured 5 cases with a set of 4 identical questions per case, each covering a common indication for nasal endoscopy. Rankings were synthesized into Normalized Attention Scores (NASs) and Weighted Normalized Attention Scores (W-NASs) to represent the perceived importance of each feature, scaled from 0 to 1. General concordance was found for examination findings on nasal endoscopy within each case. The perceived features of importance differed between cases based on clinical presentation. For instance, in evaluating postnasal drip, the middle meatus was selected as the most important structure to examine (NAS, 0.73), with mucus selected as the most important abnormal finding (W-NAS, 0.66). The primary feature of interest for mucus was whether it was purulent or not (W-NAS, 0.67). Similar analyses were performed for features in each case. The implicit framework existing among rhinologists may help standardize examinations and improve diagnostic accuracy, augment the instruction of trainees, and inform the development of artificially intelligent algorithms to enhance clinical decision-making during nasal endoscopy.

Posterior Nasal Nerve Ablation as a Viable Treatment Option for the Primary Symptom of Postnasal Drip.

Postnasal drip (PND) syndrome is a prevalent complaint encountered in otolaryngology practices. PND may be refractory to medical therapy, and surgical treatments are complicated by side effects. While posterior nasal nerve (PNN) ablation has demonstrated efficacy for chronic rhinitis overall, we sought to examine the effect of PNN ablation for patients with PND as their primary complaint. This is a retrospective case series study of 40 chronic rhinitis (CR) patients with a primary complaint of PND. Included patients had to have failed medical therapy such as anti-cholinergic nasal sprays, reflux treatments, and/or nasal steroids. Primary outcome measures included 22 item Sino-Nasal Outcome Test (SNOT-22) PND component and Total Nasal Symptom Score. Secondary outcome measure was subjective improvement, defined as a > 30% improvement in PND symptoms. Median follow-up was 138 days (interquartile range: 72-193). 72.5% (29/40) of patients reported at least a 30% improvement in PND symptoms. Mean PND SNOT-22 scores were 4.2/5 (SD = 0.8) pre-procedure versus 1.9/5 (SD = 1.3) post-procedure (P = .001). PNN ablation response did not correlate to ipratropium bromide nasal spray response, although younger and non-smoker patients had better response rates. This exploratory study of PNN ablation for the primary symptom of PND demonstrates efficacy as assessed by the PND component of SNOT-22 and subjective improvement. These results can be useful in guiding physician-patient discussions in determining treatment options for medically refractory PND.

Safety and efficacy of cryotherapy on chronic rhinitis: a systematic review and meta-analysis.

Chronic rhinitis is when the nasal passages become inflamed and irritated, causing symptoms like nasal congestion, runny nose, sneezing, and postnasal drip that last for at least 12weeks. While various medical treatments are available for chronic rhinitis, studies have shown that patients often do not comply with the treatment or report that it is ineffective. Cryotherapy for the nasal mucosa is a surgical option that has shown promise for these patients, with acceptable side effects. Our goal is to evaluate the existing literature regarding the effectiveness and safety of cryotherapy as a treatment for chronic rhinitis. We searched four electronic databases for relevant studies. Data were extracted from the included studies after screening procedures. Using the random effect model, we calculated the pooled mean difference (MD) for our continuous outcomes and pooled proportions for categorical outcomes. The I2 test was used to detect heterogenicity. Randomized controlled trials (RCTs) were assessed for methodological quality using the Cochrane risk of bias assessment tool 2, while observational studies and single-arm studies were assessed using the National Institutes of Health's tools. Our study comprised 21 studies; eighteen were eligible for analysis, with 1663 patients with chronic rhinitis. All of our assessed outcomes showed improvement with cryotherapy from their baseline status. Our pooled MDs for Total Nasal Symptom Score (rTNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and Nasal Obstruction Symptom Evaluation (NOSE) scores were as follows: ( - 3.58, 95% CI [ - 3.80, - 3.37], p < 0.001), ( - 1.48, 95% CI [ - 1.68, - 1.27], p < 0.001), and ( - 26.65, 95% CI [ - 33.98, - 19.31], p < 0.001), respectively. Regarding nasal obstruction and rhinorrhea, cryotherapy showed effectiveness in 61% and 52% of patients in the complete relief subgroup and 26% and 34% in the < 50%-relief subgroup, respectively. We observed significant improvement in our measured outcomes as rTNSS, RQLQ, and NOSE scores compared to the baseline state, demonstrating the cryotherapy's efficacy. This improvement was consistent in all subsequent follow-up periods. However, we need more high-quality RCTs for stronger evidence to be generalized.

Continued PPI use and gastrointestinal evaluations after a negative pH study in patients with throat symptoms from possible extraesophageal GERD.

Recent guidelines have advocated for upfront pH testing in patients with isolated symptoms of extra-esophageal gastrointestinal reflux disease (EE-GERD) under the assumption that a negative pH study will prevent further gastrointestinal (GI) investigations, proton pump inhibitor (PPI) use, and reduce cost. We sought to evaluate if this actually occurs. A retrospective study was performed on patients who underwent 24-hour combined pH-impedance testing off PPI for suspected EE-GERD. A negative study was defined as DeMeester score <14.7. 59 patients were included (mean age 53.2; 50.8% women). Most (38, 64.4%) had a negative study. Findings of laryngopharyngoreflux on laryngoscopy did not predict pH results. Those with a negative study had the same number of followup GI appointments, repeat endoscopies, and repeat pH studies compared to those with a positive study (p=NS). While PPIs were more frequently stopped in those with a negative pH study, still 14 (36.8%) were continued on a PPI. At the end of the follow-up period (mean 43.6 months), 18 (47.4%) subjects with a negative pH study were still prescribed PPIs. Patients who were diagnosed with post-nasal drip or rhinits were significantly less likely to still be receiving a PPI (5.6% vs 35.0%, p=0.045). Despite a negative pH study, a substantial number of patients with isolated EE-GERD symptoms are continued on a PPI and they undergo GI follow-up at the same rate as those with a positive study. These findings bring into question the recent recommendations for upfront pH testing in suspected EE-GERD and its reported cost savings.

Homoeopathic treatment for chronic cough – a multicentric, prospective, exploratory trial

Context Cough is a major symptom of respiratory and some non-respiratory ailments for which patients usually seek primary medical care. Homoeopathy is frequently used for treatment of chronic cough. Objective This study aims to assess whether homoeopathy is useful for treating chronic cough resulting from Upper airway cough syndrome (UACS), Asthma and related syndromes, or Gastroesophageal reflux disease (GERD). Study Design A multi‑centre, exploratory, prospective trial. Study setting The study was conducted in the outpatient departments of 10 centres of CCRH, India from May 2018 – June 2020. Patients Patients of any gender, between 7-65 years of age, presenting with cough lasting &gt;8 weeks, were enrolled. Main Outcome Measure(s) Cough Severity Index (CSI) and EQ-5D-5L scales were used to analyse the outcomes. Results Out of 2397 patients screened only 706 cases, with minimum four follow ups were analysed, on modified Intention to Treat (mITT) basis. CSI and EQ-5D-5L scores were used to analyse the outcomes of the study. The mean of the CSI score at baseline was 19.09 whereas it reduced to 3.89 in the eighth follow-up with p value &lt;0.01. The mean of the EQ-5D-5L score at baseline was 50.59 which increased to 73.79 in the last follow-up, with p-value&lt;0.05. Phosphorus, Arsenic album, Pulsatilla, Sulphur, Lycopodium and Silica were found to be the most frequently prescribed medicines.

Short-term quality of life assessment after sinus surgery for chronic rhinosinusitis

Chronic rhinosinusitis (CRS) has a negative impact on health-related quality of life (HRQoL). Functional endoscopic sinus surgery (FESS) is the treatment of choice for those not responding to medical treatments. To date, the short-term effects of FESS on HRQoL are still unclear. Evaluation of the short-term effects of FESS on HRQoL in CRS patients using the SNOT-22 questionnaire. The results of the validated German version of the Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire were analysed from 89 patients with CRS before surgery and 10-14 days (n = 77), four (n = 77), six weeks (n = 76) and 6 months (n = 71) after FESS, and compared with those of 1,000 healthy controls selected using a non-probability quota sample in accordance to the distribution of the German Microcensus. Compared to the preoperative mean SNOT-22 score (47.35), CRS patients significantly improved in HRQoL 10-14 days (31.75, p < 0.01), 4 weeks (25.84, p < 0.01), 6 weeks (24.16, p < 0.01) and 6 months after FESS (27.16, p < 0.01). Pre- and 6 months postoperatively, the five most important SNOT-22 items were nasal obstruction, smell and taste reduction, thick, mucous nasal secretions, need to blow the nose and postnasal drip. At the 2, 4 and 6-week follow-up, the reduction in smell and taste was most frequently perceived as limiting the HRQoL. This follow-up study shows for the first time that the reduction in smell and taste should be treated and controlled concervatively in the short term after FESS.

Well-Established and Traditional Use of Vegetal Extracts as an Approach to the "Deep Roots" of Cough.

Cough is a common presenting symptom for patients in a primary care setting and significantly impacts a patient's quality of life. Cough involves a complex reflex arc beginning with the stimulation of sensory nerves that function as cough receptors that stimulate the cough center in the brain. This "cough center" functions to receive these impulses and produce a cough by activating efferent nervous pathways to the diaphragm and laryngeal, thoracic, and abdominal musculature. Drugs that suppress the neural activity of cough are non-specific as those treatments are not directed toward pathogenic causes such as inflammation and oxidative stress. Moreover, they block a reflex called the watchdog of the lung and have a defense mechanism. Acute respiratory infections of the upper and lower airways most commonly cause acute cough. In contrast, the most common causes of chronic cough are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, all associated with an inflammatory reaction at the level of the cough receptors. The use of natural compounds or herbal drugs such as carob syrup, dry blackcurrant extract, dry extract of caraway fruit, dry extract of ginger rhizome, dry extract of marshmallow root, and dry extract of ivy leaves, to name a few, not only have anti-inflammatory and antioxidant activity, but also act as antimicrobials, bronchial muscle relaxants, and increase gastric motility and empty. For these reasons, these natural substances are widely used to control cough at its deep roots (i.e., contrasting its causes and not inhibiting the arch reflex). With this approach, the lung watchdog is not put to sleep, as with peripheral or central inhibition of the cough reflex, and by contrasting the causes, we may control cough that viruses use at self-advantage to increase transmission.

Postnasal Drip

Postnasal drip (PND) is a common symptom encountered when evaluating subjects with sinonasal disease; it may be present without sinonasal disease or as a symptom of laryngopharyngeal reflux (LPR). It is postulated that PND stems from dysfunction of normal mucus clearance mechanisms, however, there is no definitive evidence elucidating an exact pathophysiology. Compounding the uncertainties surrounding PND is the lack of an objective assessment tool. Instead, treating physicians must rely on subjective complaints and investigators utilize validated patient reported outcome instruments, such as the sino-nasal outcome test (SNOT), to determine treatment efficacy. This review seeks to discuss the current understanding of PND and evidence regarding effective treatment strategies.

INDICATORS OF MUC 5AC AND MUC 1 MUCOPOLYSACCHARIDE EXPRESSION IN THE NASAL MUCOSA OF PATIENTS WITH POSTNASAL DRIP SYNDROME AND NASAL SEPTUM DEVIATION

Introduction. Determining the cause of postnasal drip syndrome can be quite challenging. Nasal septum deformation has been recognized as one possible factor. Understanding the fundamental processes of postnasal drip syndrome is crucial for developing targeted therapeutic strategies for treating this pathology. In our study, we examined the clinical and histological features of postnasal drip syndrome in individuals with nasal septum deformation and investigated the expression of mucopolysaccharides, specifically the indicators of MUC 5AC and MUC 1.&#x0D; The aim. This study aims to investigate the clinical and histological aspects of postnasal drip syndrome (PNDS) in patients with nasal septum deformation. Specifically, the study aims to explore the expression levels of MUC5AC and MUC1 in biopsies of the nasal turbinate mucosa.&#x0D; Materials and methods. A total of 29 samples of nasal mucosa from the lower nasal turbinates were collected. These samples were divided into two groups: patients with nasal septum deviation with and without postnasal drip syndrome. Levels of MUC5AC and MUC1 were determined using Western blot analysis.&#x0D; Results. Upon analysis of histological sections, we identified a significant increase in tissue metaplasia and lymphoid infiltration in the nasal mucosa of patients with postnasal drip syndrome compared to the control group. The levels of mucopolysaccharides, MUC5AC and MUC1, were higher in the nasal mucosa of the research group compared to the control group.&#x0D; Conclusions. The obtained data suggest that anatomical changes in the nasal cavity may play a role in the development of postnasal drip syndrome through alterations in mucin secretion.

Spontaneous Cerebrospinal Fluid Leak Presenting as Middle Ear Effusion Caused by Arachnoid Granulations

While middle ear effusion (MEE) is a common ailment in children with Eustachian tube dysfunction, it occurs less frequently in adults. In such cases, a meticulous assessment is essential to discern the underlying cause of MEE. We present an unusual case of spontaneous cerebrospinal fluid (CSF) leak attributed to arachnoid granulation presenting as MEE. A 59-year-old obese female presented with right ear fullness, reduced hearing, and a persistent postnasal drip for 2 years. Audiological testing shows unilateral mild-to-moderate conductive hearing loss in the right ear. Tympanometry assessment revealed a persistent type B pattern in the right ear, indicating persistent unilateral conductive hearing loss. However, despite receiving treatment with nasal decongestants and antihistamines for 2 weeks, no signs of improvement were observed. Subsequently, a right myringotomy and grommet insertion were performed, resulting in the drainage of clear watery fluid that persisted for 2 weeks. A high-resolution computed tomographic scan of the temporal bone revealed the right MEE, bony defect in the right tegmen tympani, and bony irregularities of both tegmen tympani. Magnetic resonance imaging unveiled herniation of the right inferior temporal lobe through the identified tegmen defect. The patient subsequently underwent cortical mastoidectomy, lateral skull base repair, and mastoid obliteration. The histopathological examination of the biopsy taken from the right middle ear tissue revealed fragments of glial tissue with small fragments of trabeculae, which were confirmed by the positivity of the glial fibrillary acidic protein stain. The patient has remained asymptomatic for 10 months following the operation, and her hearing has fully returned to normal. It is advisable to consider CSF effusion as a potential differential diagnosis, particularly among adults aged over 50 years, even in the absence of a history of head trauma, mastoid surgery, or meningitis, when confronted with persistent unilateral MEE.

Management of Persistent Postnasal Drip Without Sinus Affection

Persistent postnasal drip (PPND), characterized by chronic mucus sensation in the throat without evident sinus involvement, poses challenges in otolaryngology. This study aimed to evaluate low dose, long duration Clarithromycin’s efficacy in managing PPND symptoms, addressing the limitations of existing therapies. A prospective, randomized, controlled trial was conducted with 50 participants (18-65 years) diagnosed with PPND but without sinus pathology (proved by sinus clear CT Paranasal sinus scans). They received either Clarithromycin (250 mg daily) or a placebo for 12 weeks. Validated assessment tools, such as the nasal symptom score (NSS), visual analog scale (VAS), and Sino-nasal outcome test-22 (SNOT-22), measured treatment outcomes. Current therapies addressing associated symptoms exhibit limited efficacy, prompting the need for novel treatment strategies. The study revealed a significant improvement in PPND symptoms with low-dose, long-duration Clarithromycin treatment. Participants exhibited reduced throat-clearing frequency, cough episodes, and subjective mucus sensation. Objective assessments showed enhanced nasal pathology and mucociliary clearance post-treatment. Low-dose, long-duration Clarithromycin treatment demonstrated promising efficacy in ameliorating PPND symptoms and improving quality of life without sinus involvement. These findings emphasize the potential therapeutic role of macrolides in addressing PPND’s underlying pathophysiology. Further research, including larger trials, is essential to validate these outcomes and establish effective clinical guidelines for managing PPND.