A Novel Device for the Clinical Assessment of Intranasal Trigeminal Sensitivity

Objective: Despite the significance of trigeminal pathology, practical clinical tests that accurately evaluate intranasal trigeminal function are scarce. The aim of the present study is to introduce a practical procedure for the assessment of intranasal trigeminal sensitivity. Methods: We developed a device to stimulate the nasal mucosa using carbon dioxide, which is self-administered intranasally by holding down a timed button until the required sensory response has been triggered. The trigeminal sensitivity is derived from the measured administration time in conjunction with the concentration of carbon dioxide administered. Sixty-three healthy participants were used to validate the device, after which the new device was compared with a standard lateralization task in an additional 16 participants. In 20 participants, the experiment was repeated to verify test–retest reliability. Results: Statistical analysis showed significant consistency in administration-duration in healthy individuals, including those in the test–retest group. Those participants with higher scores in the lateralization task were found to show higher intranasal sensitivity measured by the new device. Conclusion: Herein, we present the design and validation of a novel device for the practical assessment of intranasal trigeminal sensitivity. In this study, we demonstrate the efficacy and reliability of this device

Gustatory Function in Patients With Chronic Rhinosinusitis

Objectives: Recent research has shown that taste receptors in airway epithelial cells are involved in defending against upper respiratory tract infection. The aim of the present study was to investigate gustatory function in patients with chronic rhinosinusitis (CRS). Methods: Taste function was assessed using the extended “taste strip” test in 37 patients with CRS (20 males, 17 females; mean age = 32.1 years; range, 20-82 years) and 135 healthy controls (70 males, 65 females; mean age = 29.5 years; range, 18-84 years). Results: The mean (±SD) total extended taste score was 12.8 (±3.5) in patients and 14.5 (±3.2) in controls. Analysis of variance indicated an interaction of sinusitis and gender (P < .05) with significantly lower total scores and significantly poorer results for the bitter taste among male patients compared to controls (P < .01). In addition, CRS patients exhibited a trend toward decreased sweet taste perception compared to controls, but this did not reach significance (P = .051). Conclusions: Patients with CRS exhibited decreased gustatory function compared to healthy controls. The effect was most pronounced for bitter taste. Thus, the assessment of gustatory function seems to be useful for detecting potential risk factors for recurrent upper respiratory tract infection

Radiological Markers of the Olfactory Cleft: Relations to Unilateral Orthonasal and Retronasal Olfactory Function

The opacification of the olfactory cleft (OC) has been associated with birhinal orthonasal olfaction in patients with chronic rhinosinusitis (CRS). The aim of this study was to determine the associations between monorhinal and birhinal orthonasal, and retronasal olfaction with radiological markers of the OC in a cohort of patients with CRS. Results were analyzed in a CRS-cohort including 13 patients with nasal polyposis (CRSwNP) and 12 patients with non-eosinophilic CRS (non-eCRS). Monorhinal and birhinal orthonasal olfactory function, and OC-air volume were higher in non-eCRS compared CRSwNP. OC-opacification was also higher in CRSwNP compared to non-eCRS. In the entire CRS-cohort, those with higher OC-opacification showed significantly lower orthonasal and retronasal olfactory test results compared to those with lower OC-opacification across all three coronal planes. Similarly, higher unilateral OC-opacification was also associated with lower ipsilateral orthonasal olfactory function. Correlation analysis further revealed a positive correlation between monorhinal and birhinal orthonasal olfaction with ipsilateral and overall OC-air volume. Likewise, birhinal and monorhinal orthonasal, and retronasal olfactory test results correlated negatively with the overall and ipsilateral Lund-Mackay scores. Monorhinal and birhinal orthonasal, and retronasal olfactory function were lower in CRS patients with higher ipsilateral and overall OC-opacification compared to those with lower OC-opacification

Bitter Taste Disrupts Spatial Discrimination of Piperine-Evoked Burning Sensations: A Pilot Study

Simple Summary The chemical senses smell, taste, and trigeminal sense enable us to interact with the environment and play an essential role in protecting us from hazardous events. It is theorized that capsaicin and piperine not only elicit burning, but also bitter sensations through bitter taste-responding gustatory receptor cells that possess special channels. Similar psychophysiological responses to capsaicin and piperine suggest that bitter taste might also disrupt the spatial discrimination to piperine-induced burning sensations. Results showed that bitter taste disrupted the spatial discrimination of piperine-evoked burning sensations, providing further evidence for a qualitative similarity between burning and bitter sensations and the usefulness of chemical irritants in spatial discrimination tasks. Abstract This study aimed to investigate the perceptual similarity between piperine-induced burning sensations and bitter taste using piperine-impregnated taste strips (PTS). This pilot study included 42 healthy participants. PTS of six ascending concentrations (1 mg, 5 mg, 10 mg, 15 mg, 20 mg, and 25 mg piperine/dL 96% ethanol) were presented at the anterior tongue, and participants rated perceived intensity and duration. Then, participants performed a spatial discrimination task in which they had to report which of the two strips presented to the anterior tongue contained an irritating stimulus when one strip was always a PTS while the other strip was impregnated with either a single taste quality (sweet or bitter) or a blank strip. Repeated measures one-way ANOVA revealed that burning sensations of higher concentrated PTS were perceived more intense and more prolonged compared to lower concentrated PTS. McNemar’s test showed that PTS were identified correctly significantly less often when presented with bitter strips compared to when presented with blank (p = 0.002) or sweet strips (p = 0.017). Our results showed that bitter taste disrupts the spatial discrimination of piperine-evoked burning sensations. PTS might serve as a basis for further studies on disease-specific patterns in chemosensory disorders

Cyclic changes of sensory parameters in migraine patients

Background Migraine shows a cyclic pattern with an inter-ictal-, a pre-ictal, an ictal- and a post-ictal phase. We aimed to examine changes in psychophysical parameters during the migraine cycle. Methods The perception of nociceptive and non-nociceptive stimuli and an electrically induced axon-reflex-erythema were assessed in 20 healthy controls and 14 migraine patients on five consecutive days according to different phases of the migraine cycle. Pain was rated three times during a 10-second electrical stimulus. The size of the axon-reflex-erythema was determined using laser-Doppler-imaging. Intensity and hedonic estimates of odours presented by Sniffin’ Sticks were rated. Results In healthy controls, no significant changes over the test days were observed. In migraine patients pain thresholds at the head decreased with an ictal minimum. Less habituation after five seconds of stimulation at the head was found pre-ictally, whereas reduced habituation to 10-second electrical stimulation was present in all phases. The axon-reflex-erythema size showed an inter-ictal-specific minimum at the head. odours were perceived ictally as more unpleasant and intense. Conclusions Somatosensory functions, pain thresholds and habituation as predominantly central parameters, axon-reflex-erythema as a peripheral function of trigeminal neurons and odour perception as a predominantly extra-thalamic sensation change specifically over the migraine cycle indicating complex variations of neuronal signal processing

Olfactory and trigeminal interaction of menthol and nicotine in humans

The purpose of the study was to investigate the interactions between two stimuli—menthol and nicotine—both of which activate the olfactory and the trigeminal system. More specifically, we wanted to know whether menthol at different concentrations modulates the perception of burning and stinging pain induced by nicotine stimuli in the human nose. The study followed an eightfold randomized, double-blind, cross-over design including 20 participants. Thirty phasic nicotine stimuli at one of the two concentrations (99 and 134 ng/mL) were applied during the entire experiment every 1.5 min for 1 s; tonic menthol stimulation at one of the three concentrations (0.8, 1.5 and 3.4 μg/mL) or no-menthol (placebo control conditions) was introduced after the 15th nicotine stimulus. The perceived intensities of nicotine’s burning and stinging pain sensations, as well as perceived intensities of menthol’s odor, cooling and pain sensations, were estimated using visual analog scales. Recorded estimates of stinging and burning sensations induced by nicotine initially decreased (first half of the experiment) probably due to adaptation/habituation. Tonic menthol stimulation did not change steady-state nicotine pain intensity estimates, neither for burning nor for stinging pain. Menthol-induced odor and cooling sensations were concentration dependent when combined with low-intensity nicotine stimuli. Surprisingly, this dose dependency was eliminated when combining menthol stimuli with high-intensity nicotine stimuli. There was no such nicotine effect on menthol’s pain sensation. In summary, we detected interactions caused by nicotine on menthol perception for odor and cooling but no effect was elicited by menthol on nicotine pain sensation

Absorption and distribution of etoricoxib in plasma, CSF, and wound tissue in patients following hip surgery—a pilot study

The perioperative administration of selective cyclooxygenase-2 (COX-2)-inhibitors to avoid postoperative pain is an attractive option: they show favorable gastro-intestinal tolerability, lack inhibition of blood coagulation, and carry a low risk of asthmatic attacks. The purpose of this study was to determine the cerebrospinal fluid (CSF), plasma, and tissue pharmacokinetics of orally administered etoricoxib and to compare it with effect data, i.e., COX-2-inhibition in patients after hip surgery. The study was performed in a blinded, randomized, parallel group design. A total of 12 adult patients were included who received 120 mg etoricoxib (n = 8) or placebo (n = 4) on day 1 post-surgery. Samples from plasma, CSF, and tissue exudates were collected over a period of 24 h post-dosing and analyzed for etoricoxib and prostaglandin E2 (PGE2) using liquid chromatography-tandem mass spectrometry and immuno-assay techniques. CSF area under the curve (AUC) [AUCs(O–24h)] for etoricoxib amounted to about 5% of the total AUC in plasma (range: 2–7%). Individual CSF lag times with respect to (50%) peak plasma concentration were ≤2 h in all but one case (median: 1 h). PGE2 production in tissue was significantly blocked by the COX-2 inhibitor starting with the appearance of etoricoxib in tissue and lasting for the whole observation period of 24 h (P < 0.01). In conclusion, etoricoxib reaches the CSF and site of surgery at effective concentrations and reduces PGE2 production at the presumed site of action

Herb&ndash;Drug Interaction in Inflammatory Diseases: Review of Phytomedicine and Herbal Supplements

Many people worldwide use plant preparations for medicinal purposes. Even in industrialized regions, such as Europe, where conventional therapies are accessible for the majority of patients, there is a growing interest in and usage of phytomedicine. Plant preparations are not only used as alternative treatment, but also combined with conventional drugs. These combinations deserve careful contemplation, as the complex mixtures of bioactive substances in plants show a potential for interactions. Induction of CYP enzymes and pGP by St John&rsquo;s wort may be the most famous example, but there is much more to consider. In this review, we shed light on what is known about the interactions between botanicals and drugs, in order to make practitioners aware of potential drug-related problems. The main focus of the article is the treatment of inflammatory diseases, accompanied by plant preparations used in Europe. Several of the drugs we discuss here, as basal medication in chronic inflammatory diseases (e.g., methotrexate, janus kinase inhibitors), are also used as oral tumor therapeutics

Environmental and non-infectious factors in the aetiology of pharyngitis (sore throat)

OBJECTIVES: The aim of this review is to examine the causes, pathophysiology and experimental models of non-infectious pharyngitis (sore throat). INTRODUCTION: The causes of sore throat can be infectious (viruses, bacteria, and fungi) or non-infectious, although the relative proportion of each is not well documented. METHODS: A PubMed database search was performed for studies of non-infectious sore throat. RESULTS AND CONCLUSIONS: Non-infectious causes of sore throat include: physico-chemical factors, such as smoking, snoring, shouting, tracheal intubation, medications, or concomitant illness; and environmental factors including indoor and outdoor air pollutants, temperature and humidity, and hazardous or occupational irritants. The pathophysiology underlying non-infectious sore throat is largely uncharacterised, although neurogenic inflammation looks to be a promising candidate. It is likely that there will be individual disposition factors or the coincidence of more than one irritant with possible—up to now unknown—interactions between them. Therefore, experimental models with defined conditions and objective endpoints are needed. A new model using cold dry air to directly induce pharyngeal irritation in humans, with pharyngeal lavage to measure biomarkers, may provide a useful tool for the study of mechanisms and treatment of non-infectious sore throat

A Novel Device for the Clinical Assessment of Intranasal Trigeminal Sensitivity

Objective: Despite the significance of trigeminal pathology, practical clinical tests that accurately evaluate intranasal trigeminal function are scarce. The aim of the present study is to introduce a practical procedure for the assessment of intranasal trigeminal sensitivity. Methods: We developed a device to stimulate the nasal mucosa using carbon dioxide, which is self-administered intranasally by holding down a timed button until the required sensory response has been triggered. The trigeminal sensitivity is derived from the measured administration time in conjunction with the concentration of carbon dioxide administered. Sixty-three healthy participants were used to validate the device, after which the new device was compared with a standard lateralization task in an additional 16 participants. In 20 participants, the experiment was repeated to verify test–retest reliability. Results: Statistical analysis showed significant consistency in administration-duration in healthy individuals, including those in the test–retest group. Those participants with higher scores in the lateralization task were found to show higher intranasal sensitivity measured by the new device. Conclusion: Herein, we present the design and validation of a novel device for the practical assessment of intranasal trigeminal sensitivity. In this study, we demonstrate the efficacy and reliability of this device