Nasal obstruction and headache. A real correlation?

to evaluate the relationships between headache and nasal obstruction or nasal allergy on a group of Italian school children

Alterations in rhinosinusal homeostasis in a sportive population: our experience with 106 athletes

The aim of the present work was to analyse the alterations of rhino-sinusal physiology in 106 professional athletes (swimmers, skiers, boxers and runners) using objective rhinological methods. Every athlete underwent an accurate anamnesis, a complete objective ORL evaluation, an active anterior rhinomanometry, an acoustic rhinometry and an evaluation of mucociliary transport time (MCTt). Skiers were also submitted to a nasal decongestion test (NDT). In swimmers, the mean MCTt was 27.4+/-4.97 min (normal value: 13+/-3 min; P<0.0001). The average MCTt for the skier group was 19.58+/-1.92 min ( P<0.0001); the mean value of total basal nasal resistance was 0.37+/-0.05 Pa/ml per s (normal value =0.25 Pa/ml per s; P<0.001). After NDT, total nasal resistance was 0.18+/-0.02 Pa/ml per s. In the group of boxers, the total mean nasal resistance was 0.64+/-0.05 Pa/ml per s ( P<0.001); the mean cross-sectional area at the nasal valve level was 0.57+/-0.04 cm(2) (normal value =0.55+/-0.05 cm(2)) and at the inferior turbinate level 0.83+/-0.05 cm(2) (normal value =0.4+/-0.04 cm(2); P<0.001); the TMC average time was 27.35+/-2.21 min ( P<0.0001). Finally, for the runners, the mean MCT time was 20.56+/-2.35 min ( P<0.001). Knowing the alterations of the physiological nasal respiration is of extreme importance to develop a correct and timely therapeutic approach to be able to restore rhino-sinusal homeostasis. Athletes, in fact, need the earliest therapeutic aid in order to avoid the interference of prolonged rhino-sinusal alterations with their performance and also to avoid a more serious clinical situation concerning the inferior airways

Atomized nasal douche vs nasal lavage in acute viral rhinitis

To evaluate the efficacy of the atomized nasal douche in the restoration of physiological nasal functions in patients affected by acute viral rhinosinusitis, when compared with nasal lavages with isotonic sodium chloride solution

Treatment of recurrent chronic hyperplastic sinusitis with nasal polyposis

To demonstrate the long-term efficacy of intranasal furosemide, an inhibitor of the sodium chloride cotransporter channel at the basolateral surface of the respiratory epithelial cell, vs no therapeutic intervention vs intranasal mometasone furoate, a corticosteroid, in preventing relapses of chronic hyperplastic sinusitis with nasal polyposis

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Nasal immunotherapy is effective in the treatment of rhinitis due to mite allergy. A double-blind, placebo-controlled study with rhinological evaluation

The aim of this paper is to evaluate the efficacy of intranasal hyposensitizing therapy in perennial rhinitis. 36 patients suffering from perennial allergic rhinitis (Dermatophagoides-sensitive) underwent a double blind placebo-controlled trial for a period of 8 months. The efficacy of nasal immunotherapy was evaluated by collecting symptoms score and evaluating objective rhinological parameters (nasal resistance, cross areas and volumes, mucociliary clearance times, specific nasal provocation threshold). A significant improvement (p&#x003C0,01) of symptom score of active against placebo group was observed after treatment. Also objective nasal parameters (total nasal resistances, mucociliary clearance, C-notch area, and provocative threshold) significantly (p&#x003C0,01) improved after treatment. Adverse local reactions were rare and did not interfere with the protocol. The results underline the efficacy and quickness of local nasal immunotherapy in the treatment of perennial allergic rhinitis documented by the improvement of subjective and objective parameters

ENT manifestations of gastroesophageal reflux.

Gastroesophageal reflux (GER) has been associated with a variety of supraesophageal symptoms or diseases, including chronic cough, laryngeal disorders, rhinosinusitis, otitis media, and oral cavity lesions. In this article, we review the relationship between GER and ear, nose, and throat (ENT) symptoms. Data in the published literature are frequently conflicting. Only a few studies are controlled, and an evidence-based approach provides weak support for a causal association between GER and ENT manifestations. The GER diagnostic method should be standardized utilizing new parameters, and the definition and diagnostic accuracy of ENT pathologies also must be better specified. A firm connection remains controversial, and further randomized trials are needed

Group A Streptococcus and its antibiotic resistance

Acute pharyngo-tonsillitis caused by beta-haemolytic group A Streptococcus is a common disease in childhood. Epithelial cells are the initial sites of the host invasion by group A Streptococcus. Although group A Streptococcus has been considered an extracellular pathogen, recent studies have demonstrated that strains of this bacterium can internalize into epithelial cells both in vitro and in vivo. As adherence to and internalization into host cells significantly contributes to the pathogenesis of group A Streptococcus infections, internalization of group A Streptococcus by human epithelial cells has been extensively studied during the past decade. Multiple mechanisms are involved in this process. Most strains of Streptococcus pyogenes express the fibronectin-binding proteins F1 and F2, which promote bacterial adherence to and entry into human cells. Strains containing the gene for the protein F1 have been proved to be responsible for the failure of antibiotic treatment to eradicate Streptococcus pyogenes. Thus, in a significant number of cases, streptococcal internalization might contribute to eradication failure and persistent throat carriage. Since treatment failure, asymptomatic group A Streptococcus carriers and recurrent group A Streptococcus infections represent the main group A Streptococcus reservoir, from which the bacteria are spread in the general population, the choice of antibiotic is crucial. Beta-lactams select a large number of F1-positive organisms: therefore, macrolides, and, possibly, last generation molecules, are the best and first choice for antibiotic treatment against group A Streptococcus

Treatment of inferior turbinate hypertrophy: a randomized clinical trial

In the past 130 years, many surgical procedures for turbinate reduction have been developed. We analyzed the long-term efficacy of 6 of these surgical techniques (turbinectomy, laser cautery, electrocautery, cryotherapy, submucosal resection, and submucosal resection with lateral displacement) over a 6-year follow-up period. We randomly divided 382 patients into 6 therapeutic groups and surgically treated them at the Department of Otorhinolaryngology of the University of Siena. After 6 years, only submucosal resection resulted in optimal long-term normalization of nasal patency and in restoration of mucociliary clearance and local secretory IgA production to a physiological level with few postoperative complications (p < .001). The addition of lateral displacement of the inferior turbinate improved the long-term results. We recommend, in spite of the greater surgical skill required, submucosal resection combined with lateral displacement as the first-choice technique for the treatment of nasal obstruction due to hypertrophy of the inferior turbinates

Allergic Rhinitis: Natural History. A Twenty Years Follow up Study

Although there is an agreement on the increase of the prevalence of allergic rhinitis in last decades, data emerging from various studies appear to be widely dishomogeneous. Another point that needs a clarification is the relationship between allergic rhinitis and lower airways pathologies such as asthma or bronchitis. In this study, we followed the evolution of allergic rhinitis in a group of patients in the last 20 years to highlight the efficacy of different treatments in the prevention of complications, specifically asthma. Patients who didn't receive any kind of treatment experimented a remission of symptoms in 4 cases, a stability of the disease in 6 and the development of complications in 11. In the group treated with symptomatic drugs we highlighted a recovery in 11 patients, a stability of symptoms in 2 and complications in 2. At last, patients undergone immunotherapy considered their symptoms improved in 60 % and stable in 40 % of cases. In conclusion, Immunotherapy guarantees, in a large number of patients, remission of local symptoms and valid protection against district and bronchial complications. Symptomatic treatment with antihistamines and/or cortisones represents a valid alternative, and it's always to be preferred to abstention from any treatment