[Clinical evaluation of the efficacy of Salsomaggiore (Italy) thermal water in the treatment of rhinosinusal pathologies]

Aim of the research was to demonstrate the efficacy of a treatment with thermal water as nasal spray (Salsomaggiore Italy) vs saline on chronic rhinosinusitis with/out nasal polyps

Sodium enoxaparin treatment of sensorineural hearing loss: an immune-mediated response?

The authors propose the existence of a new entity of autoimmune sensorineural hearing loss on the basis of diagnostic study and treatment experience with a series of 30 patients. Immunological mechanisms play an important role in the pathogenesis and natural course of various inner-ear diseases. Patients may present clinically with symptoms resembling Ménière's disease or even with sudden deafness. Currently, no widely used standard protocol for treatment of this autoimmune sensorineural hearing loss exists. Prompted by such observations, we implemented a protocol using a particular kind of heparin--sodium enoxaparin--with a low molecular weight. Patients were randomly assigned to two groups; to those in the first group, enoxaparin was administered subcutaneously at a dose of 2,000 IU twice daily for 10 days; the patients in the second group were treated with placebo. At the beginning and at the end of the therapy period, the patients were evaluated by instrumental examinations. Specifically excluded were patients with abnormal known coagulation. On discharge, all patients treated with enoxaparin presented both a subjective and objective decrease in symptoms. No patient experienced side effects from this treatment. The results indicate that administration of sodium enoxaparin abates sensorineural hearing loss in patients with autoimmune diseases. The clinical response to therapy can confirm diagnosis

[Specific nasal provocative test in allergic rhinitis diagnosis: reliability and standardization]

Specific vasomotorial rhinopathy, or allergic rhinitis is to be seen as a systemic pathology characterized by a condition of hyperactivity, the target organ of which is the nose. Particular attention, among the diagnostic tests, should be reserved to the specific nasal provocative test (sNPT), which has been part of the clinical routine for years but has nonetheless failed to achieve a suitable level of standardization. With this intent, we have devoted the present work to the assay of several phlogosis mediators (tryptase, specific IgE and ECP) before and after performing the sNPT. We have studied 20 patients affected by allergic rhinitis, aged between 13 and 61, with single or multiple allergen sensitivities, but in any case with a predominant sensitization, who underwent sNPT between October 2000 and July 2001. In every patients we performed ECP, tryptase and specific IgE assay via direct incubation in the nasal mucosa, before and after specific nasal provocation. The results of the sNPT (rhinomanometry and symptoms score) were compared with the variations in the phlogosis mediators assayed at nasal level. On the basis of the variations in the rhinomanometric resistance and symptoms score, the sNPT was positive in 10 patients (50%). Tryptase and specific IgE increased to a statistically significant degree (respectively, p = 0.01 and p 0.05). Overall, the simultaneous assay of ECP, tryptase and specific IgE, increasing the sensibility of the sNPT, enabled a positive result to be ascertained in 60% of the subjects examined. The method is furthermore based on the principle of local reactivity in that it assays the phlogosis mediators not at systemic level, but directly in the target organ, showing itself to be more specific than level I and II tests

[Rationale of the use of COX-2 inhibitors in ENT pathologies]

Upper airways inflammations (rhinitis, rhinosinusitis, polyposis, otitis, pharyngitis, etc) the pathologies most commonly encountered in the daily clinical practice and they represent, because of the high sanitary costs, an important social problem. The Literature suggests that almost all the symptoms, which characterize upper airways inflammations, are induced by the production of prostaglandins by cyclooxigenase (COX); it is obvious the need of a therapeutic action at this level. The non steroidal anti-inflammatory drugs (NSAID) block the activity of both COX-1 and COX-2, whereas the selective inhibitors of COX-2 (the coxibs) act only on this isoform. Actually, the therapeutic effects of both NSAIDs and coxibs are due to their actions on COX-2, while the system toxicity of NSAIDs (gastrointestinal perforation or ulcer, reduction of glomerular filtration rate, prolongation of bleeding time) is ascribable to the inference of these drugs with the COX-1. In conclusion, a correct approach to ENT inflammations must implies the use of drugs efficacious against the typical symptoms of the inflammatory process (and specifically the symptom: pain), eventually joined with an appropriate antibiotic treatment; in this context, a selective inhibitor of COX-2 short course treatment offers the double advantage of managing the inflammation and avoiding damages to the gastric mucosa

The nasal congestion relevance and a novel suggestion to prevent and treat it

BACKGROUND. Nasal congestion is a common symptom in allergic and non-allergic rhinitis, rhinosinusitis and nasal polyps. Although several options exist, no drug is overall efficacious. The aim of this study was to evaluate the clinical effectiveness of a medical device, containing dipotasssium glycyrrhizinate, which is an osmotically acting substance with anti-edema and anti-inflammation effects specifically against the pro-inflammatory High Mobility Group Box 1 (HMGB1) protein. MATERIAL AND METHODS. A multicenter prospective study with a pre-post design has been performed in 8 Italian ENT Departments, consecutively enrolling 161 both genders patients affected by persistent nasal congestion. Patients received 2 puff of dipotassium glycyrrhizinate into each nostril two times a day over the course of four weeks. The severity of symptoms was assessed subjectively, as measured by a 0 to 5 visual analog scale (VAS), and objectively through endoscopic assessment, active anterior rhinomanometry (AAR), and by mean of the evaluation of mucociliary transport times (MCTt). Differences in subjective and objective severity measures before and after treatment were compared using Paired-Sample Wilcoxon Signed Rank Test. RESULTS. All evaluated symptoms and all objective scores improved after treatment: the improvement was statistically signifi-cant (p<0.001). CONCLUSION. The study results confirm the efficacy of dipotassium glycyrrhizinate in treating nasal congestion