Conventional versus endoscopic inferior turbinate reduction: technique and results.
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Different modalities of turbinate reduction procedures are available for treatment of vasomotor rhinitis not responding to appropriate medical therapy. Amongst these, conventional inferior turbinectomy (non-endoscopic) is the most widely performed procedure. With the advent of nasal endoscopes, inferior turbinoplasty has been gaining popularity worldwide. The purpose of this study was to compare the post-operative complaints and hospital stay of conventional versus endoscopic inferior turbinate reduction techniques performed non-randomly on 15 and 21 patients of vasomotor rhinitis respectively from January 1998 to December 1999 at Hospital Universiti Kebangsaan Malaysia (HUKM). A total of 36 patients (22 males and 14 females) with a mean age of 30.6 years underwent turbinate reduction procedures during this period with a post-operative follow up ranging from 3 months to 6.7 months (mean 3.8 months). There was a significant difference between the conventional and the endoscopic technique with regards to nasal discomfort (p = 0.05) and dry throat (p = 0.02) which was less severe when performed endoscopically. The average hospital stay in hours by the endoscopic technique was almost half compared to the conventional technique. Due to the improved visualisation and minimal post-operative complaints and reduced hospital stay, the technique of endoscopic inferior turbinoplasty is currently the procedure of choice at our center. In septoplasty when endoscopic instrument is not needed, the standard turbinate reduction procedure is still performed. The availability of pre and post-operative acoustic rhinomanometric evaluation will be helpful as an objective measurement of nasal symptoms in the near future. (+info)
Nasal wall compliance in vasomotor rhinitis.
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Nasal compliance is a measure related to the blood volume in the nasal mucosa. The objective of this study was to better understand the vascular response in vasomotor rhinitis by measuring nasal cross-sectional area and nasal compliance before and after mucosal decongestion in 10 patients with vasomotor rhinitis compared with 10 healthy subjects. Nasal compliance was inferred by measuring nasal area by acoustic rhinometry at pressures ranging from atmospheric pressure to a negative pressure of -10 cmH2O. Mucosal decongestion was obtained with one puff per nostril of 0.05% oxymetazoline. At atmospheric pressure, nasal cross-sectional areas were similar in the vasomotor rhinitis group and the healthy subject group. Mucosal decongestion did not induce any decrease of nasal compliance in patients with vasomotor rhinitis in contrast with healthy subjects. Our results support the hypothesis, already proposed, of an autonomic dysfunction based on a paradoxical response of the nasal mucosa in vasomotor rhinitis. Moreover, the clearly different behavior between healthy subjects and vasomotor rhinitis subjects suggests that nasal compliance measurement may therefore represent a potential line of research to develop a diagnostic tool for vasomotor rhinitis, which remains a diagnosis of exclusion. (+info)
Olfactory receptor gene polymorphisms and nonallergic vasomotor rhinitis.
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Rhinitis and related problems such as facial pressure and nasal congestion are a very common reason people seek medical care. There are four, often overlapping, syndromes or conditions that account for most of what patients perceive as "nose" problems or rhinitis. These conditions are irritant rhinitis, the anterior nasal valve effect, migraine with vasomotor symptoms, and allergic rhinitis. Virtually all patients with allergic rhinitis have some concomitant irritant or nonallergic rhinitis. Many migraine sufferers with vasomotor nasal symptoms will have their nasal congestion, headaches, and runny noses exacerbated by irritant rhinitis, allergic rhinitis, and/or a preexisting nasal valve effect. Failure to consider all of the causes for the symptoms will result in poor clinical outcomes. The work-up and management of these common conditions is discussed in this article. (+info)
Capsaicin and nicotine-sensitive afferent neurones and nasal secretion in healthy human volunteers and in patients with vasomotor rhinitis.
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1. Applications of capsaicin, nicotine and methacholine were made locally onto the nasal mucosa in human controls and patients suffering from hyperreactive nasal disorders. Perception of sensation was registered as a sympton score and secretion quantified. The sensory reaction (irritation - pain) to capsaicin was similar in the three groups studied, i.e. controls, a group of patients with the diagnosis of vasomotor rhinitis and a group of patients with increased nasal secretion as the main symptom of the hyperreactive disorder. Nicotine induced only a mild itching sensation in the three groups. However, capsaicin and nicotine challenge caused a significantly larger secretory response in the last group than in the unselected vasomotor rhinitis group and in the control group. 2. Pretreatment with muscarinic receptor antagonists almost completely abolished the secretory response to both capsaicin and nicotine, and blocked methacholine-induced secretion. Furthermore, pretreatment with a combination of local anaesthetic and vasoconstrictor agent abolished the capsaicin-induced irritation, as well as the capsaicin- and nicotine-induced secretion on both the ipsilateral and the contralateral side. Therefore, no clearcut contribution seems to be exerted by locally released peptides from sensory neurones as direct trigger substances for the secretory response to capsaicin. 3. In conclusion, the nasal secretory response, in man, to both capsaicin and nicotine, seems to be mediated via cholinergic parasympathetic reflexes. In patients with hyperreactive non-allergic disorders of the nasal mucosa with rhinorrhea as the main complaint, the enhanced secretion may be due to a hyperreactive efferent cholinergic mechanism rather than hypersensitive irritant receptors on capsaicin- and nicotine-sensitive sensory neurones. Challenge with irritant agents seems a useful test for the evaluation of both afferent and efferent reflexogenic responses in hyperreactive disorders of the nasal mucosa. (+info)
Rhinitis medicamentosa.
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Rhinitis medicamentosa, the syndrome of rebound nasal congestion secondary to prolonged topical intranasal use of vasoconstrictors, is reviewed. In this condition, the nasal airway is very obstructed; atrophic rhinitis is the most serious complication. Management consists of withdrawing the offending nasal spray and alleviating the nasal obstruction by means of any of several treatment modalities. (+info)