An Objective Method to Record Changes in Nasal Reactivity during Treatment of Non-Allergic Nasal Hyperreactivity

Hallén, H.; Juto, Jan-Erik

doi:10.1159/000276617

Cited by 11 publications

(10 citation statements)

References 8 publications

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“…Therefore, there is a need for an objective method of measuring changes in mucosal swelling in patients with nasal hypereactivitiy. This finding is in line with the results reported by others who argue that symptom scores alone are not sufficient for studying changes in the degree of hyperreactivity [21].…”

Section: Discussionsupporting

confidence: 93%

Correlation between Objective Nasal Mucosal Swelling and Estimated Stuffiness during Long-Term Use of Vasoconstrictors

Gräf

Juto²

1994

ORL

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The correlation between nasal mucosal swelling and estimated stuffiness was evaluated in 13 healthy volunteers who entered the trial. The nasal mucosa was challenged with increasing concentrations of histamine solutions. The amount of mucosal swelling was recorded using rhinostereometry, and the stuffiness was estimated by the subjects on a visual analogue scale. Then the subjects were randomly chosen to receive either oxy- or xylometazoline nasal spray for 30 days. After 10 days on the drug, the histamine sensitivity was enhanced, and after another 20 days, it had increased further, reflecting the development of rhinitis medicamentosa. Before the subjects started the nasal spray and after 10 days on the drug, a correlation between stuffiness and swelling was seen in the individual subject only when the degree of stuffiness almost obliterated the nasal opening. At the end of the month, no correlation was present. In all histamine provocations throughout the month, a very high correlation was noted between mean mucosal swelling and mean stuffiness. It is concluded that the symptom scores for nasal obstruction are useful for determining nasal mucosal swelling in groups. However, in the individual subjects one can estimate the mucosal swelling only when the amount of swelling almost obliterates the nasal opening. This cannot be done when the mucosa is hyperreactive.

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Section: Discussionsupporting

confidence: 93%

Correlation between Objective Nasal Mucosal Swelling and Estimated Stuffiness during Long-Term Use of Vasoconstrictors

Gräf

Juto²

1994

ORL

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“…Patients with rhinitis medicamentosa are clinically identical with patients having vasomotor rhinitis with nasal blockage as their main symptom. We have previously reported that 14 days of treatment with budesonide nasal spray significantly reduced the histamine sensitivity in patients with vasomotor rhinitis [14].…”

Section: Discussionmentioning

confidence: 88%

“…This is probably because oedema was still present after treatment. In two other studies it has also been suggested that the rebound congestion in rhinitis medicamentosa results from interstitial oedema, because of incomplete decongestion after the application of an ·-agonist [1,14]. Patients with rhinitis medicamentosa are clinically identical with patients having vasomotor rhinitis with nasal blockage as their main symptom.…”

Section: Discussionmentioning

confidence: 95%

“…The pathophysiology of patients with vasomotor rhinitis seems to consist of a dysfunction in vasomotor tone, resultling in nasal hyperreactivity without the development of interstitial oedema [14]. Rhinitis medicamentosa on the other hand is a disease where the overuse of topical decongestants seems to induce the formation of oedema, nasal hyperreactivity and tolerance to decongestants.…”

Section: Discussionmentioning

confidence: 99%

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Changes in Nasal Reactivity in Patients with Rhinitis medicamentosa after Treatment with Fluticasone Propionate and Placebo Nasal Spray

Gräf¹,

Hallén²

1998

ORL

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Aim of the Study: To study the changes in nasal reactivity in patients with rhinitis medicamentosa during treatment with placebo or fluticasone propionate, in order to better understand the mechanisms of nasal congestion in such patients. Study Design: A parallel, double-blind study. Twenty patients with rhinitis medicamentosa were randomized to either placebo or fluticasone treatment during 14 days. Material and Methods: Nasal mucosa reactivity was studied with a histamine challenge model using three concentrations of histamine to challenge the nasal mucosa (1, 2 and 4 mg histamine/ml). Recordings of the nasal mucosa response were made 5 min after each challenge, using rhinostereometry and acoustic rhinometry, before and after the period of treatment. Results: The fluticasone group had a significantly increased histamine sensitivity after treatment, unlike the placebo group who had an unchanged or slightly decreased histamine sensitivity after treatment. Conclusions: The results of this study support the theory that the nasal obstruction in rhinitis medicamentosa is due to interstitial oedema rather than to vasodilatation. On the first day of vasoconstrictor withdrawal, the inferior concha was congested and oedematous with a limited capacity to respond to histamine challenge. However, after 14 days of treatment with a corticosteroid nasal spray, the oedema was reduced and the increase in histamine sensitivity reflected the persistence of nasal hyperrreactivity. In the placebo group, histamine sensitivity remains unchanged with the measuring technique we used. This probably indicates that oedema was still present after treatment.

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“…Patients with vasomotor rhinitis have an increased sensitivity to histamine compared with healthy subjects, 22 and 14 days' treatment with topical nasal corticosteroids reduces nasal reactivity and symptoms. 23 Likewise, Stjärne and coworkers 24 treated therapy-resistant patients with vasomotor rhinitis with capsaicin, a substance known to activate unmyelinated C fibers, with a depletion of vasoactive substances. These patients reported a positive effect on nasal symptoms for up to 6 months before nasal symptoms recurred.…”

Section: Commentmentioning

confidence: 99%

Ten Days' Use of Oxymetazoline Nasal Spray With or Without Benzalkonium Chloride in Patients With Vasomotor Rhinitis

Gräf¹,

Enerdal²,

Hallén³

1999

Arch Otolaryngol Head Neck Surg

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An Objective Method to Record Changes in Nasal Reactivity during Treatment of Non-Allergic Nasal Hyperreactivity

Cited by 11 publications

References 8 publications

Correlation between Objective Nasal Mucosal Swelling and Estimated Stuffiness during Long-Term Use of Vasoconstrictors

Correlation between Objective Nasal Mucosal Swelling and Estimated Stuffiness during Long-Term Use of Vasoconstrictors

Changes in Nasal Reactivity in Patients with Rhinitis medicamentosa after Treatment with Fluticasone Propionate and Placebo Nasal Spray

Ten Days' Use of Oxymetazoline Nasal Spray With or Without Benzalkonium Chloride in Patients With Vasomotor Rhinitis

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