Evidence‐based recommendations regarding the differential diagnosis and assessment of nasal congestion: using the new GRADE system

Spronsen, Erik van; Ingels, K.J.A.O.; Jansen, A.P.; Graamans, K.; Fokkens, Wytske J.

doi:10.1111/j.1398-9995.2008.01729.x

Cited by 55 publications

(71 citation statements)

References 128 publications

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“…The perception of nasal airflow is a subjective sensation and is therefore, by definition, difficult to quantify. Moreover, inconsistency between subjective nasal obstruction and the appearance of the nasal cavities is not uncommon [30][31][32].…”

Section: Discussionmentioning

confidence: 99%

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A Before-after Assessment of the Efficacy of Narivent® in the Treatment of Symptoms Associated with Allergic Rhinitis in a Paediatric Population

Mansi¹

2012

TOMDJ

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Rationale and aim: Allergic rhinitis (AR) is a common disorder that affects people of all ages, peaking in childhood and in the teenage years. Although AR is not a serious disease, it is clinically relevant because underlies many symptoms and complications which severely affect children's quality of life.The aim of this study was to evaluate the clinical effectiveness of Narivent ® , an osmotically acting medical device with anti-oedematous and anti-inflammatory effects, in the treatment of symptoms associated with allergic rhinitis in a paediatric population.Methods: A single-centre prospective study with a pre-post design was conducted with consecutive enrolment in an Italian Otolaryngology Department of 20 both genders children with allergic rhinitis.Patients received 1 puff of Narivent ® into each nostril 2 times a day over the course of 4 weeks. The severity of major symptoms associated with AR, such as nasal congestion, rhinorrhoea, sneezing and nasal itching, was assessed subjectively as measured by a 0 to 10 visual analogue scale (VAS).Differences in subjective severity measures before and after treatment were compared using Paired-Sample Wilcoxon Signed Rank Test.Results: Nasal congestion, rhinorrhoea and sneezing significantly improve after treatment (p<0.001). Conclusion:Study results confirm the efficacy of Narivent ® in the treatment of nasal congestion and other major symptoms in children with AR over a 4 weeks period.

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Section: Discussionmentioning

confidence: 99%

“…In fact, questionnaires, symptom scoring systems and particularly VAS are all tolls capable of determining subjective changes in perceived congestion severity, offering a reproducible and quantifiable evaluation of patients' symptoms [30][31][32].…”

Section: Discussionmentioning

confidence: 99%

A Before-after Assessment of the Efficacy of Narivent® in the Treatment of Symptoms Associated with Allergic Rhinitis in a Paediatric Population

Mansi¹

2012

TOMDJ

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“…Acoustic rhinometry (AcRh), rhinomanometry, nasal peak inspiratory flow, and vasoconstrictor responses to sympathomimetics (congestion index) (24,26,27) rely on changes in airway dimensions and geometry to determine whether the nose is obstructed (28). Microstereometry and laser Doppler studies examine smaller scale changes in the superficial lamina propria vessels (2). Evaluation of tissue histopathology (24) and nasal secretion production in provocation studies (20,29) has been used less often, but is a promising avenue for investigation.…”

Section: Subjective Perceptions Of Fullness Versus Objective Measuresmentioning

confidence: 99%

“…Nasal congestion has been defined as the objective restriction of nasal cavity airflow caused by mucosal pathology and/or increased mucous secretions when anatomical variations have been excluded (2). ''Congestion'' as an objective variable was proposed by Corey and colleagues (3).…”

mentioning

confidence: 99%

“…Rhinologists have attempted to capture the magnitude of this sensation using linear analog scales, anchored ordinal scales, questionnaires such as RhinoSinusitis Outcome Measurement (RSOM-31), SinoNasal Assessment Questionnaire (SNAQ-11), Congestion Quantifier five-item test for nasal congestion (CQ5) (7), SinoNasal Outcome Test 22 (SNOT-22; however, SNOT-20 and SNOT-16 exclude congestion), and others (2).…”

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Subjective Nasal Fullness and Objective Congestion

Baraniuk¹

2011

Proceedings of the American Thoracic Society

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How well do subjective descriptions of the sensation of nasal closure or absence of nasal patency agree with objective measures of nasal geometry and airflow? Problems with this concept begin with terminology. ''Congestion'' has been applied to both the subjective and objective measures. Therefore, the term ''fullness'' will be used to describe perceptions of nasal mucosal heaviness or blockage that subjects with allergic rhinitis articulate. ''Congestion'' will refer to the objective measures used to assess patency. Sensations attributed to the nasal mucosa are highly integrated interpretations summed from multiple subsets of nociceptive and other neurons. Activation of sensor systems is required to depolarize afferent neurons. These sensors and other receptor proteins can be modulated by inflammation as part of the neural plasticity that leads to increased sensitivity to nasal stimuli. This plasticity and hyperalgesia may extend from the afferent neuron to spinal cord dorsal horn synapses, and regulatory and analytical regions of the brainstem and cerebrum. Although glandular hypersecretion can deliver obstructing material into the nasal cavities, the dilation of deep venous sinusoids is the strongest factor regulating nasal airspace volumes. There is a long history of attempts to correlate subjective sensations to objective measurements such as airflow resistance (rhinomanometry), nasal wall geometry (acoustic rhinometry), and peak nasal inspiratory flow. The medical evidence supporting each method has been analyzed on the basis of the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system. These results provide a starting point for linking the outcomes of pathophysiological processes with a patient's psychometrically calibrated sensation of airflow.

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