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Rhinitis
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Vinay Mehta, Srinivasan Ramanuja, Pramod S Kelkar
Intranasal decongestants include phenylephrine, oxymetazoline, xylometazoline and naphazoline. Although available over-the-counter, they are not meant to be used as monotherapy or for long-term use, as downregulation of alpha-adrenergic receptor develops after 3 to 7 days, and can result in rebound nasal congestion. In contrast, the combination of a topical nasal decongestant and topical corticosteroid may effectively treat symptoms without causing rhinitis medicamentosa.
Mastoiditis
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
Michael Farnham, Timothy Ketterhagen
On physical exam, he is fussy but not ill-appearing. Nasal congestion is present. There is proptosis of the left ear and the left tympanic membrane is erythematous, dull, and bulging. The patient cries when the left ear and mastoid process are palpated. There is minimal overlying erythema and warmth. Cardiac and pulmonary exam are normal. The physical exam is otherwise unremarkable.
Physiology of Sleep and Sleep Disorders
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
General measures for treatment of sleep breathing disorders include behavioural modification and lifestyle advice comprising weight control, elevation of the bed head, and avoidance of supine posture, alcohol, tobacco, sedatives and narcotics.96, 97 Significant weight loss has been associated with a ‘cure’ rate of 10–20% in OSAHS.98–101 Treatment of nasal congestion using nasal steroids may be helpful, especially if there is nasal obstruction or upper airway resistance due to rhinitis. Driving should be avoided if excessively sleepy and subjects with OSAS must inform the relevant driving licencing authority of the diagnosis. Driving may be allowed if symptoms are controlled on treatment, with confirmation by medical opinion.
Current and emerging treatment modalities for bacterial rhinosinusitis in adults: a comprehensive review
Published in Expert Opinion on Pharmacotherapy, 2022
Maria Gabriella Matera, Barbara Rinaldi, Vito de Novellis, Paola Rogliani, Mario Cazzola
A systemic decongestant (such as pseudoephedrine or phenylephrine) or topical nasal decongestant (such as xylometazoline) are commonly used in patients with ABRS to minimize nasal congestion and improve patient symptoms [27]. Still, there are side effects to be aware of, including the possibility of developing rhinitis medicamentosa with prolonged topical use and hypertension with oral decongestants, as well as irritability, palpitations, and insomnia [3]. Nasal decongestants should not be taken for more than ten days precisely because of the risk of rebound rhinitis [27]. Canadian guidelines recommend not using them for more than three days [4]. However, not enough data are available for a recommendation based on evidence. The EPOS 2020 steering group did not recommend using decongestants, at least in post-viral ARS, due to the lack of clinically relevant data [14]. However, due to the effectiveness of oral decongestants in reducing nasal congestion, Canadian guidelines advise patients without contraindications to consider these medications a treatment option [4].
Chronic rhinosinusitis with nasal polyps: mechanistic insights from targeting IL-4 and IL-13 via IL-4Rα inhibition with dupilumab
Published in Expert Review of Clinical Immunology, 2020
Chronic rhinosinusitis (CRS) is the umbrella term used to describe generalized inflammation of the sinonasal system. Nasal congestion, excess anterior/posterior nasal mucus with facial pain/pressure and reduction or loss of smell persisting 12 weeks or more are hallmark clinical features [1]. CRS is broadly divided into CRS with and without nasal polyps (CRSwNP and CRSsNP respectively). About 30% of the CRS population have CRSwNP. It is a distinct clinical entity with a more specific inflammatory subtype. CRSwNP and asthma are often co-associated [2]. Here, inflammatory tissue grows out of the of the sinonasal lining as visible obstructive inflammatory masses on nasal examination (Figure 1). Whilst both forms of CRS are equally severe [1], CRSwNP groups often have more recurrent sinus surgery and despite such intervention continue to demonstrate more extensive disease in terms of radiological imaging (Figure 2) and measures of disease severity [3].
HMGB1 in nasal inflammatory diseases: a reappraisal 30 years after its discovery
Published in Expert Review of Clinical Immunology, 2020
Giorgio Ciprandi, Luisa Maria Bellussi, Giulio Cesare Passali, Valerio Damiani, Desiderio Passali
HMGB1 plays a relevant pathogenic role in nasal inflammatory diseases as documented in some studies and synthetically reported in Table 1. Accordingly, patients with severe symptoms have high serum levels and extracellular expression of HMGB1. Considering these matters, to inhibit HMGB1 could represent a new therapeutic strategy. In this regard, GA inhibits HMGB1 chemotactic and mitogenic function by a scavenger mechanism on extracellular HMGB1 accumulation. There is preliminary evidence that GA is effective and safe in the treatment of AR and CRSwNP. In particular, nasal congestion is a preferential target as the available medical device contains also glycerol and mannitol that have an additional osmotic activity. As a consequence, a synergic effect, anti-inflammatory and decongestant, could be obtained in clinical practice. Nasal congestion is a key symptom in allergic rhinitis and CRS [62,63]. In fact, blunting nasal congestion is well recognized by patients and improves their quality of life [64]. However, given that the evidence concerning the GA effectiveness in AR and CRSwNP is still preliminary, no definitive conclusion could be drawn about its real effect in HMGB1 inhibition. Further mechanistic and randomized-controlled studies should be performed to confirm this perspective.