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Biomedical subjects

R Eccles

Publications and source records attributed to R Eccles.

At least 19 recordsLinked to original sources
PubMed2006

Understanding submucosal electrosurgery for the treatment of nasal turbinate enlargement.

The surgical management of inferior turbinate enlargement is controversial. Submucosal electrosurgical techniques for turbinate reduction include conventional diathermy, radiofrequency tissue reduction and coblation. All electrosurgical techniques use radiofrequency electricity to damage turbinate tissue but differ in the control and delivery of energy. This review will examine the history of submucosal electrosurgery and clarify the various techniques. This review will also examine the evidence for the efficacy and safety of electrosurgery for the treatment of nasal turbinate enlargement, and will make a case that no progress will be made in clinical trials on the safety and efficacy unless there is standardisation of equipment and techniques in nasal electrosurgery.

Diathermy↗
PubMed2006

Efficacy and safety of over-the-counter analgesics in the treatment of common cold and flu.

RATIONALE: Common cold and flu are the most common human illnesses, and over-the-counter (OTC) analgesics are widely used to treat the pain and fever symptoms. Despite the every day use of these analgesic there is little information available in the literature on the efficacy and safety of these medicines in treating colds and flu symptoms. The aim of this review was to determine the safety and efficacy of the analgesics, aspirin, paracetamol and aspirin for the treatment of colds and flu. METHODS: Electronic databases and a personal database were searched and the information retrieved together with information from relevant textbooks has been integrated in the review. RESULTS: The literature search established that there is relatively little information on the use of analgesics in treating colds and flu and that much of the safety and efficacy data must be related to other pain and fever models. The review establishes that aspirin, paracetamol and ibuprofen are safe in OTC doses and that there is no evidence for any difference between the medicines as regards efficacy and safety for treatment of colds and flu (except in certain cases such as the use of aspirin in feverish children). There is also no evidence that these medicines prolong the course of colds and flu by any effect on the immune system or by reducing fever. CONCLUSION: Despite the lack of clinical data on the safety and efficacy of analgesics for the treatment of colds and flu symptoms a case can be made that these medicines are safe and effective for treatment of these common illnesses.

Acetaminophen↗
PubMed2006

Do chronic changes in nasal airflow have any physiological or pathological effect on the nose and paranasal sinuses? A systematic review.

.A reduction in nasal airflow associated with anatomical defects of the nose such as nasal septal deviation has been proposed to cause nasal pathology. . The majority of animal experiments where one nasal passage is surgically closed over several months report only minor changes in the histology of the nasal epithelium and no rhinitis or sinusitis. .Complete abolition of nasal airflow associated with laryngectomy or the treatment of atrophic rhinitis is not associated with the development of rhinitis or sinusitis. . Radiological studies have shown a lack of association between the degree of nasal septal deviation and evidence of rhinosinusitis. .Such studies provide evidence that reduced nasal airflow causes no significant nasal disease. . There is no convincing evidence that a reduction in nasal airflow is a causative factor for rhinitis or sinusitis.

Animals↗
PubMed2006

Assessment of subjective scales for selection of patients for nasal septal surgery.

OBJECTIVE: To investigate the use of subjective measures to assist the surgeon in patient selection for septal surgery. STUDY DESIGN: Prospective, observational. Approved by local ethics committee. SETTING: ENT outpatient department, University Hospital of Wales. PARTICIPANTS: Forty-six participants on the waiting list for septal surgery for nasal obstruction. MAIN OUTCOME MEASURE: Measurement of nasal partitioning of airflow by rhinospirometer (GM Instruments, Scotland), subjective scales, and investigator's assessment of septal deviation. RESULTS: The subjective scores, and investigator's assessment of septal deviation, were compared with the rhinospirometer objective measurements for correlation, sensitivity and specificity. The rhinospirometry results showed that 20% of the patients on the waiting list had objective measures of partitioning of nasal airflow within a normal range for healthy subjects. The ordinal scale proved to be more useful than the visual analogue scale for patient selection. The subjective scores of airflow partitioning from the double ordinal scale correlated well with the rhinospirometry measurements (r = 0.8). The ordinal scale also had a sensitivity of 81% and a specificity of 60%. The investigator's subjective assessment of septal deviation had a high sensitivity at around 100% but had a lower specificity (30%). CONCLUSIONS: The use of a subjective ordinal scale to measure partitioning of airflow greatly increased the specificity of patient selection and it is proposed that this scale may be useful to the surgeon when assessing patients for septal surgery.

Adolescent↗
PubMed2006

Chronic inferior turbinate enlargement and the implications for surgical intervention.

Nasal obstruction due to chronic enlargement of the inferior turbinate is a common problem for the ENT surgeon. This review will discuss the pathology of 'bilateral' and 'unilateral' turbinate enlargement associated with chronic rhinitis and nasal septal deviation, and focus on the structural changes in the turbinates. Cellular hyperplasia, tissue oedema and vascular congestion all contribute to turbinate enlargement, but there is some evidence that bony enlargement is associated with unilateral turbinate enlargement. There is no evidence for cellular hypertrophy despite the common use of the term 'turbinate hypertrophy' and this term should be replaced with the more correct term of 'turbinate enlargement'. The underlying pathology of turbinate enlargement has important implications for the surgical management of nasal obstruction.

Chronic Disease↗
PubMed2005

Evidence for correlation of objective and subjective measures of nasal airflow in patients with common cold.

OBJECTIVES: To utilize posterior rhinomanometry and conductance, as units of measurement, to further investigate the relationship between subjective and objective measures of nasal airflow. DESIGN: A prospective, observational study. SETTING: Common Cold Research Centre. PARTICIPANTS: Sixty healthy volunteers from the staff and student population of Cardiff University with an upper respiratory tract infection. MAIN OUTCOMES MEASURES: To determine correlations between visual analogue scores (VAS) and posterior rhinomanometry for total, unilateral, high and low conductance groups. RESULTS: No correlation was found between total VAS and total conductance (r = 0.17, P = 0.10). A substantially significant correlation was found between unilateral VAS and unilateral conductance (rho = 0.50, P < 0.001). The unilateral VAS and conductance were highly correlated for the low total conductance group (rho = 0.61, P < 0.001). CONCLUSIONS: Posterior rhinomanometry allows actual measurement of the combined and unilateral conductance of nasal passages. The units of conductance, as opposed to resistance, allow totally obstructed nasal passages to be included in analysis. Visual analogue scores and conductance correlate strongly in unilateral measures for participants with a low total nasal conductance. Posterior rhinomanometry and units of conductance are recommended for future studies investigating the relationship between objective and subjective measures of nasal airflow.

Common Cold↗
PubMed2004

Cough induced by airway vibration as a model of airway hyperreactivity in patients with acute upper respiratory tract infection.

Patients with acute upper respiratory tract infection (URTI) have been shown to be hyperreactive to inhaled tussigens such as citric acid and capsaicin, and the authors propose that this may be due to an increased sensitivity of airway receptors that mediate cough. In recent studies we have demonstrated that cough may be induced by vibration of the airway at the level of the throat or chest in patients with URTI but that the same stimuli induce little or no cough in healthy subjects. The difference between the patients with URTI and healthy subjects in their response to airway vibration may be explained on the basis of hyperreactivity of airway sensory receptors. We propose that the model of cough induced by airway vibration may be useful for studies on the pathophysiology and pharmacology of airway hyperreactivity in acute cough. The airway vibration model of cough may have some advantages over inhaled tussigens as the stimulus is easily controlled and the method is safe for use in children.

Acute Disease↗
PubMed2004

[Cough induction by high-frequency chest percussion in healthy volunteers and patients with common cold].

BACKGROUND: In patients with chronic obstructive pulmonary disease, chest percussion is often used to facilitate the drainage of respiratory secretions which may be removed from the airway by coughing. The cough reflex is believed to be mediated by mechanically sensitive rapidly adapting receptors (RARs). Chest percussion stimulation may stimulate RAR cough receptors, but there is no evidence that mechanical airway stimulation in man induces cough. The aim of this study was to determine if cough can be induced by high-frequency chest percussion in healthy subjects and in patients with acute upper respiratory tract infection (URTI). METHODS: Two groups were studied: 15 healthy subjects and 29 subjects with URTI, mean age 22 years. Percussion stimulation (70 Hz) was applied to the chest. Cough frequency and latency were recorded. All subjects were asked to complete a questionnaire about how they felt after the chest percussion by questionnaires. RESULTS: The results demonstrate that high-frequency chest percussion causes cough in human subjects with a recent history of URTI, but induces relatively little cough in healthy subjects. In URTI subjects there was a significant increase in the number of coughs after three periods of airway vibration, whereas in healthy subjects there was no change in cough. Furthermore, analysis of the questionnaires showed that more of the subjects with URTI felt an urge to cough compared to the healthy subjects in the subjective questionnaires. CONCLUSIONS: This study demonstrates that cough can be induced in subjects with URTI by chest percussion. This method of inducing cough in subjects with URTI may be useful for studies on the mechanism of cough and for studies on antitussive medicines.

Adolescent↗
PubMed2004

Efficacy of fusafungine in acute rhinopharyngitis: a pooled analysis.

Upper respiratory tract infections are generally mild but they are associated with an enormous loss in productivity. Treatment consists of reduction of local symptoms e.g. local inflammation and prevention of potential superinfections. Besides its bacteriostatic activity against most micro-organisms involved in respiratory tract infections fusafungine displays original anti-inflammatory properties. To optimise nasal and throat deposition, a new fusafungine oro-nasal spray using HFA 134a was developed and its efficacy was evaluated in patients with acute rhinopharyngitis based on improvement of significant nasal symptoms. Three randomised double-blind placebo-controlled parallel-group studies with identical objectives design and dosage were performed and results were pooled for a better evaluation of treatment effect (532 patients). The percentage of responders (patients with nasal symptom score improvement from Day 0 to Day 4) was 61.5 +/- 2.9% with fusafungine vs 46.8 +/- 3.1% with placebo (p=0.009) with an odds ratio of 1.8 (p=0.01) in favour of fusafungine. The nasal symptom score distribution at Day 4 showed an odds ratio of 1.56 (p=0.011) also in favour of fusafungine. For patients treated early (onset of symptoms 1 pounds day) the percentage of responders was 65.9 +/- 4.1% with fusafungine vs 38.3 +/- 4.0% with placebo (p=0.022) with an odds ratio of 3.08 (p=0.033) in favour of fusafungine. Therefore fusafungine through its dual bacteriostatic and original anti-inflammatory properties is an effective treatment of acute rhinopharyngitis especially when administered early.

Acute Disease↗
PubMed2003

The use of nasal spirometry for the assessment of unilateral nasal obstruction associated with changes in posture in healthy subjects and subjects with upper respiratory tract infection.

Nasal spirometry was used to measure the effect of acute rhinitis associated with upper respiratory tract infection (URTI) on the changes in nasal airflow that occur with postural change. Results in 12 healthy subjects and 12 subjects with URTI were expressed as the nasal partitioning of airflow ratio (NPR), a new measure of nasal airflow. Values of NPR range from 0 (equality of airflow) to 1 (unilateral nasal obstruction). In subjects with URTI there was a significant change (P < 0.006) in the median NPR from 0.19 sitting to 0.87 supine, with five subjects having complete unilateral nasal obstruction. The change in the median NPR in the healthy subjects from 0.09 sitting to 0.13 supine was not significant. The results illustrate the incidence of complete unilateral nasal obstruction associated with URTI when lying flat and demonstrate the usefulness of nasal spirometry in studying nasal airflow partitioning in health and disease.

Acute Disease↗
PubMed2003

The use of nasal spirometry as an objective measure of nasal septal deviation and the effectiveness of septal surgery.

Nasal spirometry, after decongestion, was used to assess the severity of septal deviation in 31 patients before and after nasal septal surgery. Patients were divided into two groups on the basis of their preoperative nasal partitioning of airflow ratio (NPR). The NPR ranges from 0.00 (equality of airflow) to 1.00 (total unilateral obstruction) with the normal range defined as 0.00-0.34. In 14 patients with a preoperative NPR within the normal range, the median NPR was not influenced by surgery (preop 0.14 to postop 0.12, P= 0.07). In 17 patients with a preoperative NPR outside the normal range, there was a significant reduction of the median NPR after surgery (preop 0.50 to postop 0.16, P < 0.01). The correlation of NPR with subjective assessment of the deviation was r = 0.85 (P < 0.01), and with patient subjective symptom assessment r= 0.94 (P < 0.01) preoperatively and r= 0.51 (P < 0.01) postoperatively. The findings indicate that nasal spirometry may be useful in patient selection for septal surgery.

Adult↗
PubMed2002

The powerful placebo in cough studies?

Placebo treatment has been reported to improve subjective and objective measures of disease in up to 30-40% of patients with a wide range of clinical conditions. A review of 8 clinical trials on the effects of antitussive medicines on cough associated with acute upper respiratory tract infection shows that 85% of the reduction in cough is related to treatment with placebo, and only 15% attributable to the active ingredient Treatment with a cough medicine can be viewed as consisting of three components: pharmacological, physiological (demulcent) and placebo. The placebo effect is related to belief in the effectiveness of the treatment and this idea must in some way influence the central control of cough. Studies on the placebo effect of analgesics indicate that the placebo effect may be mediated by endogenous opioid neurotransmitters and this may explain the analgesic potency of opioid medicines such as morphine. In the present paper a model is proposed to explain the antitussive effects of placebo treatment on the basis of endogenous opioid neurotransmitters. With active pharmacological ingredients contributing only 15% to the effects of cough treatment it seems reasonable to conduct more research on the other components of treatment such as placebo.

Antitussive Agents↗
PubMed2002

Voluntary control of cough.

Cough is normally referred to a reflex mediated by control centres in the respiratory areas of the brainstem. However, there is much experimental information that indicates that human cough is under voluntary control and that higher centres such as the cerebral cortex have an important role in both initiating and inhibiting cough. Studies on acute cough associated with common cold, and capsaicin induced cough have demonstrated that human cough can be voluntarily inhibited and often abolished. Further evidence for some role of consciousness in the control of cough comes from studies that show that cough is inhibited or abolished during sleep and with light anaesthesia. This paper discusses the historical development of the brainstem 'cough centre' and discusses the experimental evidence on the voluntary control of cough in man. A cough model demonstrating the voluntary and reflex control of cough in man is proposed. A hypothesis is proposed that cough associated with common cold is a mixture of both reflex and voluntary cough.

Consciousness↗
PubMed2002

An explanation for the seasonality of acute upper respiratory tract viral infections.

Despite a great increase in our understanding of the molecular biology of the viruses associated with acute upper respiratory tract viral infections (URTIs) there is a remarkable lack of knowledge and ideas about why URTI should exhibit a seasonal incidence. Most publications in this area either acknowledge a complete lack of any explanation for the seasonality of URTI or put forward an explanation relating to an increased "crowding" of susceptible persons in winter. This review will discuss some of the ideas concerning the seasonality of URTI and put forward a new hypothesis for discussion, namely that seasonal exposure to cold air causes an increase in the incidence of URTI due to cooling of the nasal airway. The hypothesis is supported by literature reports demonstrating that inhalation of cold air causes cooling of the nasal epithelium, and that this reduction in nasal temperature is sufficient to inhibit respiratory defences against infection such as mucociliary clearance and the phagocytic activity of leukocytes. A case is also made to suggest that warming of the nasal airway during fever and nasal congestion may help to resolve a current URTI.

Body Temperature↗
PubMed2002

Acute cooling of the body surface and the common cold.

There is a widely held belief that acute viral respiratory infections are the result of a "chill" and that the onset of a respiratory infection such as the common cold is often associated with acute cooling of the body surface, especially as the result of wet clothes and hair. However, experiments involving inoculation of common cold viruses into the nose, and periods of cold exposure, have failed to demonstrate any effect of cold exposure on susceptibility to infection with common cold viruses. Present scientific opinion dismisses any cause-and-effect relationship between acute cooling of the body surface and common cold. This review proposes a hypothesis; that acute cooling of the body surface causes reflex vasoconstriction in the nose and upper airways, and that this vasoconstrictor response may inhibit respiratory defence and cause the onset of common cold symptoms by converting an asymptomatic subclinical viral infection into a symptomatic clinical infection.

Animals↗
PubMed2000

Role of cold receptors and menthol in thirst, the drive to breathe and arousal.

Menthol is widely used in candy, chewing gum, toothpastes, cigarettes and common cold medications. Menthol has been shown to stimulate cold receptors in the mouth and nose. The present paper puts forward the hypothesis that menthol, by its effects on oral and nasal cold receptors, may influence thirst, the drive to breathe, and arousal. The satisfying effects of menthol on thirst and breathing, together with an effect on arousal, may explain the popularity of menthol and account for the very large amount of menthol-containing products that are consumed each day.

Arousal↗