Nedocromil sodium is a mast-cell stabilizer that prevents or ablates both the acute and late phases of the allergic response. It is an antiinflammatory agent that is not a steroid. It is more potent than the currently available mast-cell stabilizer, cromolyn, and maintenance therapy may be possible at less frequent intervals than the initially recommended regimen of 4 times daily. Nedocromil for pulmonary administration is currently available. The nasal form has undergone clinical trials but has not yet been released in the United States.

Administration, Intranasal↗

PubMedDate not supplied

Intranasal corticosteroid injection: indications, technique, and complications.

The intranasal injection of corticosteroids for symptomatic relief of nasal obstruction in selected cases has been described by several authors and widely used for over 25 years. Recently, circulated reports of blindness following such injections caused a number of otolaryngologists to discontinue using the procedure. All reported cases of visual complications following intranasal corticosteroid injection are reviewed, together with the reported experiences of the author and others who have successfully used the technique in thousands of cases. Preliminary topical cocainization of nasal mucosa and slow submucosal injection of a micronized corticosteroid suspension to minimize the risk of vasospasm and embolization involving the ophthalmic circulation are stressed. Indications for the procedure, the most common side effects, and the proper technique of injection are described.

Administration, Intranasal↗

PubMedDate not supplied

Evaluation of systemic absorption of intraturbinally injected triamcinolone.

As measured by depression of plasma cortisol following intranasal injection of 40 mg triamcinolone acetonide, slight systemic absorption was evident after three days in approximately 60% of patients studied. However, cortisol values were not lowered below normal limits at any time. No adrenal suppression was apparent after repeated injections. Comparison is made with the effect on plasma cortisol of triamcinolone administered by intramuscular or intra-articular injection.

Absorption↗

PubMedDate not supplied

Allergic fungal sinusitis: learning from our failures.

For more than five years, patients referred to the Department of Otolaryngology-Head and Neck Surgery at the University of Texas Southwestern Medical Center at Dallas with allergic fungal sinusitis (AFS) have been managed using a regimen combining surgery, perioperative corticosteroids, and immunotherapy for relevant antigens (fungal and non-fungal). The initial success of this program has been previously reported. Continued experience with this treatment plan, however, has yielded some cases of recurrence of AFS. Careful review of these cases implicate two major factors associated with treatment failure: (1) lack of compliance with immunotherapy, and (2) inadequate initial surgical extirpation of all allergic mucin. These cases and associated factors will be discussed.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Comprehensive management of allergic fungal sinusitis.

In little more than a decade, allergic fungal sinusitis has gone from a medical curiosity to one of the more perplexing problems to challenge the otorhinolaryngologist. These patients are typically immunocompetent adolescents or young adults with pansinusitis (unilateral and bilateral) and polyposis, atopy, and characteristic radiographic findings. Allergic mucin contained within the sinuses demonstrates numerous eosinophils and Charcot-Leyden crystals, and fungal stains show the presence of noninvasive hyphae. Fungal cultures may or may not be positive. We have found the following approach to allergic fungal sinusitis to be most effective: 1) Adequate preoperative evaluation and medical preparation; 2) Meticulous exenterative surgery; 3) Closely supervised immunotherapy with relevant fungal and non-fungal antigens; 4) Medical management including topical and systemic corticosteroids as needed; 5) Irrigation and self-cleansing by the patient; and 6) Close clinical follow-up with endoscopically guided debridement when necessary.

Adolescent↗

PubMedDate not supplied

Allergic fungal sinusitis-induced visual loss.

In this report we review 56 adult and 26 pediatric patients who presented to our practice with pathologically confirmed allergic fungal sinusitis from 1989 to 1997. Of this group, three patients presented with visual loss and were treated with prompt surgical decompression followed by immunomodulation.

Adolescent↗