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PubMed1989

Capsaicin and nicotine-sensitive afferent neurones and nasal secretion in healthy human volunteers and in patients with vasomotor rhinitis.

1. Applications of capsaicin, nicotine and methacholine were made locally onto the nasal mucosa in human controls and patients suffering from hyperreactive nasal disorders. Perception of sensation was registered as a sympton score and secretion quantified. The sensory reaction (irritation - pain) to capsaicin was similar in the three groups studied, i.e. controls, a group of patients with the diagnosis of vasomotor rhinitis and a group of patients with increased nasal secretion as the main symptom of the hyperreactive disorder. Nicotine induced only a mild itching sensation in the three groups. However, capsaicin and nicotine challenge caused a significantly larger secretory response in the last group than in the unselected vasomotor rhinitis group and in the control group. 2. Pretreatment with muscarinic receptor antagonists almost completely abolished the secretory response to both capsaicin and nicotine, and blocked methacholine-induced secretion. Furthermore, pretreatment with a combination of local anaesthetic and vasoconstrictor agent abolished the capsaicin-induced irritation, as well as the capsaicin- and nicotine-induced secretion on both the ipsilateral and the contralateral side. Therefore, no clearcut contribution seems to be exerted by locally released peptides from sensory neurones as direct trigger substances for the secretory response to capsaicin. 3. In conclusion, the nasal secretory response, in man, to both capsaicin and nicotine, seems to be mediated via cholinergic parasympathetic reflexes. In patients with hyperreactive non-allergic disorders of the nasal mucosa with rhinorrhea as the main complaint, the enhanced secretion may be due to a hyperreactive efferent cholinergic mechanism rather than hypersensitive irritant receptors on capsaicin- and nicotine-sensitive sensory neurones. Challenge with irritant agents seems a useful test for the evaluation of both afferent and efferent reflexogenic responses in hyperreactive disorders of the nasal mucosa.

Adult↗

PubMed1999

Ten days' use of oxymetazoline nasal spray with or without benzalkonium chloride in patients with vasomotor rhinitis.

CONTEXT: In most countries, the use of topical nasal decongestants is limited to a maximum of 10 days because of the risk of developing rebound mucosal swelling and rhinitis medicamentosa. OBJECTIVE: To determine whether topical nasal decongestants can be safely used for 10 days in patients with chronic inflammation of the nasal mucosa. DESIGN: Double-blind, randomized, controlled, parallel study. PATIENTS: Thirty-five patients with vasomotor rhinitis selected from our outpatient department. INTERVENTION: Eighteen patients received oxymetazoline hydrochloride (0.5 mg/mL) nasal spray containing the preservative benzalkonium chloride (0.1 mg/mL), and the other 17 were treated with oxymetazoline nasal spray without benzalkonium chloride. Before and after the treatment, recordings of the nasal mucosa and minimal cross-sectional area were made with rhinostereometry and acoustic rhinometry, followed by histamine hydrochloride challenge tests. Symptoms of nasal stuffiness were estimated on visual analog scales (0-100) in the morning and the evening, just before the nasal spray was used. RESULTS: No rebound swelling was found after the 10-day treatment in the 2 groups with either of the methods or as estimated by symptom scores. In the group receiving oxymetazoline containing benzalkonium chloride, but not in the other group, the histamine sensitivity was significantly reduced after treatment (P<.001). CONCLUSIONS: It is safe to use topical nasal oxymetazoline with or without benzalkonium chloride for 10 days in patients with vasomotor rhinitis. However, this study indicates that benzalkonium chloride in nasal decongestant sprays affects the nasal mucosa also after short-term use.

Benzalkonium Compounds↗

PubMed1992

Treatment of allergic and vasomotor rhinitis by the local application of different concentrations of silver nitrate.

In 1980, Bhargava et al. reported a new treatment of allergic and vasomotor rhinitis by the local application of 15 per cent silver nitrate. The results of further studies of the treatment by using different concentrations of silver nitrate ranging from 5 per cent to 25 per cent and normal saline as placebo are presented here; 15 per cent has been found to be the most effective concentration giving successful results in 75.7 per cent of cases. It is applied to the anterior portion of both inferior turbinates and the anterior part of the nasal septum once a week on five occasions. Best relief was obtained from the most annoying symptoms of sneezing and rhinorrhoea. Asthma was controlled in 50 per cent of such patients who had attacks of allergic rhinitis followed by asthma. For this widely prevalent disease, the treatment was found to be simple, easy and useful, with negligible side-effects.

Administration, Topical↗

PubMed1994

[Comparative value of skin tests and IgE antibodies in the serum in patients with chronic vasomotor rhinitis].

In order to assess values of skin testing and determination of pulp, as a credible indicator considering sensibilisation of an organism, 61 patients suffering from chronic vasomotor rhinitis were tested. By application of "prick" test, skin test results were positive in 30 patients and negative in 31. Presence of specific IgE antibodies in the serum was assessed in all patients by "ELISA" test. In 51 patients (83.6%) both kinds of findings corresponded. In 26 patients both skin parameters were negative while in 10 patients (16.40%) findings did not correspond. It was established that for Dermatophagodies pteronyssinus specific IgE antibodies are determined in serum when pap is 5 mm wide. Grasp pollen always caused strong local reactions, regularly more than 10 mm. Considerably high levels of IgE antibodies was also established while other pollens did not show such correspondence.

Allergens↗

PubMed1977

Treatment of vasomotor rhinitis with intranasal disodium cromoglycate (SCG). Results from a double-blind cross-over study.

The effect of SCG powder (Lomudalr, Intalr) intranasally in vasomotor rhinitis has been studied on 49 adult volunteers in a double-blind cross-over study during 13 weeks in January--April 1973. The dose of SCG was 40 mg/day. Although a substantial number of results were obtained, no significant difference between the effects of SCG and placebo treatment, on variables measured, was detected. However, some patients experienced relief with, and preferred, the treatment with SCG. The results from this investigation are discussed in comparison with those from other studies including patients with vasomotor rhinitis.

Administration, Intranasal↗

PubMed1983

Ipratropium (Atrovent) in the treatment of vasomotor rhinitis of elderly patients.

Ipratropium is a parasympatholytic agent with high topical activity. The effect of intranasal ipratropium was studied in 34 patients who were over 60 years of age and who suffered from chronic watery vasomotor rhinorrhoea. The study was a double-blind cross-over placebo controlled trial. Trial parameters were: daily nasal symptom and side effect scores, nasal methacholine testing before and after treatment, and clinical evaluation. The active drug clearly reduced nasal discharge. Nasal methacholine testing showed reduction of nasal secretion after the active treatment period. The majority of the patients preferred the active drug to the placebo. Excessive drying of the nasal mucosa was the most common side effect. Ipratropium seems to have a beneficial effect on vasomotor rhinitis, which often is an irritating condition in elderly patients.

Administration, Intranasal↗

PubMed2002

Autonomic dysfunction, vasomotor rhinitis, and extraesophageal manifestations of gastroesophageal reflux.

OBJECTIVE: Several recent reports suggest there may be a relationship between chronic rhinitis and extraesophageal manifestations of gastroesophageal reflux (EER). It is hypothesized that this relationship is a result of autonomic nervous system (ANS) dysfunction. STUDY DESIGN: Patients with isolated vasomotor rhinitis (VR), both VR and EER, and a control group were studied by a battery of tests designed to objectively evaluate ANS function. In addition all 3 groups underwent barium esophagogram and 4-site (proximal pharynx, distal pharynx, proximal esophagus, and distal esophagus) ambulatory pH monitoring. Adult patients fulfilling diagnostic criteria for VR, and with both VR and EER underwent objective ANS testing in a recently developed ANS testing laboratory. The control group consisted of age- and sex-matched adults without diagnostic criteria for VR or EER. RESULTS: In patients with VR only (n = 9), 2 patients had a positive esophagogram, whereas a positive pharyngeal reflux probe was found in 1 and an abnormal composite autonomic scoring scale (CASS) was found in 8 (mean VR CASS = 1.750 vs control CASS 0.556, P =.02). The group with VR and EER (n = 12) had a positive esophagogram in 10 patients, positive pharyngeal reflux by probe in 9, and all 12 had an abnormal CASS (mean CASS VR/EER = 2.909 vs CASS control = 0.556, P =.001 and vs VR CASS = 1.750, P =.05). The control patients (n = 9) had normal transesophageal gastroduodenoscopy in 8, 1 had a positive pharyngeal probe study, and all 9 had a normal CASS. In addition ANS testing in patients with diagnostic criteria for both VR/EER revealed statistically significant evidence of an adrenergic deficit as compared with control patients on the basis of mean phase II blood pressure response to Valsalva maneuver (mean phase II VR/EER = -16.730 vs control = -7.780, P =.05). In the VR only group, the phase II blood pressure decrease was greater than in control patients, but did not reach statistical significance (mean phase II VR = -9.370 vs control = -7.780, P = 0.672). CONCLUSION: Patients with VR and VR/EER have objective evidence of ANS dysfunction when compared with a group of age- and sex-matched control patients. Patients with both VR/EER demonstrate a significantly greater degree of ANS dysfunction than patients with isolated VR. The mechanism by which VR and EER interact is not entirely clear, but ANS dysfunction is objectively associated with both disorders. In addition, patients with VR/EER seem to demonstrate hypofunction of the adrenergic component of the ANS, in contrast to the generally held hypothesis that VR results from increased cholinergic activity. Further characterization of the type of ANS abnormality may allow the development of novel pharmacologic therapies for these disorders.

Adult↗

PubMedDate not supplied

[Intranasal laser coagulation in the therapy of vasomotor rhinitis in elderly patients].

Laser coagulation of concha nasalis inferior is essentially atraumatic, bloodless, sterile and causes no edema. The specific effect of a laser beam on microcirculation suggests that laser surgery can be viewed as a pathogenetic method of therapy of vasomotor rhinitis. Laser coagulation of concha nasalis inferior was performed in 74 patients, 42 of which were older than 50 years. The elderly patients suffered from other diseases, e.g. ischemic heart disease or cardiopulmonary pathology, which excluded contact surgery intervention. Laser therapy was well tolerated by all the patients. Good results were recorded in 80% of patients without concomitant sinusitis and in 66.6% of patients with concomitant sinusitis.

Aged↗

PubMed1999

State and trait anxiety in women affected by allergic and vasomotor rhinitis.

It is still debatable whether anxiety and depression in patients affected by rhinitis could play a role in the genesis of the disease, whether they are a consequence of the symptoms. The aim of this study was to evaluate anxiety levels in both state and trait forms, and depression, in patients affected by allergic (AR) and vasomotor rhinitis (VMR). A total of 45 women, 24 AR and 21 VMR were compared with 64 healthy nonallergic women matched for age and sociodemographic characteristics. All subjects were administered the State and Trait Anxiety Inventory (STAI) and the Zung self-rating depression scale. The percentage of subjects with high levels of state anxiety was significantly higher in AR (p<0.005) and VMR (p<0.01) with respect to controls. The percentage of subjects with high levels of trait anxiety was significantly higher in AR (p<0.001) and VMR (p<0.05) than controls. There was no significant difference in depression between AR and VMR and controls. No significant difference was found in state anxiety, trait anxiety, or depression between AR and VMR. In conclusion, anxiety in patients with rhinitis is present both as a state and as a trait, at least when measured with the STAI.

Adolescent↗

PubMed1990

Diagnostic value of acoustic rhinometry: patients with allergic and vasomotor rhinitis compared with normal controls.

By means of the acoustic reflection technique, termed acoustic rhinometry, cross-sectional areas along the whole upper airway can be measured by an acoustic click. This paper describes the normal values obtained from 134 probands. The normal curve shows the minimal cross-sectional area (I-notch) to be located at the isthmus nasi. The second narrowest segment of the nasal cavity is located at the head of the inferior concha (C-notch). In patients with turbinate hypertrophy due to allergic or vasomotor rhinitis the minimal cross-sectional area is sited at the head of the inferior turbinate. Furthermore, acoustic rhinometry allows exact measurements of size and location of the congested mucosa following challenge with allergens in patients affected with allergic rhinitis. After anterior turbinoplasty of patients with turbinate hypertrophy improved nasal breathing was associated with an enlargement of the cross-sectional areas at the head of the anterior inferior turbinate. Acoustic rhinometry not only enables to distinguish the various deviations of the nasal structures from normal (valve stenosis, septal deviation, turbinate hypertrophy, tumour masses) concerning their location and size, but also allows to demonstrate exactly the efficacy of rhinosurgical techniques.

Adult↗

PubMedDate not supplied

Capsaicin's effect on rat nasal mucosa substance P release: experimental basis for vasomotor rhinitis treatment.

Substance P (SP) is one of several neuropeptides found in nasal mucosa. It exists primarily in sensory afferent neurons, which are best demonstrated by immunohistochemical staining. These substance P-like immunoreactive (SPLI) nerve fibers are unmyelinated C fibers, which connect to the trigeminal ganglion and the spinal trigeminal nucleus. They are found around vessels and seromucinous glands in the submucosa. When the nasal mucosa receives a noxious stimulus, SP is released and acts orthodromically as a comediator of nasal pain, while antidromically it induces vasodilatation, plasma extravasation, mucosal edema, and rhinorrhea. Its antidromic effects have been implicated in vasomotor rhinitis and can be blocked by topical intranasal capsaicin application. Wolf and others have demonstrated in human subjects that vasomotor rhinitis can be blocked up to 1 year by a series of intranasal capsaicin applications. It has not yet been demonstrated that nasal mucous SP levels following noxious nasal stimulus change after intranasal capsaicin pretreatment. Consequently a project was designed to determine whether intranasal capsaicin pretreatment would affect nasal substance P release measured in nasal secretion. Nasal secretion SP levels were measured before and after noxious nasal stimulus in controls and in capsaicin pretreated rats. The difference in measured nasal secretion SP levels were significant (p < 0.05).

Administration, Intranasal↗

PubMed1984

Cryotherapy for chronic vasomotor rhinitis: technique and patient selection for improved results.

Current methods of therapy of chronic vasomotor (non-allergic) rhinitis are frequently unsuccessful. This led to the development of a standardized technique of intranasal cryotherapy (longer freeze duration and larger area of therapy than previously reported) which was utilized in 50 patients. Indications for cryotherapy included: failure of medical therapy in anatomically normal patients with mucosal disease caused only by vasomotor rhinitis. Minimal follow-up was 2 years. Obstructive symptoms (subjective and objective evaluation) were eliminated in 92% and markedly improved in the remaining 8%. Excessive drainage (subjective) was relieved in 47%, markedly improved in 41%, and minimally improved (therapeutic failure) in 12%. Complications were minor; however, increased postoperative pain, drainage and healing duration (compared to prior series) were encountered. This cryotherapy technique provides significantly improved results in the treatment of vasomotor rhinitis when proper patient selection and technique are utilized.

Adolescent↗

PubMed1979

Chronic vasomotor rhinitis: cryogenic and other surgical modes of treatment.

Cryosurgical treatment of chronic vasomotor rhinitis provides a safe, effective and uncomplicated mode of management for this very common otolaryngologic disorder. Data relating to three hundred fifty patients is presented with particular reference to patient selection criteria, cryosurgical techniques and results.

Adrenal Cortex Hormones↗

PubMed1981

[Anterior rhinomanometry and intranasal challenge tests. Technique and results in 270 cases. Usefulness for the aetiological diagnosis of vasomotor rhinitis (author's transl)].

Nasal response to a large number of stimuli is almost invariably the same, with sneezing, watery rhinorrhoea and nasal obstruction constituting the three major conventional symptoms of the so-called vasomotor (autonomic) rhinitis. These symptoms are not specific to allergic reactions but can be seen in viral infections, sudden changes in temperature, inhalation of irritant fumes or of certain smells. The aetiological diagnosis of vasomotor rhinitis therefore is sometimes very difficult but seems to be greatly facilitated by intranasal challenge tests associated with anterior rhinomanometry.

Allergens↗

PubMedDate not supplied

A comparative tolerance study of terfenadine-pseudoephedrine combination tablets and pseudoephedrine tablets in patients with allergic or vasomotor rhinitis.

In this multicentre, double-blind, randomized, parallel group study, 315 patients with allergic or vasomotor rhinitis were treated on a twice daily dosing schedule with either a 60 mg terfenadine-120 mg pseudoephedrine hydrochloride combination or 120 mg pseudoephedrine hydrochloride (extended release) for 2 weeks. No clinically significant differences between the two groups were noted in body weight, temperature, respiration rate or blood pressure following the treatment period. An increase in mean heart rate of approximately 5 beats/min from entry to the final clinic visit was noted in both treatment groups. No clinically significant changes were noted in either treatment group when pre- and post-treatment electrocardiograms were compared. There were also no clinically significant alterations in laboratory values, which included serum chemistry, haematology and urinalysis, within or between either group. The adverse events profiles for both groups were similar. The most frequent adverse event was insomnia, in 40 (25.3%) patients given the terfenadine-pseudoephedrine combination and in 42 (26.8%) of those given pseudoephedrine. No unusual or unexpected adverse events were reported.

Adult↗

PubMed1975

Bilateral transnasal cauterization of the vidian nerve in vasomotor rhinitis.

A brief report of twenty cases of bilateral cauterization of the Vidian Nerve Canals in intractable non-atopic chronic Vasomotor Rhinitis by a Trans-Nasal approach not previously described is given. The authors find this approach to be a much safer and simpler procedure than either the Trans-Septal or the Trans-Antral routes. The advantages of this approach to the Vidian Nerve Canal over the Trans-Septal and Trans-Antral routes are discussed.

Anesthesia, Local↗

PubMed1976

Treatment of vasomotor rhinitis with intranasal beclomethasone dipropionate (Becotide). Results from a double-blind cross-over study.

The effect of beclomethasone dipropionate (Becotide) intranasally in vasomotor rhinitis has been studied on 39 adult volunteers in a double-blind cross-over study during 9 weeks in February-April 1975. The dose of beclomethasone dipropionate was 300 mug/day. Twenty-five patients preferred the beclomethasone dipropionate period, 5 patients the placebo period, and 9 patients had no preference. About three-quarters (74 per cent) of the patients considered themselves free of symptoms or greatly improved after the treatment with beclomethasone dipropionate. Statistical calculation of the daily nasal symptoms score confirms the improvement. The speediest effect was registered for sneezing, followed by nasal catarrh, nasal itching, and blocking. No changes in the levels of cortisol occurred during the treatment. The bacteriological and mycological findings (analysed with regard to Candida albicans) were fairly constant.

Adult↗

PubMed1978

A comparative evaluation of oral decongestants in the treatment of vasomotor rhinitis.

In a seven-week double-blind crossover study, Disofrol (dexbrompheniramine maleate +d-isoephedrine sulphate) was compared with Lunerin (brompheniramine + 2-amino-1-phenyl-propanol-(1)-hydrochloride) and with placebo in the treatment of vasomotor rhinitis in thirty-one patients. From the patients' evaluations on diary cards Disofrol reduced the symptom running nose to a higher degree than Lunerin, an effect possibly ascribable to a greater anticholinergic activity. Both preparations had equal ability to relieve nasal blockage and both combinations were found to be more effective than placebo.

Adult↗