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At least 19 recordsLinked to original sources

Upper airway motor outputs during sneezing and coughing in decerebrate cats.

The purposes of the present study were to determine which upper airway movements cause a difference in the expiratory airflow pathway between sneezing and coughing, and to develop a new animal model for studying the neural mechanism of sneezing in paralyzed animals, i.e. fictive sneezing. We compared the upper airway motor patterns of sneezing and coughing, induced by electrical stimulation of the anterior ethmoidal nerve (AEN) and superior laryngeal nerve, respectively, in non-paralyzed decerebrate cats. Respiratory and laryngeal motor patterns that consisted of an inspiration phase, compression phase, and expulsion phase were observed for both sneezing and coughing. The main difference was observed in the activity of the elevator of the back of the tongue, styloglossus (SG) muscle, which was explosively activated during the expulsion phase of sneezing, whereas it was virtually silent during coughing. The nasopharyngeal closers were weakly to moderately activated during sneezing. Their activities during coughing were weaker than during sneezing. Furthermore, the AEN-induced activities of the phrenic and abdominal nerves and the lateral branch of the hypoglossal nerve (lat-XII), which innervates the SG muscle, in paralyzed cats were consistent with the activities of the diaphragm, abdominal, and SG muscles during actual sneezing in non-paralyzed cats. Thus, we conclude that tongue movement is the main difference in the motor outputs between sneezing and coughing, which probably causes greater nasal airflow in sneezing, and that it is necessary to record the activity of the lat-XII to identify fictive sneezing in paralyzed cats.

Abdominal Muscles↗

Urethral closure mechanisms under sneeze-induced stress condition in rats: a new animal model for evaluation of stress urinary incontinence.

The urethral closure mechanism under a stress condition induced by sneezing was investigated in urethane-anesthetized female rats. During sneezing, while the responses measured by microtip transducer catheters in the proximal and middle parts of the urethra increased, the response in the proximal urethra was almost negligible when the bladder response was subtracted from the urethral response or when the abdomen was opened. In contrast, the response in the middle urethra during sneezing was still observed after subtracting the bladder response or after opening the abdomen. These responses in the middle urethra during sneezing were significantly reduced approximately 80% by bilateral transection of the pudendal nerves and the nerves to the iliococcygeous and pubococcygeous muscles but not by transection of the visceral branches of the pelvic nerves and hypogastric nerves. The sneeze leak point pressure was also measured to investigate the role of active urethral closure mechanisms in maintaining total urethral resistance against sneeze-induced urinary incontinence. In sham-operated rats, no urinary leakage was observed during sneeze, which produced an increase of intravesical pressure up to 37 +/- 2.2 cmH2O. However, in nerve-transected rats urinary leakage was observed when the intravesical pressure during sneezing exceeded 16.3 +/- 2.1 cmH2O. These results indicate that during sneezing, pressure increases elicited by reflex contractions of external urethral sphincter and pelvic floor muscles occur in the middle portion of the urethra. These reflexes in addition to passive transmission of increased abdominal pressure significantly contribute to urinary continence mechanisms under a sneeze-induced stress condition.

Animals↗

Sneeze-evoking region within the brainstem.

The neuronal mechanisms of sneezing were examined in precollicular-postmammillary decerebrate cats. Mechanical stimulation (frequency 20 Hz, peak-to-peak displacement 0.5 mm) of the nasal membrane evoked a series of sneezes. In the same preparation, electrical stimulation (duration 0.2 ms, frequency 10 Hz, 5-50 microA) delivered to the lower brainstem also evoked sneezes. The changes in EMG activity and subglottic pressure during brainstem-induced sneeze were similar to those recorded nasal-induced sneeze. The sneeze-evoking region was located along the ventromedial part of the spinal trigeminal nucleus and the adjacent pontine-medullary lateral reticular formation, and extended rostrocaudally from P4.0 to P14.5 according to the Horsley-Clarke coordinates. These results suggest that the sneeze-evoking region is a distinct structure of the brainstem, having a homogeneous function. This region appears to control the epipharyngeal, intrinsic laryngeal and respiratory muscles. The integrated activity of these muscles underlies the generation of a sneeze.

Abdominal Muscles↗

Psychogenic intractable sneezing: case reports and a review of treatment options.

OBJECTIVE: To report 2 cases of the uncommonly seen diagnosis of psychogenic intractable sneezing, to review the clinical presentation, workup, and various previous treatment modalities, and to present a unique method of treatment. DATA SOURCES: The literature was reviewed using a MEDLINE search of the following keywords: psychogenic intractable sneezing, paroxysmal sneezing, factitious sneezing, respiratory disorders, conversion disorders, habit cough, and psychogenic cough. The search was restricted to articles published from 1966 onward, although older references were cross-referenced from more recent articles. RESULTS: Sneezing alone can be caused by foreign substances, odors, chemical irritants, allergies, and other less common factors. Psychogenic intractable sneezing, although not a particularly common disease, occurs mainly in adolescent girls for which a cause may not be found. Patients are usually refractory to various medications and have an otherwise unremarkable extensive workup. Treatments have included corticosteroids, antihistamines, hydroxyzine hydrochloride, and decongestants among other pharmacologic agents, as well as psychotherapy. Based on the presented case reports, a trial of isotonic sodium chloride solution with suggestion therapy was able to rid the patients of their intractable sneezing. CONCLUSIONS: Psychogenic intractable sneezing is a real disease. Although other diseases may be considered, the workup may merely include an extensive history and physical examination. Many treatments have been tried with varying success, including those that incorporate psychotherapy. A variation of suggestiontherapy is offered as a unique treatment modality.

Child↗

Circadian sneezing.

Prompted by the observation that a fellow medical student sneezed at about the same time in class every morning, we recorded the time of each of the 118 sneezes she made on 69 days over a 6.5-month period. Analysis of the sneeze times with the goodness-of-fit test revealed a highly nonuniform distribution (p < 0.0001) with a significantly increased probability of sneeze production within a small time interval centered at 8:20 AM. After ruling out the known causes of sneezing, we propose that the subject had a circadian fluctuation in her sneeze threshold independent of any immediate external stimulus. We compare this circadian rhythm to other periodic phenomena such as cyclic esotropia and rapid-cycling bipolar disease as well as to illnesses such as the periodic paralyses in which rapid and reversible changes occur in the neuromuscular system, and we discuss the peculiar circumstances favorable to documenting a circadian sneeze.

Adult↗

Paroxysmal sneezing in children: two new cases.

Paroxysmal sneezing is an uncommon condition primarily affecting adolescents. Most of the reported cases were thought to be psychogenic, and only two were felt to be due to nasal sensitivity. This paper reports two adolescents with paroxysmal sneezing, neither of whom had apparent psychologic or emotional problems. In one child the sneezing continued during sleep. The other child was successfully treated with topical nasal anesthesia. Both children were felt to have nasal sensitivity as the etiology of their paroxysmal sneezing. The evaluation of the patient with paroxysmal sneezing requires a thorough history and physical examination. One must not assume that every case of paroxysmal sneezing is of psychogenic origin. Topical nasal anesthesia should be tried for control of intractable paroxysmal sneezing.

Administration, Intranasal↗

The photic sneeze response: a descriptive report of a clinic population.

BACKGROUND: The prevalence of the photic sneeze response (PSR) as well as other characteristics have been studied in selected populations. However, the PSR has not been investigated in a general eye care patient population. This study was performed in an attempt to characterize the epidemiologic, descriptive, and demographic aspects of the photic sneeze response among patients attending for primary eye care. METHODS: A questionnaire on demographics, risk factors, and triggering stimuli was distributed to 500 consecutive patients presenting for a general eye examination at an academic health center optometry clinic. RESULTS: Three hundred and sixty-seven of 500 questionnaires were returned (73.4%). Among this sample 33% were self-recognized photic sneezers with the majority being females (67%) and Caucasian (94.3%). Statistically significant correlations were found between the presence of photic sneezing and the presence of a deviated nasal septum and a non-significant association was found with tobacco use. Uniform frequency of sneezing does not occur in response to light stimulus; only 12.3% of sneezers responded consistently to sunlight exposure. The majority of sneezers (90.7%) responded with three or fewer sneezes. The interval between successive sneezes was fewer than 19 seconds in 85% of respondents. Fewer than 27% of respondents were able to recall a parent who exhibited a sneeze response. CONCLUSIONS: The PSR is not an uncommon phenomenon. Systemic associations with the PSR are as diverse as deviated nasal septum and tobacco use. Results suggest that there may be a threshold level of light or frequency of light exposure which produces the response and that more patients may acquire the response than inherit it.

Adolescent↗

PAROXYSMAL SNEEZING.

Although sneezing is a particularly common symptom, there are surprisingly few references to this subject in the medical literature. Many of these references are shrouded in superstition and unscientific theory. Preparation of this report was stimulated by an interesting example of severe uncontrollable non-allergic paroxysmal sneezing which was carefully investigated with regard to both physical and psychological factors. A further example of paroxysms of sneezing occurring in a patient with temporal lobe seizures is also discussed with particular reference to the control of the sneezing episodes in association with anticonvulsant medication and control of the epileptic attacks. In addition, the neurophysiological mechanisms of sneezing are reviewed and the specific neurological references to the subject are discussed in relation to physiological and clinical data. At times the symptom of sneezing would appear to reflect some unknown disorder which may have central and possibly cortical affiliations.

Anticonvulsants↗

Local and systemic capsaicin pretreatment inhibits sneezing and the increase in nasal vascular permeability induced by certain chemical irritants.

The effects of local exposure to chemical irritants and mechanical stimulation on sneezing reflexes have been studied in normal and capsaicin-pretreated, conscious guinea-pigs. The influence of local and systemic capsaicin pretreatment on vascular permeability to plasma proteins and the cardiovascular effects of local application of capsaicin to the nasal mucosa have also been studied in anaesthetized animals. Local application of capsaicin (threshold dose 3 microM), nicotine (threshold dose 300 microM) or formalin to the nasal mucosa induced reflex sneezing discharges. Systemic or local capsaicin pretreatment abolished or reduced the sneezing responses to capsaicin and formalin. The response to nicotine was also reduced following local pretreatment with capsaicin, while the response to systemic pretreatment with capsaicin was only slightly affected. The sneezing response to mechanical stimulation was not affected by capsaicin pretreatment. Pretreatment with a local anaesthetic induced a similar dose-dependent inhibition of the sneezing responses to both capsaicin and nicotine. Local application of disodium cromoglycate to the nasal mucosa reduced the sneezing response to capsaicin, but not that to nicotine. Local pretreatment with the 3 mM and 30 mM capsaicin solution inhibited the increase in vascular permeability to plasma proteins in the nasal mucosa induced by i.v. capsaicin. Local pretreatment with capsaicin did not result in any reduction in the capsaicin-induced permeability in the ureter, suggesting that such treatment did not have any major systemic toxic effects. However, a small, acute increase in respiratory insufflation pressure, indicating broncho constriction, was seen when the 30 mM capsaicin solution was applied to the nasal mucosa.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Substance P as a potent stimulator of sneeze responses in experimental allergic rhinitis of guinea pigs.

Substance P was examined for sneeze-inducing activity and its involvement of sneeze responses in experimental allergic rhinitis. Substance P, dripped into a nostril of guinea pigs, at concentrations of 100 pM and above induced sneezing in a dose-dependent fashion. The activity of substance P was not affected by the previous subcutaneous injections of capsaicin that depleted substance P in nerve fibers. Histamine induced sneezing at concentrations of 30 mM and above and the activity was reduced by capsaicin treatment. The frequency of antigen-induced sneezing was proportional to the substance P content in nasal mucosa of sensitized guinea pigs treated with increasing doses of capsaicin; correlation coefficient 0.91. These results suggest that substance P plays an important role as a stimulator of sneeze responses in experimental allergic rhinitis in guinea pigs.

Animals↗

Factitious sneezing.

We report a case of hysterical, intractable paroxysmal sneezing in an adolescent girl. The patient had been observed by two pediatricians, an allergist, an emergency room physician, and a chiropractor. She had been treated with antihistamines, epinephrine, corticosteroid nasal spray, and a 1-week course of an oral corticosteroid without improvement. She was referred for evaluation of an allergic etiology before continuing her workup with a computed tomographic head scan. The patient had been sneezing almost daily for 3 mo up to 2000 times a day. The patient did not sneeze at night. She had nasal congestion but no rhinorrhea or eye symptoms. She did not sneeze during the interview. The results of a physical examination were normal except for mild obesity. No organic cause was found. Most cases of intractable paroxysmal sneezing reported in the literature occur in adolescents and appear to have a psychogenic etiology. The problem was discussed with the child and parents, and psychologic therapy was recommended. Considerable decrease in sneezing subsequently occurred, but the parents credited this is further chiropractic therapy.

Adolescent↗

C-Fos-like immunoreactivity in the cat brainstem evoked by sneeze-inducing air puff stimulation of the nasal mucosa.

Sneeze is one of the most important protective reflex of the respiratory tract. It is elicited from trigeminal peripheral fields and results in major changes in the discharge patterns of the medullary respiratory-related neurons. The pattern of c-Fos-like immunoreactivity evoked by sneezing was explored as a structural approach to the networks involved in this particular model of trigemino--respiratory interactions. Sneezes were elicited in anaesthetized adult cats by driving air puffs to the superior nasal meatus through a catheter. Additional cats were used as controls for anaesthesia and for catheter insertion into the nostril. In sneezing cats, immunoreactivity was evoked in projection areas of the ethmoidal afferents which innervate the superior nasal meatus, e.g. the subnuclei caudalis, interpolaris and in the interstitial islands of the trigeminal sensory complex. Immunoreactivity was also markedly enhanced in the areas devoted to respiratory control in the medulla (solitary complex, nucleus retroambiguus) and in the pontine parabrachial area. C-Fos expression was also evoked in the lateral aspect of the parvicellular reticular formation in sneezing cats. This area might be of major importance in the adaptation of the ventilatory system to expulsive functions.

Anesthesia↗

Activities of vagal receptors in the different phases of sneeze in cats.

We studied the activity of 50 slow-adapting receptors (SAR), 13 rapidly-adapting receptors (RAR) and 3 expiratory modulated receptors in the different phases of sneeze in tracheostomized and non-tracheostomized anaesthetized cats. SAR activity increased progressively during the first phase of the preparatory inspiration in parallel to integrated diaphragmatic activity. During the second phase of the preparatory inspiration, SAR increased their discharge frequency; higher threshold SAR and RAR were recruited. During the compressive phase, discharge of SAR kept stable or increased slightly in parallel to an increase in transpulmonary pressure, while expiratory modulated receptors were activated. During the expulsive phase, only RAR were activated. Increase in transpulmonary pressure at the end of the inspiration phase of sneeze shortened expiratory duration and increased the rate of rise of expiratory muscle activity. Increase in transpulmonary pressure at the end of the compressive phase further shortened expiratory duration. These results suggest: first, a facilitatory effect on the triggering of the second phase of the preparatory inspiration from SAR; second, a modulation of the early stage of expiration by SAR, RAR and expiratory modulated receptors during the compressive phase; third, a permissive effect on a rapid expulsive thrust by SAR which can be further limited by RAR; fourth, a facilitatory effect on the triggering of inspiratory activity that follows the expiratory thrust by RAR. Both SAR and RAR might participate in the occurrence of successive sneeze in an attack and in the increased frequency of sneezing. Our results suggest that complex convergent inputs from nasal and vagal receptors, which alter the respiratory rhythm and rhythmogenesis, modulate finely the sneeze reflex.

Animals↗

Intractable sneezing due to IgE-mediated triethanolamine sensitivity.

Sneezing has been commonly recognized as part of the nasal allergic reaction in response to pollen and inhalant allergens; isolated intractable sneezing is an unusual presentation in allergic patients. An 8-yr-old white girl developed intractable sneezing in the fall while walking past an area where fresh roofing tar was being prepared. Her personal and family histories were negative for allergic disease or symptoms. Positive physical findings were boggy nasal mucosa; pollen and inhalant skin tests were negative. Response to topical cromolyn and beclomethasone administered intranasally was only partial; antihistamines were little help. Upon careful review of history, exposure to clothes washed in Miracle White Laundry Soil and Stain Remover correlated to symptoms; removal from clothing by extensive washing relieved the sneezing, which recurred upon exposure. Prick test was positive to triethanolamine at 10(7)M to 10(-4)M and not to other ingredients of this product. Investigation demonstrated dose-dependent leukocyte histamine release (25% to 27% specific release) to triethanolamine (10(-4)M to 10(-7)M); this release (50% at 10(-5)M) was inhibited by preincubation with cromolyn sodium (5 X 10(-6)M). Passive cutaneous anaphylaxis was demonstrated to triethanolamine (10(-7)M to 10(-4)M); specific IgE to triethanolamine was demonstrated by polystyrene tube radioimmunoassay. Controls had no histamine release or specific IgE. Thus exposure to triethanolamine caused IgE-mediated intractable sneezing.

Child↗

Influence of vagal afferents in the sneeze reflex in cats.

We studied the effects of bilateral vagotomy and step pulmonary inflations (5, 10, 15 mmHg, i.e., 0.66, 1.33, 2 kKPa) on sneeze reflex in ketamine-anaesthetized cats. Bilateral vagotomy lengthens the duration of preparatory inspiration and diminishes the amplitude of expiratory activities in sneeze. In contrast, 5 mmHg pulmonary inflation facilitates the sneeze. It shortens the inspiratory preparation and increases the frequency of sneeze attacks. At 10 mmHg pulmonary inflations, inspiration is inhibited and only expiratory thrust occurs. At 15 mmHg pulmonary inflations, vagal afferent stimulations inhibit the sneeze.

Afferent Pathways↗

Changes in Fos-like immunoreactivity evoked by maturation of the sneeze reflex triggered by nasal air puff stimulation in kittens.

The sneeze reflex is a valuable tool for exploring the maturation of the respiratory control in the newborn as it alters both inspiratory and expiratory activities. Air puff stimulation of the superior nasal meatus innervated by ethmoidal afferents consistently evokes sneeze in adult cats. Such stimulation evokes only a reinforcement of expiratory activities in newborn kittens. This study demonstrates that the pattern of Fos-like immunoreactivity evoked by nasal stimulation changes during functional maturation of sneeze. Nasal stimulation evoked immunoreactivity (i) in the trigeminal sensory complex, at the levels where nasal afferents project, (ii) in the reticular formation, (iii) in the solitary complex and (iv) in the parabrachial area of mature kittens. The evoked immunoreactivity was the same in newborn kittens as in mature kittens in the projection areas of the nasal primary afferents. Fos response was less than half that in mature kittens in the reticular formation and absent in the solitary complex or the parabrachial area. Sneeze can be elicited from the time when evoked immunoreactivity in the solitary complex and the parabrachial area is above control levels. These data provide evidence that the maturation of sneeze is dependent on the development of central relays allowing peripheral inputs to be integrated by neurons engaged in respiratory control.

Aging↗

Role of triangularis sterni during coughing and sneezing in dogs.

Studies in mammals have found that during breathing the triangularis sterni (TS) muscle regulates expiratory airflow and the end-expiratory position of the rib cage and furthermore that the respiratory activity of this muscle is influenced by a variety of chemical and mechanical stimuli. To assess the role of the TS during coughing and sneezing, electromyograms (EMGs) recorded from the TS were compared with EMGs of the transversus abdominis (TA) in eight pentobarbital-anesthetized dogs. During coughing induced by mechanically stimulating the trachea or larynx (n = 7 dogs), peak EMGs increased from 23 +/- 2 to 74 +/- 5 U (P less than 0.00002) for the TS and from 21 +/- 6 to 66 +/- 4 U (P less than 0.0002) for the TA. During sneezing induced by mechanically stimulating the nasal mucosa (n = 3 dogs), peak EMG of the TS increased from 10 +/- 3 to 66 +/- 7 U (P less than 0.005) and peak EMG of the TA increased from 10 +/- 2 to 73 +/- 7 U (P less than 0.02). For both muscles the shape of the EMG changed to an early peaking form during coughs and sneezes. Peak expiratory airflow during coughs of different intensity correlated more closely with peak TS EMG in three dogs and with peak TA EMG in four dogs; peak expiratory airflow during sneezes of different intensity correlated more closely with peak TS than TA EMG in all three animals. These results suggest that the TS is actively recruited during coughing and sneezing and that different neuromuscular strategies may be utilized to augment expiratory airflow.

Animals↗