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Summary Background The field of laryngology has grown exponentially since the advent of the transnasal flexible laryngoscopy. Flexible laryngoscopy when performed skillfully using the proper technique, facilitates a good view of the hidden areas of the larynx. Objective To compare the effectiveness of the topical agents in providing a more comfortable experience for the patient, allowing the practitioner to advance the endoscope with less friction, pain and discomfort for the patient using 10% lidocaine spray, 2% lidocaine gel, 4% lidocaine with xylometazoline (1:1) soaked pledgets, or aqueous gel. Materials and Methods A prospective randomized single-blinded clinical trial was conducted in a tertiary care teaching hospital in South India where 376 patients were recruited and allocated into four groups based on the topical preparation used. Following endoscopy, each subject filled a questionnaire grading their experience on a visual analogue scale. The clinician also then answered a questionnaire on aspects of the endoscopy performed. Results The pain score and the ease of performing the procedure among the different groups were comparable. Those in the 10% lidocaine arm experienced significant burning sensation (P = 0.0001). The other variables such as throat pain (P = 0.783), gag reflex (P = 0.318), unpleasant taste (P = 0.092), globus (P = 0.190), swallowing difficulty after the procedure (P = 0.273), difficulty in breathing (P = 0.744) and willingness to have a repeat procedure (P = 0.883) were also comparable. Conclusion Aqueous gel can be used topically during a flexible nasopharyngolaryngoscopy instead of an anesthetic agent alone or one combined with a nasal decongestant.

Cough is the most common respiratory symptom that can have various causes. It is a major clinical problem that can reduce a patient’s quality of life. Thus, clinical guidelines for the treatment of cough were established in 2014 by the cough guideline committee under the Korean Academy of Tuberculosis and Respiratory Diseases. From October 2018 to July 2020, cough guidelines were revised by members of the committee based on the first guidelines. The purpose of these guidelines is to help clinicians efficiently diagnose and treat patients with cough. This article highlights the recommendations and summary of the revised Korean cough guidelines. It includes a revised algorithm for the evaluation of acute, subacute, and chronic cough. For a chronic cough, upper airway cough syndrome (UACS), cough variant asthma (CVA), and gastroesophageal reflux disease (GERD) should be considered in differential diagnoses. If UACS is suspected, first-generation antihistamines and nasal decongestants can be used empirically. In cases with CVA, inhaled corticosteroids are recommended to improve cough. In patients with suspected chronic cough due to symptomatic GERD, proton pump inhibitors are recommended. Chronic bronchitis, bronchiectasis, bronchiolitis, lung cancer, aspiration, intake of angiotensin-converting enzyme inhibitor, intake of dipeptidyl peptidase-4 inhibitor, habitual cough, psychogenic cough, interstitial lung disease, environmental and occupational factors, tuberculosis, obstructive sleep apnea, peritoneal dialysis, and unexplained cough can also be considered as causes of a chronic cough. Chronic cough due to laryngeal dysfunction syndrome has been newly added to the guidelines.

The article presents current data on acute rhinosinusitis, its essence, classification, etiology, pathogenesis, treatment approaches in children. It is emphasized that the key to successful treatment of this disease is the impact on all parts of pathogenesis. Given the leading etiopathogenetic links of acute rhinosinusitis, its comprehensive treatment requires prescribing of preparations with anti-infection, anti-inflammatory, secretolytic and immune-stimulating action, as well as nasal decongestants — to eliminate the swelling of the nasal mucosa and to improve the quality of life of the patient. The detailed description of nasal decongestants is presented, the attention is paid to the next generation drug without preservatives — dosed nasal drops Nasivin® Sensitive.

Acute infectious rhinosinusitis is the most common clinical form of respiratory pathology in childhood. Despite the fact that in 90 % of cases the main etiological factor leading to the development of rhinosinusitis is viral infection, 13 % of them are complicated by bacterial inflammation. Acute respiratory di­seases with manifestations of rhinosinusitis constantly recurring in the child can lead to the formation of allergic, non-allergic rhinitis and chronic rhinosinusitis — multifactorial chronic inflammatory diseases of the upper respiratory tract. The pathogenesis of acute infectious rhinosinusitis, in spite of the abundance of data, has been underinvestigated. The article highlights the problem of acute infectious rhinosinusitis treatment in children from the standpoint of modern ideas about the development of inflammatory process in the nasal mucosa, the role of innate immunity, and the functioning of mucociliary clearance. Data on the clinical manifestations of acute infectious rhinosinusitis are presented, clinical and diagnostic criteria for its detection are given. The mechanisms of action of nasal decongestants are described, as well as the features of their use, the immunological and anti-inflammatory effects of these drugs. Attention is focused on the mechanisms of action of oxymetazoline. Recommendations for the use of oxymetazoline in pediatric practice are given.

Acute respiratory diseases are one of the most common reasons for visiting a doctor in pediatric practice. Most episodes of this pathology have a viral etiology, signs of inflammation from the upper respiratory tract and proceed with symptoms of acute rhinitis (acute nasopharyngitis). The most of episodes of acute rhinitis last no more than 10 days and end with the patient’s recovery. The most common complications of acute rhinitis in children are acute rhinosinusitis and acute otitis media. These diseases are often mild and rarely have complications. However, a large number of patients with acute respiratory diseases increases the likelihood of a situation in which the doctor will encounter a problem patient. The article proposes care pathways for practitioners to manage patients with acute rhinological symptoms lasting up to 10 days and from 10 days to 3 months. The care pathways are based on several key points. No1: each patient must be analyzed for the presence of alarming symptoms, upon detection of which the patient should be urgently hospitalized. No2: all patients should be dynamically observed by a doctor until complete recovery, the patient should not receive treatment without the supervision of a doctor. No3: the basis of treatment is drugs for symptomatic therapy, which are selected depending on the dominant symptom that has the greatest impact on the patient’s well-being. To eliminate nasal mucosal edema, it is rational to use nasal decongestants (original oxymetazoline) for children of all ages; the course and dosages are determined according to the age of the child. Antibacterial drugs should be prescribed strictly according to indications in the presence of convincing data for the bacterial etiology of the disease.

Introduction: Common cold is frequently encountered by people and it also largely affects productivity of the daily routine life. Combination of Paracetamol, Phenylephrine and Chlorpheniramine maleate which acts as an antipyretic, nasal decongestant and anti-histaminic respectively, can be used for the symptomatic treatment of common cold. To the above-mentioned combination, Sodium Citrate was added as an expectorant and Menthol for cooling effect and this post marketing surveillance study was conducted to test the efficacy and safety for the symptomatic treatment of common cold. Methodology: Out of 200 enrolled, 174 patients completed the study. Safety assessment was made by analysing the adverse events reported by the patient or their guardian. Efficacy was evaluated by total symptom score [TSS] (eleven-point scale ranging from 0 to 10 where 0 is no symptom to 10 is the maximum symptoms) which was extrapolated to four-point Likert-type symptom severity scales. Results: TSS was reduced from 5.57 at baseline visit to 3.40 at day 3 to 1.69 at day 5. At day 3 and day 5 there was TSS reduction of 38.865 % and 69.690 % respectively as compared to baseline. 18 episodes of adverse drug reactions were reported and all of them were of expected and non-serious nature. Conclusion: Fixed-dose combination of Paracetamol 125mg, Phenylephrine 5mg, Chlorpheniramine Maleate 1mg, Sodium Citrate 60mg and mentholated flavoured syrupy base q.s. per 5ml was found to be safe and efficacious for the treatment of common cold in children of age between 2 to 12 years.

Purpose Chronic rhinosinusitis (CRS) is observed in almost 100% of patients with cystic fibrosis (CF). CF-related CRS treatment is extremely challenging because of the underlying genetic defect leading to its development. CRS in CF is often refractory to standard therapy, while recurrences after surgical treatment are inevitable in the majority of patients. This study provides a precise review of the current knowledge regarding possible therapeutic options for CF-related CRS. Methods The Medline and Web of Science databases were searched without a time limit using the terms “cystic fibrosis” in conjunction with “otorhinolaryngological manifestation”, “rhinology” and “sinusitis”. Results Precise guidelines for CF-induced CRS therapy are lacking due to the lack of large cohort randomized controlled trials. None of the existing therapeutic agents has already been recommended for CRS in CF. Therapy targeting the underlying genetic defect, intranasal dornase alfa administration, and topical delivery of colistin and tobramycin showed promising results in CF-related CRS therapy. Besides the potential effectiveness of nasal steroids, strong recommendations for their usage in CF have not been provided yet. Systemic corticosteroid usage is controversial due to its potential negative influence on pulmonary disease. Ibuprofen revealed some positive effects on CF-related CRS in molecular and small cohort studies. Intranasal irrigation with saline solutions could relieve sinonasal symptoms. Nasal decongestants are not recommended. Endoscopic sinus surgery is the first-line surgical option for refractory CRS. Extensive surgical approaches should be considered as they could improve long-term outcomes in CRS. Conclusion Further studies are warranted to establish consensus for CF-related CRS therapy.

Clonidine is drug which was initially used as a nasal decongestant and now commonly used in the treatment of several conditions both in adults and children. Even though there is no minimum toxic dose for this drug, low-dose clonidine poisonings are commonly seen in children. Accidental ingestion of this drug or transdermal exposure can cause altered sensorium, hypertension, hypotension and bradycardia because of various mechanism of action. Key words: Clonidine, intoxication, hypotension, miosis.

Introduction Symptomatic relief of acute rhinosinusitis is commonly achieved with nasal decongestants. The current observational study investigated the efficacy and safety of treatment of acute rhinosinusitis with Ectoin® Rhinitis Spray compared to or in combination with Xylometazoline-containing decongesting nasal spray. Methods Patients with acute rhinosinusitis applied either Ectoin® Rhinitis Spray, Xylometazoline nasal spray or a combination of both products. Rhinosinusitis symptoms were assessed, and nasal oedema and endonasal redness were determined by rhinoscopy. Patient diaries based on the validated SNOT (Sino Nasal Outcome Test) questionnaire evaluated rhinosinusitis parameters over time and influences of the disease on quality of life. Following treatment, investigators and patients judged the efficacy and tolerability. Results Ectoin® Rhinitis Spray diminished common rhinosinusitis symptoms such as nasal obstruction, nasal secretion, facial pain/headache, and smell/taste impairment. Upon treatment over 7 days, rhinosinusitis sum scores decreased statistically significantly (p ® Rhinitis Spray, whereas treatment with Xylometazoline-containing nasal spray resulted in nasal mucosa dryness. Concomitant treatment with both products diminished the development of nasal dryness and required fewer applications of Xylometazoline-containing nasal spray. Conclusion Ectoin® Rhinitis Spray is an effective, natural treatment option for acute rhinosinusitis, which may be used as monotherapy or as add-on treatment with a Xylometazoline-containing nasal spray. The concomitant use of Ectoin® Rhinitis Spray might reduce the needed dose of decongestant nasal spray and counteract bothersome side effects such as dry nasal mucosa. Trial registration The current study was registered in the ClinicalTrials.gov database under the identifier: NCT03693976 (date of registration: Oct 3, 2018).

Objective: To compare the postoperative complications of conventional polypectomy versus Endoscopic sinus surgery. Study Design: This is cross sectional study. Setting: Study carried out at E.N.T department, Tertiary care hospital from April 2019 - March 2020. Materials & Methods: 52 out of which 32 were male and 20 were female. Benign nasal polyps within 14 yrs to 80 years from emergency and out- patient department both were included in our study. Only recurrent and neoplastic lesions were not inclusive of this study. Postoperatively the patient was prescribed with oral antibiotics, nasal decongestants and nasal douche with normal saline, followed by local steroids after 1.5 months. The post operative evaluation (both endoscopic and clinical) was done at 2 weeks, 6 weeks and 3 months post operatively and data was recorded. Statistical package for social sciences (SPSS) software version 20.0. Results: A total of 52 patients were recruited for the study with age ranging from 18 to 40 years. The mean age was 24.65± SD 4.12. There were 32 (61.53%) males and 20 (38.46%) female patients. Two weeks were observed postoperative complications. The intranasal complications after simple intranasal polypectomy i.e. bleeding (SIP 8(30.76%) Versus ESS 5(19.23%)), crusting (SIP 10(38.46%) Versus ESS 6(23.07%)), Synechiae formation (SIP 3(11.53%) Versus ESS 1(3.84%)), recurrence 0% were observed. At upto 6th weeks observed the intranasal complications after simple intranasal polypectomy i.e. bleeding (SIP 5(19.23%) Versus ESS 2(7.69%)), crusting (SIP 6(23.07%) Versus ESS 2(7.69%)), Synechiae formation (SIP 2(7.69%) Versus ESS 1(3.84%)), recurrence 0% were observed. Three months were observed the intranasal complications after simple intranasal polypectomy i.e. bleeding (SIP 1(3.84%) Versus ESS 0%), crusting (SIP 0% Versus ESS 0%), Synechiae formation (SIP 4(15.38%) Versus ESS 3(11.53%)), recurrence 3(11.53%) were observed only in simple intranasal polypectomy group. While the intraorbital and intracranial complications were not observed. Conclusion: We would like to conclude our study in favor of ESS to be superior to other intranasal polypectomy procedures in terms of post operative complications.

Nasal congestion is one of the most common symptoms of common colds and rhinitis, due to an inflammatory reaction, vasodilation, increased nasal blood flow and vascular permeability. Nasal obstruction is often a multifactorial problem, in addition to infectious causes, it can be caused by a combination of anatomical aberrations, swelling of the nasal mucosa and enlargement of the turbinates. Anatomical and structural problems, such as nasal septum deviation and nasal valve collapse, are usually treated surgically. Drug therapy of nasal obstruction is aimed at reducing edema and inflammation of the nasal mucosa. Pharmacotherapy of nasal obstruction is aimed at reducing inflammation and/or swelling of the mucous membrane. Decongestants are widely prescribed to relieve symptoms. The drugs used have different mechanisms of action and include systemic and topical drugs. This article discusses decongestants as a treatment for nasal obstruction. When applied topically, the drugs of this group act directly on the α2 and α1-adrenergic receptors of the nasal cavity, causing vasoconstriction, a decrease in the volume of the nasal conch, an increase in nasal patency, and relieving the symptoms of obstruction. The existing risk of developing side effects, both systemic and local, is reduced with atopic exposure and proper dosing of the drug used. Preferably, the use of drugs with low bioavailability. The suppression of the ciliated epithelium can be caused not only by the pathological process, but also by the composition of drugs. The value is given to the acidity of the buffer system. The optimal pH value of intranasal agents is about 6 (neutral range). The combination with anticholinesterase substances reduces the production of pathological discharge. The use of multi-component medicines allows you to restore nasal breathing and suppress excessive nasal secretion. One of the effective and safe drugs of topical action is Xylometazoline, as a monocomponent agent or in combination with ipratropium bromide.

The nature of the clinical manifestations of purulent-inflammatory diseases of the ENT organs is determined, first of all, by the localization of the process, and in addition, by the severity of the reactions of general and local inflammation. In this regard, the authors of the article propose to consider the main factors of pathogenesis that determine the sequence and relationship of the stages of the inflammatory response: edema, redness, fever, pain and dysfunction. A special role in the implementation of the regulatory mechanisms of inflammation belongs to active molecules, the so-called inflammatory mediators. The authors of the article consider the main cellular and plasma mediators, concluding that most of the effects they carry out are accompanied by a violation of the integrity of the vascular wall, exudation, edema and tissue swelling. A similar reaction is, in general, nonspecific and is observed in a number of inflammatory diseases of the ENT organs, such as acute rhinitis, allergic rhinitis, acute sinusitis, eustachitis, acute otitis media. This circumstance allows the authors to conclude that a local therapeutic effect is necessary on this particular link of pathogenesis. To this end, the authors of the article propose the use of nasal decongestants, drugs with an alpha-adrenomimetic effect, which effectively relieve swelling of the nasal mucosa and facilitate nasal breathing. In clinical practice, preparations based on xylometazoline have proven themselves well.

Rhinitis or nasopharyngitis are the most common manifestations of acute respiratory viral infection (ARVI) in children. Inflammation of the mucous membrane in the nasal cavity develops in more than 70% of ARVI cases, and rhinovirus infection is the most common etiological factor for these conditions. In this article, the authors present a short review of the existing data on the use of combined drugs based on N-acetylcysteine and tuamingheptan in the treatment of acute rhinological pathology in children. The authors present generalized data on the nature of the course of acute rhinitis, as the main manifestation of acute respiratory viral infection in children, and modern views on the tactics of treating this condition. The main theses on symptomatic treatment of nasal obstruction in acute rhinitis using nasal decongestants are presented. However, the use of nasal vasoconstrictor drugs as monotherapy to treat acute rhinitis may be less effective, as a buildup of thick discharge in the nasal cavity, which a patient is not always able to blow out from the nose (especially in childhood), prevents the drug injected into the nasal cavity from contacting the mucous membrane. The main pathogenetic grounds for the use of mucolytics in the treatment of acute rhinitis and acute rhinosinusitis are presented. The use of N-acetylcysteine-based drugs in otorhinolaryngological practice has been substantiated. N-acetylcysteine is a direct mucolytic agent. Its action is associated with the ability of its free sulfhydryl groups to break intra- and intermolecular disulfide bonds of acidic mucopolysaccharides of a thick discharge. As conclusions, the authors talk about the prospect of using combined drugs based on N-acetylcysteine and tuamingheptan both in the symptomatic treatment of acute rhinitis and as an adjunct treatment for acute rhinosinusitis in children.

Prevention of middle ear barotrauma with oxymetazoline/fluticasone treatment Middle ear barotrauma (MEB) is a common complication of hyperbaric oxygen (HBO2) therapy. It has been reported in more than 40% of HBO2 treatments and can interrupt the sequence of HBO2. MEB may lead to pain, tympanic membrane rupture, and even hearing loss.The aim of this study was to determine if pretreatment with intranasal fluticasone and oxymetazoline affected the incidence of MEB. We conducted a retrospective chart review of subjects undergoing HBO2 at our institution between February 1, 2014, and May 31, 2019. Subjects in the fluticasone/oxymetazoline (FOT) treatment group used intranasal fluticasone 50 mcg two times per day and oxymetazoline 0.05% one spray two times per day beginning 48 hours prior to initial HBO2. Oxymetazoline was discontinued after four days. Fluticasone was continued for the duration of HBO2 therapy. A total of 154 unique subjects underwent 5,683 HBO2 treatments: 39 unique subjects in the FOT group underwent 1,501 HBO2; 115 unique subjects in the nFOT (no oxymetazoline or fluticasone treatment) group underwent 4,182 HBO2 treatments. The incidence of MEB was 15.4% in the FOT group and 16.2% in the nFOT group. This was not a statistically significant difference (OR = 0.77; p = 0.636). Treatment pressure, age over 65 years, male sex, and BMI were not associated with a difference in MEB incidence. In summary, pretreatment with intranasal oxymetazoline and fluticasone in patients undergoing HBO2 did not significantly reduce MEB. More investigation with larger numbers of participants and prospective studies could further clarify this issue.

The main causes for objectively confirmed chronic impaired nasal breathing in children are adenoid and turbinate hypertrophy. Turbinate hypertrophy may be addressed by turbinate surgery. However, specialized guidelines include no specific indications for pediatric patients. The decongestant test consists of simulating the effect of turbinate surgery by means of a nasal decongestant. This project, developed by the YO-IFOS rhinology group, aims to establish a cutoff value for the nasal decongestant test with rhinomanometry to select children for turbinate surgery. Children between 4 and 15 years of age were included. Cases were consecutively selected from children affected by turbinate hypertrophy undergoing turbinate radiofrequency ablation with or without adenoidectomy. Controls were consecutively selected from a sample of healthy children. All the subjects were examined with anterior active rhinomanometry with and without nasal decongestant. Sample included 72 cases and 24 healthy controls. There was a statistically significant difference in the improvement with the decongestant between cases (57.91%) and controls (15.67%). The ROC curve revealed an area under the curve of 0.97. The highest amount of correctly classified individuals (93.44%) corresponded to the cutoff value of 31.66%. However, the value with the highest specificity and highest Youden’s index was the 38.88% improvement in nasal resistance with nasal decongestant. In conclusion, a preliminary cutoff value for the decongestant test used with rhinomanometry in children has been established. This test could help identify children for turbinate surgery.

The problem of long-term and uncontrolled use of decongestants remains one of the most relevant problems of modern otorhinolaryngology. To date vasoconstrictors are the most actively used drugs for the treatment of acute and chronic rhinitis, as well as other diseases accompanied by nasal congestion. Most of the topical decongestants are selective α2-adrenergic agonists that act on postsynaptic α2-adrenergic receptors, which perform the main function in the implementation of sympathetic stimuli in the nasal cavity. Sympathomimetic drugs in addition to the main vasoconstrictor effect also have their own anti-inflammatory and antioxidant effects. Topical decongestants are included in the treatment guidelines for acute and chronic rhinitis, rhinosinusitis, allergic rhinitis, acute and chronic otitis media, eustachitis. The recommended duration of decongestants is usually limited to 5–7 days. Longer use of this drug class can lead to paresis of the nasal mucosa vessels or an allergic reaction, to the development of rhinitis medicamentosa. Side effects that occur with the use of topical decongestants are divided into 2 groups: local symptoms and general toxic reactions. However, with strict adherence to the recommended dosing regimen of topical decongestants, to the method of use and to the duration of use, undesirable side effects are rare. The group of vasoconstrictor drugs received a new development as a result of the combination of decongestants with other drugs, which lead to the reducing local side effects and the elimination of not only nasal congestion, but also other symptoms of the common cold.

Nasal decongestants (ND) are representatives of the pharmacological group of α-adrenomimetics and are widely used in clinical practice. These drugs are successfully used as symptomatic therapy of acute rhinosinusitis (AR), as well as as part of the complex therapy of acute otitis during unloading therapy for the auditory tube. The use of ND is necessary before conducting an endoscopic examination of the nasal cavity, for a better assessment of the state of the ostiomeatal complex, the olfactory cleft, as well as differential diagnosis of various forms of rhinitis and dysosmia. ND are indispensable in the prevention of complications of AR, such as acute eustachiitis, exudative otitis media and acute otitis media. Also, these drugs are used in the prevention of the development of aerotitis and ear barotrauma. The most commonly used nasal medications of medium and long duration of action, such as xylometazoline and oxymetazoline. This article presents clinical studies demonstrating the high efficacy and safety of these drugs as part of the treatment of AR. It is shown that oxymetazoline and xylometazoline are well tolerated by patients with a minimum number of adverse events. Modern representatives of ND are such drugs as Otrivin express 0.05% with the aroma of menthol, the main active ingredient of which is oxymetazoline, Otrivin 0.1% Moisturizing formula and Otrivin 0.1% with menthol and eucalyptus, which includes xylometazoline as the main active ingredient. These drugs have confirmed their effectiveness and safety in a large number of clinical studies and can be recommended as local vasoconstrictors.

Implant dentistry has grown to be one of the topmost earning disciplines of dentistry, and hence there is a migration of practitioners towards it. Since the last few years, here is a sudden growth in the number of dental inserts placed per year. And hence many complications that are associated with implant dentistry are on the rise. This article concentrates on some of the complications that are associated with implant placement during the operative procedure and immediate postoperative time period. Delayed complications as failure to osseointegrate and Peri Implantitis is are not discussed in this article. A proper informed consent needs to be documented. It is absolutely necessary to include complications like bleeding, swelling, post-operative infection, facial discoloration, paraesthesia, hypersensitivity, loose teeth, trismus and pain. And major complications can be defined as a complication that may need additional treatments and can cause irreversible damages. Treatment of sinusitis incorporates foundational treatment with anti-toxins, chlorhexidine mouthwashes, water systems with saline through the nasal opening, and the utilization of nasal decongestants. In the event that the disease exacerbates or an ousted embed is in the sinus, revolutionary correction medical procedure of the maxillary sinus will be required and the antral mucosa totally eliminated.

There is growing demand for simple to operate, sensitive, on-site quantitative assays to investigate concentrations of drug molecules in pharmaceutical preparations for quality assurance. Here, we report on the development of two colorimetric analysis methods for the study the antibiotic doxycycline hyclate (DOX) and the nasal decongestant oxymetazoline hydrochloride (OXY), in solution as well as in their respective formulations. We compare a UV/vis spectrophotometry method with a color change recorded on a microfluidic paper-based analytical device (μPAD). Detection is based on the pharmaceutical compounds coupling with diazotized 4-aminoacetophenone (DAAP) under alkaline conditions to produce colored azo-dye products. These azo-compounds were monitored by absorbance at 425 nm for DOX and 521 nm for OXY, with linear calibration graphs in the concentration range of 0.5–35 mg L−1 (DOX) and 1.0–40 mg L−1 (OXY) and limits of detection of 0.24 mg L−1 (DOX) and 0.32 mg L−1 (OXY). For the μPAD method, color intensity was measured from photographs and a linear increase was observed at concentrations from above approximately 15 mg L−1 for both compounds and up to 35 mg L−1 for DOX and 40 mg L−1 for OXY. The developed methods were also applied to the formulated pharmaceuticals and no interference was found from the excipient. Thus, the paper-based device provides an inexpensive, simple alternative approach for use outside centralized laboratories with semi-quantitative capability.

Significant role of getting the required amount of air into the human body belongs to the breathing by the nose. The nasal cavity prepares the air for reciprocity with the lower respiratory tract owing to the complex structure of the mucous membrane. When nasal obstruction occurs, breathing is carried out mainly through the mouth, and there is a violation of the basic functions of the nose, as well as the ingress of unadapted aggressive air to the sensitive alveolar structures of the lungs. This leads first to functional, and then to morphological and structural changes. In addition, difficult nasal breathing leads to impaired aeration of the paranasal cavities, middle ear cavity and hypoxia of all organs of the body. Even short episodes of nasal obstruction affect the quality of life, and prolonged untreated or incorrectly treated acute viral rhinosinusitis can spill over into lingering bacterial diseases of the ENT organs. Decongestants are used to eliminate nasal congestion. Decongestants include a wide range of substances that are used topically or systemically, in the form of monotherapy or in combination with other substances. The most popular drugs in this group are topical decongestants, since they have the most pronounced effect. The main nasal decongestants can be divided into two groups: sympathomimetic amines: primary aliphatic; phenolic and non-phenolic compounds, as well as imidazoline derivatives. Among the modern vasoconstrictor drugs oxymetazoline. Using it strictly according to the instructions within 3–5 days guarantees the absence of the development of local and systemic complications.

Context: The displacement of the gingiva around the tooth allows proper access during preparation, precise impression taking, and cementation procedures that has a direct bearing on the health of the periodontium. Several methods and agents are used for this purpose. Aims: The primary aim of the study was to clinically evaluate the efficacy of naphazoline as a gingival retraction agent. The secondary aim was to compare it with tetrahydrozoline and aluminum chloride. Settings and Design: Fifteen patients participated in a randomized crossover clinical trial at the Army College of Dental Sciences, Secunderabad, Telangana, India. Subjects and Methods: Preliminary maxillary impressions were made with irreversible hydrocolloid for all patients to fabricate custom trays. After that, baseline impressions and cast for control group measurements were prepared. Gingival displacement was carried out in the right maxillary central incisor for all, with retraction cord soaked in three agents, either, aluminum chloride, tetrahydrozoline, or naphazoline. These agents were used in all patients with a washout period of 14 days. Elastomeric monophase impressions and die stone casts were recorded for each group. The central incisors were sectioned, and gingival retraction was measured using a measuring stereomicroscope. Statistical Analysis Used: The gingival displacement was statistically analyzed using one-way ANOVA and post hoc Bonferroni. Results: Naphazoline had the highest retraction (138.160 μm) followed by tetrahydrozoline (136.039 μm) and aluminum chloride (130.759 μm). Conclusions: Naphazoline, tetrahydrozoline, and aluminum chloride show a clinically and statistically significant amount of displacement when compared to control. Among the three agents, naphazoline showed maximum displacement and maybe a good alternative with fewer side effects.

Background Epiphora is a common ophthalmologic sign that is most commonly caused by distal acquired lacrimal obstruction. Recent data have demonstrated that external dacryocystorhinostomy (EXT-DCR) and endoscopic endonasal dacryocystorhinostomy (END-DCR) can be considered the treatments of choice. However, different post-surgical medical therapies are available and are currently used to improve surgical outcomes, although no direct comparison has been performed. Objective To analyse the influence of post-surgical medical treatments on END-DCR and EXT-DCR outcomes. Methods A structured search was conducted using the U.S. National Library of Medicine (PubMed), EMBASE, SCOPUS, and Cochrane databases with a final search performed in May 2020. The research identified papers published later than 2000 with at least 50 single clinician procedures performed in EXT-DCR and END-DCR. Articles that studied acute infections, revision cases, mixed cohort studies of acquired and congenital obstruction, and tumour were excluded. The influence of systemic antibiotic/steroids, local application of mitomycin C, nasal/ocular antibiotic, nasal/ocular steroids and nasal decongestants was analysed. Results In total, 11,445 papers were selected, 2,741 of which were reviewed after screening, and 18 included after full text review (0.6% of the initial articles reviewed) which involved 3,590 procedures. Considering the low number of publications on EXT-DCR, statistical analysis of post-surgical therapy was not feasible. In END-DCR, the analyses were performed only for nasal steroids (p = 0.58), oral antibiotics (p = 0.45) and nasal decongestant (p = 0.27), which demonstrated no meaningful influence. Given the variable association between adjunctive medical therapies, pharmacologic molecular heterogeneity and modality/concentration of application, these results should be considered critically. Additionally, no differences were seen for application of silicone stenting, whereas, no statistical analysis was performed for mitomycin C. Conclusions Given the high success rate of EXT-DCR and END-DCR and the heterogeneity of literature data, the effective influence of post-surgical medical therapy is difficult to identify. Future large prospective randomized studies could help in detecting the optimal adjunctive therapy for these surgeries.

Background Topical nasal decongestant sprays are used commonly in routine otolaryngology practice to reduce the symptoms of nasal airway obstruction (NAO) through vasoconstriction, thereby reducing the bulk of vasoerectile tissue and increasing nasal airflow. Such tissue is found predominantly on the lateral wall of the nose within the inferior turbinates (ITs), but recent evidence suggests that it may also be found medially within the nasal septal swell body (SSB). Objective To determine whether isolated topical decongestion of the medial nasal wall, targeting the SSB, is as effective as isolated decongestion of the lateral nasal wall, targeting the IT, in maximizing nasal patency. Methods A double-blinded, randomized controlled, crossover study was performed investigating the effect of decongestion of the lateral nasal wall or septum in isolation on nasal airflow. Isolated decongestion was performed by placing a cottonoid, soaked in oxymetazoline and attached to a silastic sheet, into the nasal cavity randomly facing either the septum or lateral nasal wall, bilaterally. Anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow (PNIF), and subjective patient-reported outcomes (Sinonasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation (NOSE) scores) were recorded at baseline and postdecongestion. Decongestion of the alternate site was then performed at a later date. Results A total of 20 healthy volunteers (30% females, mean age 26.6 ± 3.8 years) were recruited. Improvements in nasal obstruction and SNOT-22 scores were found following decongestion of the septum compared with baseline (mean difference: 0.82, t = 2.32, P = .04; mean difference: 3.30, t = 2.50, P = .04, respectively). Improvements in mean inspiratory flow, minimal cross-sectional area, volume, and PNIF were also demonstrated. Conclusion This study suggests that the SSB contains erectile tissue that responds to topical decongestant therapy in a similar manner to IT tissue. The SSB may represent a novel target in surgery for NAO.

Objetivo: Estudar a prevalência do uso de descongestionantes nasais tópicos por automedicação e a auto percepção da qualidade de vida pelos acadêmicos da graduação em áreas da saúde da Universidade Federal do Amazonas, em Manaus-Amazonas-Brasil. Métodos: Estudo transversal de natureza qualitativa e quantitativa. A coleta de dados consistiu na aplicação de questionário estruturado pela própria equipe de pesquisa e do Índice de 8 itens EuroHisQol 8, versão validada e traduzida para o português. Para análise estatística utilizou-se o teste qui-quadrado e o teste exato de Fisher, com nível de significância de 5%. Resultados: Dos 279 participantes, 69,9% já se automedicaram com descongestionantes. Aqueles já diagnosticados com doenças nasais crônicas e os que já consultaram ou receberam orientação médica acerca do fármaco, em momento anterior ao uso, foram mais propensos a utilizar o medicamento por automedicação (p

BackgroundTopical nasal decongestants are frequently used as part of the medical management of symptoms related to Eustachian tube dysfunction.ObjectiveThis study aimed to assess the effect of topical xylometazoline hydrochloride sprayed in the anterior part of the nose on Eustachian tube active and passive opening in healthy ears.MethodsActive and passive Eustachian tube function was assessed in healthy subjects before and after intranasal administration of xylometazoline spray, using tympanometry, video otoscopy, sonotubometry, tubo-tympano-aerodynamic-graphy and tubomanometry.ResultsResting middle-ear pressures were not significantly different following decongestant application. Eustachian tube opening rate was not significantly different following the intervention, as measured by all function tests used. Sonotubometry data showed a significant increase in the duration of Eustachian tube opening following decongestant application.ConclusionThere remains little or no evidence that topical nasal decongestants improve Eustachian tube function. Sonotubometry findings do suggest that further investigation with an obstructive Eustachian tube dysfunction patient cohort is warranted.

The article analyzes the problems of population aging that are relevant for the world civilization, the peculiarities of changes in the body in old age and senility, in particular, the nasal cavity and paranasal sinuses. The analysis of algorithms of actions of an otorhinolaryngologist when prescribing drugs for the treatment of inflammatory diseases of the nasal cavity and paranasal sinuses in elderly patients is given. The advantages of using a combined nasal spray containing a nasal decongestant of 0.1% xylometazoline and 5% dexpanthenol as a means that improves regeneration and reduces the cytotoxic effect of xylometazoline are reflected. The research of domestic and foreign authors testifying to the rationality of using this combined drug in the practice of an otorhinolaryngologist in the treatment of pathology of the nasal cavity and paranasal sinuses in elderly people is presented.В статье рассмотрены проблемы старения населения, актуальные для мировой цивилизации, особенности изменений организма, в частности полости носа и околоносовых пазух, в пожилом и старческом возрасте. Приведен анализ алгоритмов действий врача-оториноларинголога при назначении препаратов для лечения воспалительных заболеваний полости носа и околоносовых пазух у пожилых пациентов. Отражены преимущества использования комбинированного назального спрея, содержащего назальный деконгестант ксилометазолин 0,1% и декспантенол 5%, как средства, улучшающего регенерацию и уменьшающего цитотоксический эффект ксилометазолина. Приведены исследования отечественных и зарубежных авторов, свидетельствующие о рациональности использования данного комбинированного препарата в практике врача-оториноларинголога при лечении патологии полости носа и околоносовых пазух у лиц пожилого возраста.

Background Common cold is a frequent illness in northern hemisphere between late autumn and early spring. Patients suffering from it frequently turn to pharmacists instead of physicians in order to receive medical advice and treatment. We studied its treatment advised by pharmacists in Poland, as well as evidence for the efficacy of their recommendations by utilizing a self-developed questionnaire and a study of existing literature. Methods The data were collected by 27 pharmacists who worked in four large network community pharmacies in Lodz, Poland. The study took place from December 2019 to February 2020. Data were recorded only if the patient asked for pharmacy counselling for over-the counter (OTC) products due to common cold self-diagnosis and a product was sold. Pharmacists’ recommendations were compared with the results of a literature review of best evidence to determine appropriateness of the pharmacists’ decisions. Results In four out of five cases the pharmacists recommended products contained paracetamol. In addition, in one out of three patient encounters they advised nasal decongestant, inosines and/or OTC mucolytics. There was a significant relationship between fever and recommendation frequency of some analgesics, inosines, mucolytics and sore throat products (OR > 1, p 1, p 1, p 1, p Conclusions Our study suggests that the most common rationale for pharmacist recommendation on anti-common cold treatment was to take a “shotgun” approach. Pharmacists commonly made recommendations for products that lack strong evidence for efficacy (i.e. anti-viral agents) and are potentially unnecessary, based on presentation of the symptom. Reasons for this situation include lack of training, lack of time to evaluate the patient, lack of awareness of evidence as well as drug company marketing and financial incentives (i.e. fulfilling sale plans and target sale bonuses). Trial registration The study was a non-interventional, observational research trial. The study registration was not required.

The over-the-counter nasal decongestant oxymetazoline (eg, Afrin) is used in the pediatric population for a variety of conditions in the operating room setting. Given its vasoconstrictive properties, it can have cardiovascular adverse effects when systemically absorbed. There have been several reports of cardiac and respiratory complications related to use of oxymetazoline in the pediatric population. Current US Food and Drug Administration approval for oxymetazoline is for patients ≥6 years of age, but medical professionals may elect to use it short-term and off label for younger children in particular clinical scenarios in which the potential benefit may outweigh risks (eg, active bleeding, acute respiratory distress from nasal obstruction, acute complicated sinusitis, improved surgical visualization, nasal decongestion for scope examination, other conditions, etc). To date, there have not been adequate pediatric pharmacokinetic studies of oxymetazoline, so caution should be exercised with both the quantity of dosing and the technique of administration. In the urgent care setting, emergency department, or inpatient setting, to avoid excessive administration of the medication, medical professionals should use the spray bottle in an upright position with the child upright. In addition, in the operating room setting, both monitoring the quantity used and effective communication between the surgeon and anesthesia team are important. Further studies are needed to understand the systemic absorption and effects in children in both nonsurgical and surgical nasal use of oxymetazoline.

BACKGROUND: Olfactory dysfunction is an early and sensitive marker of COVID‐19 infection. Although self‐limiting in the majority of cases, when hyposmia or anosmia persists it can have a profound effect on quality of life. Little guidance exists on the treatment of post‐COVID‐19 olfactory dysfunction, however several strategies have been proposed from the evidence relating to the treatment of post‐viral anosmia (such as medication or olfactory training). OBJECTIVES: To assess the effects (benefits and harms) of interventions that have been used, or proposed, to treat persisting olfactory dysfunction due to COVID‐19 infection. A secondary objective is to keep the evidence up‐to‐date, using a living systematic review approach. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane COVID‐19 Study Register; Cochrane ENT Register; CENTRAL; Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished studies. The date of the search was 16 December 2020. SELECTION CRITERIA: Randomised controlled trials including participants who had symptoms of olfactory disturbance following COVID‐19 infection. Only individuals who had symptoms for at least four weeks were included in this review. Studies compared any intervention with no treatment or placebo. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. Primary outcomes were the recovery of sense of smell, disease‐related quality of life and serious adverse effects. Secondary outcomes were the change in sense of smell, general quality of life, prevalence of parosmia and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included one study with 18 participants, which compared the use of a 15‐day course of oral steroids combined with nasal irrigation (consisting of an intranasal steroid/mucolytic/decongestant solution) with no intervention. Psychophysical testing was used to assess olfactory function at baseline, 20 and 40 days. Systemic corticosteroids plus intranasal steroid/mucolytic/decongestant compared to no intervention Recovery of sense of smell was assessed after 40 days (25 days after cessation of treatment) using the Connecticut Chemosensory Clinical Research Center (CCCRC) score. This tool has a range of 0 to 100, and a score of ≥ 90 represents normal olfactory function. The evidence is very uncertain about the effect of this intervention on recovery of the sense of smell at one to three months (5/9 participants in the intervention group scored ≥ 90 compared to 0/9 in the control group; risk ratio (RR) 11.00, 95% confidence interval (CI) 0.70 to 173.66; 1 study; 18 participants; very low‐certainty evidence). Change in sense of smell was assessed using the CCCRC score at 40 days. This study reported an improvement in sense of smell in the intervention group from baseline (median improvement in CCCRC score 60, interquartile range (IQR) 40) compared to the control group (median improvement in CCCRC score 30, IQR 25) (1 study; 18 participants; very low‐certainty evidence). Serious adverse events andother adverse events were not identified in any participants of this study; however, it is unclear how these outcomes were assessed and recorded (1 study; 18 participants; very low‐certainty evidence). AUTHORS' CONCLUSIONS: There is very limited evidence available on the efficacy and harms of treatments for persistent olfactory dysfunction following COVID‐19 infection. However, we have identified other ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available. For this (first) version of the living review we identified only one study with a small sample size, which assessed systemic steroids and nasal irrigation (intranasal steroid/mucolytic/decongestant). However, the evidence regarding the benefits and harms from this intervention to treat persistent post‐COVID‐19 olfactory dysfunction is very uncertain.

Nasal decongestant reduces blood flow to the nasal turbinates, reducing tissue volume and increasing nasal airway patency. This study maps the changes in nasal anatomy and measures how these changes affect nasal resistance, flow partitioning between superior and inferior cavity, flow patterns and wall shear stress. High-resolution MRI was applied to capture nasal anatomy in 10 healthy subjects before and after application of a topical decongestant. Computational fluid dynamics simulated nasal airflow at steady inspiratory flow rates of 15 L.min$$^{-1}$$ - 1 and 30 L.min$$^{-1}$$ - 1 . The results show decongestion mainly increases the cross-sectional area in the turbinate region and SAVR is reduced (median approximately 40$$\%$$ % reduction) in middle and lower parts of the cavity. Decongestion reduces nasal resistance by 50$$\%$$ % on average, while in the posterior cavity, nasal resistance decreases by a median factor of approximately 3 after decongestion. We also find decongestant regularises nasal airflow and alters the partitioning of flow, significantly decreasing flow through the superior portions of the nasal cavity. By comparing nasal anatomies and airflow in their normal state with that when pharmacologically decongested, this study provides data for a broad range of anatomy and airflow conditions, which may help characterize the extent of nasal variability.

A simple, novel, cost-effective and highly sensitive spectrofluorimetric method was developed for estimation of the nasal decongestant oxymetazoline (OMZ) whether per se or in its pharmaceutical preparations using colloidal silver nanoparticles (AgNPs). The method is based on the high catalytic potential activity of AgNPs on the fluorescence intensity of OMZ leading to 12-fold increase in its fluorescene intensity. The response was linear over the range of 20.0 to 700.0 ng/mL with lower detection limit of 5.0 ng/mL and limit of quantification of 14.0 ng/mL. The proposed method was applied to the assay of commercial nasal drops, nasal spray and aqueous humor. Interference likely to be encountered from co-administered drugs was studied. The developed method was optimized and validated as per International Council of Harmonization (ICH). An explanation for the drug-AgNPs interaction was proposed.

Rhinitis medicamentosa is drug-induced rhinitis which occurs by prolonged and overdose usage of topical nasal decongestants. There is not much of treatment choice rather than nasal steroids. In this pathological study, we have been aimed to represent the healing effects of xylitol on damaged nasal mucosa due to rhinitis medicamentosa. 30 Wistar rats were separated into 5 groups. During 2 months, oxymetazoline was given to the first group, and saline was given to second group intranasally. First and second group animals were examined at the end of 2 months and rhinitis medicamentosa was detected. Oxymetazoline was given to the third, fourth, and fifth groups during 2 months. Then xylitol solution, mometasone, and saline were applied, respectively, for 15 days. After the experiment, rats’ nasal mucosas were evaluated histopathologically. Xylitol and mometasone were found to be more effective than the control group in terms of histopathological changes. Effectivity of xylitol and mometasone was compared and not a significant value was determined. According to the results, xylitol solution is effective as mometasone, usable and well-priced in the treatment of rhinitis medicamentosa. More comprehensive and ultrastructural studies on animals and human studies with rhinometric evaluation should be performed.

Oxymetazoline, a nasal decongestant drug was investigated by a sensitive, simple and reproducible electrochemical method using Titania (TiO2) nanoparticles and carboxyl group functionalized multi-walled carbon nanotubes fabricated on glassy carbon electrode using cyclic voltammetry and differential pulse voltammetry. The possible electro-oxidation mechanism of this drug was also studied in detail. The performance of designed method was determined by electrochemical impedance spectroscopy, cyclic voltammetry and anodic stripping differential pulse voltammetry. The obtained results revealed enhanced electrochemical behavior of oxymetazoline as compared to bare glassy carbon electrode. Under optimum conditions i.e. buffer pH; pH 7.0 phosphate buffer solution, accumulation potential; 0 V, and accumulation time; 180 s, the differential pulse voltammetric response of oxymetazoline was probed between the linear concentration range of 0.12 μM to 1.5 μM in aqueous medium containing pH 7.0 PBS and 20% methanol. The limit of detection of oxymetazoline was evaluated as 4.40 nM. Moreover, the developed sensing method was validated for its practical application in nasal spray with excellent recovery.

The nasal decongestant oxymetazoline (OMZ) exhibits anti-oxidative and antiinflammatory properties (I. Beck-Speier et al., J Pharmacol Exp Ther. 2006;316:842–851). In a follow up study, we hypothesized that OMZ generates pro-resolving lipoxins being paralleled by production of immune-modulating prostaglandin E2 (PGE2) and anti-inflammatory 15(S)-hydroxy-eicosatetraenoic acid [15(S)-HETE] and depletion of pro-inflammatory leukotriene B4 (LTB4). Human neutrophils (PMN) were chosen as the cellular system. The effect of OMZ on these parameters as well as on respiratory burst activity and oxidative stress marker 8-isprostane was analyzed in unstimulated and co-stimulated PMN by ultrafine carbon particles (UCP) or opsonized zymosan (OZ), respectively. In unstimulated cells, OMZ induced formation of PGE2, 15(S)-HETE, and LXA4. The levels of LTB4 and 8-isoprostane were not affected, whereas respiratory burst activity was drastically inhibited. In UCP- and OZ-stimulated control cells, all parameters were elevated. Here, OMZ maintained the increased levels of PGE2, 15(S)-HETE, and LXA4, but substantially suppressed levels of LTB4 and 8-isoprostane and inhibited the respiratory burst activity. These findings suggest a switch from the pro-inflammatory eicosanoid class LTB4 to the pro-resolving LXA4. Since LXA4 is most relevant in returning inflamed tissue to homeostasis, OMZ is postulated to terminate rhinitis-related inflammation, thus contributing to shortening of disease duration. Keywords:: oxymetazoline, rhinitis, neutrophil, eicosanoid, lipoxin A4

Otitis media with effusion (OME) is a frequent paediatric disorder. The condition is often asymptomatic, and so can easily be missed. However, OME can lead to hearing loss that impairs the child's language and behavioural development. The diagnosis is essentially clinical, and is based on otoscopy and (in some cases) tympanometry. Nasal endoscopy is only indicated in cases of unilateral OME or when obstructive adenoid hypertrophy is suspected. Otitis media with effusion is defined as the observation of middle-ear effusion at consultations three months apart. Hearing must be evaluated (using an age-appropriate audiometry technique) before and after treatment, so as not to miss another underlying cause of deafness (e.g. perception deafness). Craniofacial dysmorphism, respiratory allergy and gastro-oesophageal reflux all favour the development of OME. Although a certain number of medications (antibiotics, corticoids, antihistamines, mucokinetic agents, and nasal decongestants) can be used to treat OME, they are not reliably effective and rarely provide long-term relief. The benchmark treatment for OME is placement of tympanostomy tubes (TTs) and (in some cases) adjunct adenoidectomy. The TTs rapidly normalize hearing and effectively prevent the development of cholesteatoma in the middle ear. In contrast, TTs do not prevent progression towards tympanic atrophy or a retraction pocket. Adenoidectomy enhances the effectiveness of TTs. In children with adenoid hypertrophy, adenoidectomy is indicated before the age of 4 but can be performed later when OME is identified by nasal endoscopy. Children must be followed up until OME has disappeared completely, so that any complications are not missed. Keywords: Otitis media with effusion, Tympanostomy tube, Ventilation tube, Grommet, Child

One of the main functions of the nose is respiratory and olfactory. Difficulty in nasal breathing, nasal congestion, nasal discharge can complicate the respiratory and olfactory functions of the nose or make them impossible. Most often the cause is swelling of the mucous. Nasal obstruction and rhinorrhea are the most common symptoms in diseases of the nasal cavity and paranasal sinuses. Of great importance is the use of local vasoconstrictors to eliminate swelling in the nasal cavity and prevent complications associated with auditory tube dysfunction. It is proved that the use of nasal decongestants helps to reduce swelling in the nasal cavity and in the osteomeatal complex. Otrivin Moisturizing formula, Otrivin Menthol, Otrivin Complex and Otrivin Sea are effective and well tolerated means to eliminate swelling in the nasal cavity and reduce nasal discharge and rehabilitation of olfactory function.

Introduction The goal of treatment in allergic rhinitis is a complete elimination of symptoms or achieving significant clinical improvement. The role of the pharmacist has been receiving particular attention in terms of the initial diagnosis and treatment of allergic rhinitis patients and their sufficiently early referral to a specialist in case of persistent symptoms. Aim This study attempted to estimate the rates of nasal OTC use in patients diagnosed with allergic rhinitis. Material and methods Study population was 18,578 subjects (4,192 patients diagnosed with AR and 14,386 healthy controls): children aged 6–7 years, adolescents aged 13–14 years, and adults aged 20–44 years. We used translated and validated versions of ECRHS and ISAAC questionnaires. Results The rates of nasal decongestant use in the allergic rhinitis group were 60.4% in children, 50.7% in adolescents, and 43.0% in adults, with these figures significantly higher than in the control group (p < 0.05). The most common nasal agent was Oxymetazoline and Xylometazolini hydrochloridum 0.1%. Conclusions Over a half of the evaluated allergic rhinitis patients used nasal decongestants, which poses a potential risk of uncontrolled side effects. There is an urgent need to introduce patient education on medical treatment.

Many studies have indicated associations between impaired nasal breathing and sleep disorders. However, the precise nature of the relationship between nasal patency and sleep remains unclear.We analysed the effects of nasal patency on sleep architecture and breath in nasal obstruction-predominant obstructive sleep apnoea (NO-OSA) patients by applying nasal decongestant.A randomized, placebo-controlled double-blind crossover study was performed in OSA patients with chronic nasal obstruction and without obvious pharyngeal narrowing. All OSA patients (confirmed by polysomnography) were recruited and completed 2 overnight studies (randomly applying oxymetazoline or placebo). Data collected after oxymetazoline or placebo treatments were compared. The ClinicalTrials.gov identifier is NCT03506178.Compared with placebo, oxymetazoline resulted in significant increase in rapid eye movement sleep (p = 0.027) and reduction of stage 1 sleep (p = 0.004), as well as arousal index (p = 0.002). Moreover, great improvements in apnoea/hypopnea index (AHI) were observed (p 0.001); AHI in the supine position was significantly reduced (p = 0.001). Oxygen saturation during sleep was increased significantly [mean oxygen saturation (p = 0.005) and lowest oxygen saturation (p = 0.024)]. Oxygen desaturation index was significantly reduced (p 0.001).Improving nasal patency by decongestant could improve sleep quality, AHI, and oxygen saturation level during sleep.

Visine eye drops are a commonly used topical drug for irritation of the eye. The active component in Visine eye drops is tetrahydrozoline. Tetrahydrozoline is an imidazoline derivative found in several ophthalmic and nasal decongestants. Exposure is common in young children, who unintentionally ingest it, but cases have been rising in the adult population. The main systemic effects are bradycardia and hypotension due to activation of the central alpha-adrenergic receptors. In this case report, a 76-year-old man presents with bradycardia after 24 hours following ingestion of 120 mL of 0.05% tetrahydrozoline (eight bottles of Visine eye drops) in a suicide attempt. His initial ECG demonstrated complete heart block and QT prolongation. Subsequent ECGs showed unremitting first-degree atrioventricular block and QT prolongation. Here, we are presenting the first case of complete heart block following tetrahydrozoline consumption.

Background: Over the past 20 years or so, the drug misuse scenario has seen the emergence of both prescription-only and over-the-counter (OTC) medications being reported as ingested for recreational purposes. OTC drugs such as antihistamines, cough/cold medications, and decongestants are reportedly the most popular in being diverted and misused.Objective: While the current related knowledge is limited, the aim here was to examine the published clinical data on OTC misuse, focusing on antihistamines (e.g., diphenhydramine, promethazine, chlorpheniramine, and dimenhydrinate), dextromethorphan (DXM)- and codeine-based cough medicines, and the nasal decongestant pseudoephedrine.Methods: A systematic literature review was carried out with the help of Scopus, Web of Science databases, and the related gray literature. For data gathering purposes, both the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and PROSPERO guidelines were followed (PROSPERO identification code CRD42020209261).Results: After completion of the selection, eligibility, and screening phases, some 92 articles were here taken into consideration; case reports, surveys, and retrospective case series analyses were included. Findings were organized according to the specific OTC recorded. Most articles focused here on DXM (n = 54) and diphenhydramine (n = 12). When specified, dosages, route(s) of administration, toxicity symptoms (including both physical and psychiatric ones), and outcomes were here reported.Conclusion: Results from the systematic review showed that the OTC misusing issues are both widespread worldwide and popular; vulnerable categories include adolescents and young adults, although real prevalence figures remain unknown, due to a lack of appropriate monitoring systems. Considering the potential, and at times serious, adverse effects associated with OTC misusing issues, healthcare professionals should be vigilant, and ad hoc preventative actions should be designed and implemented.