Nasal Cytology in Radiofrequency Turbinate Volume Reduction

Introduction: Radiofrequency turbinate volume reduction (RFTVR) is an effective treatment of inferior turbinate hypertrophy. RFTVR can reduce epithelial cell alterations in nasal mucosa. The aim of this observational study was to evaluate the effects of RFTVR on nasal obstruction and cytology, stratifying for different types of rhinitis. Methods: Nasal cytology and subjective nasal obstruction were evaluated on 113 patients before RFTVR (T0) and after 3 months (T1). The patients were divided into groups on the basis of the underlying disease: allergic rhinitis, nonallergic rhinitis, rhinitis medicamentosa, and other diseases (e.g., hormonal-based turbinate hypertrophy). Results: Nasal cytology at T0 identified 42 patients with allergic rhinitis, 40 with nonallergic rhinitis, 19 with rhinitis medicamentosa, and 12 with other diseases. An improvement of nasal cytology at T1 was observed in 29.2% of cases. They mainly consisted of patients with nonallergic rhinitis with neutrophils, whose neutrophil infiltrate decreased. Only 2 cases (1.7%) showed a worsening of nasal cytology at T1. A statistically significant decrease in subjective nasal obstruction was observed for every group (p < 0.05). Higher differences of nasal obstruction between T0 and T1 were found in patients with rhinitis medicamentosa or other diseases. Conclusion: RFTVR represents a safe and effective treatment for turbinate hypertrophy of various etiology. It is not responsible for a worsening of inflammatory infiltrate of the nasal mucosa.

RHINITIS MEDICAMENTOSA: PRINCIPLES OF DIAGNOSIS AND TREATMENT

RHINITIS MEDICAMENTOSA: PRINCIPLES OF DIAGNOSIS AND TREATMENT Ye. Bogomolov1, S. V. Zaikov2, S. O. Zubchenko3 1 National Pirogov memorial medical university, Vinnitsya, Ukraine 2 Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine 3 Danylo Halytsky Lviv National Medical University, Lviv, Ukraine Abstract. Nasal congestion is a common symptom that affects up to 30 % of the world’s population. Uncontrolled intake of nasal decongestants to relieve nasal congestion leads to rhinitis medicamentosa (RM), a subtype of drug-induced rhinitis, which is a chronic dysfunction of the nasal mucosa due to prolonged use of local vasoconstrictors. RM occurs with equal frequency in men and women, but is more common in young and middle-aged adults, and the described incidence into laryngological clinics ranges from 1 % to 7 %. In Ukraine, the problem is not statistically studied, but almost 2 billion hryvnias were spent by Ukrainians on the purchase of 40 million packages of decongestants per year (August 2019 — July 2020), which means that every Ukrainian, including newborns, used at least 1 package of this drug. The main diagnostic criteria for RM, in addition to detecting the presence of nasal obstruction (hyperemia, edema of the nasal mucosa with disorders of nasal breathing and nasal congestion) and reduction of edema of the nasal mucosa with the use of vasoconstrictors, are indications of a history of long-term nasal decontamination. The only drugs whose efficacy in RM has been proven not only in experimental but also in clinical randomized placebo-controlled studies are intranasal glucocorticoids (GCS). Currently, intranasal GCS are considered the most effective drugs available for the treatment of RM. Key words: rhinitis medicamentosa, nasal congestion, nasal decongestants.

Investigation of cytotoxic effects of oxymetazoline on lung in a rat model of rhinitis medicamentosa

Background: Rhinitis medicamentosa, also known as ‘rebound congestion,’ is inflammation of the nasal mucosa caused by the overuse of topical nasal decongestants. Although local decongestants resolve the initial nasal obstruction, the overuse causes rebound obstruction. However, how the overuse of the decongestant causes rhinitis medicamentosa is not known. Objectives: Here, we show the intracellular effects of oxymetazoline, commonly used a local decongestant, on the cell death pathways. We also investigated the antioxidative effects of erdosteine suspension (175 mg/5mL), an antioxidative agent. Methods: Thirty Wistar-albino rats were used to form the rhinitis medicamentosa model. After rhinitis medicamentosa was clinically detected, we removed the whole lungs of animals to perform the molecular analyses of cell death pathways. Results: We found a statistically significant decrease in the expression levels of Atg5 (p=0.021), Atg7 (p=0.013) and Ulk1 (p=0.036) in the oxymetazoline group compared to the control group (p<0.05); however, Caspase 3 expression level was recorded to be significantly increased in the oxymetazoline group, and the expression level of Beclin1 recorded to be substantially increased in erdosteine group (p=0.001). Conclusion: Based on these grounds, we suggest that vasoconstriction in capillary vessels caused by oxymetazoline could lead to a decrease in the blood supply, which triggers autophagy to ensure cellular homeostasis.

Rhinitis medicamentosa: a nationwide survey of Canadian otolaryngologists

Background Rhinitis medicamentosa is a non-allergic form of rhinitis that is typically caused by prolonged use of topical nasal decongestants. This condition commonly affects young adults and treatment is not trivial. We aimed to survey Canadian Otolaryngologists to determine practice patterns and their opinions regarding this under-studied condition. Methods An electronic survey was sent to practicing Otolaryngologists within the Canadian Society of Otolaryngology – Head and Neck Surgery. The survey contained 16 questions pertaining to the diagnosis and treatment of rhinitis medicamentosa, as well as opinions on public and primary care awareness of proper use of nasal decongestants. Results The survey was distributed to 533 Otolaryngologists and 69 surveys were returned (response rate of 13%). Cessation and weaning of decongestant (96%), and intranasal steroids (94%) were the most common methods for treating RM. Intranasal saline rinses (55%) and oral steroids (25%) were also supported by some respondents. For those who recommended cessation/weaning, 61% also concurrently introduced an intranasal steroid during this process. The majority responded that current warnings on nasal decongestants were inadequate (75%), and were not visible enough (79%). Conclusions Rhinitis medicamentosa is a common, and very preventable condition. Although the literature lacks a standardized approach to RM, our survey has shown that many Otolaryngologists diagnose and treat RM in a similar manner. Treatment tends to focus on decongestant cessation, often with concurrent introduction of intranasal steroids. It was felt the warning labels on the topical medications are not currently satisfactory.