Otorhinolaryngologic Diseases

Acupuncture for patients with seasonal allergic rhinitis was found to be more effective than antihistamine use or a sham intervention.

A 58-year-old man with a past medical history of chronic sinus disease and hypothyroidism presented with left periorbital pain and erythema that worsened despite outpatient treatment with topical antibiotics. An outpatient CT scan showed pansinusitis and orbital stranding. The diagnosis was orbital cellulitis and sinusitis.

In my customized Google news, I have a category for cosmetic surgery. Most items that turn up are self-serving PR announcements, but recently there was lengthy coverage of the death during cosmetic surgery of aspiring Chinese pop star Wang Bei.

A previously healthy 19-year-old woman presents with a sore throat that has become progressively more painful over the course of 1 week. She also has left-sided neck swelling, light-headedness, and intermittent headaches. She denies recent sexual activity.

For 10 weeks, a 34-year-old woman had refractory sinusitis, epistaxis, painful sores in her mouth with erosions in the nasal cartilage and palate, and otitis media in the left ear.

Physical clues to allergic rhinitis include the allergic crease on the dorsum of the nose and allergic "shiners" or periorbital ecchymosis.

For my patients who use nasal spray, I advise them to use the right hand to spray into the left nostril and the left hand to spray into the right nostril.

Many pharmacological options exist for allergic rhinitis. Intranasal corticosteroids are the most effective medication class for patients with moderate to severe symptoms; those with milder intermittent symptoms can be treated with a second-generation oral or intranasal antihistamine.

A 14-year-old girl is seen because of long-standing nasal itch, intermittent nasal congestion, and clear nasal discharge. Allergies to house dust mites and to cats shown on prior skin testing. Often has marked eye swelling when exposed to cats. Receives antihistamines when in flare-up and prior to cat exposure. The consumption of dairy products exacerbates all of the above.

A 62-year-old woman presents with epistaxis from the right nostril. Thenosebleed has lasted about 90 minutes, and she has become alarmedby the amount of blood on the tissues and washcloth she has applied to hernose.

While avoidance measures are a key component of the treatment of allergic rhinitis, pharmacological therapies are often needed to adequately control symptoms. Intranasal corticosteroids are highly effective and are particularly useful in patients with moderate to severe disease.

Allergic rhinitis is highly prevalent; about 20% of adults in the United States and 25% of children worldwide are affected. It is a major societal expense, with direct costs, attributable to physician visits and medications, of up to $5 billion per year, and indirect costs, mainly stemming from lost productivity, of up to $9.7 billion per year. In the United States, allergic rhinitis results in 3.5 million lost workdays and 2 million lost schooldays each year.

Progressively worsening nasal congestion and headaches with diplopia and left proptosis for 2 months prompted an ophthalmology consultation for a 67-year-old woman. She had been evaluated multiple times for allergic rhinitis and recurrent sinusitis.

In addition to standard therapy for sinusitis, suggest that patients breathe in steam from water that contains eucalyptus leaves or oil.

A previously healthy 16-year-old boy presents for evaluation of a slightly pruritic, nontender, generalized rash.

An 18-year-old woman with a history of allergic rhinitis and moderate persistent asthma presented with right-sided nasal congestion of 6 months’ duration. Her symptoms persisted despite her usual allergy medications, allergen immunotherapy, and 2 courses of antibiotics. A sinus CT scan showed complete opacification of the right maxillary sinus with increased attenuation of the mucin. Allergic fungal rhinosinusitis was suspected, and an otolaryngologist was contacted.

A 55-year-old woman seen because of new lump under right side of her jaw; present for 24 hours. Associated neck discomfort causing dysphagia, and also a raspy turn to the voice; both much worse in last 12 hours. No dyspnea. No sore throat.

abstract: Common causes of poorly controlled asthma include nonadherence to long-term inhaler therapy; environmental exposures; and uncontrolled comorbidities, such as allergic rhinitis. Adherence can be limited by many factors, including inadequate patient education, medication cost, prior failed treatment, poor physician-patient relationship, unrealistic expectations for therapy, and depression. For patients who have a poor perception of their symptoms, emphasizing the "disconnect" between symptoms and pulmonary function can help motivate them to monitor themselves with a peak flow meter and to adjust their medication accordingly. For patients with allergic triggers, instituting allergen-specific environmental controls can decrease symptoms and urgent care visits for asthma. Chronic rhinosinusitis and gastroesophageal reflux disease can also contribute to difficult-to-control asthma, and treatment of these comorbidities can help reduce asthma symptoms. (J Respir Dis. 2007;28(9):365-369)

Acute invasive fungal rhinosinus- itis occurs predominantly in immunocompromised patients, such as those with neutropenia and transplant recipients. The diagnosis requires biopsy, but permanent section can be time-consuming and result in a delay in treatment. Ghadiali and colleagues conducted a study to evaluate the accuracy of frozen-section biopsy in this setting.

abstract: In the treatment of certain allergies, sublingual immunotherapy (SLIT) may represent an attractive alternative to subcutaneous immunotherapy (SCIT) because of its lower risk of systemic reactions. The most common adverse reactions are local symptoms, such as oral "itchiness." GI complaints, rhinoconjunctivitis, urticaria, and asthma are uncommon reactions to this therapy, and no fatalities have been reported. In contrast to SCIT, accelerated induction schedules for SLIT do not appear to be associated with an increased risk of systemic reactions. SLIT may present an opportunity for broadening the use of immunotherapy by extending it to patients who are not candidates for SCIT because they dislike injections, find the frequent visits to the physician's office inconvenient, or are concerned with the safety of SCIT. The optimal effective dose and dosing schedule need to be established before a cost-benefit analysis can be performed. (J Respir Dis. 2007;28(6):237-243)

SEUOL, Korea -- The average body mass index in a group of children with otitis media with effusion was about 35% higher than among those with no history of ear infection, found researchers here.

abstract: Subcutaneous allergen immunotherapy is clearly beneficial in the treatment of select patients with allergic rhinitis or asthma. However, this therapy is underused, partly because it requires administration in a medical facility. Sublingual immunotherapy (SLIT) may be a promising alternative; it appears to be associated with fewer adverse effects, which suggests that it might be administered at home. Currently, there is no FDA-approved formulation for SLIT in the United States. However, allergists are showing increased interest in this therapy, and an approved formulation may be available in the near future. A number of studies have shown the clinical efficacy of SLIT, but many questions remain unanswered, including the effective dose, optimal treatment schedules, and overall duration of treatment. (J Respir Dis. 2007;28(4):162-168)

MEMPHIS, Tenn. -- Clinicians may one day give children a nasal spray of viral enzymes to prevent acute otitis media, researchers said here.

In addition to causing classic symptoms such as heartburn, gastroesophageal reflux (GER) is thought to cause a number of non-GI symptoms, such as cough and sore throat. Animal studies also suggest that GER may cause eustachian tube dysfunction. Now, a study from Japan indicates that there may be a link between GER and otitis media with effusion (OME) in adults.

SAN DIEGO -- Allergic fungal sinusitis deserves a place of its own at the table of nasty chronic rhinosinusitis infections, researchers asserted here.

In the treatment of chronic rhinosinusitis, antibiotics are often given for 3 to 6 weeks, but the optimal regimen has not been established. Dubin and coworkers conducted a study to assess the effectiveness of a 3-week course. They found that for some patients, significant radiographic improvement occurs when antibiotics are given for more than 3 weeks.

LONDON -- As a quick screening tool, the ratio of a patient's white blood cell types differentiated acute purulent tonsillitis from infectious mononucleosis, researchers here reported.

A study conducted in France provides further evidence of how allergic rhinitis adversely affects quality of life. Léger and associates found that allergic rhinitis impairs all dimensions of sleep quality.

Many patients with postnasal drip syndrome, allergic rhinitis, or sinusitis use nasal saline solution erratically and only a few drops at a time. Be sure to tell patients that they must flush their nasal passages with a generous amount of saline solution at least 4 or 5 times a day to have an effect.