The Experts below are selected from a list of 99 Experts worldwide ranked by ideXlab platform
Ronald Eccles - One of the best experts on this subject based on the ideXlab platform.
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the relationship between nasal index and nasal airway resistance and response to a Topical Decongestant
Rhinology, 2011Co-Authors: Neela Doddi, Ronald EcclesAbstract:The differences in the shape and size of the nose have been proposed to be an adaptation to climate with broad noses (platyrrhine) evolving in a warm humid environment where there was little need for air conditioning and narrow noses (leptorrhine) evolving in colder climates where the air needed more warming. The main aim of this research was to determine if there was any relationship between the shape of the nose as expressed in terms of nasal height and width (nasal index) and total nasal airway resistance (NAR), as one would predict that the narrower leptorrhine noses would have a greater resistance to air flow than the broader platyrrhine noses. It was also proposed that the narrow leptorrhine nose would have better developed vascular tissue than the broad platyrrhine nose in order to condition cold air, and would exhibit a greater response to nasal decongestion. No correlation was found between nasal index and NAR (r = -0.09) and similarly no correlation was found between nasal index and response to a Topical nasal Decongestant (r = 0.02). The absence of any physiological differences between the different nose types may be due to acclimatisation of participants to the area of recruitment.
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effects of intranasal xylometazoline alone or in combination with ipratropium in patients with common cold
Current Medical Research and Opinion, 2010Co-Authors: Ronald Eccles, Kaj Martensson, Shirley C ChenAbstract:AbstractBackground:Common cold is one of the most prevalent conditions that family doctors encounter. One of the first symptoms to occur is nasal congestion, which can have a negative impact on daily life and prompts many patients to seek treatment for relief. Xylometazoline nasal spray (Otrivin) is a Topical Decongestant that has been used successfully for many years and is generally recognized as an effective and safe therapy. However, most studies have investigated its clinical efficacy in healthy patients and few have included patients with common cold. * Otrivin® is a registered trademark of Novartis AG, Basel, Switzerland.Scope:To review the published clinical efficacy and safety of xylometazoline alone and in combination in the management of nasal congestion in patients with common cold. Literature searches of PubMed and the Cochrane Library were conducted to obtain published open or blinded, randomized, placebo- or active-controlled studies on the use of xylometazoline hydrochloride for the sympto...
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an evaluation of nasal response following different treatment regimes of oxymetazoline with reference to rebound congestion
American Journal of Rhinology, 1997Co-Authors: Sara Morris, Jawad S Martez, Donald K Riker, Ronald Eccles, Theodore J WitekAbstract:This was a randomized, double-blind vehicle controlled study aimed at investigating the effects on nasal function of 7 days treatment with the Topical Decongestant oxymetazoline (0.05% w/v). Fifty healthy volunteers took part in the study and these were randomly allocated to three treatment groups (i) daily oxymetazoline (b.i.d. 150 μl per nostril) (ii) intermittent oxymetazoline, with oxymetazoline being substituted for vehicle at the morning doses on days 1, 3, and 7; and (iii) daily vehicle (b.i.d. 150 μl per nostril). The nasal airway was assessed by measurement of nasal airway resistance (NAR) using posterior rhinomanometry, subjective scaling of nasal patency by means of a visual analogue scale (VAS), and clinical visual examination. On days 1, 2, 3, and 7, NAR and VAS measurements were obtained before the morning dose and up to 6 hours after dosing; clinical visual examinations were also performed before dosing on these days. NAR and VAS measurements were also made following withdrawal of treatment...
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Nasal airflow asymmetry and the effects of a Topical nasal Decongestant.
Rhinology, 1992Co-Authors: R. G. Williams, Ronald EcclesAbstract:Nasal airway resistance (NAR) is normally asymmetrical due to the nasal cycle. The aims of this study were to determine the degree of this asymmetry in healthy subjects and those with acute rhinitis associated with common cold, and to investigate how the administration of a Topical nasal Decongestant (xylometazoline) influenced the asymmetry in NAR. Unilateral NAR was measured by active anterior rhinomanometry, and was shown to be asymmetrical in both healthy subjects and those suffering with acute rhinitis. The asymmetry in NAR was greater in those with acute rhinitis than in the healthy group, with a ratio between "high" and "low" sides of 2.3:1 in the rhinitis group compared to a ratio of 1.7:1 in the healthy subjects. Administration of a Topical nasal Decongestant caused a significant decrease in total NAR in both groups and abolished the asymmetry in NAR in the healthy subjects (ratio is 1:1 after decongestion). However, significant asymmetry of NAR was still present in the group with acute rhinitis following the administration of Decongestant (ratio is 1.5:1 after decongestion). These findings show that the normal asymmetry in NAR was increased during acute rhinitis associated with common cold, and that in healthy subjects (but not in those with rhinitis) the asymmetry was abolished by administration of a Topical Decongestant. The results are discussed in relation to nasal sympathetic tone and nasal blood flow.
Gerhard A. Zielhuis - One of the best experts on this subject based on the ideXlab platform.
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No effect of a nasal Decongestant on eustachian tube function in children with ventilation tubes.
The Laryngoscope, 2002Co-Authors: Niels Van Heerbeek, Koen J. A. O. Ingels, Gerhard A. ZielhuisAbstract:OBJECTIVE: The aim of the study was to assess the effect of a Topical Decongestant on eustachian tube function in children with ventilation tubes because of persistent otitis media with effusion. STUDY DESIGN: A randomized, double-blinded, placebo-controlled study. METHODS: At the outpatient departments of a secondary referral hospital and a tertiary referral hospital, eustachian tube function was measured before and after intranasal administration of five drops of 0.05% xylometazoline hydrochloride or placebo in 80 randomly selected children with ventilation tubes because of otitis media with effusion. RESULTS: Xylometazoline nose drops had no effect on the ventilatory or the protective function of the eustachian tube. CONCLUSIONS: Topical Decongestants do not have a positive effect on eustachian tube function in children. Therefore, the use of Topical Decongestants to prevent or treat otitis media with effusion in children is not justified and should be discouraged.
Frederick K. Kozak - One of the best experts on this subject based on the ideXlab platform.
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Intranasal Topical local anesthetic and Decongestant for flexible nasendoscopy in children: a randomized, double-blind, placebo-controlled trial.
Archives of Otolaryngology-head & Neck Surgery, 2013Co-Authors: Neil K. Chadha, Jeffrey P. Ludemann, Frederick K. KozakAbstract:Importance To our knowledge, the present study is the first double-blind, randomized, placebo-controlled trial in children to compare nasal preparation sprays administered before flexible nasendoscopy with placebo. Objective To compare the degree of pain experienced by children undergoing flexible nasendoscopy after 1 of 3 intranasal sprays: placebo, Decongestant with Topical local anesthetic (TLA), or Decongestant without TLA. Design, Setting, and Participants A randomized placebo-controlled trial with blinding of participants, caregivers, observers, and otolaryngologists was conducted in a tertiary pediatric otolaryngology ambulatory clinic. Participants included a consecutive sample of children aged 3 to 12 years requiring flexible nasendoscopy. Exclusion criteria included concomitant respiratory tract infection, known allergy to a trial agent, or previous flexible nasendoscopy. One hundred fifty-one children were assessed for eligibility; 24 eligible children refused participation and 69 were included and block-randomized. All completed the study, and there were no adverse events. Interventions Nasal spray administration of placebo (normal saline); xylometazoline hydrochloride, 0.05% (Decongestant); or lidocaine hydrochloride, 1%, with xylometazoline hydrochloride, 0.05% (TLA with Decongestant) was performed 10 minutes before flexible nasendoscopy. Main Outcomes and Measures Primary outcome measure was the child-reported Wong-Baker Faces Pain (WBFP) scale. Secondary outcomes included the caregiver-proxy WBFP scale; the Face, Legs, Activity, Cry, and Consolability (FLACC) scale; and the physician-reported Difficulty of Procedure Visual Analog Scale (DPVAS). Results Twenty-three children were recruited in each of the intervention arms. Baseline characteristics were comparable between groups. The mean child-rated WBFP scale scores were 2.4, 1.8, and 2.2 for the placebo, Decongestant, and TLA with Decongestant groups, respectively ( P = .45). Although the finding was statistically nonsignificant, Decongestant had the lowest mean caregiver-proxy WBFP scale score, lowest observer-rated FLACC scale score, and highest physician-rated DPVAS score. Subgroup analysis did not demonstrate any correlation between the outcomes and age or sex. Conclusions and Relevance This study revealed no statistically significant difference in the discomfort experienced by children undergoing flexible nasendoscopy after placebo, Decongestant, or TLA with Decongestant. Decongestant was associated with the least discomfort (on child, caregiver, and observer-rated pain scale scores) and the lowest rating for difficulty of procedure. With these findings, the study suggests that there is no significant benefit of Topical Decongestant with or without TLA compared with placebo in reducing pain associated with pediatric flexible nasendoscopy. Trial Registration clinicaltrials.gov Identifier:NCT01351298
Niels Van Heerbeek - One of the best experts on this subject based on the ideXlab platform.
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No effect of a nasal Decongestant on eustachian tube function in children with ventilation tubes.
The Laryngoscope, 2002Co-Authors: Niels Van Heerbeek, Koen J. A. O. Ingels, Gerhard A. ZielhuisAbstract:OBJECTIVE: The aim of the study was to assess the effect of a Topical Decongestant on eustachian tube function in children with ventilation tubes because of persistent otitis media with effusion. STUDY DESIGN: A randomized, double-blinded, placebo-controlled study. METHODS: At the outpatient departments of a secondary referral hospital and a tertiary referral hospital, eustachian tube function was measured before and after intranasal administration of five drops of 0.05% xylometazoline hydrochloride or placebo in 80 randomly selected children with ventilation tubes because of otitis media with effusion. RESULTS: Xylometazoline nose drops had no effect on the ventilatory or the protective function of the eustachian tube. CONCLUSIONS: Topical Decongestants do not have a positive effect on eustachian tube function in children. Therefore, the use of Topical Decongestants to prevent or treat otitis media with effusion in children is not justified and should be discouraged.
Mieke L Van Driel - One of the best experts on this subject based on the ideXlab platform.
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Nasal Decongestants in monotherapy for the common cold (Review)
Cochrane Database of Systematic Reviews, 2016Co-Authors: Laura Deckx, An De Sutter, Linda Guo, Nabiel A Mir, Mieke L Van DrielAbstract:Background: Many treatments for the common cold exist and are sold over-the-counter. Nevertheless, evidence on the effectiveness and safety of nasal Decongestants is limited. Objectives: To assess the efficacy, and short- and long-term safety, of nasal Decongestants used in monotherapy to alleviate symptoms of the common cold in adults and children. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 6, June 2016), which contains the Cochrane Acute Respiratory Infections (ARI) Specialised Register, MEDLINE (1946 to July 2016), Embase (2010 to 15 July 2016), CINAHL (1981 to 15 July 2016), LILACS (1982 to July 2016), Web of Science (1955 to July 2016) and clinical trials registers. Selection criteria: Randomised controlled trials (RCTs) and cluster-RCTs investigating the effectiveness and adverse effects of nasal Decongestants compared with placebo for treating the common cold in adults and children. We excluded quasi-RCTs. Data collection and analysis: Three review authors independently extracted and summarised data on subjective measures of nasal congestion, overall patient well-being score, objective measures of nasal airway resistance, adverse effects and general recovery. One review author acted as arbiter in cases of disagreement. We categorised trials as single and multi-dose and analysed data both separately and together. We also analysed studies using an oral or Topical nasal Decongestant separately and together. Main results: We included 15 trials with 1838 participants. Fourteen studies included adult participants only (aged 18 years and over). In six studies the intervention was a single dose and in nine studies multiple doses were used. Nine studies used pseudoephedrine and three studies used oxymetazoline. Other Decongestants included phenylpropanolamine, norephedrine and xylometazoline. Phenylpropanolamine (or norephedrine) is no longer available on the market therefore we did not include the results of these studies in the meta-analyses. Eleven studies used oral Decongestants; four studies used Topical Decongestants. Participants were included after contracting the common cold. The duration of symptoms differed among studies; in 10 studies participants had symptoms for less than three days, in three studies symptoms were present for less than five days, one study counted the number of colds over one year, and one study experimentally induced the common cold. In the single-dose studies, the effectiveness of a nasal Decongestant was measured on the same day, whereas the follow-up in multi-dose studies ranged between one and 10 days. Most studies were conducted in university settings (N = eight), six at a specific university common cold centre. Three studies were conducted at a university in collaboration with a hospital and two in a hospital only setting. In two studies the setting was unclear. There were large differences in the reporting of outcomes and the reporting of methods in most studies was limited. Therefore, we judged most studies to be at low or unclear risk of bias. Pooling was possible for a limited number of studies only; measures of effect are expressed as standardised mean differences (SMDs). A positive SMD represents an improvement in congestion. There is no defined minimal clinically important difference for measures of subjective improvement in nasal congestion, therefore we used the SMDs as a guide to assess whether an effect was small (0.2 to 0.49), moderate (0.5 to 0.79) or large (≥ 0.8). Single-dose Decongestant versus placebo: 10 studies compared a single dose of nasal Decongestant with placebo and their effectiveness was tested between 15 minutes and 10 hours after dosing. Seven of 10 studies reported subjective symptom scores for nasal congestion; none reported overall patient well-being. However, pooling was not possible due to the large diversity in the measurement and reporting of symptoms of congestion. Two studies recorded adverse events. Both studies used an oral Decongestant and each of them showed that there was no statistical difference between the number of adverse events in the treatment group versus the placebo group. Multi-dose Decongestant versus placebo: nine studies compared multiple doses of nasal Decongestants with placebo, but only five reported on the primary outcome, subjective symptom scores for nasal congestion. Only one study used a Topical Decongestant; none reported overall patient well-being. Subjective measures of congestion were significantly better for the treatment group compared with placebo approximately three hours after the last dose (SMD 0.49, 95% confidence interval (CI) 0.07 to 0.92; P = 0.02; GRADE: low-quality evidence). However, the SMD of 0.49 only indicates a small clinical effect. Pooling was based on two studies, one oral and one Topical, therefore we were unable to assess the effects of oral and Topical Decongestants separately. Seven studies reported adverse events (six oral and one Topical Decongestant); meta-analysis showed that there was no statistical difference between the number of adverse events in the treatment group (125 per 1000) compared to the placebo group (126 per 1000). The odds ratio (OR) for adverse events in the treatment group was 0.98 (95% CI 0.68 to 1.40; P = 0.90; GRADE: low-quality evidence). The results remained the same when we only considered studies using an oral Decongestant (OR 0.95, 95% CI 0.65 to 1.39; P = 0.80; GRADE: low-quality evidence). Authors' conclusions: We were unable to draw conclusions on the effectiveness of single-dose nasal Decongestants due to the limited evidence available. For multiple doses of nasal Decongestants, the current evidence suggests that these may have a small positive effect on subjective measures of nasal congestion in adults with the common cold. However, the clinical relevance of this small effect is unknown and there is insufficient good-quality evidence to draw any firm conclusions. Due to the small number of studies that used a Topical nasal Decongestant, we were also unable to draw conclusions on the effectiveness of oral versus Topical Decongestants. Nasal Decongestants do not seem to increase the risk of adverse events in adults in the short term. The effectiveness and safety of nasal Decongestants in children and the clinical relevance of their small effect in adults is yet to be determined.
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nasal Decongestants in monotherapy for the common cold
Cochrane Database of Systematic Reviews, 2016Co-Authors: Laura Deckx, An De Sutter, Linda Guo, Nabiel A Mir, Mieke L Van DrielAbstract:Background Many treatments for the common cold exist and are sold over-the-counter. Nevertheless, evidence on the effectiveness and safety of nasal Decongestants is limited. Objectives To assess the efficacy, and short- and long-term safety, of nasal Decongestants used in monotherapy to alleviate symptoms of the common cold in adults and children. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 6, June 2016), which contains the Cochrane Acute Respiratory Infections (ARI) Specialised Register, MEDLINE (1946 to July 2016), Embase (2010 to 15 July 2016), CINAHL (1981 to 15 July 2016), LILACS (1982 to July 2016), Web of Science (1955 to July 2016) and clinical trials registers. Selection criteria Randomised controlled trials (RCTs) and cluster-RCTs investigating the effectiveness and adverse effects of nasal Decongestants compared with placebo for treating the common cold in adults and children. We excluded quasi-RCTs. Data collection and analysis Three review authors independently extracted and summarised data on subjective measures of nasal congestion, overall patient well-being score, objective measures of nasal airway resistance, adverse effects and general recovery. One review author acted as arbiter in cases of disagreement. We categorised trials as single and multi-dose and analysed data both separately and together. We also analysed studies using an oral or Topical nasal Decongestant separately and together. Main results We included 15 trials with 1838 participants. Fourteen studies included adult participants only (aged 18 years and over). In six studies the intervention was a single dose and in nine studies multiple doses were used. Nine studies used pseudoephedrine and three studies used oxymetazoline. Other Decongestants included phenylpropanolamine, norephedrine and xylometazoline. Phenylpropanolamine (or norephedrine) is no longer available on the market therefore we did not include the results of these studies in the meta-analyses. Eleven studies used oral Decongestants; four studies used Topical Decongestants. Participants were included after contracting the common cold. The duration of symptoms differed among studies; in 10 studies participants had symptoms for less than three days, in three studies symptoms were present for less than five days, one study counted the number of colds over one year, and one study experimentally induced the common cold. In the single-dose studies, the effectiveness of a nasal Decongestant was measured on the same day, whereas the follow-up in multi-dose studies ranged between one and 10 days. Most studies were conducted in university settings (N = eight), six at a specific university common cold centre. Three studies were conducted at a university in collaboration with a hospital and two in a hospital only setting. In two studies the setting was unclear. There were large differences in the reporting of outcomes and the reporting of methods in most studies was limited. Therefore, we judged most studies to be at low or unclear risk of bias. Pooling was possible for a limited number of studies only; measures of effect are expressed as standardised mean differences (SMDs). A positive SMD represents an improvement in congestion. There is no defined minimal clinically important difference for measures of subjective improvement in nasal congestion, therefore we used the SMDs as a guide to assess whether an effect was small (0.2 to 0.49), moderate (0.5 to 0.79) or large (≥ 0.8). Single-dose Decongestant versus placebo: 10 studies compared a single dose of nasal Decongestant with placebo and their effectiveness was tested between 15 minutes and 10 hours after dosing. Seven of 10 studies reported subjective symptom scores for nasal congestion; none reported overall patient well-being. However, pooling was not possible due to the large diversity in the measurement and reporting of symptoms of congestion. Two studies recorded adverse events. Both studies used an oral Decongestant and each of them showed that there was no statistical difference between the number of adverse events in the treatment group versus the placebo group. Multi-dose Decongestant versus placebo: nine studies compared multiple doses of nasal Decongestants with placebo, but only five reported on the primary outcome, subjective symptom scores for nasal congestion. Only one study used a Topical Decongestant; none reported overall patient well-being. Subjective measures of congestion were significantly better for the treatment group compared with placebo approximately three hours after the last dose (SMD 0.49, 95% confidence interval (CI) 0.07 to 0.92; P = 0.02; GRADE: low-quality evidence). However, the SMD of 0.49 only indicates a small clinical effect. Pooling was based on two studies, one oral and one Topical, therefore we were unable to assess the effects of oral and Topical Decongestants separately. Seven studies reported adverse events (six oral and one Topical Decongestant); meta-analysis showed that there was no statistical difference between the number of adverse events in the treatment group (125 per 1000) compared to the placebo group (126 per 1000). The odds ratio (OR) for adverse events in the treatment group was 0.98 (95% CI 0.68 to 1.40; P = 0.90; GRADE: low-quality evidence). The results remained the same when we only considered studies using an oral Decongestant (OR 0.95, 95% CI 0.65 to 1.39; P = 0.80; GRADE: low-quality evidence). Authors' conclusions We were unable to draw conclusions on the effectiveness of single-dose nasal Decongestants due to the limited evidence available. For multiple doses of nasal Decongestants, the current evidence suggests that these may have a small positive effect on subjective measures of nasal congestion in adults with the common cold. However, the clinical relevance of this small effect is unknown and there is insufficient good-quality evidence to draw any firm conclusions. Due to the small number of studies that used a Topical nasal Decongestant, we were also unable to draw conclusions on the effectiveness of oral versus Topical Decongestants. Nasal Decongestants do not seem to increase the risk of adverse events in adults in the short term. The effectiveness and safety of nasal Decongestants in children and the clinical relevance of their small effect in adults is yet to be determined.
