The effect of the tonicity of saline nasal douching solutions on mucociliary clearance was studied in order to ascertain whether hypertonicity conferred any advantage. Thirty-eight normal subjects were included in a randomised double-blind crossover trial. Saline douching solutions of 0.9%, 3% and 5% tonicity were used and mucociliary clearance was measured by the saccharin clearance time (SCT). The resultant SCT after administration of 5% saline was significantly reduced compared to both 0.9% (P = 0.005) and 3% saline (P = 0.04). There was no difference between 0.9% and 3% saline administration. Thus hypertonic saline solutions improve mucociliary clearance, although this was only observed with solutions of 5% tonicity. The effect is probably brought about by changes in mucus rheology.

Squamous cell carcinoma of the nasal vestibule is a rare disease with significant morbidity and mortality, and a five-year recurrence-free survival rate of between 42 and 92 per cent. There are several staging systems: the American Joint Committee on Cancer (AJCC) skin and nasoethmoid complex system, the Union International Centre Cancer (UICC) nasal fossa system, and Wang's system. Treatment options include radiotherapy or surgery for early lesions, but more advanced cases require radical surgery with post-operative radiotherapy. We present a case series spanning the last 20 years in one centre, and we compare this series with cases reported in the literature, paying particular attention to staging, treatment and outcome. We found that patients with tumours staged T2 or T3 (Wang system) who received radiotherapy alone did poorly in comparison with those who received surgery or surgery and radiotherapy.

The distribution of topical nasal sprays is suboptimal, the main obstruction to adequate delivery in normal volunteers being the nasal valve. We aimed to test the hypothesis that, in patients with rhino-sinusitis, hypertrophy of the inferior turbinate also limits the distribution of administered drug to the middle meatus. We modelled the effect of inferior turbinate hypertrophy and reduction by effecting congestion (by ipsilateral isometric exercise) and decongestion (topical oxymetazoline) in normal volunteers. The method chosen to estimate drug delivery to the middle meatus used endoscopic photography after the administration of dyed aqueous spray. A randomized cross-over study design was used and 20 nasal cavities were studied. The congestion/decongestion manoeuvres significantly altered nasal airflow, as measured by peak inspiratory nasal flow (P < 0.001). Congestion diminished significantly drug delivery to the middle meatus, as compared with decongestion (P = 0.026). This may support a clinical role for inferior turbinate reduction to improve the efficacy of topical nasal therapy, as well as improving nasal airflow.

We present a case of a patient with an allergy to Merocel nasal tampons and the subsequent complications and implications of this.

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