The most commo n clin ical syndro mes that cause nasal congestion are allergic rhinitis, vasomotorrhinitis, chronic sinusitis, and upp er respiratory vira l inf ections (common colds). Nasa l congestion, in turn , can lead to sequelae suc h as sinusitis, otitis media, and the onse t or worsening of mild to severe sleep dis turbances, including obs tructive sleep apnea. There is a host of conservative treatments, inc lud ing decongestan t pharmacotherapy, antiallergy measu res, and nasal dilation dev ices. Several surgical procedu res are also available. This art icle reviews the current guidelinesfor the workup and diagnosis of nasa l congestion and briefly describes the many and var ied approaches to treatment.
Acoustic rhinometry (AR) evaluates the cross-sectional areas and volume of the nasal cavity through acoustic reflections. Successive valleys displayed on an AR graph are believed to correspond to anatomic landmarks. To assess the anatomic accuracy of AR, we performed AR and endoscopic measurements with a rigid endoscope in 85 normal human subjects after topical decongestion. Endoscopic measurements were recorded for distances between the midcolumella and the nasal valve, the anterior end of the inferior turbinate, the anterior end of the middle turbinate, the midportion of the middle turbinate, and the posterior nasopharynx. The first AR valley most closely corresponded with endoscopic measurements of the nasal valve. The second valley had a mean value that corresponded with the anterior end of the inferior turbinate. The third valley matched best with the values of the anterior end of the middle turbinate. Nasopharyngeal measurements by each modality yielded a good agreement. AR appears to correspond to nasal anatomic landmarks but not in an exact point-to-point manner.
We analyzed the distribution of nasal erectile tissue by reviewing five sets of magnetic resonance imaging scans that were obtainedpre-andpost-decongestion. We found that cavernous tissues were located at three sites: the inferior turbinate, the middle turbinate, and the nasal septum. This study reaffirms the findings of previous studies that were performed with other modalities such as computed tomography scanning and cadaver dissections.
SummaryBackgroundThere is a paucity of large‐scale studies evaluating the clinical benefit of the Gaviscon Double Action (DA) alginate‐antacid formulation for treating gastroesophageal reflux disease (GERD) symptoms.AimRandomised double‐blind placebo‐controlled parallel‐group study to evaluate efficacy and safety of Gaviscon DA in reducing heartburn, regurgitation and dyspepsia symptoms in individuals with mild‐to‐moderate GERD in China.MethodsParticipants with symptomatic GERD (n = 1107) were randomised to receive Gaviscon DA or placebo (two tablets four times daily) for seven consecutive days. The primary endpoint compared the change in Reflux Disease Questionnaire (RDQ) score for the GERD (heartburn + regurgitation) dimension between Gaviscon DA and placebo. Secondary endpoints compared the change in RDQ scores for individual heartburn, regurgitation and dyspepsia dimensions, overall treatment evaluation (OTE) scores and incidence of adverse events (AEs).ResultsMean RDQ GERD scores: 2.51 for Gaviscon DA and 2.50 for placebo at baseline; 1.25 for Gaviscon DA and 1.46 for placebo post treatment. Gaviscon DA was statistically superior to placebo in reducing GERD and dyspepsia RDQ scores [least‐squares mean (LSM) difference: GERD −0.21, P < 0.0001; dyspepsia −0.18, P = 0.0004], despite a substantial placebo response. The Gaviscon DA group reported more favourable overall treatment responses than the placebo group across all OTE categories (P < 0.0001). Superior relief of GERD symptoms was observed both in those with non‐erosive and those with erosive reflux disease (LSM difference −0.14 [P = 0.038] and −0.29 [P < 0.0001] respectively). Incidence of AEs was similar in both groups.ConclusionGaviscon DA tablets provide effective and safe reduction in acid reflux and dyspepsia symptoms in Chinese individuals with mild‐to‐moderate GERD. ClinicalTrials.gov: NCT01869491
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