Nasal and Exhaled Nitric Oxide in Allergic Rhinitis

Abstract

OBJECTIVE: 1) Establish current opinion from medico-legal sources based upon the following questions: Does the surgeon owe a duty of care to advise an x-ray for nasal fracture secondary to assault? Does a fracture demonstrated by x-ray result in the ability of the prosecution to establish a greater degree of harm against the victim? 2) Identify patients who underwent manipulation under anesthetic (MUA) of nasal fracture secondary to assault and investigate their legal outcomes. METHOD: A number of relevant medical and legal sources were contacted. The above questions were posed and advice sought. In this retrospective study, all adult patients who underwent MUA of a nasal fracture over a 1-year period (1st January 2007-1st January 2008) were contacted. If reported as a non-accidental fracture, further questions were asked; whether a facial x-ray was performed pre-operatively; did the patient proceed to press charges; if so, the outcome of the prosecution and court hearing. RESULTS: 97 patients underwent MUA of nasal fracture in the unit over the year. Information was available for 68 patients, non-accidental injury accounted for 26 cases (38%). Six patients within this group proceeded to press charges. The legal outcome of these patients is discussed. Literature review highlights controversy regarding the value of imaging but little is published giving guidance in cases of non-accidental nasal fractures where legal action is likely to proceed. CONCLUSION:We present an up-to-date review of medical and legal perspectives and the legal outcome of patients presenting with non-accidental nasal fractures managed in our department.

Nasal ventilation is an important factor in evaluating the diagnostic value of nasal nitric oxide in allergic rhinitis

“…Some studies showed increased nasal NO levels in AR patients, whereas other studies demonstrated no differences, or even decreased nasal NO levels, in AR patients compared with control subjects . Moreover, nasal NO concentration was found to be significantly lower in a persistent allergic rhinitis group than in an intermittent group, even though exhaled NO concentration was significantly higher in the former group . One study demonstrated that nasal NO level was lower in patients with nasal polyps than in patients with asthma, allergic rhinitis, and control subjects .…”

Clinical application of nasal nitric oxide measurement in pediatric airway diseases

“…Likewise to asthma, a high expression of the NOS2 isoform has been reported in patients with AR . While FeNO is consistently high in AR, data on nNO are controversial as some studies found increased nNO levels, while others did not . These findings may be explained by the fact that high nNO concentrations derive from the induction of NOS in the inflamed mucosa provided osteomeatal patency .…”

A Prospective Cross-Sectional Study on Exhaled Nitric Oxide and Sensitivity to Indoor Inhaled Aeroallergens in Patients with Rhinosinusitis with Nasal Polyps

“…Also, in the absence of asthma, allergic rhinitis patients had a higher level of exhaled NO than the normal control group. On the other hand, those with resistant allergic rhinitis had higher exhaled NO concentrations, while there was a lower concentration of nasal NO compared to the control group so that in the severe stages of the disease and rhinitis, which are resistant to NO treatment, nasal NO can be reduced (25). In 2014, Green et al studied the sensitivity of CRS patients and reported that a high percentage of patients with positive CRS had Positive Prick Test (SPT), and the highest sensitivity in these patients belonged to A. alternata, cat, and Ragweed (15).…”