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xylometazoline hydrochloride [keywords]
- The evaluation of adenoid hypertrophy and obstruction grading based on rhinomanometry after nasal decongestant test in children. [Journal Article]
- Eur Rev Med Pharmacol Sci 2013 Nov; 17(21):2962-7.
Adenoid hypertrophy (AH) is a very common problem in children. Nasal Fiberoptic Endoscopy (NFE) represents the gold standard method to diagnose AH. Rhinomanometry represents a valid diagnostic support. The aim of our study was to analyze the grade of nasal obstruction caused by AH, in a group of children, with rhinomanometry standard and after ND test versus NFE.Two hundred and eighty-four of 300 collaborative children, diagnosed as chronic oral breathers, were enrolled. All children underwent a complete physical examination, anterior active rhinomanometry and a second rhinomanometry after the administration of the nasal decongestant (ND) xylometazoline. All children were evaluated using Nasal Fiberoptic Endoscopy (NFE).At rhinomanometry nasal obstrucion was found of grade 1 in 102 (35.9%) children, of grade 2 in 41 (14.4%), of grade 3 in 52 (18.3%), of grade 4 in 37 (13%) and of grade 5 in 52 (18.3%). Those patients were tested also with rhinomanometry after ND: grade 1 in 108 (38%) children, grade 2 in 52 (18.3%), grade 3 in 56 (19.7%), grade 4 in 23 (8.1%) and grade 5 in 45 (15.8%). At NFE: 83 (29.2%) patients presented a grade 0, 73 (28.7%) a grade 1, 51 (17.9%), 34 (11.9%) a grade 3 and 43 (15.1%) a grade 4. Comparing the grade of nasal obstruction in NFE and in RM after ND we found a great correlation for grade 1 and grade 5 (respectively 84.3% and 79,1%, p < 0.001) and low correlation for the others grades of obstruction. When compared to NFE, rhinomanometry test after ND had 81.1% sensitivity and 84.3% specificity. Operating Characteristic (ROC) curves were derived using data related to rhinomanometry vs NFE, and to Rhinomanometry after ND vs NFE.Rhinomanometry after ND, compared to rmhinomanometry, is more specific and useful to evaluate nasal obstruction due to AH in children. RM after ND is a great tool to assess the severity of nasal obstruction. In fact, the minimum and maximum degrees of obstruction to the RM after ND correlate significantly (p < 0.01) with those of NFE.
- Intranasal Topical Local Anesthetic and Decongestant for Flexible Nasendoscopy in Children: A Randomized, Double-blind, Placebo-Controlled Trial. [JOURNAL ARTICLE]
- JAMA Otolaryngol Head Neck Surg 2013 Oct 24.
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.
- The effect of xylometazoline spray for expansion of nasal cavity. [Journal Article]
- Korean J Anesthesiol 2013 Aug; 65(2):132-5.
During nasotracheal intubation it is important to have proper pretreatment for nasal mucosa constriction and nasal cavity expanding. Nasal packing of epinephrine gauze is widely used as well as xylometazoline. The aim of this study was to compare and evaluate the efficacy of prophylactic intranasal spray of xylometazoline against epinephrine gauze packing in expanding the nasal cavity.Volunteers (n = 32) in their twenties without nasal disease such as septal deviation or rhinitis were enrolled in the study. The more patent nostril in each subject was measured by acoustic rhinometry as the base value. After intranasal spray of xylometazoline, the same nostril was remeasured by same method. Twenty four hours later, intranasal packing of epinephrine gauze was done and the same treatment was done. Subject preferences about the procedures were asked.THERE WERE SIGNIFICANT DIFFERENCE AMONG TREATMENTS (BASE VALUE: 0.582 ± 0.164 cm(2), xylometazoline spray: 0.793 ± 0.165 cm(2), epinephrine gauze packing: 0.990 ± 0.290 cm(2)) in acoustic rhinometry. While the epinephrine gauze packing showed more efficient mucosa constriction, subjects preferred xylometazoline spray.Even though xylometazoline spray was less effective than epinephrine gauze packing, the simplicity and convenience compensated. In patients undergoing nasotracheal intubation, xylometazoline spray can be an alternative to epinephrine gauze packing.
- Nasal flow, volumes, and minimal cross sectional areas in asthmatics. [Journal Article, Research Support, Non-U.S. Gov't]
- Respir Med 2013 Oct; 107(10):1515-20.
The Unified Airways hypothesis suggests an involvement of the upper airways in asthma. Critical parameters of the nasal airway can be quantified objectively with acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF).We aimed to investigate nasal airway patency in asthmatics compared to non-asthmatic controls. Nasal volume, cross sectional area and flow were measured using acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) in 87 asthmatics and 93 non-asthmatic controls before and after decongestion with xylometazoline. Nasal congestion index (NCI) was calculated, and allergy status was assessed by skin prick test or specific IgE.We found significantly smaller minimum cross sectional area and nasal cavity volume in asthmatics than controls, and the cross sectional area is at its minimum at 2-3 cm from the nasal orifice in both groups. AR and PNIF measurements are not different in allergic and non allergic subjects in either group. The effect of xylometazoline is not significantly different between the 2 groups with regard to AR, but there is a significant improvement in PNIF for the asthmatics when assessed by the NCI.The present study demonstrates a significantly smaller nasal airway when assessed by minimum cross sectional area and nasal cavity volume in asthmatics than controls, and these findings apply to asthmatics and controls irrespective of allergy status.
- Unilateral pupillary dilatation following septoplasty: cause for concern? [Journal Article]
- J Coll Physicians Surg Pak 2013 Jul; 23(7):515-6.
We report and explain unilateral pupillary dilatation following routine septoplasty and trimming of inferior turbinates. The unilateral pupillary dilatation was caused by inadvertent instillation of sympathomimetic, (xylometazoline hydrochloride) in the eye during preparation for nasal surgery. The effect was short-lived and the patient made a full recovery. Unilateral pupillary dilatation after sinonasal surgery can be alarming due to the possibility of injury to the globe and intracranial haemorrhage but can also be explained by the mydriatic effect of the sympathomimetic nasal drops and sprays used to decongest the nose. Such possibility should be borne in mind and would help to explain and reduce the anxiety and avoid unnecessary investigations.
- [Nasal decongestants and eye drops: keep out of children's reach!]. [News]
- Perspect Infirm 2013 Mar-Apr; 10(2):63.
- Nasotracheal intubation with three indirect laryngoscopes assisted by standard or modified Magill forceps. [Comparative Study, Journal Article, Randomized Controlled Trial]
- Anaesthesia 2013 May; 68(5):467-71.
We assessed the effect of modifying standard Magill forceps on the laryngeal introduction of an Eschmann stylet during nasotracheal intubations with three indirect laryngoscopes (Airtraq™, C-MAC(®) or GlideScope(®)) in patients with predicted difficult intubation. We allocated 50 participants to each laryngoscope. The stylet was advanced by one forceps followed by the other (standard or modified), with each sequence allocated to 25/50 for each laryngoscope. There were no differences in rates of failed tracheal intubation with the allocated laryngoscopes: 6/50, 5/50 and 5/50, respectively. An Eschmann stylet was advanced into the trachea less often with the standard forceps (65% vs 93%, p < 0.0001). Mean (SD) time for stylet advancement was longer with the standard forceps, 38 (30) vs 19 (19) s, p < 0.0001. In conclusion, the modified Magill forceps facilitated nasotracheal intubation, independent of the type of indirect laryngoscope.
- [Nasal drops addiction--the case report]. [Case Reports, English Abstract, Journal Article]
- Przegl Lek 2012; 69(10):1168-9.
The article describes the case of 34-years old man, who has used nasal drops with xylomethazoline for three years. Health consequence of uncontrolled use of the drops and treatment were prescribed. Described problem confirms the need of physicians and pharmacists cooperation to limit the problem of drug-addiction.
- Reversible cardiomyopathy due to chronic use of xylometazoline topical nasal spray. [Letter]
- Int J Cardiol 2013 Apr 5; 164(2):e17-8.
- The development and application of a system for simultaneously determining anti-infectives and nasal decongestants using on-line solid-phase extraction and liquid chromatography-tandem mass spectrometry. [Journal Article, Research Support, Non-U.S. Gov't, Validation Studies]
- J Pharm Biomed Anal 2012 Jul.:24-32.
A method for the simultaneous analysis of antibiotics, antiviral and nasal decongestants in treated sewage effluent and surface water has been developed and validated. The method uses on-line solid phase extraction (SPE) of injected high-volume samples in conjunction with liquid chromatography-tandem mass spectrometry (LC-MS/MS). This method includes a range of antibiotics (Trimethoprim, Oxytetracycline, Ofloxacin, Norfloxacin, Ciprofloxacin, Azithromycin, Doxycycline, Sulfamethoxazole, Erythromycin and Clarithromycin), an antiviral (Oseltamivir) and nasal decongestants (Naphazoline, Oxymetazoline and Xylometazoline). The method's detection limits (MDLs) ranged from (0.2 ng L(-1)) to (3.1 ng L(-1)), based on a 1 mL extraction volume. Its intra-day precision was determined by performing nine runs with 200 ng L(-1) samples; the intra-day relative standard deviation (RSD) ranged from 1% to 19%. Inter-day precision was determined by analyzing samples in triplicate over the course of three days, yielding relative standard deviations ranging from <5% to <26%. The linearity (R(2)) for all compounds tested was >0.90. Spike relative recoveries ranged from 40% to 157% and 40% to 152% for STP effluent and surface water samples, respectively. Finally, the method was used to analyze real effluent and surface water.