Acta Oto-Laryngologica

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Ostial Function in Allergic Rhinitis Ingemar Melén, Alf Ivarsson & Camilla Schrewelius To cite this article: Ingemar Melén, Alf Ivarsson & Camilla Schrewelius (1992) Ostial Function in Allergic Rhinitis, Acta Oto-Laryngologica, 112:sup492, 82-85, DOI: 10.3109/00016489209136817 To link to this article:

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Date: 29 March 2016, At: 23:08

Acta Otolaryngol (Stockh) 1992; Suppl. 492: 82-85

Ostial Function in Allergic Rhinitis INGEMAR MELEN,’ ALF IVARSSON’ and CAMILLA SCHREWELIUS3 From the ‘Department of Otorhinolaryngology, Central Hospital, Skovde and the ‘Department of Otorhinolaryngology, University of Lund, Malmo General Hospital, Malmo and ’AB Draco, Lund, Sweden

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Melbn I, Ivarsson A, Schrewelius C. Ostial function in allergic rhinitis. Acta Otolaryngol (Stockh) 1992; SUPPI 492: 82-85. In order to evaluate the maxillary ostial function a double-blind, group comparative study with intranasal budesonide and placebo was carried out in 20 adult patients suffering from seasonal rhinitis. The trial started with an entry visit 3 weeks before pollen peak with clinical assessments (physical examination and ostial diameter measurements) followed by a 3-week treatment period. Treatment was either intranasal budesonide 200 p g b.i.d. or matching placebo b.i.d. The trail ended at pollen peak with clinical assessment. The results showed normal ostial diameters in the patients suffering from seasonal rhinitis. There were no statistical significant differences in ostial diameter change between the treatment groups except between budesonide and placebo in sitting position at measurement time 0 min. It seems that pollen does not reach the ostial region. Key worh: ostial function, allergic rhinitis.

INTRODUCTION The aetiology of maxillary sinusitis is only partly known. There is reason to believe, however, that being affected by diseased sinuses or failure to recover after maxillary sinusitis might be due to maxillary ostial obstruction. It is also believed that patients with allergic rhinitis are more often affected by sinusitis ( 1). Treatment with decongestants (intranasally or orally) has therefore been used for a long time more or less in a routine fashion in order to achieve improved nasal and sinusal ventilation. Melin et al. (2,3) found that phenylpropanolamine had a significant decongestant effect on the ostial airway resistance on healthy subjects as well as in patients with chronic maxillary sinusitis. The present study was designed to examine the ostial function during pollen season in patients with seasonal allergic rhinitis. MATERIAL AND METHODS The study was of a randomized double-blind placebo controlled design with parallel groups. Patients were recruited from the allergic and ENT clinics and had a positive skin test to birch. Patients were allocated at random to active or placebo treatment. Clinical assessments were performed twice, before and during the pollen season. Five men and 15 women participated with a mean age of 34 and 31 years, respectively (range 19-51). The duration of allergic rhinitis was 14 and 12 years, respectively. Patients with diseases or conditions which might interfere with evaluation of efficacy or safety were excluded such as chronic infections, nasal polyposis, septum deviations sufficiently symptomatic to produce obstruction and other therapies such as systemic corticosteroids, anti-histamines, antihypertensive drugs, etc. The treatment was two puffs per nostril to be administered in the morning and in the evening. Each actuation delivers 25 micro1 = 50 pg. Patients on active treatment were thus to receive a total daily dosage of 400 pg budesonide. The treatment period was 3 weeks. Every evening before going to bed the patients evaluated their symptoms over the preceding 24-h period. Symptoms to be evaluated were nasal obstruction, rhinorrhea and sneezing. Scoring

Ostial .function in allergic rhinitis

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Table I. Severity of symptoms (diary data) during day 1-21 in the 20 treated patients (n = 10) meanfSD



1.12 f 0.82



0.98 f 0.76


0.37 f0.36


1.01 f 0.68


0.57 f0.49


1.21 & 0.56



Budesonide range

(n = 10) mean f SD

Placebo range

Blocked nose

0.00- 1.43

0.56 f0.59

Runny nose



Itchy nose



0.10- 1.50

was made using the scale 0-3 (0 = no symptoms, 1 = mild symptoms, 2 = moderate symptoms, 3 = severe symptoms). A pressure-flow technique developed by Aust & Drettner (4) and modified by Ivarsson et al. (5) was used to measure the ostial airway resistance. A special cannula (5) was used to record the pressure rise within the sinus at an artificial air-flow directed from the sinus into the nasal cavity. The first registration was made before the pollen season and the second during the pollen peak. The ostial airway resistance was studied in both a sitting and a recumbent position during one hour (at 0, 30 and 60 min). Paired Student's t-test was used for the data analysis. The main variable was the equivalent ostial diameter. Comparisons of the effect of the ostial diameter of the different treatments before and after pollen season were made. p < 0.05 was considered statistically significant. The treatment groups were comparable with regard to sex, age, weight, height and duration of seasonal rhinitis. RESULTS The mean patient scores of the nasal symptoms averaged over day 1-21 are listed in Table I. Budesonide treatment was associated with a reduction in the severity of all nasal symptoms recorded. All differences between the two treatments except for blocked nose were statistically significant ( p = 0.016 to 0 = 0.044). Ostial diameter measurements before and at pollen peak and differences in ostial diameter between treatment groups at different measurement times 0, 30 and 60min both in sitting and recumbent positions are listed in Table 11. The ostial mean diameter for both groups ranged in the sitting position at time 0 min between 2.22 and 2.43 mm and the mean value in the recumbent position ranged between 2.13 and 2.64 mm. There were no statistical significant differences in ostial diameter change between the treatment groups except between budesonide and placebo in sitting position at measurement time 0 min. The difference reached statistical significance ( p = 0.046). DISCUSSION As far as we know, no reports have so far been published on ostial measurements in patients with allergic rhinitis. It is generally accepted that obstruction of the maxillary sinus ostia is of importance for the development of a maxillary sinus infection. In allergic rhinitis a nasal mucosa swollen to various degrees is present and the question is whether the mucosa, in the region of the ostia, is involved. In the study by Savolainen (1) acute sinusitis seems to be more common in allergic than non-allergic individuals and allergy might therefore be a predisposing factor to acute sinusitis. In many studies, maxillary ostial function tests have shown a correlation between impaired ostial function and sinus disease (6,7,8). When the









-0.28 0.32

2.36 0.23 0.73 10

2.64 9.34 I .08


mean SEM + SD






1.oo 10

-0.15 0.12 0.35 8

mean SEM + SD

2.28 0.21 0.62 9



-0.24 0.32 0.92 8

2.43 0.22 0.70 10

2.43 0.30 0.84 8






0.13 0.12 0.33 8

2.33 0.21 0.66 10

2.22 0.36 1.01 8

2.13 0.36 1.08 9




mean SEM SD


mean SEM + SD



2.10 0.33 0.99 9

1.78 0.29 0.83 8

2.40 0.33 1.03 10

2.08 0.42 I .26 10





0 mm DIFF

30 min

0 min

1.84 0.33 0.97 9

1.74 0.23 0.72 10

2.15 0.21 0.67 10

2.03 0.17 0.53 9



-0.51 0.38 1.04 8

+0.02 0.24 0.67 8


-0.26 0.35 1.10 10

-0.12 0.32 0.95







2.09 0.28 0.89 10

2.21 0.33 I .04

2.20 0.32 1.02 10


1.68 0.3 1 0.91

1.97 0.29 0.92 10

I .64 0.25 0.78 9

1.71 0.26 0.81 10

1.78 0.31 0.92 9



0 mm ENTRY

60 min


-0.24 0.39 I .24 10

-0.10 0.28 0.85


-0.12 0.39 1.24 10

-0.10 0.25 0.75 9








Table 11. Ostial diameter measurements before (entry) and at pollen peak (after) and digerences between budesonide and placebo

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Ostial .fiction in allergic rhinitis 85

ostium has a diameter of less than approximately 2.5mm, the oxygen content of the maxillary sinus is lower than normal and the correlation between the disturbed patency of the ostium under recurrent sinusitis is therefore considered possible (9). The ostial diameters in both groups in our study before and at pollen peak were in mean above 2.2 mm, which can be considered a normal ostial size. This fact indicates that a patient with seasonal allergy has normal ventilation of the sinuses. Whether the allergic patient is more susceptible to sinus infection is not yet clarified, but probably mucosal or immunological factors are of more importance than ostial obstruction. In earlier studies phenylpropanolamine orally showed a significant increase of the equivalent ostial diameter compared to placebo (2). In this study there was a tendency of keeping the ostial diameter unaffected during the pollen season in the budesonide group, but it is uncertain if the corticosteroid reached the entrance of the ostial channel or affected the nasal mucus membrane secondarily. No significant changes of the ostial diameters could be registered in the placebo group, and probably the pollen does not reach the ostial region. An explanation for this might be the complicated anatomy of the area combined with ciliar activity. Rain and cold weather during the expected pollen peak complicated the study and may account for the mild symptoms recorded. To overcome problems with variable pollen seasons nasal provocation tests should be used in further studies. REFERENCES 1. Savolainen S. Allergy in patients with acute maxillary sinusitis. Allergy 1989; 44:116-22. 2. Meltn I, Andreasson L, Ivarsson A, Jannert M, Johansson C-J. Effects of phenylpropanolamine on ostial and nasal airway, resistance in healthy individuals. Acta Otolaryngol (Stockh) 1986; 102: 99-105. 3. MelCn I, Friberg B, Andreasson L, Ivarsson A, Jannert M, Johansson C-J. Effects of phenylpropanolamine on ostial and nasal patency in patients treated for chronic maxillary sinusitis. Acta Otolaryngol (Stockh) 1986; 101: 494-500. 4. Aust R, Drettner B. The functional size of the human maxillary ostium in vivo. Acta Otolaryngol (Stockh) 1974; 78: 432-5. 5. Ivarsson A, AndrCasson L, Jannert M, Erlandsson B. Patency tests of the maxillary ostium-model experiments. Acta Otolaryngol (Stockh) 1983; 96: 295-305. 6. Flottes L, Clerc P, Riu R, Devilla F. La physiologie des sinus, ses applications cliniques et therapeutiques. Paris: Librairie Arnette, 1960. 7. Drettner B. Measurements of the resistance of maxillary ostium. Acta Otolaryngol (Stockh) 1965; 60: 499- 505. 8. Jannert M, AndrCasson L, Ivarsson A. Studies on the maxillary ostial function in cases with maxillary pain, intrasinusal cysts and chronic sinusitis. Acta Otolaryngol (Stockh) 1984; 97: 325-34. 9. Aust R, Drettner B. Oxygen tension in the human maxillary sinus under normal and pathological conditions. Acta Otolaryngol (Stockh) 1974; 78: 264-9. Address for correspondence: Ingemar Melt%, ENT Department, Central Hospital, S-541 85 SkOVDE, Sweden

Ostial function in allergic rhinitis.

In order to evaluate the maxillary ostial function a double-blind, group comparative study with intranasal budesonide and placebo was carried out in 2...
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