Hans Rundcrantz

POSTURAL VARIATIONS OF NASAL PATENCY

Comparative quantitative measurements of the nasal airway resistance (Rn) in different positions were performed in normal individuals, in patients with allergic rhinitis, and in patients with common colds during and after infection. In normal persons and in patients recovered from common colds Rn increased only very little in positions of 20° or less above the horizontal plane. In rhinitic patients the same positions were followed by a considerable increase of Rn caused by swelling of the. nasal mucosa due to hydrostatic blood pressure increase. This was proved by the effect of neck vein compression causing about the same increase of Rn as the horizontal position. The mucosal reactions to high transmural pressures support the theory of vascular hypotonicity in the rhinitic nose. In view of the biological and clinical consequences of the postural effects on the nasal mucosa, common colds should not be “cured” with bed rest; at night, rhinitic patients should take up a body position of more than 204dG above...

Gas Tension and pH in Middle Ear Effusion

The composition of gases and the gas tension in middle ear effusion in patients with serous otitis media have been investigated. By using a specially designed micro-method, very small amounts of middle ear fluid could be analyzed. The effusion was obtained by puncturing the air cells of the mastoid process. The average value of Po2 was 41 mm Hg; Pco2 was 58 mm Hg, pH 7.24. The possible mechanism for the impaired perfusion of the mucous membranes is discussed as well as some clinical consequences.

A Clinical Method for Determination of Nasal Airway Resistance

Quantitative determinations of nasal airway resistance (Rn) must be made at specified flow rates (V) through the nose. The most reliable method to determine Rn is when V and the pressure drop across the nose (Pn) are recorded simultaneously during spontaneous breathing. A new rhinomanometric method using a flow regulator is described. The values of Rn obtained from this method have been compared to those obtained from simultaneous recordings of Pn and V on the same subjects. Ten healthy persons and a number of rhinitic patients were examined with both methods and very good agreement was found between the results of the two methods. Furthermore, the new method gave information on abnormalities of vascular reactions in nasal diseases when other methods do not. The transducer and recording system were later exchanged for a liquid or mechanical manometer which makes the new method very convenient for clinical use.

Posture and Pressure Within the Internal Jugular Vein

The blood pressure of the bulb of the internal jugular vein was studied in healthy volunteers in different postures. The positions examined were horizontal, dorsal and lateral, and also several elevation degrees of the upper part of the body. The influence of compression of the neck veins upon the venous pressure was also studied. A compression of 25 mm Hg produced the same increase in venous pressure as that caused by a change from the sitting to the recumbent position. The investigations are intended as the basis for further studies of the variations of congestion occurring in different body positions in the mucosa of the nose, the Eustachian tube, and the middle ear.

Posture and Congestion of Nasal Mucosa in Allergic Rhinitis: Objective Measure of Effect of Specific Treatment

In a series of untreated allergic rhinitis head-low position with consequent increase of the hydrostatic pressure of the blood in the nose was followed by congestion of the nasal mucosa. The increase of the nasal airway resistance was measured objectively and was found in 17 of 25 patients, but not in healthy persons. This increase of the airway resistance disappeared with the allergic symptoms after specific desensitization. The underlying pathophysiological mechanism responsible for the mucosal congestion is briefly discussed. Registration of this reaction of the nasal mucosa provides for the first time a simple test for objective evaluation of the effect of specific treatment of allergic rhinitis.

Allergic Rhinitis and Intravascular Aggregation of Blood Cells

It is well known that intravascular aggregation of blood cells occurs in all sorts of tissue trauma including antigen-antibody reaction. Judging from the special architecture of the fine vasculature of the nasal mucosa, sludge of blood should readily occur in certain pathological conditions, such as hay fever. Dextran of low molecular weight, Rheomacrodex®, has proved an effective inhibition of intravascular aggregation. In the present investigation injection of this agent was found to decrease the severity and duration of the reaction of the nasal mucosa to pollen, as measured by the difference in airway resistance. The findings suggest that intravascular aggregation in the vascular network in the nasal mucosa may be a component of importance in allergy and infections and if left untreated it may result in pathological changes of the mucosa, because of anoxic damage to the tissue.

Dscg Eye Drops in Allergic Rhino-Conjunctivitis

Thirty patients with allergic rhinoconjunctivitis were treated with eye drops containing 2% DSCG during the pollen season of 1977. Sixteen patients were treated with active substance and 14 with placebo. The results show a statistically significant difference in favour of the DSCG drops. DSCG in eye drops seems to be a valuable complement to the drugs available today for the treatment of allergic rhinoconjunctivitis.

The Effect of Oral Decongestants in Acute Rhinitis as Related to Variations in Body Position

By means of rhinomanometry the effects of two oral decongestants, d-pseudoephedrine and phenylpropanolamine were compared in acute infectious rhinitis. In a single-blind study involving 20 patients no difference was found between 120 mg d-pseudoephedrine and 100 mg phenylpropanolamine in relieving nasal congestion.In an open study, the effect of 100 mg phenylpropanolamine as related to body position was measured in 14 patients. No difference was found between taking medicine and remaining recumbent as compared with assuming an upright position only.

Therapeutic Mastoidocentesis in Pseudomonas-Mastoiditis

Psendomonas pyocyanea is a malevolent bacteria. Secondary infection of acute otitis with this agent can cause mastoiditis. It is shown that local instillation of colistin is efficacious in the treatment of such cases, and seems to be specially valuable because of the risk of further spread of this inflammation during operation without proper control of the pseudomonas infection. Two cases of acute mastoiditis caused by Ps. pyocyanea were successfully treated with mastoidocentesis, i.e. puncture of the mastoid process and with repeated local deposition of highly concentrated colistin solution. The patients made a rapid recovery and no side effects were noticed during treatment at follow-ups 6 and 12 months later. Mastoidocentesis and deposition of appropriate antibiotics may also be used in other middle ear diseases, and in selected cases it may provide a useful alternative to mastoidectomy.Pseudomonas pyocyanea ist eine gefurchtete Bakterienart. Sekundarinfektion einer akuten Otitis media mit Ps. pyocyane...

Elimination of Bacteria from the Nasopharynx

Eightynine children with acute otitis media were treated with penicillin-V alone or penicillin-V followed by Spiramycin or Trimethoprim-sulfamethoxazole (sequence therapy) in a double blind study. The combination penicillin-V + Trimethoprim-sulfamethoxazole eradicated the strains of Streptococcus pneumoniae and Branhamella catarrhalis. Nevertheless, the frequence of relapses and serous otitis media was not influenced and the investigation does not indicate that sequence therapy is an alternative in favour of penicillin-V treatment alone in primary cases of acute otitis media. In cases of repeated relapses caused by streptococcus pneumoniae, Trimethoprim-sulfamethoxazole may be a useful alternative.