Department of Otolaryngology - Head & Neck Surgery, The Ohio State University, Columbus, Ohio, USA.
Laryngoscope. 2024 Mar;134(3):1100-1106. doi: 10.1002/lary.30968. Epub 2023 Aug 17.
Oxymetazoline relieves nasal obstructive symptoms via vasoconstriction, however, the changes in nasal structures and aerodynamics that impact symptoms the most remain unclear.
This prospective, longitudinal, and single blinded cohort study applied Computational Fluid Dynamic (CFD) modeling based on CT scans at baseline and post-oxymetazoline on 13 consecutive patients with chronic nasal obstruction secondary to inferior turbinate hypertrophy from a tertiary medical center. To account for placebo effect, a sham saline spray was administered with subject blindfolded prior to oxymetazoline, with 30 min rest in between. Nasal Obstruction Symptom Evaluation (NOSE) and unilateral Visual Analogue Scale (VAS) scores of nasal obstructions were collected at baseline, after sham, and 30 min after oxymetazoline.
Both VAS and NOSE scores significantly improved from baseline to post-oxymetazoline (NOSE: 62.3 ± 12.4 to 31.5 ± 22.5, p < 0.01; VAS: 5.27 ± 2.63 to 3.85 ± 2.59, p < 0.05), but not significantly from baseline to post-sham. The anatomical effects of oxymetazoline were observed broadly throughout the entire length of the inferior and middle turbinates (p < 0.05). Among many variables that changed significantly post-oxymetazoline, only decreased nasal resistance (spearman r = 0.4, p < 0.05), increased regional flow rates (r = -0.3 to -0.5, p < 0.05) and mucosal cooling heat flux (r = -0.42, p < 0.01) in the inferior but not middle turbinate regions, and nasal valve Wall Shear Stress (WSS r = -0.43, p < 0.05) strongly correlated with symptom improvement.
Oxymetazoline broadly affects the inferior and middle turbinates, however, symptomatic improvement appears to be driven more by global nasal resistance and regional increases in airflow rate, mucosal cooling, and WSS, especially near the head of the inferior turbinate.
3: Well-designed, prospective, single blinded cohort trial. Laryngoscope, 134:1100-1106, 2024.
羟甲唑啉通过血管收缩缓解鼻塞症状，但影响症状最明显的鼻腔结构和空气动力学变化仍不清楚。
本前瞻性、纵向、单盲队列研究应用基于 CT 扫描的计算流体动力学（CFD）模型，对来自三级医疗中心的 13 例因下鼻甲肥大导致慢性鼻塞的连续患者，在基线时和使用羟甲唑啉后进行研究。为了考虑安慰剂效应，在使用羟甲唑啉之前，让患者蒙上眼睛接受假盐水喷雾治疗，并在两者之间休息 30 分钟。在基线、假治疗后和羟甲唑啉后 30 分钟收集鼻腔阻塞症状评估（NOSE）和单侧视觉模拟量表（VAS）评分。
VAS 和 NOSE 评分均从基线显著改善至羟甲唑啉后（NOSE：62.3±12.4 至 31.5±22.5，p<0.01；VAS：5.27±2.63 至 3.85±2.59，p<0.05），但从基线至假治疗后无显著改善。羟甲唑啉的解剖学作用广泛存在于中下鼻甲的整个长度（p<0.05）。在羟甲唑啉后发生显著变化的众多变量中，只有下鼻甲区域的鼻阻力降低（spearman r=0.4，p<0.05）、局部流速增加（r=-0.3 至-0.5，p<0.05）和黏膜冷却热通量（r=-0.42，p<0.01），以及下鼻甲区域的鼻阀壁面剪应力（WSS r=-0.43，p<0.05）与症状改善强烈相关。
羟甲唑啉广泛影响中下鼻甲，但症状改善似乎更多地由整体鼻阻力和局部气流率、黏膜冷却和 WSS 的增加驱动，尤其是在下鼻甲头部附近。
3：精心设计的前瞻性单盲队列研究。喉镜，134：1100-1106，2024。
