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265 Bacterial sinusitis exacerbating asthma
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BACTERIAL SINUSITIS EXACERBATING ASTHMA. R. Friedman, M.D., M. Ackerman, M.D., E. Wald7M.D. G. Friday, M.D., J. Reilly, M.D., M. Casselbrant M.D. and P. Fireman, M.D. Pittsburgh, PA. Signs, symptoms and x-ray abnormalities of sinusitis are frequent in children with asthma and it is not known whether sinus inflammation is associated with bacterial infection or other mechanisms. Eight asthmatics (ages 5 to 15 with exacerbation of asthma despite years), bronchodilator therapy were studied after maxAll illary sinusitis was confirmed by x-ray. had cough, wheezing, nasal stuffiness, rhinorrhea and were afebrile; 4 had headaches, 2 had Maxillary sinus aspirates were facial pain. obtained and bacterial cultures were positive in 5: B. catarrhalis (2), non-typeable H. influenNose and throat zae (Z), S. pneumoniae (1). cultures did not correlate with sinus cultures. All patients received bronchodilators and 4 of 8 received steroids. All were treated for 14 to 28 days with antibiotics during which 7 of 8 improved clinically including all with positive Asthma diary symptom scores sinus cultures. Pulmonwere kept by 5; all showed improvement. ary function tests improved in 5 of 7 following the antibiotic and asthma therapy including the 4 patients with positive cultures. Sinus x-rays cleared in 3, improved in 3 and were unchanged In summary, in 2 following antibiotic therapy. bacterial sinusitis was documented in 5 of 8 Clinchildren who had exacerbation of asthma. x-ray and pulmonary function imical symptoms, proved after therapy with antibiotics and bronchodilators.
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EFFECT OF DRUGS ON PROVOCATIVE ANTIGEN-INDUCED EUSTACHIAN TUBE OBSTRUCTION (ETO). P. Fireman, M.D., M. Ackerman, M.D., R. Friedman, M.D., W. Doyle, Ph.D., C. Bluestone, M.D. Pittsburgh, PA. The efficacy of beclomethasone, chlorpheniramine and cromolyn sodium in the prevention of ET0 induced by intranasal provocative antigen (ragweed or timothy) challenge was studied in 16 allergic rhinitis (AR) patients who were skin ET0 was measured by test and/or RAST positive. a 9-step pressure swallow tympanogram. Prior to antigen challenge, 11 patients sprayed 50 mcg beclomethasone into each nostril 4 times daily for 4 days, 11 patients took 8 mg chlorpheniramine twice daily for 4 days and 9 patients used 4% cromolyn solution, 2 drops into each nostril 4 times daily. Then, these patients were each challenged with their minimum antigen dose, which ranged from 0.1 mg to 100 mg that had been ET0 was previously determined to provoke ETO. prevented completely or partially in 11 of 21 ears after beclomethasone, 8 of 20 ears after chlorpheniramine and 11 of 17 ears after cromolyn. Drug therapy lessened symptoms of AR in 60% of patients and of these subjects, ET0 was prevented in 7 of 13 ears with beclomethasone, 5 of 14 with chlorpheniramine and 9 of 9 with in whom 10 mg provoked cromolyn. One patient, ET0 prior to drug therapy developed ET0 with Thus, 20 mg after each of the medications. chlorpheniramine and cromolyn beclomethasone, can prevent antigen-induced ETO.
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STUDIES OF EUSTACHIAN TUBE OBSTRUCTION AFTER PROVOCATIVE NASAL CHALLENGES. M. Ackerman, M.D., R. Friedman, M.D.. W. Doyle, Ph.D., C. Bluestone, M.D. and P. Fireman, M.D. Pittsburgh, PA. We have nreviouslv documented eustachian tube obstruction (ETO) as measured by a 9-step pressure swallow tympanogram, after provocative pollen challenges in allergic rhinitis (AR) patients. To determine the antigen dose response relationship required to produce ETO, intranasal insufflations of increasing amounts of pollen (ragweed or timothy) from 0.1 to 100 mg were delivered to 28 patients, ages 20 to 31 years, with allergic rhinitis who were skin test and/or RAST positive to ragweed or timothy. Our results showed 3 ears developed ET0 at 0.1 mg, 1 at 0.5 mg, 4 at lmg, 27 at 10 mg, 15 at 50 mg and 2 at 100 mg. ET0 persisted from 2 to 120 hours. Dose responses and duration of ET0 were compared to patients' serum RAST which ranged from 3 to 36% B/T (median 25.9%). The patients with the highest RAST values (>25.9%) required lower antigen challenges (210 mg) to develop ET0 (p
use facial muscles difSince mouthbreathers ferently from nosebreathers, there may be aberrant facial growth as part of the adaptation to the oral mode of respiration. To evaluate this, 30 allergic mouthbreathers aged 6-12 years were compared with 15 nonallergic nosebreathers of similar age. The mouthbreathers had positive allergy history and skin tests and severe nasal edema, while the controls had none of these. The upper anterior facial height and total anterior facial height were significantly larger in the mouthbreathers. Angular relationships of the sella-nasion, palatal and occlusal planes to the mandibular plane were greater in the mouthbreathers, and their gonial angle was larger. The mouthbreathers' maxilla and mandible were more retrognathic. Palatal height was higher and overjet was greater in the mouthbreathers. Maxillary intermolar width was narrower in the mouthbreathers and was associated with a higher prevalence of posterior crossbite. Overall, mouthbreathers had longer faces with narrower maxillae and retrognathic jaws. These findings support previous claims that nasal airway obstruction is associated with abtiormal facial growth and suggests that aggressive intervention to improve nasal airflow is warranted.
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BACTERIAL SINUSITIS EXACERBATING ASTHMA. R. Friedman, M.D., M. Ackerman, M.D., E. Wald7M.D. G. Friday, M.D., J. Reilly, M.D., M. Casselbrant M.D. and P. Fireman, M.D. Pittsburgh, PA. Signs, symptoms and x-ray abnormalities of sinusitis are frequent in children with asthma and it is not known whether sinus inflammation is associated with bacterial infection or other mechanisms. Eight asthmatics (ages 5 to 15 with exacerbation of asthma despite years), bronchodilator therapy were studied after maxAll illary sinusitis was confirmed by x-ray. had cough, wheezing, nasal stuffiness, rhinorrhea and were afebrile; 4 had headaches, 2 had Maxillary sinus aspirates were facial pain. obtained and bacterial cultures were positive in 5: B. catarrhalis (2), non-typeable H. influenNose and throat zae (Z), S. pneumoniae (1). cultures did not correlate with sinus cultures. All patients received bronchodilators and 4 of 8 received steroids. All were treated for 14 to 28 days with antibiotics during which 7 of 8 improved clinically including all with positive Asthma diary symptom scores sinus cultures. Pulmonwere kept by 5; all showed improvement. ary function tests improved in 5 of 7 following the antibiotic and asthma therapy including the 4 patients with positive cultures. Sinus x-rays cleared in 3, improved in 3 and were unchanged In summary, in 2 following antibiotic therapy. bacterial sinusitis was documented in 5 of 8 Clinchildren who had exacerbation of asthma. x-ray and pulmonary function imical symptoms, proved after therapy with antibiotics and bronchodilators.
267
266
EFFECT OF DRUGS ON PROVOCATIVE ANTIGEN-INDUCED EUSTACHIAN TUBE OBSTRUCTION (ETO). P. Fireman, M.D., M. Ackerman, M.D., R. Friedman, M.D., W. Doyle, Ph.D., C. Bluestone, M.D. Pittsburgh, PA. The efficacy of beclomethasone, chlorpheniramine and cromolyn sodium in the prevention of ET0 induced by intranasal provocative antigen (ragweed or timothy) challenge was studied in 16 allergic rhinitis (AR) patients who were skin ET0 was measured by test and/or RAST positive. a 9-step pressure swallow tympanogram. Prior to antigen challenge, 11 patients sprayed 50 mcg beclomethasone into each nostril 4 times daily for 4 days, 11 patients took 8 mg chlorpheniramine twice daily for 4 days and 9 patients used 4% cromolyn solution, 2 drops into each nostril 4 times daily. Then, these patients were each challenged with their minimum antigen dose, which ranged from 0.1 mg to 100 mg that had been ET0 was previously determined to provoke ETO. prevented completely or partially in 11 of 21 ears after beclomethasone, 8 of 20 ears after chlorpheniramine and 11 of 17 ears after cromolyn. Drug therapy lessened symptoms of AR in 60% of patients and of these subjects, ET0 was prevented in 7 of 13 ears with beclomethasone, 5 of 14 with chlorpheniramine and 9 of 9 with in whom 10 mg provoked cromolyn. One patient, ET0 prior to drug therapy developed ET0 with Thus, 20 mg after each of the medications. chlorpheniramine and cromolyn beclomethasone, can prevent antigen-induced ETO.
266
STUDIES OF EUSTACHIAN TUBE OBSTRUCTION AFTER PROVOCATIVE NASAL CHALLENGES. M. Ackerman, M.D., R. Friedman, M.D.. W. Doyle, Ph.D., C. Bluestone, M.D. and P. Fireman, M.D. Pittsburgh, PA. We have nreviouslv documented eustachian tube obstruction (ETO) as measured by a 9-step pressure swallow tympanogram, after provocative pollen challenges in allergic rhinitis (AR) patients. To determine the antigen dose response relationship required to produce ETO, intranasal insufflations of increasing amounts of pollen (ragweed or timothy) from 0.1 to 100 mg were delivered to 28 patients, ages 20 to 31 years, with allergic rhinitis who were skin test and/or RAST positive to ragweed or timothy. Our results showed 3 ears developed ET0 at 0.1 mg, 1 at 0.5 mg, 4 at lmg, 27 at 10 mg, 15 at 50 mg and 2 at 100 mg. ET0 persisted from 2 to 120 hours. Dose responses and duration of ET0 were compared to patients' serum RAST which ranged from 3 to 36% B/T (median 25.9%). The patients with the highest RAST values (>25.9%) required lower antigen challenges (210 mg) to develop ET0 (p
use facial muscles difSince mouthbreathers ferently from nosebreathers, there may be aberrant facial growth as part of the adaptation to the oral mode of respiration. To evaluate this, 30 allergic mouthbreathers aged 6-12 years were compared with 15 nonallergic nosebreathers of similar age. The mouthbreathers had positive allergy history and skin tests and severe nasal edema, while the controls had none of these. The upper anterior facial height and total anterior facial height were significantly larger in the mouthbreathers. Angular relationships of the sella-nasion, palatal and occlusal planes to the mandibular plane were greater in the mouthbreathers, and their gonial angle was larger. The mouthbreathers' maxilla and mandible were more retrognathic. Palatal height was higher and overjet was greater in the mouthbreathers. Maxillary intermolar width was narrower in the mouthbreathers and was associated with a higher prevalence of posterior crossbite. Overall, mouthbreathers had longer faces with narrower maxillae and retrognathic jaws. These findings support previous claims that nasal airway obstruction is associated with abtiormal facial growth and suggests that aggressive intervention to improve nasal airflow is warranted.
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