Subjective feeling of nasal obstruction and its response to nasal steroids in the elderly

Objectives: This study aims to compare the effectiveness of topical nasal steroids for nasal obstruction symptoms between advanced age patients and young-middle age patients based on acoustic rhinometry values and correlations with mucociliary clearance. Patients and Methods: Our study population consisted of 27 advanced aged patients 15 males, 12 females; mean age 67 years; range, 65 to 76 group 1 and 36 young-middle aged patients 20 males, 16 females; mean age 36.1 years; range, 15 to 49 years group 2 . Patients with a history of allergic rhinitis AR with positive skin prick tests were referred from the Department of Respiratory Medicine. All patients were evaluated with objective and subjective methods before and after using topical nasal steroids for six weeks. We used rhinometric evaluation and saccharin test as objective methods and assessed patients with nasal obstruction symptom evaluation NOSE and visual analog scale VAS as subjective methods. Results: Baseline subjective scores of group 1 were significantly lower than group 2 p0.05 . Baseline total minimum cross-sectional area MCA3 and total volume of nasal cavity VOL3 values of group 1 were significantly higher than group 2 p0.05 . Conclusion: In this study, we have shown that the elderly have reduced awareness of their nasal symptoms of AR. We have demonstrated that topical treatment with nasal steroids was more effective in the young-middle age group subjectively.

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  • Baiardini I, Braido F, Tarantini F, Porcu A, Bonini S, Bousquet PJ, et al. ARIA-suggested drugs for allergic rhinitis: what impact on quality of life? A GA2LEN review. Allergy 2008;63:660-9.
  • Canuel M, Lebel G. Epidemiology of allergic rhinitis in Quebec: from a 2008 population-based survey. Chronic Dis Inj Can 2014;34:163-8.
  • Blaiss MS; Allergic Rhinitis in Schoolchildren Consensus Group. Allergic rhinitis and impairment issues in schoolchildren: a consensus report. Curr Med Res Opin 2004;20:1937-52.
  • Shedden A. Impact of nasal congestion on quality of life and work productivity in allergic rhinitis: findings from a large online survey. Treat Respir Med 2005;4:439-46.
  • Morais-Almeida M, Pite H, Pereira AM, Todo- Bom A, Nunes C, Bousquet J, et al. Prevalence and classification of rhinitis in the elderly: a nationwide survey in Portugal. Allergy 2013;68:1150-7.
  • Slavin RG. Allergic rhinitis: managing the adult spectrum. Allergy Asthma Proc 2006;27:9-11.
  • Baptist AP, Nyenhuis S. Rhinitis in the Elderly. Immunol Allergy Clin North Am 2016;36:343-57.
  • Todo-Bom A, Loureiro C, Almeida MM, Nunes C, Delgado L, Castel-Branco G, et al. Epidemiology of rhinitis in Portugal: evaluation of the intermittent and the persistent types. Allergy 2007;62:1038-43.
  • Khattiyawittayakun L, Chitsuthipakorn W, Kanjanawasee D, Snidvongs K. Effects of double-dose intranasal corticosteroid for allergic rhinitis: a systematic review and meta- analysis. Int Forum Allergy Rhinol 2018 Sep 4. [Epub ahead of print] Seresirikachorn K,
  • Van Neste D. Skin response to histamine dry skin prick test: influence of duration of the skin prick on clinical parameters and on skin blood flow monitoring. J Dermatol Sci 1990;1:435-9.
  • Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg 2004;130:157-63.
  • Khairuddin NK, Salina H, Gendeh BS, Wan Hamizan AK, Lund VJ. Quality of life and recurrence of disease in patients with eosinophilic and non-eosinophilic 1 chronic rhinosinusitis with nasal polyposis. Med J Malaysia 2018;73:1-6.
  • Stanley P, MacWilliam L, Greenstone M, Mackay I, Cole P. Efficacy of a saccharin test for screening to detect abnormal mucociliary clearance. Br J Dis Chest 1984;78:62-5.
  • Kjaergaard T, Cvancarova M, Steinsvåg SK. Nasal congestion index: A measure for nasal obstruction. Laryngoscope 2009;119:1628-32.
  • Karabulut H, Baysal S, Acar B, Babademez MA, Karasen RM. Allergic rhinitis (AR) in geriatric patients. Arch Gerontol Geriatr 2011;53:270-3.
  • Patterson CN. The aging nose: characteristics and correction. Otolaryngol Clin North Am 1980;13:275-88.
  • Bousquet J, Reid J, van Weel C, Baena Cagnani C, Canonica GW, Demoly P, et al. Allergic rhinitis management pocket reference 2008. Allergy 2008;63:990-6.
  • Vignola AM, Scichilone N, Bousquet J, Bonsignore G, Bellia V. Aging and asthma: pathophysiological mechanisms. Allergy 2003;58:165-75.
  • Huss K, Naumann PL, Mason PJ, Nanda JP, Huss RW, Smith CM, et al. Asthma severity, atopic status, allergen exposure and quality of life in elderly persons. Ann Allergy Asthma Immunol 2001;86:524-30.
  • Slavin RG. Allergic rhinitis: managing the adult spectrum. Allergy Asthma Proc 2006;27:9-11.
  • Bellanti JA, Azem M, MacDowell-Carneiro AL, Tutuncuoglu SO, Wallerstedt DB. Possible mechanisms of late-life-onset allergic diseases and asthma in the senior citizen. Allergy Asthma Proc 2000;21:267-70.
  • Dykewicz MS, Fineman S, Nicklas R, Lee R, Blessing-Moore J, Li JT, et al. Joint Task Force Algorithm and Annotations for Diagnosis and Management of Rhinitis. Ann Allergy Asthma Immunol 1998;81:469-73.
  • Grossman J, Gopalan G. Efficacy and safety of mometasone furoate nasal spray in elderly subjects with perennial allergic rhinitis. J Allergy Clin Immunol 2009;123:S271.
  • Lindemann J, Tsakiropoulou E, Konstantinidis I, Lindemann K. Normal aging does not deteriorate nose-related quality of life: assessment with “NOSE” and “SNOT-20” questionnaires. Auris Nasus Larynx 2010;37:303-7.
  • Connolly MJ, Crowley JJ, Charan NB, Nielson CP, Vestal RE. Reduced subjective awareness of bronchoconstriction provoked by methacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale. Thorax 1992;47:410-3.
  • Ho JC, Chan KN, Hu WH, Lam WK, Zheng L, Tipoe GL, et al. The effect of aging on nasal mucociliary clearance, beat frequency, and ultrastructure of respiratory cilia. Am J Respir Crit Care Med 2001;163:983-8.
  • Getchell ML, Chen Y, Ding X, Sparks DL, Getchell TV. Immunohistochemical localization of a cytochrome P-450 isozyme in human nasal mucosa: age-related trends. Ann Otol Rhinol Laryngol 1993;102:368-74.
  • Edelstein DR. Aging of the normal nose in adults. Laryngoscope 1996;106:1-25.
  • Kirtsreesakul V, Somjareonwattana P, Ruttanaphol S. The correlation between nasal symptom and mucociliary clearance in allergic rhinitis. Laryngoscope 2009;119:1458-62.
  • Sforza C, Grandi G, De Menezes M, Tartaglia GM, Ferrario VF. Age- and sex-related changes in the normal human external nose. Forensic Sci Int 2011;204:205.e1-9.