Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4473_Библиотеки_им_академика_М_И_Перельмана
.pdf
12 Physiology andPathophysiology ofSneezing andItching: Mechanisms oftheSymptoms
https://t.me/medicina_free
137
What is the benet of photic sneeze reex?
Photic sneezing reex exists in animals for which
the smell sensation is vital to survive and can be
used to clean the nasal cavity. Animals such as
cats and dogs sneeze largely through their nose,
while the adults sneeze through their mouth. The
reex arc may also be useful to a limited extent in
human beings when it is considered that the nasal
respiration is dominant in the neonatal period.
Babies have no other way to get rid of the annoying little tickle caused by normal mucus. Young
children sometimes have more disgusting ways
of dealing with that sensation, but babies just
sneeze often with the help of photic sneeze reex.
In conclusion, photic sneeze reex, which can
lead the drivers to have accidents following a
sudden exposure to sunlight at the end of a long
tunnel, or can cause a plane crash by inactivating
the masks of jet pilots, can be considered to be an
annoying “holdover” of evolution [51, 52].
Hyden and Arlinger examined whether the
tickling inside the nose prior to photic sneeze in
cases is associated with a recordable local activity or not, and they stated that no reproducible
electrical activity could be recorded [53].
Langer etal. designed a study to study the cortical keystones of photic sneezing, and revealed
that photic sneeze might be the result of superior
sensitivity to visual stimuli in the visual cortex
and of co-activation of somatosensory areas [54].
The ‘photic sneeze reex’ is therefore not a classical reex that occurs only at a brainstem or spinal cord level but, in contrast to many theories,
involves also specic cortical areas.
Sevillano et al. assessed the ocular involvement in the pathophysiology of ACHOO syndrome and stated that a dominant autosomal
inheritance with mild penetrance was demonstrated, with 67% of the studied subjects showing
some degree of prominent corneal nerves [55].
Wand etal. performed a genome-wide association study on photic sneeze reex in the
Chinese population to uncover the underlying
genetic markers in a Chinese population of 3417
individuals, and reproducibly identied both a
replicative rs10427255 on 2q22.3 and a novel
locus of rs1032507 on 3p12.1in various effect
models [56].
There is no recognized management for photic sneeze reex; however, Bobba etal. offered a
practical approach to minimizing the PSR by utilizing the Philtral Pressure Technique [57]. This
involved rm digital pressure applied by the
patient’s index nger transversely to the skin of
the sub-philtral region, directed posterosuperiorly onto the maxilla.
12.3.3 Physical Stimulants
oftheTrigeminal Nerve
Physical or mechanical stimulants in the innervation zone of the trigeminal nerve may trigger
sneezing reex. Some of these stimulants include
pulling hair, tearing off eyebrows, or orbital
injections administered frequently during ocular
surgery under local anesthesia [58, 59].
12.3.4 Central Nervous System
Pathologies
The lateral medullary syndrome (LMS), or
Wallenberg’s syndrome, often results from occlusion or dissection of the vertebral artery. Vertebral
artery dissection has been blamed on many different life events, such as sneezing [60].
Paroxysmal sneezing at the onset of LMS is usually interpreted as a cause, since a violent sneeze
could potentially result in a vertebral artery dissection causing LMS. Due to inactivation of
sneezing center in LMS, sneezing cannot occur
although the sensation of sneezing is present
[61–63]. Localization of the human sneeze center
was described in a patient with right LMS, initially presenting with violent sneezes and followed by brief loss of the sneeze reex with
eventual recovery [64].
Sneezing may commonly accompany temporal
lobe and grand mal epilepsy. It may be observed
during the aura prior to an epileptic seizure or it
may develop as an autonomic reexive response
during the seizure as well [65, 66]. Beverwyck
commented upon the analogy of the epileptic seizure with hiccups and sneezing and noted that the
physiological and anatomical basis for such a
138
https://t.me/medicina_free
M. Songu and T. M. Onerci
hypothesis remained to be unexplained [67]. In the
mid-nineteenth century, Jackson used the term
epilepsy “as the name for occasional, sudden,
excessive, rapid and local discharges of grey matter” [68]. Jackson further commented upon the
healthy and yet random discharge and concluded
that “a sneeze is a sort of healthy epilepsy.”
12.3.5 Psychogenic (Intractable)
Sneezing
Intractable sneezing, rst described by Shilkrel in
1949, is a rare pathological condition that has
been detected in more than 50 cases in literature
up to present [69–71]. Kanner referred to a
13-year-old girl who had incessant sneezing for
over 2months and whose progress was followed
by a daily newspaper communique [72]. A diagnosis of hysteria was made and subsequent psychotherapy eliminated the sneezing. Yater
referred to similar explosive repetitious episodes
and considered them to be a sort of imitation of
the true act of sneezing [73].
Psychogenic intractable sneezing occurs
mainly in adolescent girls for which a cause may
not be found. Organic lesions or causes should
always be carefully excluded [71]. Patients are
usually refractory to various medications and
have an otherwise unremarkable extensive
workup [74, 75]. Inspiratory phase is quite short
and the amount of nasal mucosal secretion
expelled very low. Eyes may remain open during
sneezing. It usually develops due to psychogenic
factors and is refractory to medical treatment
[76]. Approximately 25% of the reported cases
resolve without any form of treatment, except
counseling of the patient and family [71].
Psychogenic sneezing responds well to psychological measures such as psychotherapy, biofeedback, relaxation exercises, supportive
psychotherapy (i.e., explanation of nature of illness, suggestion to overcome symptoms), and
behavior therapy (reward when there is symptom
reduction, aversion therapy, hypnosis, and relaxation). The role of anxiolytic drugs lies in reducing underlying anxiety and making the patient
more amenable to psychotherapy [77].
Medically unexplained physical symptoms
usually carry diagnostic difculties for the physicians [71]. The most important factors that
increase these diagnostic difculties are the possibility of an underlying physical illness and the
uncertainty encountered as to how far the investigations for physical causes should go. It was
determined that in some somatization patients,
organic pathologies were revealed during follow up. Paradoxically, it is known that repetitive and
advanced investigations for any organic etiology
in conversion disorder may increase the anxiety
and doubts in the family and thus prolong the
duration of the illness. In conclusion, one must
not assume that every case of paroxysmal sneezing is of psychogenic origin. Due to the nature of
such a disorder, these patients should undergo
medical evaluations before a psychogenic cause
is even considered.
12.3.6 Snatiation* Reex
An uncontrollable sneezing attack developing as
a result of stretching of the stomach following an
excessive nutrition is rst described by Teebi
etal. as a reex with autosomal dominant inheritance pattern [78]. The mechanism of development is unknown. Snatiation* is a combination of
the words “sneeze” and “satiation.” Snatiation
also stands for “Sneezing Noncontrollably At a
Tune of Indulgence of the Appetite-a Trait
Inherited and Ordained to be Named” [79]. This
abbreviation was supposed to facilitate the future
cases to be evaluated in the same class. Recently,
two patients have been reported, who state that
several members of their family sneeze on a full
stomach [80]. This report doubles the number of
families with snatiation reex in the medical
literature.
12.3.7 Sexual Ideation or Orgasm
An association between sexual excitement and
sneezing was rst described in the nineteenth
century [49, 81] followed by a young German
otolaryngologist who developed a theory of
12 Physiology andPathophysiology ofSneezing andItching: Mechanisms oftheSymptoms
https://t.me/medicina_free
139
“nasal reex neurosis” due to the nding of erectile tissue in both nasal mucous membranes and
genital areas [82, 83]. The rst report of this phenomenon in the literature describes a 69-year-old
man who complains of severe sneezing immediately following orgasm, with no associated psychiatric morbidity [84]. Stromberg in 1975 and
Korpas in 1979 described male orgasm as a precipitant for the sneeze reex [85, 86]. Bhutta
described a middle-aged man with uncontrollable
ts of sneezing with sexual thought. The patient
had no other rhinological symptoms and psychiatric morbidity [87]. Bhutta et al. performed a
search of Internet “chat rooms” and found 17
people of both sexes reporting sneezing immediately upon sexual ideation and three people after
orgasm. Although Internet reports do not give an
accurate incidence, their ndings do suggest that
it is much more common than recognized. One
year later, Bhutta and Maxwell revealed their
experience on internet-based media or by spontaneous contact with the authors that sneezing
induced by sexual ideation reported in additional
146 cases [80].
12.4 Diagnosis, Dierential
Diagnosis, andManagement
ofRhinitis
The evaluation of a patient with sneezing should
be individualized according to the duration and
severity of the symptom. Laboratory tests are not
necessary in the majority of patients, since the
diagnosis is usually obvious from the history and
physical examination.
It should be remembered that the history of
the patient is the most important and determining
stage for the diagnosis [88]. The patient should
be asked what his/her main complaint is; the
duration and frequency of the symptoms like
nasal discharge, stufness, and pruritus if present; whether the nasal discharge or stufness is
present on one side or both, perennial or seasonal; whether he/she has allergic complaints,
past trauma, past nasal surgery history, known
diseases, and drugs used; and also how these
symptoms effect the quality of life. In female
patients it is also important to ask whether she is
pregnant or on oral contraceptives [36]. One of
the most common signs of allergic rhinitis in
children is a horizontal creasing over the nasal
tip. This physical examination sign develops as a
result of habitual rubbing, which is also called
allergic salute, after a duration of at least 2years,
a repeated action in order to relieve pruritus and
improve respiration. This habit may turn into
facial grimacing in adulthood for social reasons.
Allergic shiner, on the other hand, is permanent
pigmentation on the skin of lower eyelid which
present as dark circles at the beginning stage. It
develops due to subcutaneous hemosiderin
through a capillary leak during periorbital venous
stasis as a result of nasal mucosal congestion.
Dennie–Morgan folds are short semilunar lines
or folds found below the inferior eyelid. These
lines develop due to venous blood retention cause
by continuous spasm of Müller’s muscle under
the inferior eyelid. Silky long eyelashes are
another outstanding concomitant sign of allergy.
Clinical examination including anterior rhinoscopy and nasal endoscopy provides large information about pathologies related to septum and
lateral nasal wall. Allergy is prediagnosed with
medical history and physical examination. If the
patient has a medical history and complaints that
are compatible with allergy, in vivo (prick test,
SET, scratch test) and/or invitro (serum-specic
IgE) allergy tests should be performed [89]. The
skin prick test is the most common epidermal
test. A positive allergen skin test that is compatible with the medical history and ndings of physical examination should be assumed to be
signicant [90]. RAST (radioallergosorbent test)
and ELISA (enzyme-linked immunosorbent
assay) tests measure the amount of allergenspecic IgE antibodies. Since there is no risk of
systemic reactions during the application of these
tests, they can safely be performed on pregnant
women, on patients with a past history of systemic reaction, during measuring the sensitivity
to antigens with a high risk of systemic reaction,
on patients with skin diseases, on people who use
drugs that may affect the prick skin test results,
and in medicolegal cases where objective data are
needed and also on children. The changes that
140
https://t.me/medicina_free
M. Songu and T. M. Onerci
develop due to gradually increasing doses of the
allergen are followed by nasal provocation test.
This test is performed when objective data are
needed for occupational rhinitis, and it is rather
used for scientic studies. Nasal cytology is not a
diagnostic method performed for routine clinical
practice and considered as an evaluation that
does not provide a sufcient support alone [91].
The use of acoustic rhinometry and rhinomanometry, which are the most common objective nasal
airway tests, is conned because they have high
costs and is time demanding in terms of application and interpretation [92]. Mucociliary function
may be evaluated for differential diagnosis in
patients with rhinitis [93]. Radiological examination is not necessary in a patient prediagnosed
with rhinitis as long as an additional pathology is
not suspected.
The treatment of persistent or recurring sneezing should be directed at the cause whenever possible. The best treatment in patients with allergic
rhinitis is to avoid the allergen [94]. Medical
treatment or when needed, even immunotherapy
when needed, is used in patients who do not benet from avoidance or environmental control
[95–98]. Some patients may benet from adjunctive surgical treatment. The management of common cold and inuenza is symptomatic.
Decongestants, antipyretics, bed rest, and
increased uid intake are recommended.
Systemic antibiotics are preferred in patients who
develop bacterial infections secondary to a viral
infection while agent-specic antibiotic treatment is applied in those who develop rhinitis secondary to specic bacteria. It is vital to diagnose
the patient and initiate the treatment immediately,
particularly in fulminant fungal infections. The
initial stage in the treatment of the patients with
NARES is avoiding the irritant environmental
conditions. Medical treatment is considered in
case the initial stage fails to succeed. The success
of steroids in early phases decreases in long-term
administrations due to decreased steroid receptors on eosinophils. Oral and topical decongestants may be used adjunctive to steroid therapy.
Capsaicin, a substance isolated from chili pepper
extract, has an initial stimulating effect on C
receptors which turns into an inhibiting effect
following repetitive applications. Antihistamines
are of no use and treatment of vasomotor rhinitis
is palliative. Oral and topical decongestants can
be applied. Topical corticosteroids are not always
benecial. Ipratropium bromide, which prevents
the secretions from serous and seromucous
glands inhibiting the cholinergic system, may be
effective. Antihistamines are of no use. In the
treatment of gestational rhinitis, medication
should denitely be avoided for the rst 10weeks,
and the treatment should denitely be applied
with obstetric advice in the following periods.
Isotonic saline sprays may be useful for pregnant
women due to their humidifying and mucosal
cleaning effects. The rst line medical treatment
for allergic rhinitis in pregnant women is cromolyn sodium, a mast cell stabilizer. Beclomethasone
and triamcinolone are the topical steroids of
choice for those who do not benet from cromolyn sodium. The safest antihistamine during
pregnancy is chlorpheniramine and the safest oral
decongestant is pseudoephedrine. In the management of rebound rhinitis, the inducing drug
should be discontinued and oral or parenteral
corticosteroids should be administered in order to
relieve the patient’s complaints, and the treatment should be supported with topical nasal corticosteroids. Surgery may be necessary if
irreversible changes have developed in the inferior conchae. The purpose of the treatment in
geriatric rhinitis should be to provide sufcient
intracellular moisture. For this purpose, it is
appropriate to humidify the nasal mucosa with
solutions including a combination of isotonic
solution and glycerine and to add guaifenesin to
treatment which stimulates the submucosal
glands. Isotonic solutions can be combined with
glycerine for the initial management of atrophic
rhinitis. Other solutions can be antibiotherapy,
estrogen support, vitamins A and D administration, iron support, or corticosteroid administration. It has also been recommended to practice
surgical closure of one or both nostrils for a
period of 1year, or surgical procedures to narrow
the nasal cavity have been recommended.
Avoiding irritant substances should be the initial
approach for the management of occupational or
irritant-induced rhinitis (Table12.2).
12 Physiology andPathophysiology ofSneezing andItching: Mechanisms oftheSymptoms
https://t.me/medicina_free
Table 12.2 Differential diagnosis of rhinitis in terms of history and laboratory tests
Feature Allergic rhinitis Infectious rhinitis NARES Vasomotor rhinitis
Onset of symptoms Seasonal/perennial Seasonal Perennial Perennial
Symptoms Sneezing Sneezing Sneezing Sneezing
Nasal stufness Nasal stufness Nasal stufness Nasal stufness
Nasal pruritus Nasal discharge Nasal discharge Nasal discharge
Nasal discharge Fever Postnasal drip
Postnasal drip Myalgia
Triggering allergen Ye s No No No
Triggering irritant Yes No Ye s Yes
Allergy tests Positive Negative Negative Negative
Nasal cytology Eosinophilia Neutrophilia Eosinophilia Rare eosinophilia
141
12.5 Complications ofSneeze
Reex
Since the symptoms of majority of upper respiratory tract infections include cough and sneezing,
numerous particles disperse into the air during
the course of these diseases. The most important
complication of sneezing that affects public
health is spread of droplet infections, tuberculosis in particular. The incidence of tuberculosis,
which was taken under control through the
improvement of efcient treatments in the second
half of the twentieth century, began to increase
again due to certain factors including the outburst
of HIV infection, the decrease in the importance
given to disease control, and poverty [99, 100].
Gwaltmey et al. have determined that the
intranasal pressure increases up to 176 mmHg
during sneezing with the mouth and the nostrils
closed [101]. Complications pertaining to this
high pressure have been reported in literature.
These complications include acute aortic dissection, cerebral venous thrombosis, loss of hearing
due to fracture footplate, abortus, orbital emphysema, pneumocephalus, acute wide-angle glaucoma, pneumatocele of the lacrimal sac, intimal
tear of the arteriovenous stula, retinal hemorrhage, and costal fracture reported in a patient
with osteoporosis [102–109].
12.6 Conclusion
Sneezing is a phenomenon that is common to all
humans and is widespread in the animal kingdom
as well. It may play an important role in maintain-
ing health in ways that we do not currently understand. Sneezing, which cannot consciously be
controlled, is a protective reex for the body during
which facial, pectoral, and abdominal muscles
function concordantly maintaining the respiration.
It is rarely a sign of serious illness or impending
disaster as feared by previous generations. On the
other hand, it can be remarkably annoying. A thorough knowledge of this reex can be a valuable aid
in the diagnosis of other concomitant diseases.
Conict of Interest The author has no nancial relationship with a commercial entity that has an interest in the
subject of this manuscript.
References
1. Songu M, Cingi C.Sneeze reex: facts and ction.
Ther Adv Respir Dis. 2009;3:131–41.
2. Aristotle. Problems, Book XXXIII (trans: Rackham
H, Hett WS). Cambridge: Harvard University Press;
1994.
3. Disraeli I. Curiosities of literature. Cambridge:
Riverside Press; 1864.
4. Prioreschi P. A history of medicine, Roman medicine, vol. III.Omaha: Horatius Press; 1998.
5. Ovesen L.A regular contribution from Lars Ovesen,
which we hope will help the busy scientist in keeping up with the literature ne arts. Eur J Cancer Prev.
2003;12:239–40.
6. Knowlson ST. The origins of popular superstitions
and customs. Forgotten Books. London: T. Werner
Laruier Clifford’s Inn; 1910.
7. Klimek L, Riechelmann H, Saloga J, et al.
Anatomie, Physiologie und Immunologie der
Nasenschleimhaut, spezische und unspezische
Abwehrmechanismen. In: Klimek L, Riechelmann
H, Saloga J, Mann W, Knop J, editors. Allergologie
und Umweltmedizin. Stuttgart-New York:
Schattauer; 1997.
142
https://t.me/medicina_free
M. Songu and T. M. Onerci
8. Kovacs I, Ludany A, Koszegi T, et al. Substance
P released from sensory nerve endings inuences
tear secretion and goblet cell function in the rat.
Neuropeptides. 2005;39:395–402.
9. Nishino T. Physiological and pathophysiological
implications of upper airway reexes in humans. Jpn
J Physiol. 2000;50:3–14.
10. Wallois F, Macron JM, Jounieaux V, etal. Trigeminal
afferences implied in the triggering or inhibition of
sneezing in cats. Neurosci Lett. 1991;122:145–7.
11. Widdicombe JG. Nasal pathophysiology. Respir
Med. 1990;84(Suppl A):3–9.
12. Torebjork HE, Hallin RG. Perceptual changes
accompanying controlled preferential blocking of A
and C bre responses in intact human skin nerves.
Exp Brain Res. 1973;16:321–32.
13. Ader R, Cohen N, Felten
D.Psychoneuroimmunology: interactions between
the nervous system and the immune system. Lancet.
1995;345:99–103.
14. Hsieh JC, Hagermark O, Stahle-Backdahl M, etal.
Urge to scratch represented in the human cerebral
cortex during itch. J Neurophysiol. 1994;72:3004–8.
15. Pfaar O, Raap U, Holz M, etal. Pathophysiology of
itching and sneezing in allergic rhinitis. Swiss Med
Wkly. 2009;139(3–4):35–40.
16. Schmelz M, Schmidt R, Bickel A, et al. Specic
C-receptors for itch in human skin. J Neurosci.
1997;17:8003–8.
17. Suranyi L. Localization of the sneeze center.
Neurology. 2001;57:161.
18. Hummel T, Doty RL, Yousem DM.Functional MRI
of intranasal chemosensory trigeminal activation.
Chem Senses. 2005;30(Suppl 1):i205–6.
19. Sarin S, Undem B, Sanico A, etal. The role of the
nervous system in rhinitis. J Allergy Clin Immunol.
2006;118:999–1016.
20. Batsel HL, Lines AJ.Neural mechanisms of sneeze.
Am J Phys. 1975;229:770–6.
21. Setzen S, Platt M.The dangers of sneezing: a review
of injuries. Am J Rhinol Allergy. 2019;33:331–7.
22. Singh NK, Kumar N, Singh AK. Physiology of
disease transmission of respiratory tract infection:
a narrative review. Infect Disord Drug Targets.
2021;21(6):e170721188930.
23. Bousquet J, van Cauwenberge P, Khaltaev N, The
ARIA Workshop Group, World Health Organization.
Allergic rhinitis and its impact on asthma. J Allergy
Clin Immunol. 2001;108(Suppl):147–334.
24. Cingi C, Topuz B, Songu M, et al. Prevalence of
allergic rhinitis among the adult population in
Turkey. Acta Otolaryngol. 2010b;130:600–6.
25. Ozdoganoglu T, Songu M. The burden of allergic rhinitis and asthma. Ther Adv Respir Dis.
2012;6:11–23.
26. Ozdoganoglu T, Songu M, Inancli HM. Quality
of life in allergic rhinitis. Ther Adv Respir Dis.
2012;6:25–39.
27. Kim D, Baraniuk JN. Neural aspects of allergic
rhinitis. Curr Opin Otolaryngol Head Neck Surg.
2007;15:268–73.
28. Klimek L, Schäfer D.Wirkung von Substanz-P in
29. Mosimann BL, White MV, Hohman RJ, et al.
30. Levi-Montalcini R.The nerve growth factor 35 years
31. Raap U, Fokkens W, Bruder M, etal. Modulation of
32. Dykewicz MS, Fineman S, Skoner DP, et al.
33. Fairbanks DNF, Kaliner M. Nonallergic rhini-
34. Stevens HE. Allergic and inammatory aspects
35. King HC, Mabry R.A practical guide to the manage-
36. Incaudo GA. Diagnosis and treatment of allergic
37. Cingi C, Ozdoganoglu T, Songu M. Nasal obstruc-
38. Imamura T, Kambara T. Substance P as a potent
39. Kira S, Nogami Y, Taketa K, etal. Size-selective
40. Kitajiri M, Kubo N, Ikeda H, etal. Effects of topical
41. Geppetti P, Fusco BM, Marabini S, etal. Secretion,
42. Canning BJ.Neurology of allergic inammation and
43. Collie WR, Pagon RA, Hall JG, et al. ACHOO
44. Sedan J. Photosternutatory reex. Rev
45. Morris HH 3rd. ACHOO syndrome: prevalence and
der Nasenschleimhaut. Allergologie. 1996;19:524.
Substance P, calcitonin gene-related peptide, and
vasoactive intestinal peptide increase in nasal secretions after allergen challenge in atopic patients. J
Allergy Clin Immunol. 1993;92:95–104.
later. Science. 1987;237:1154–62.
neurotrophin and neurotrophin receptor expression
in nasal mucosa after nasal allergen provocation in
allergic rhinitis. Allergy. 2008;63:468–75.
Diagnosis and management of rhinitis: complete
guidelines of the joint task force on the parameters
in allergy, asthma and immunology. Ann Allergy
Asthma Immunol. 1998;81:478–518.
tis and infection. In: Cummings CW, Fredrickson
JM, Harker LA, Krause CJ, et al., editors.
Otolaryngology– head and neck surgery. St. Louis:
Mosby Year Book; 1998.
of chronic rhinosinusitis. J Otolaryngol.
1991;20:395–9.
ment of nasal and sinus disorders. 1st ed. NewYork:
Thieme; 1993.
rhinitis and sinusitis during pregnancy and lactation.
Clin Rev Allergy Immunol. 2004;27:159–77.
tion as a drug side effect. Ther Adv Respir Dis.
2011;5:175–82.
stimulator of sneeze responses in experimental
allergic rhinitis of guinea pigs. Agents Actions.
1992;37:245–9.
sampling of oil mist in air and subjective symptoms among machine workers. Ind Health.
1997;35:394–8.
capsaicin on autonomic nerves in experimentallyinduced nasal hypersensitivity. An immunocytochemical study. Acta Otolaryngol Suppl. 1993;500:88–91.
pain and sneezing induced by the application of capsaicin to the nasal mucosa in man. Br J Pharmacol.
1988;93:509–14.
rhinitis. Curr Allergy Asthma Rep. 2002;2:210–5.
syndrome (autosomal dominant compelling helioophthalmic outburst syndrome). Birth Defects Orig
Artic Ser. 1978;14:361–3.
Otoneuroophthalmol. 1954;26:123–6.
inheritance. Cleve Clin J Med. 1987;54:431–3.
12 Physiology andPathophysiology ofSneezing andItching: Mechanisms oftheSymptoms
https://t.me/medicina_free
143
46. Everett HC.Sneezing in response to light. Neurology.
1964;14:483–90.
47. Beckman L, Nordenson I. Individual differences
with respect to the sneezing reex: an inherited physiological trait in man? Hum Hered. 1983;33:390–1.
48. Eckhardt LB, McLean JM, Goodell H.The genesis
of pain from the eye. Assoc Res Nerv Ment Dis Proc.
1943;23:209–17.
49. Watson WS.Diseases of the nose and its accessory
cavities. London: Lewis; 1875.
50. Brubaker AP. The physiology of sneezing. JAMA.
1919;73:585–7.
51. Benbow EW. Practical hazards of photic sneezing.
Br J Ophthal. 1991;75:447.
52. Breitenbach RA, Swisher PK, Kim MK, etal. The
photic sneeze reex as a risk factor to combat pilots.
Mil Med. 1993;158:806–9.
53. Hydén D, Arlinger S. On light-induced sneezing.
Eye (Lond). 2009;23:2112–4.
54. Langer N, Beeli G, Jäncke L.When the sun prickles
your nose: an EEG study identifying neural bases of
photic sneezing. PLoS One. 2010;5:e9208.
55. Sevillano C, Parata-Fernández A, RodriguezLopez V, etal. A curious fact: photic sneeze reex.
Autosomical dominant compelling helio- ophthalmic
outburst syndrome. Arch Soc Esp Oftalmol.
2016;91:305–9.
56. Wang M, Sun X, Shi Y, Song X, Mi H. A genomewide association study on photic sneeze reex in the
Chinese population. Sci Rep. 2019;9:4993.
57. Bobba S, Spencer SKR, Fox OJK, etal. Management
of the photic sneeze reex utilising the philtral pressure technique. Eye (Lond). 2019;33:1186–7.
58. Sekizawa SI, Ishikawa T, Sant’Ambrogio
G. Asymmetry in reex responses of nasal muscles in anesthetized guinea pigs. J Appl Physiol.
1998;85:123–8.
59. Wallois F, Bodineau L, Macron JM, et al. Role of
respiratory and non-respiratory neurones in the
region of the NTS in the elaboration of the sneeze
reex in cat. Brain Res. 1997;768:71–85.
60. Schievink WI. Spontaneous dissection of the
carotid and vertebral arteries. N Engl J Med.
2001;344:898–906.
61. Bernat JL, Suranyi L.Loss of ability to sneeze in lateral medullary syndrome. Neurology. 2000;55:604.
62. Hersch M.Loss of ability to sneeze in lateral medullary syndrome. Neurology. 2000;54:520–1.
63. Martin RA, Handel SF, Aldama AE. Inability to
sneeze as a manifestation of medullary neoplasm.
Neurology. 1991;41:1675–6.
64. Seijo-Martinez M, Varela-Freijanes A, Grandes J,
etal. Sneeze related area in the medulla: localization of the human sneeze center? J Neurol Neurosurg
Psychiatry. 2006;77:559–61.
65. Peneld W, Jasper H. Epilepsy and the functional
anatomy of the human brain. Boston: Little, Brown
& Company; 1954.
66. Peneld W, Kristiansen K.Epileptic seizure patterns:
a study of the localizing value of initial phenomena
in focal cortical seizures. Springeld: Charles C
Thomas; 1951.
67. Temkin O.The falling sickness: a history of epilepsy
from the Greeks to the beginnings of modern neurology. Baltimore: Johns Hopkins Press; 1945.
68. Jackson JH.On the scientic and empirical investigation of epilepsies. In: Taylor J, editor. Selected writings of John Hughlings Jackson, vol. 1. NewYork:
Basic Books; 1958.
69. Bhatia MS, Khandpal M, Srivastava S, et al.
Intractable psychogenic sneezing: two case reports.
Indian Pediatr. 2004;41:503–8.
70. Shilkrel HH. Psychogenic sneezing and yawning.
Psychosom Med. 1949;11:127–8.
71. Sulemanji MN, Kanbur NO, Derman O, et al.
Intractable sneezing: is it always psychogenic? Turk
J Pediatr. 2011;53(2):225–8.
72. Kanner L. Child psychiatry. 3rd ed. Springeld:
Charles C.Thomas; 1957.
73. Yater WM, Barton WM. Symptom diagnosis:
regional and general. 4th ed. NewYork: D.AppletonCentury Company; 1942.
74. Bergman GE.Psychogenic intractable sneezing in
children. J Pediatr. 1984;105:496–8.
75. Lin TJ, Maccia CA, Turnier CG. Psychogenic
intractable sneezing: case reports and a review of
treatment options. Ann Allergy Asthma Immunol.
2003;91:575–8.
76. Gopalan P, Browning ST. Intractable paroxysmal
sneezing. J Laryngol Otol. 2002;116:958–9.
77. Guner SN, Gokcen C, Gokturk B, etal. Haloperidol:
a possible medication for the treatment of exacerbation of intractable psychogenic sneezing. Int J
Pediatr Otorhinolaryngol. 2010;74(10):1196–8.
78. Teebi AS, Al-Saleh QA.Autosomal dominant sneezing disorder provoked by fullness of stomach (letter). J Med Genet. 1989;26:539–40.
79. Hall JG.The snatiation reex (letter). J Med Genet.
1990;27:275–8.
80. Bhutta MF, Maxwell H. Further cases of unusual
triggers of sneezing. J R Soc Med. 2009;102:49.
81. Mackenzie JN.Irritation of the sexual apparatus as
an etiological factor in the production of nasal disease. Am J Med Sci. 1884;87:360–5.
82. Jones E. The life and work of Sigmund Freud.
London: Penguin Books; 1974.
83. Young AR.Freud’s friend Fliess. J Laryngol Otol.
2002;116:992–5.
84. Anonymous. Paroxysmal sneeze following orgasm.
JAMA. 1972;219:1350–1.
85. Korpas J, Tomori Z. Cough and other respiratory
reexes. In: Bollinger CT, editor. Progress in respiratory research, vol. 23. Basel: Karger; 1979.
86. Stromberg BV. Sneezing: its physiology and management. Eye Ear Nose Throat Mon. 1975;54:49–53.
87. Bhutta MF, Maxwell H.Sneezing induced by sexual
ideation or orgasm: an under-reported phenomenon.
J R Soc Med. 2008;101:587–91.
88. Kramer MF.Diagnosis of persistent rhinitis. MMW
Fortschr Med. 2006;148:37–9.
144
https://t.me/medicina_free
M. Songu and T. M. Onerci
89. Settipane GA, Klein DE. Non-allergic rhinitis:
demography of eosinophils in nasal smears, blood
eosinophil counts and IgE levels. N Engl Reg
Allergy Proc. 1985;6:363–6.
90. Skoner DP. Allergic rhinitis: denition, epidemiology, pathophysiology, detection, and diagnosis. J
Allergy Clin Immunol. 2001;108:2–8.
91. Scadding GK. Non-allergic rhinitis: diagnosis and
management. Curr Opin Allergy Clin Immunol.
2001;1:15–20.
92. Galen BA. Differential diagnosis: rhinitis.
Lippincotts Prim Care Pract. 1997;1(2):129–41.
93. Shaari J, Palmer JN, Chiu AG, etal. Regional analysis of sinonasal ciliary beat frequency. Am J Rhinol.
2006;20:150–4.
94. Cingi C, Unlu HH, Songu M, etal. Seawater gel in
allergic rhinitis: entrapment effect and mucociliary
clearance compared with saline. Ther Adv Respir
Dis. 2010c;4:13–8.
95. Bousquet J, Bachert C, Canonica GW, ACCEPT-1
study group, etal. Efcacy of desloratadine in intermittent allergic rhinitis: a GA(2)LEN study. Allergy.
2009;64:1516–23.
96. Bousquet J, Bachert C, Canonica GW, ACCEPT-2
Study Group, etal. Efcacy of desloratadine in persistent allergic rhinitis– a GA2LEN study. Int Arch
Allergy Immunol. 2010;153:395–402.
97. Cingi C, Cakli H, Yaz A, et al. Phototherapy for
allergic rhinitis: a prospective, randomized, singleblind, placebo-controlled study. Ther Adv Respir
Dis. 2010a;4:209–13.
98. Gunhan K, Unlu H, Yuceturk AV, etal. Intranasal
steroids or radiofrequency turbinoplasty in persistent allergic rhinitis: effects on quality of life and
objective parameters. Eur Arch Otorhinolaryngol.
2011;268:845–50.
99. Adler JJ, Rose DN. Transmission and pathogenesis of tuberculosis. In: Rom WN, Garay SM, editors. Tuberculosis. New York: Little, Brown and
Company; 1996.
100. Centers for Disease Control and prevention.
Guidelines for preventing the transmission of
Mycobacterium tuberculosis in health-care facilities.
MMWR. 1994;43:1–132.
101. Gwaltney JM Jr, Hendley JO, Phillips CD, et al.
Nose blowing propels nasal uid into the paranasal
sinuses. Clin Infect Dis. 2000;30:387–91.
102. Baydin A, Nural MS, Guven H, etal. Acute aortic
dissection provoked by sneeze: a case report. Emerg
Med J. 2005;22:756–7.
103. Birkent H, Durmaz A, Hidir Y, etal. Sneezing-related
orbital emphysema and pneumocephalus treated
with transnasal endoscopic surgery. J Otolaryngol
Head Neck Surg. 2008;37:E167–9.
104. Fonseca AC, Ferreira JJ, Albuquerque L, et al.
Sneeze as a precipitating factor of cerebral venous
thrombosis. Eur J Neurol. 2007;14:7–8.
105. Gonzalez F. Orbital emphysema after sneezing.
Ophthal Plast Reconstr Surg. 2005;21:309–11.
106. Gupta A, Dogra PM, Singh B, etal. Arteriovenous
stula intimal tear: think before you sneeze. Ther
Apher Dial. 2010;14:124.
107. Rochels R, Bleier R, Nover A. Compression
pneumatocele of the lacrimal sac. Klin Monatsbl
Augenheilk. 1989;195:174–6.
108. Sharir M, Huntington AC, Nardin GF, etal. Sneezing
as a cause of acute angle-closure glaucoma. Ann
Ophthalmol. 1992;24:214–5.
109. Whitehead E. Sudden sensorineural hearing loss
with fracture of the stapes footplate following sneezing and parturition. Clin Otolaryngol Allied Sci.
1999;24:462–4.
The Dry Nose
https://t.me/medicina_free
RainerK.Weber, TanjaHildenbrand,
DetlefBrehmer, andJochenA.Werner
13
Core Messages
• An unequivocal denition of the dry nose
(DN) is not available. Symptoms range from
the purely subjective sensation of a rather dry
nose to visible crusting of the (inner) nose
(nasal mucosa), and a wide range of combinations are met with. Relevant diseases are
termed rhinitis sicca anterior, primary and secondary rhinitis atrophicans, rhinitis atrophicans with foetor (ozaena) and empty nose
syndrome. The diagnosis is based mainly on
the patient’s history, inspection of the nose,
endoscopy of the nasal cavity, sinuses and
nasopharynx, with CT, allergy testing and
R. K. Weber (*) · J. A. Werner
Department of Otorhinolaryngology, Head and Neck
Surgery, Rhinology Center Marburg, University
Hospital Marburg UKGM, Marburg, Germany
e-mail: weber@uk-gm.de; jochen.werner@uk-gm.de
T. Hildenbrand
Department of Otorhinolaryngology/ENT
Department, University Hospital Freiburg,
Freiburg, Germany
e-mail: tanja.hildenbrand@uniklinik-freiburg.de
D. Brehmer
Private ENT Clinic Goettingen, Faculty of Health/
School of Medicine, University Witten/Herdecke,
Goettingen, Germany
e-mail: d.brehmer@hno-praxis-goettingen.de
microbiological swabs being performed where
indicated.
• Treatment consists of the elimination of predisposing factors, moistening, removal of
crusts, avoidance of injurious factors, care of
the mucosa, treatment of infections and, where
applicable, correction of overlarge air space.
13.1 Symptoms
One of the chief functions of the nose is to warm
and moisten the inspired air, while another is to
recover the water in the expired air [1].
The nature of the in- and outow of the air
within the nasal cavity is of decisive importance
for this air-conditioning feature. In this context,
optimal distribution of the inspired air over the
nasal turbinates ensuring intimate contact of the
air with the surface-moist mucosal membrane is
essential.
The expression dry nose (DN) has not been
unambiguously dened. In the main, it is based
on relevant anamnestic patient information. ENT
specialists often employ the term rhinitis sicca,
although here, too, a clear denition is lacking.
Symptoms range from the purely subjective sensation of a somewhat dry nose to visible crusting
of the nose, and a wide range of combinations are
possible:
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
Ö. Ö. Celebi, T. M. Önerci (eds.), Nasal Physiology and Pathophysiology of Nasal Disorders,
https://doi.org/10.1007/978-3-031-12386-3_13
145
146
https://t.me/medicina_free
R. K. Weber et al.
• Sensation of dryness in the nose.
• Itching and mild burning sensation.
• Nasal obstruction.
• Crusting, scabs and ‘bogies’, possibly associated with an (unpleasant) smell.
• Epistaxis.
• Diminished sense of smell.
13.2 Aetiology
Possible causes of dry nose include a variety of
diseases, external and internal factors and environmental conditions:
• Local mechanical irritation.
• Climatic or environmental factors.
– Dry room or environmental air (relative
humidity <50%).
– Heated room or hot environment.
– Long-distance ights.
• Workplace conditions.
– Dry air and clean-room condition [2].
– Cold and heat.
– Dusty conditions (e.g. grinding/polishing
of plaster, granite, chalk, cement, wood
arsenic, nickel carbonyl, tobacco smoke).
• Drugs (cocaine).
• Side effects of medications (see Table13.1).
• Supportive nasal administration of oxygen
[3].
• Symptoms of other diseases (granulomatous,
infectious, rheumatic and immunological
disorders).
– Wegener’s granulomatosis, sarcoidosis,
tuberculosis, syphilis and leprosy (Fig.13.1).
• Wound healing phase after endonasal sinus
surgery and surgery on the nose.
• Anatomical changes to the outer and inner
nose, with modication of normal airow.
• Allergic rhinitis, in particular, house dust
mites and moulds.
• Permanent sequelae of surgery on the nose
and paranasal sinuses.
• Sequelae of head and neck radiotherapy.
• Patients with obstructive sleep apnoea (OSA)
or continuous positive airway pressure (CPAP)
treatment in sleep apnoea patients [4].
Moistening led to a reduction in symptoms [5].
• Old age.
Dry nose may be the rst symptom of an
incipient cold with a runny nose; in such a case,
however, it is of only limited duration.
Although an increased susceptibility to infec-
tions has frequently been postulated and is patho-
Table 13.1 Medications with the side effect of dry nose
Substance group Generic name Indications
Retinoids (1–10%) Isotretinoin Severe forms of acne
Doxepin (tricyclic
antidepressant)
Methyldopa (1‰–1%) Hypertension (of pregnancy)
Sympathomimetics
(local)
Antihistaminics, rst
generation
Tretinoin Promyelocyte leukaemia
Depressive conditions, anxiety syndrome, mild withdrawal symptoms
in alcoholics and drug-dependent persons, agitation, sleep disorders
Dipivefrine (eye) Glaucoma
Naphazoline Diverse forms of rhinitis, only short-term use recommended
Oxymetazoline
Phenylephrine
Tetryzoline
Tramazoline
Xylometazoline
Clemastine Urticaria, allergic rhinitis
Dimenhydrinate Vertigo, nausea, vomiting
Dimethindene Itching, itching dermatoses, allergies
Diphenhydramine Difculty getting to sleep, difculty staying asleep
Promethazine Agitation in underlying psychiatric illnesses, possibly vomiting,
nausea and sleep disorders
Terfenadine Allergic rhinoconjunctivitis, allergic skin disorders
Соседние файлы в папке Библиотека им академика М.И. Перельмана