Understanding of Rhinosinusitis :

complication and implication of

Rhinosinusitis daily practice

Dr. M.Nurrizki Haitamy Sp.T.H.T.K.L, M.Kes

 EXTERNAL NOSE
Pyramidal in shape with its root up and the base
downwards1

Consists of osteo-cartilaginous framework

covered by muscles and skin1
 Upper 1/3rd bony and lower 2/3rd cartilaginous

Shape and appearance of the external nose

affects both appearance of the face and
functional processes that take place inside the
nose2

1EXTERNAL NOSE. IN: DHINGRA PL. ED. DISEASES OF EAR NOSE AND THROAT. NEW DELHI. ELSEVIER.129-132
2DISEASES OF THE NOSE, PARANASAL SINUSES, AND FACE. IN: PROBST R, ED. BASIC OTORHINOLARYNGOLOGY. NEW YORK. THIEME.2006. 1 - 7
 NASAL CAVITY
Begin anteriorly at the nasal vestibule
Nasal septum divides the nasal cavity
into two
Boundaries of nasal cavity
 Lateral: lateral nasal wall
 Superior: cribriform plate
 Floor: hard palate

Several functionally important

structures are located on the lateral
nasal wall

1DISEASES OF THE NOSE, PARANASAL SINUSES, AND FACE. IN: PROBST R, ED. BASIC OTORHINOLARYNGOLOGY. NEW YORK. THIEME.2006. 1 - 7
 NASAL MUCOSA IN VARIOUS PARTS OF THE
NASAL CAVITY
Olfactory region
• Upper 1/3rd of lateral wall (up to
superior concha), corresponding part
of the nasal septum and the roof of
nasal cavity form the olfactory region
• Mucous membrane is paler in colour
Respiratory region
• Lower 2/3rd of nasal cavity
• Mucous membrane shows variable
thickness
• Lined by pseudostratified ciliated
columnar epithelium
• Serous and mucous, glands are located
in the submucosa

1EXTERNAL NOSE. IN: DHINGRA PL. ED. DISEASES OF EAR NOSE AND THROAT. NEW DELHI. ELSEVIER.129-132
 PARANASAL SINUSES
Air-filled cavities that communicate with the nasal
cavities

4 types of paranasal sinuses

Anatomical connections between the nasal cavity

and paranasal sinuses are functionally important
and play a key role in the pathogenesis of many
rhinologic diseases

1DISEASES OF THE NOSE, PARANASAL SINUSES, AND FACE. IN: PROBST R, ED. BASIC OTORHINOLARYNGOLOGY. NEW YORK. THIEME.2006. 1 - 7
 OSTIOMEATAL UNIT AND ITS SIGNIFICANCE
Area on the lateral nasal wall where the Ostia of the
paranasal sinuses open into the nasal cavity in a duct-
like fashion
Even minor changes can hamper ventilation in this
region
 Leads to pathologic squeal in the paranasal sinuses

Main clinical significance of this region relates to the

sites of narrowing in the ostiomeatal unit
Hyperemia and swelling of the mucosa in the setting
of a common cold can obstruct the narrow passages in
the ostiomeatal unit
 Prevents adequate ventilation of the dependent paranasal
sinus system and setting the stage for a rhinogenic
inflammation of the paranasal sinuses

1DISEASES OF THE NOSE, PARANASAL SINUSES, AND FACE. IN: PROBST R, ED. BASIC OTORHINOLARYNGOLOGY. NEW YORK. THIEME.2006. 1 - 7
 MUCOCILIARY ACTION
Mucociliary apparatus physically cleanses the inspired
air
Consists of the cilia of the respiratory epithelium and
a mucous blanket composed of two layers
Disturbances in mucociliary transport
 Increased viscosity and thickness of the sol layer
 Changes in the viscoelasticity of the gel layer
 Acute viral infection
CLASSIFICATION OF NASAL AND EAR DISORDERS
Nasal Ear
disorders disorders
Nasal Allergic rhinitis Eustachian tube and middle
congestion Vasomotor rhinitis ear infections
Rhinitis medicamentosa • Syringitis
• Otitis media
Rhinorrhea,
nose and sinus Acute, chronic rhinitis
infections Acute viral rhinosinusitis
(common cold) Ear trauma
Rhinitis sicca anterior
Nose bleeding Sinusitis
(epistaxis)

Nasal foreign Otitic barotrauma

bodies
RHINITIS
Classification based on
duration of disease2
Inflammation of the nasal mucosa1

Associated with excessive mucus Rhinitis2

production, congestion, sneezing
paroxysm, watery eyes, and nasal and
ocular pruritus.1
Acute rhinitis Chronic rhinitis
< 4 days/ week or > 4 days/week or
< 4 weeks duration > 4 weeks duration

1QUILLEN DM, FELLER DB. DIAGNOSING RHINITIS: ALLERGIC VS. NONALLERGIC. AM FAM PHYSICIAN. 2006; 73(9):1583-1590
2KRADJAN W. ACUTE AND CHRONIC RHINITIS. DR TED WILLIAMS. HTTP://DRTEDWILLIAMS.NET/COP/763/763RHINITIS.PDF. ACCESSED. AUGUST 17,2015
ACUTE RHINITIS
Acute inflammation of the nasal mucous membrane and is followed by nasal
dysfunction (which affects respiration, protection, olfaction, moistening and
warming of the inhaled air, etc.)
 Usually lasts for < 4 days/ week or < 4 weeks duration

Most prevalent infectious disease.

Common cause include rhinoviruses and coronaviruses
 Accounts ½ of the total infections
 Other pathogens may include influenza viruses and adenoviruses

Symptoms – Dry stage followed by catarrhal stage

Characterized by lethargy,
headache, fever and local Characterized by watery,
discomfort in the nose and initially serous nasal discharge
nasopharynx like burning, and nasal obstruction.
soreness.

1DISEASES OF THE NOSE, PARANASAL SINUSES, AND FACE. IN: PROBST R, ED. BASIC OTORHINOLARYNGOLOGY. NEW YORK. THIEME.2006. 27-67
MANAGEMENT OF ACUTE VIRAL RHINITIS
Nasal Relieve nasal obstruction
decongestants
Not used for >1 week.
Discontinuation is recommended after 3 days of use2
Antibiotics Used only in bacterial superinfection

Other Cleanliness
measures
Chamomile steam inhalation
Infrared therapy

THE NOSE, PARANASAL SINUSES, AND FACE. IN: PROBST R, ED. BASIC OTORHINOLARYNGOLOGY. NEW YORK. THIEME.2006. 27-67. 2 RAMEY T.
1DISEASES OF

RHINITIS MEDICAMENTOSA. J INVESTIG ALLERGOL CLIN IMMUNOL 2006; VOL. 16(3): 148-155.
ACUTE RHINOSINUSITIS (ARS)
Sudden onset of 2 or more symptoms of nasal discharge, nasal blockage or
congestion, facial pain or pressure and reduction or loss of sense of smell, which
are < 12 weeks in duration.1

Etiology 2 Signs and symptoms 1

• Viral upper respiratory infection • Low‐grade fever

• Nasal polyps • Malaise
• Mucociliary dysfunction associated • Headache
with cystic fibrosis • Cough
• immune deficiencies • Bilateral nasal mucosal oedema
• Purulent nasal secretions
• Sinus tenderness
• Toothache
• Periorbital swelling

1MASOOD A, MOUMOULIDIS I, PANESAR J. ACUTE RHINOSINUSITIS IN ADULTS: AN UPDATE ON CURRENT MANAGEMENT. POSTGRAD MED J. 2007; 83(980):

402–408.
2OSGUTHORPE JD. ADULT RHINOSINUSITIS: DIAGNOSIS AND MANAGEMENT. AM FAM PHYSICIAN. 2001;63(1):69-77
 ACUTE RHINOSINUSITIS (ARS)
Inflammation of the nasal mucosa and lining of the paranasal sinuses
 Obstruction of sinus ostia
 Impaired ciliary transport

Viral etiology in majority of cases

 Superimposed bacterial infection in 0.5-2%
 Symptoms for at least 7-10 days or worsening after 5-7 days

Symptoms present for < 4 weeks

“Recurrent ARS” with > 4 episodes, lasting > 7-10days
NOTES: Most viral upper respiratory tract infections are caused by
rhinovirus, but coronavirus, influenza A and B, parainfluenza, respiratory
syncytial virus, adenovirus, and enterovirus are also causative agents.
 ACUTE RHINOSINUSITIS (ARS)
Major symptoms
 Facial pain/pressure • Hyposmia/anosmia
 Facial congestion/fullness • Purulence on exam
 Nasal obstruction
• Fever (ARS only)
 Nasal discharge/purulence

Minor symptoms
 Headache • Dental pain
 Fever (non-ARS)
• Cough
 Halitosis
• Ear pain/pressure/fullness
 Fatigue

Diagnosis with two major or one major and

two minor factors
TREATMENT AND COMPLICATIONS
Complications3
Treatment Acute ear Most common in children
infection
• Pain relievers like Wheezing seen in children with
Acetaminophen1 asthma
• Decongestant nasal Sinusitis Inflammation and
sprays/drops may infection of the sinuses in
adults or children
help relieve a
blocked nose2 Other Streptococcal pharyngitis,
secondary pneumonia, bronchiolitis in
• Cough syrups infections children

1DISEASES AND CONDITIONS COMMON COLD. MAYO CLINIC. HTTP://WWW.MAYOCLINIC.ORG/DISEASES-CONDITIONS/COMMON-

COLD/BASICS/TREATMENT/CON-20019062. 2013. ACCESSED AUG 18, 2015. 2COMMON COLD – TREATMENT. NHS CHOICES.
HTTP://WWW.NHS.UK/CONDITIONS/COLD-COMMON/PAGES/TREATMENT.ASPX. 2015. ACCESSED AUG 18, 2015. 3DISEASES AND CONDITIONS COMMON COLD.
 CHRONIC RHINOSINUSITIS (CRS)
Symptoms present for > 12 consecutive weeks
“Subacute” for symptoms between 4-12 weeks
Chronic inflammation
 Bacterial, fungal, and viral
 Allergic and immunologic
 Anatomic
 Genetic predisposition

NOTES: One of the major problems with identifying the pathogenesis of CRS is that neither symptoms, findings, nor
radiographs, taken independently, are sufficient basis for the diagnosis. One study showed that current symptom-based
criteria had only a 47% correlation with a positive CT scan result.
Stankiewicz JA, Chow JM: A diagnostic dilemma for chronic rhinosinusitis: definition accuracy and validity. Am J
Rhinol 2002; 16:199-202.
SYMPTOMS, DIAGNOSIS AND MANAGEMENT OF
RHINOSINUSITIS
Allergy Testing

Diagnosis
Symptoms
• Painful pressure in the cheeks and forehead
• Thick yellow-green nasal discharge
Examination of nasal passages -
• Postnasal drip, often with a bad taste Rhinoscopy or Nasal endoscopy
• Cough
• Congestion MRI or CT scan
• Toothache
• Fever

Acute Sinusitis Management Chronic Sinusitis Management

• Recover without any prescribed medications • Intranasal corticosteroid sprays may be

• Oral Decongestants or nasal decongestant appropriate for recurrent sinusitis
sprays might help relieve symptoms and • Treating allergies by avoiding triggers or
promote drainage of the infection with medications or allergy shots can help
• Sinus saline recipe may relieve symptoms. prevent recurrences of sinusitis.
• Pain relievers such as acetyl salicylic acid, • Endoscopic sinus surgery may be considered
acetaminophen or ibuprofen may be when medical treatment fails
beneficial

1SINUSITIS. AMERICAN ACADEMY OF ALLERGY ASTHMA AND IMMUNOLOGY. HTTP://WWW.AAAAI.ORG/CONDITIONS-AND-TREATMENTS/ALLERGIES/SINUSITIS.ASPX. 2015. ACCESSED. AUGUST 18,2015
DIAGNOSIS AND TREATMENT
Diagnosis1 Treatment

• Patient’s history • Sufficient drinking of water

• Inspection- inner and external • Cleansing and removal of the
nose crusts
• Endoscopy- nasal cavity, • Nasal ointments (glycerol) gives
nasopharynx moistening effect and protect
• Allergy testing and microbial the nose from water loss2
swabs • Dexpanthenol widely used as a
• Computed tomography (to rule humidifier/moisturizer
out any associated disease) • Kehrl et al study confirmed that
dexpanthenol nasal spray is an
effective medicinal treatment of
rhinitis sicca anterior and is
more effective than common
medications 3
1HILDENBRAND T, WEBER RK, BREHMER D. RHINITIS SICCA, DRY NOSE AND ATROPHIC RHINITIS: A REVIEW OF THE LITERATURE. EUROPEAN ARCHIVES OF OTO-
RHINO-LARYNGOLOGY. 2011; 268(1): 17-26. 2SONNEMANN U, SCHERNER O, WERKHÄUSER N. TREATMENT OF RHINITIS SICCA ANTERIOR WITH ECTOINE
CONTAINING NASAL SPRAY. JOURNAL OF ALLERGY. 2014; 1-10.3 KEHRL W, SONNEMANN. DEXPANTHENOL NASAL SPRAY AS AN EFFECTIVE
NASAL DECONGESTANTS
NASAL CONGESTION(NC)
Pathophysiology2
Described as fullness, obstruction, reduced
airflow, or being “stuffed up,”1
• Mucosal inflammation is
the central mechanism that
NC has not been extensively studied. 1
contribute to congestion
 Allergic Rhinitis(AR) is the common cause for NC. • Inflammation induces the
 Burden of NC can be indirectly estimated based vasodilatation, increased
on AR burden blood flow and vascular
permeability
• This reduce the physical
Global incidence of AR is estimated as 10- size of the nasal passages
20%1

1STEWART M, FERGUSON BJ, FROMER L. EPIDEMIOLOGY AND BURDEN OF NASAL CONGESTION. INTERNATIONAL JOURNAL OF GENERAL MEDICINE .2010;
3:37–45
2NACLERIO RM, BACHERT C, BARANIUK JN. PATHOPHYSIOLOGY OF NASAL CONGESTION. INTERNATIONAL JOURNAL OF GENERAL MEDICINE . 2010; 3 :47–57
DISEASES CAUSING NC AND QUALITY OF LIFE
(QOL)
Allergic Rhinitis Rhinosinusitis Nasal polyposis(NP)

• 10-20% globally • 66-70% Rhinosinusitis • NC is one of the

• Study on 111 have NC severe symptom in NP
patients with • Significant decrease • 2-4% of prevalence
moderate-to-severe in QOL globally
perennial AR
reported significantly
lower scores of QOL
• Impairment in
physical limitations,
pain, social
functioning, general
health perception,
energy/fatigue

Economic burden for the treatment of associated disease of NC is also very high

1STEWART M, FERGUSON BJ, FROMER L. EPIDEMIOLOGY AND BURDEN OF NASAL CONGESTION. INTERNATIONAL JOURNAL OF GENERAL MEDICINE .2010; 3:37–45
ADRENERGIC RECEPTORS
Classified into 2 types based on
affinities of adrenergic agonists. Adrenergic
receptors
Nasal decongestants acts on α and
β receptors and decrease nasal
congestion
 Selective α 1 and 2 agonists, α-
Adrenergic agonist are common α β
nasal decongestants drug class

α1, α2 β1, β2, β3

1TRIPATHI KD. ESSENTIALS OF MEDICAL PHARMACOLOGY. NEW DELHI: JAYPEE BROTHERS MEDICAL PUBLISHERS;C2013:125-137
CLASSIFICATION OF NASAL DECONGESTANTS
selective α1 Selective α2 α-Adrenergic
agonist agonist Agonist

Phenylephrine Naphazoline Pseudoephedrine

Oxymetazoline Xylometazoline Phenylpropanolamine

Oxymetazoline

1TRIPATHI KD. ESSENTIALS OF MEDICAL PHARMACOLOGY. NEW DELHI: JAYPEE BROTHERS MEDICAL PUBLISHERS;C2013:125-137
OVERVIEW OF NASAL DECONGESTANTS
Naphazoline Xylometazoline Oxymetazoline Pseudoephedrine Phenylpropanolamine

Mode of Selective α2 agonist) Selective α2 Selective α2 Alpha-Adrenergic Directly stimulate

action agonist) agonist) Agonist. adrenergic receptors but
probably indirectly
stimulates both α- and β-
adrenergic receptors
Duration of Longer duration of Longer duration of Long duration of
action action (12 hours) action (10 hours)2 action (12 hours)
Dose 0.1% topical in nose 0.05–0.1% topical 0.025–0.05% 30- 60 mg three 25–50 mg daily
in nose topical in nose times a day

Adverse Impairs mucosal Impairs mucosal Impairs mucosal Rise in BP can occur, Rise in BP
effects ciliary function ciliary function ciliary function especially in
causing Atrophic causing Atrophic causing Atrophic hypertensive, CNS
rhinitis and anosmia, rhinitis and anosmia, rhinitis and effects
CNS depression and CNS depression and anosmia, CNS
rise in BP, initial rise in BP depression and
stinging sensation rise in BP

1TRIPATHI KD. ESSENTIALS OF MEDICAL PHARMACOLOGY.

NEW DELHI:JAYPEE BROTHERS MEDICAL PUBLISHERS;C2013:125-137. 2 SUDAFED 0.1% NASAL
SPRAY. MHRA. HTTP://WWW.MHRA.GOV.UK/HOME/GROUPS/PAR/DOCUMENTS/WEBSITERESOURCES/CON152860.PDF. ACCESSED SEPTEMBER 18.09.2015
NASAL DECONGESTANTS
Two main types are used:
 Adrenergics (largest group)
 Constrict dilated blood vessels
 Nasal mucosa
 Corticosteroids
 Reduce inflammation

COPYRIGHT 2007 THOMSON DELMAR LEARNING, A DIVISION OF THOMSON LEARNING INC. ALL RIGHTS RESERVED.
GOAL OF NASAL DECONGESTANTS
To reduce congestion
Two dosage forms
 Oral
 Topical
 Nasal spray

COPYRIGHT 2007 THOMSON DELMAR LEARNING, A DIVISION OF THOMSON LEARNING INC. ALL RIGHTS RESERVED.
 ORAL DECONGESTANTS
Prolonged effects
Less potent
No rebound congestion
Exclusively adrenergics
Example: pseudoephedrine (Sudafed)

COPYRIGHT 2007 THOMSON DELMAR LEARNING, A DIVISION OF THOMSON LEARNING INC. ALL RIGHTS RESERVED.
TOPICAL DECONGESTANTS
Adrenergics
 Prompt onset
 Sustained use–rebound congestion

Both adrenergics and steroids

 Potent; work well

COPYRIGHT 2007 THOMSON DELMAR LEARNING, A DIVISION OF THOMSON LEARNING INC. ALL RIGHTS RESERVED.
OXYMETAZOLINE
OXYMETAZOLINE-STRUCTURE AND MECHANISM
OF ACTION Mechanism of Action 2

• Oxymetazoline is a direct
acting sympathomimetic
amine
• Acts on alpha-adrenergic
receptors in the arterioles
Imidazole derivative with direct acting of the conjunctiva and nasal
sympathomimetic activity1 mucosa
Chemical Name - 6-tert-butyl-3-(4,5- • In nasal it produces
dihydro-1H-imidazol-2-ylmethyl)-2,4- constriction, resulting in
dimethylphenol
decreased blood flow and
Molecular Formula - C16H24N2O decreased nasal congestion
Molecular weight - 260.37456 g/mol

1 Oxymetazoline. PubChem.
https://pubchem.ncbi.nlm.nih.gov/compound/oxymetazoline#section=Top. Accessed.
August 18,2015.
2 Oxymetazoline. DrugBank. http://www.drugbank.ca/drugs/DB00935. Accessed. August
COMMON DOSAGE IN DIFFERENT AGE GROUPS
Strength Dosage
Adults1 0.025% 4 to 6 drops to each nostril twice daily as needed
solution
0.05% solution 2 to 3 drops to each nostril twice daily as needed

0.05% spray 2-3 sprays per nostril q12hr2

Pediatric1 0.025% >= 2 years to 5 years - 2 to 3 drops to each nostril twice

solution daily as needed.
6 years to 18 years: 4 to 6 drops to each nostril twice daily as
needed.
0.05% solution >= 6 years to 18 years: 2 to 3 drops to each nostril twice
daily as needed
0.05% spray >= 6 years to 18 years: 1 to 2 sprays to each nostril twice
daily as needed
1Oxymetazoline Nasal Dosage. Drugs.com. http://www.drugs.com/dosage/oxymetazoline-
nasal.html#Usual_Adult_Dose_for_Nasal_Congestion. Accessed September 18.09.2015. 2
oxymetazoline (OTC). Medscape. http://reference.medscape.com/drug/afrin-duramist-
PHARMACOLOGY
Pharmacokinetics- described as what the body does to a drug, refers to the
movement of drug into, through, and out of the body.1
Pharmacodynamics - study of what a drug does to the body

Pharmacokinetics2 Pharmacodynamics6

• Absorption • Used as a vasoconstrictor to relieve nasal

• Occasional systemic absorption may congestion
occur.2 Bioavailability of drug is 11%. 3 • Constricts the (Sympathomimetic action)
The time taken for (Tmax)peak plasma smaller arterioles of the nasal passages.
concentration is 5-10 minutes.4 • Produces a prolonged (up to 12 hours)
• Distribution decongesting effect.
• 80% protein binding.3
• Metabolism
• Half life of drug is 5-6 hours. 3
• Elimination
• Oxymetazoline is eliminated via kidney.5

Safe dose or dose above which systemic effects occur7

Adults: Not to exceed 2 doses/24 hr and for no longer than 3-5 days. (dose is 2-3 sprays per nostril q12hr)
Children: Not to exceed 2 doses/24 hr for no longer than 3-5 days (2-3 sprays per nostril q12hr)
ADVERSE REACTIONS AND PRECAUTIONS FOR
OXYMETAZOLINE USE Transient burning
Adverse
effects1 Stinging
Sneezing
Increased nasal discharge or dryness of nasal mucosa

• Safe use during • No adequate studies in • Allergy to

pregnancy has not been women for use during Oxymetazoline
established. breastfeeding • Dryness in the nose
• Oxymetazoline nasal • Potential benefits must be
solutions should be used weighed against risks
during pregnancy only before taking this
when instructed by a medication
clinician

Pregnancy2 Breastfeeding2 Other

conditions2

1Oxymetazoline Hydrochloride. Drug.com. http://www.drugs.com/monograph/oxymetazoline-hydrochloride.html. 2015. Accessed. August 18,2015.

2 OXYMETAZOLINE.toxnet. http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+hsdb:@term+@rn+@rel+1491-59-4.2007. Accessed August 18, 2015.
 Anti-viral

TRIPLE ACTION OF OXYMETAZOLINE Anti- inflammatory

Vasoconstrictive effect
OMZ HAS VIRUCIDAL ACTIVITY AGAINST
HUMAN PATHOGENIC VIRUSES
An in-vitro to demonstrate the antiviral activity of Oxymetazoline on Human
Rhinovirus

A direct dose-dependent virucidal activity of Virus titer was less after treatment
OMZ against HRV-14 with OMZ

OMZ exhibits a clear dose-dependent Virucidal activity which is evident from decrease of
subsequent plaque formation after infection with pre-treated virus particles
1KoelschS, Tschaikin M, Sacher F. Anti-Rhinovirus-specific Activity of the Alpha-sympathomimetic Oxymetazoline. Arzneimittel-Forschung (Drug
Research) . 2007;57(7):475–482.
OXYMETAZOLINE (OMZ) TERMINATES RHINITIS-
RELATED INFLAMMATION Interferes with neutrophil membranes by
activating cytoplasmatic phospholipase A2
(cPLA2)
 cPLA2 liberates arachidonic acid from membrane
phospholipids which is a precursor of inflammatory
substrates

Inhibits 5-lipoxygenase (5-LO), the initial

enzyme of leukotriene synthesis
 Reduced production of pro-inflammatory LTB4.

Inhibits respiratory burst activity (NADPH

oxidase)
 Diminishes the production of tissue-damaging reactive
oxygen species (ROS)

1SpeierIB, Oswald B, Maier KL.et al. Oxymetazoline Inhibits and Resolves Inflammatory
Reactions in Human Neutrophils. J Pharmacol Sci.2009; 110: 276 – 284.
 VASOCONSTRICTIVE EFFECT OF OMZ ADDS
TO ITS NASAL DECONGESTIVE EFFICACY
Constricts the dilated blood vessels in the nasal mucosa.
 Results in shrinking of nasal membranes due to which drainage of mucus and circulation of air is
improved.
 Reduces nasal stuffiness.

Provides immediate symptomatic relief.

Decongestant effects of oxymetazoline longer lasting (up to 12 hours) than ephedrine

3-5 days is the usual dosage period.

1 Whittaker C. Nasal sprays: a short review. S Afr Pharm J . 2011;78(7):21–23
2Reinecke S. and M.Tschaikin. 2005. Investigation of the Effect of Oxymetazoline on the Duration of Rhinitis. Results of a placebo-controlled double-blind
study in patients with acute rhinitis. MMW Fortschr Med 147 Suppl 3: 113-118.
SUMMARY OF TRIPLE ACTION OF OXYMETAZOLIN
Pharmacodynamic Scientific Clinical benefit Effect on
Properties of Evidence Course of
Oxymetazoline disease
Antiviral Inhibitis the activity of Causal In vitro Studies 1,2 Fights the faster and
HRV 14, downregulates Effect viruses that stronger
virus receptor ICAM-1 cause rhinitis improvement of
symptoms like
sneezing,
Antioxidative/ Inhibits pro- Pathogenetic In vitro Study 3 Inhibits rhinitis
rhinorrhea, nasal
Anti-inflammatory inflammatory pathways, Effect symptoms
obstruction,
suppresses oxidative
impaired taste
stress
and smell and
Vasoconstrictive de-swelling of nasal Symptomatic Clinical Study 4 Decongestion of general well-
mucosa Effect the nose, easy being +
breathing and Shortens the
outflow of duration of cold
secretion and from 6 to 4 days
germs

Clinical Study 5
(vs. Saline solution)
1)Sacher et al., 2005 Antiviral Properties of Oxymetazolin, DAZ, No. 5: 111-112 Glatthaar-Saalmueller B et al. 2005. Oxymetazoline exerts antiviral activity against human rhinovirus-14 and downregulates expression of ist receptor ICAM-1
on human umbilical vein endothelial cells. OEGAI Annual Meeting, Graz/Austria, December 01-03: P51. 3)Beck-Speier et al., 2006, Oxymetazoline Inhibits Proinflammatory Reactions: Effects on Arachidonic Acid-Derived Metabolites, JPET
316: 843-851. Westerveld et al,1995, Anti-oxidant actions of oxymethazoline an xylomethazoline, Eur J Clin Pharmacol 291: 27-31 Connell JT., 1969, Effectiveness of topical nasal decongestants. Annals of Allergy 27: 541-546 Reinecke
S. & Tschaikin M., 2005, Investigation of the effect of oxymetazoline on the duration of rhinitis. Results of a placebo-controlled double-blind study in patients with acute rhinitis. MMW Fortschr Med 147 Suppl 3:113-118
 Random, double blind, pengujian klinik plasebo-
kontrol pada lebih dari 200 pasien dengan Rhinitis
Akut

Efek dari Oxymetazoline pada durasi Rhinitis Akut. Hasil dari

plasebo-kontrol, double blind studi pada pasien Rhinitis Akut
Objektif:
Untuk meneliti apakah iliadin yang mengandung Oxymetazoline mempunyai
makna yang berarti pada durasi Rhinitis pada pasien Rhinitis Akut
dibandingkan larutan saline

Hasil:
• Iliadin mengurangi durasi Rhinitis selama 2 hari dibandingkan larutan
Saline (4 hari vs 6 hari, p<0.001) (gbr 1)
• Waktu rata-rata, mula kerja adalah 25 detik dibandingkan larutan saline
90 detik
• Perbaikan gejala sejak hari ke 2 dan bertahan sampai selesai studi
• Iliadin di toleransi lebih baik dibandingkan larutan saline, yang dinilai
oleh Dokter dan pasien

Kesimpulan:
• Efek terapi dari iliadin lebih signifikan dibandingkan larutan saline.
Durasi Rhinitis berkurang selama 2 hari dibandingkan larutan saline
• Oxymetazoline mempunyai keunggulan dengan tripel aksi (anti
peradangan, anti oksidatif dan efek anti viral) dalam mengatasi Rhinitis
Prospektif, acak, double blind, plasebo-kontrol uji klinis:
• Dilakukan pada 24 center, klinik dokter umum dengan
247 pasien penderita Rhinitis Akut lebih dari 48 jam
• Pengukuran utama (primari): durasi Rhinitis
• Pengukuran sekondari : mula kerja obat (detik)
 Studi Observasi

Efikasi, tolerabilitas, kemudahan penggunaan obat semprot hidung yang

mengandung Alpha-sympathomimetics
Objektif:
Menilai efikasi, tolerabilitas dan kemudahan penggunaan obat semprot
hidung yang mengandung Oxymetazoline dan Xylometazoline pada kasus
Rhinitis akut dalam praktek sehari-hari

Hasil:
• Terlihat perbaikan pada kedua grup
• Sensasi ketidaknyamanan seperti rasa kesemutan, rasa terbakar secara
signifikan dirasakan oleh grup Xylometazoline
• Oxymetazoline lebih mudah digunakan*
• Pasien dan dokter memberikan rating yang sangat baik untuk
Oxymetazoline
• Tolerabilitas Oxymetazoline dinilai lebih abik dibandingkan
Xylometazoline (gbr 1)

Kesimpulan:
Studi Observasi:
• Oxymetazoline dan Xylometazoline dinilai efektif
• 200 pasien dengan Rhinitis Akut selama lebih dari 48
• Obat semprot hidung yang mengandung Oxymetazoline lebih disukai
jam
dari segi tolerabilitas, kemudahan penggunaan.
• 100 pasien menggunakan Oxymetazoline (iliadin), 101
pasien menggunakan Xylometazoline
• Durasi penggunaan sampai 7 hari
• Dokter dan pasien mengevaluasi efikasi dan
tolerabilitas dan kemudahan penggunaan produk
 Prospektif, studi acak dan terb

Kombinasi penggunaan Oxymetazoline dan Fluticasone lebih memiliki efikasi

dibandingkan hanya Fluticasone untuk pasien Rhinitis Alergi
Matreja PS, Gupta V, Kaur J, et al. Efficacy of fluticasone and oxymetazoline as the treatment for allergic rhinitis. Journal of Clinical and
Diagnostic Research. 2012;6(1): 85-88.

Objektif:
Membandingkan efikasi dari kombinasi fluticasone dan
oxymetazoline dengan penggunaan fluticasone selama 4 minggu
untuk pasien Rhinitis Alergi

Hasil:
• Kombinasi Oxymetazoline dan fluticasone lebih efektif
dibandingkan pemberian fluticasone saja:
• Mengurangi daytime symptom score
• Mengurangi Night time symptom score
• Mengurangi Composite symptom score

Kesimpulan:
• Pasien pada grup 1 dan 2 mengalami perbaikan Group 1 - Oxymetazoline (0.05%)
• Perbaikan yang signifikan pada nilai PDTS, PNTS dan PCS pada nasal drop selama 1 minggu, 2 puffs
Fluticasone furoate (nasal spray
pasien yang di terapi dengan the patients Oxymetazoline dan 100μg/ hari) pada setiap lubang Prospektif, acak, studi pada 123 pasien
fluticasone furoate dibandingkan pasien yang diterapi dengan hidung selama 4 minggu Rhinitis Alergi untuk membandingkan efikasi
fluticasone furoate saja Group 2 - Group 2 menerima hanya Oxymetazoline dan Fluticasone dibandingkan
Fluticasone furoate nasal spray hanya Fluticasone pada pasien rawat jalan
PDTS: Daytime Nasal Symptom Score (100μg/day) selama 4 minggu
PNTS: Nighttime Nasal Symptom Score
PCS: Composite Symptom score
Layanan Bedah Minimal Invasif , Hemodialisa, CT SCAN dan Audiometri
RS ISLAM PURWOKERTO

42
 Thank You

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