BOTOX Trial for Hay Fever and Asthma Treatment

As you probably know, the introduction of Botox injections has revolutionized cosmetic industry. But Botox is not just the world's most famous wrinkle-buster – it has been rather used to treat more than 50 different medical conditions like migraines, incontinence, excessive sweating or ophthalmological disorders!

Now Australian investigators from Melbourne – under the leadership of professor Philip Bardin – are going to conduct a world-first randomized placebo-controlled trial of a Botox gel that could potentially provide relief to people with hay fever (allergic rhinitis). Under the trial, a Botox gel will be applied to the nose to hopefully give hay fever sufferers relief from sneezing, itchy eyes and runny noses for up to three months.

For the purpose of this trial, the Botox molecule has been re-engineered to be able to penetrate through the lining of the nose. Professor Bardin said preliminary studies had shown that botulinum toxin-A offered relief from allergic rhinitis by blocking nerve endings in the nasal passage and potentially blocking some of the chemicals released by the nerve endings which play a large role in causing symptoms. This reduced inflammation and halted the onset of symptoms.

Previously, the same team had very promising results applying Botox into the voicebox as a treatment for severe asthma.

REF: http://www.medicalobserver.com.au, 9th Oct 2012

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What Are Vocal Cord Nodules (Singer’s Nodules)?

Vocal cord nodules are painless “lumps” that develop on the vocal cords and cause a slowly progressive voice change (hoarseness). Vocal cord nodules are noncancerous and almost always develop due to improper or excessive voice use. Over time, repeated abuse of the vocal cords results in soft swellings on each vocal cord. If abuse will continue, these swellings will develop into harder, callous-like “lumps”.

Vocal nodules are more common in people that overuse their voice, like teachers, singers, TV and radio reporters etc. Moreover, vocal cord nodules can also develop due to different abusive vocal behaviors like chronic throat clearing, chronic coughing, yelling and whispering. As they frequently occur in untrained singers, the other common name for vocal nodules is "singer's nodules."

 Small, callus-like "lumps" on both vocal cords ("singer's nodules")

Healthy vocal cords completely come together to create a voice. In a patient with vocal cord nodules, vocal cords cannot completely adhere, as there is a bulge in the center of the vocal cords resulting in an hourglass gap when they come together. Unless the underlying voice abuse is reversed, the nodule will just get bigger with corresponding deterioration of a voice quality. Initially, the voice change may only occur in the high pitches. However, as these “lumps” get bigger, the hoarseness may extend to throughout the entire vocal pitch range.

If there is a suspicion that you might have vocal cord nodules, your ENT specialist will perform an examination that is called laryngoscopy. A small angled mirror, a rigid endoscope or flexible endoscope are utilized to deflect a beam of light down onto the vocal folds and reflect the image of the vocal cords back up to the ENT specialist.

The voice therapy and avoidance of any activities leading to voice abuse (screaming, yelling, etc.) are the mainstays of conservative management of vocal cord nodules. However, such treatment can take months. Alternative for conservative therapy may be the surgical micro-excision of the vocal nodule, a procedure in which the vocal nodule is excised with tiny blades under the control of the high-magnification microscope. Additionally, several recent studies have shown that vocal quality improvement may be obtained by steroid injections into the vocal cord nodule.

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Dr. Sasa Janjanin is double European Board-certified in ENT and Facial Plastic Surgery. He extensively trained in complete surgical and medical treatment of patients with disorders and diseases of the head and neck. However, his major expertise is in facial plastic, aesthetic and reconstructive surgery; problems related to thyroid and parathyroid glands; skin cancer; kid’s ENT problems; minimally-invasive voice-box surgery; nose, sinus and snoring complaints; and sport and diving-related ENT problems.

Secondhand Smoke May Predispose To Chronic Sinusitis!

If you have constantly clogged and swollen nose and sinuses, secondhand smoke - even in small amounts - may be one to blame! Although the harmful effects of smoking are well recognized, the secondhand smoke (also known as passive smoke) also can cause or contribute to various health problems. Passive smoke contains over 4000 substances, of which many are strong irritants, and over 50 are either known or suspected to cause cancer. And - according to the newest studies, secondhand smoke may be responsible for up to 40% of cases of chronic sinusitis!

In the study by dr. Tammemagi et al. (published in the Archives of Otolaryngology-Head & Neck Surgery journal) observed were 306 non-smoking patients who had been diagnosed as having chronic rhinosinusitis. The chronic sinusitis describes a range of unpleasant symptoms (lasting for 12 weeks or more!) that include nasal and sinus inflammation, congestion, cough, runny nose, breathing difficulties, and a reduced sense of smell. It is estimated that 16-20% of adults are suffering from this disease. In the United States only - chronic sinusitis is responsible for approximately 22 million physician visits and more than 500 000 emergency department visits annually!

In described study - the exposure of 306 non-smoking patients with sinusitis to secondhand smoke at home, work, in public places and at private social functions was compared with that of 306 individuals who were the same age, sex and race but did not have sinusitis. In each setting, more people diagnosed with sinusitis reported being exposed to secondhand smoke. For instance - more than 50% of those with sinusitis said they’d inhaled secondhand smoke at private parties and social functions, compared to just 28% of those who did not have sinusitis! In general - about 40% of chronic sinusitis cases in the study seemed to be attributable to passive smoking.

Secondhand smoke is already known to cause many other diseases. Passive smoke exposure increases susceptibility to respiratory infections or worsens infection in adults and children. As a factor which may predispose someone to develop sinusitis, secondhand smoke can inhibit immune cells and function, impair sinonasal mucociliary clearance (the self-clearing mechanism of the nose and sinuses), increase susceptibility to certain bacteria, and enhance allergic reactions to inhaled allergens.

It is estimated that 60-80 percent of all non-smokers in developed countries are exposed to secondhand smoke, making it a major public health problem. On the basis of findings of above mentioned study, patients who are susceptible to chronic sinusitis or who have chronic sinusitis should avoid exposure to secondhand smoke!

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REF:

Tammemagi CM et al. Secondhand Smoke as a Potential Cause of Chronic Rhinosinusitis. A Case-Control Study. Arch Otolaryngol Head Neck Surg. 2010;136(4):327-334. doi:10.1001/archoto.2010.43.

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