Repeated Surgical or Endoscopic Myotomy for Recurrent Dysphagia in Patients After Previous Myotomy for Achalasia.

Repeated Surgical or Endoscopic Myotomy for Recurrent Dysphagia in Patients After Previous Myotomy for Achalasia.

J Gastrointest Surg. 2015 Nov 20;

Authors: Fumagalli U, Rosati R, De Pascale S, Porta M, Carlani E, Pestalozza A, Repici A

Abstract
AIM: Surgical myotomy of the lower esophageal sphincter has a 5-year success rate of approximately 91 %. Peroral endoscopic myotomy can provide similar results for controlling dysphagia. Some patients experience either persistent or recurrent dysphagia after myotomy. We present here a retrospective analysis of our experience with redo myotomy for recurrent dysphagia in patients with achalasia.
METHODS: From March 1996 to February 2015, 234 myotomies for primary or recurrent achalasia were performed in our center. Fifteen patients (6.4 %) had had a previous myotomy and were undergoing surgical redo myotomy (n = 9) or endoscopic redo myotomy (n = 6) for recurrent symptoms.
RESULTS: Patients presented at a median of 10.4 months after previous myotomy. Median preoperative Eckardt score was 6. Among the nine patients undergoing surgical myotomy, three esophageal perforations occurred intraoperatively (all repaired immediately). Surgery lasted 111 and 62 min on average (median) in the surgical and peroral endoscopic myotomy (POEM) groups, respectively. No postoperative complications occurred in either group. Median postoperative stay was 3 and 2.5 days in the surgical and POEM groups, respectively. In the surgical group, Eckardt score was <3 for seven out of nine patients after a mean follow-up of 19 months; it was <3 for all six patients in the POEM group after a mean follow-up of 5 months.
CONCLUSIONS: A redo myotomy should be considered in patients who underwent myotomy for achalasia and presenting with recurrent dysphagia. Preliminary results using POEM indicate that the technique can be safely used in patients who have undergone previous surgical myotomy.

PMID: 26589525 [PubMed - as supplied by publisher]

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Some unpublished documents and unusual portraits of Anton von Tröltsch (1828-1890), one of the founders of this journal.

Some unpublished documents and unusual portraits of Anton von Tröltsch (1828-1890), one of the founders of this journal.

Eur Arch Otorhinolaryngol. 2015 Nov 20;

Authors: Mudry A, von Deuster C, Peinhardt J

Abstract
Anton Friedrich Baron von Tröltsch (1829-1890) was a very famous German otologist in Würzburg in the second part of the 19th century. The aim of this study is to present some unpublished documents related to his biography: a 4-page autobiographical unsigned text probably written for his habilitation in 1861, a 4-page autobiographical letter sent by von Tröltsch to the editors of the Brockhaus-Conversations-Lexikon in 1872, a unique album of portraits of the main otologists of the second part of the 19th century, collected for his 1886 Privat Docent jubilee anniversary, and a portrait of unknown origin. They are discussed with other unusual portraits. These new documents demonstrate at least two major points. One, von Tröltsch was aware of his qualities and the importance of his work in otology but he was not boastful. Two, he was really loved and respected by its colleagues, nearly 150 of them came just for a one-day ovation in Würzburg for his 25th Privat Docent Jubilee and his retirement from his otological practice. Von Tröltsch was and remains an example for all otologists.

PMID: 26589899 [PubMed - as supplied by publisher]

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Quantification of lymph nodes in the central compartment of the neck: a cadaveric study.

Quantification of lymph nodes in the central compartment of the neck: a cadaveric study.

Eur Arch Otorhinolaryngol. 2015 Nov 20;

Authors: Ofo E, Thavaraj S, Cope D, Barr J, Kapoor K, Jeannon JP, Oakley R, Lock C, Odell E, Simo R

Abstract
Differentiated thyroid cancer (DTC) accounts for over 90 % of thyroid malignancies, and is frequently associated with central neck compartment nodal metastasis that requires a therapeutic central compartment neck dissection (CCND) for clinically evident nodes. Current knowledge on the expected lymph node yield from a CCND is limited, compared with data on the lateral neck. The aim of our study was to accurately quantify nodal yield from the cadaveric central neck compartment. Twenty-eight cadaveric necks were dissected and the central neck compartment was subdivided into four regions: pre-laryngeal (delphian), pre-tracheal, right and left para-tracheal regions. Each cadaver had a thyroid gland, which was also removed, and the CCND tissue in each compartment was processed and examined by a consultant histopathologist. Only lymphoid tissue with a defined microscopic fibrous capsule and subcapsular sinus was included in the node count. The median total lymph node count per cadaver was four (range 1-16), with a median of one node detectable in each para-tracheal region (range 0-7) and the pre-tracheal region (range 0-8). The median pre-laryngeal node count was 0 (range 0- 2). The average lymph node size across all compartments was 2.9 mm. This is the first European study to assess cadaveric central neck lymph nodes and establish baseline counts for nodal yield. If a prophylactic or therapeutic CCND is required during thyroid surgery, those involved in DTC management must recognise that there is a wide range, and low median yield of central neck compartment lymph nodes.

PMID: 26589898 [PubMed - as supplied by publisher]

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[Computer Assisted Surgery around the Head (CASH) : Interdisciplinary symposium and hands-on workshop, Ulm, 25-26 September 2015].

[Computer Assisted Surgery around the Head (CASH) : Interdisciplinary symposium and hands-on workshop, Ulm, 25-26 September 2015].

HNO. 2015 Nov 20;

Authors: Hoffmann TK, Sommer F

PMID: 26589600 [PubMed - as supplied by publisher]

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[Obituary on Prof. Dr. med. Dietrich Plester (1922-2015) : Director of the Department of Otolaryngology, University of Tübingen from 1966 to 1988].

[Obituary on Prof. Dr. med. Dietrich Plester (1922-2015) : Director of the Department of Otolaryngology, University of Tübingen from 1966 to 1988].

HNO. 2015 Nov 20;

Authors: Zenner HP

PMID: 26589599 [PubMed - as supplied by publisher]

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Dysphagia in the elderly: focus on rehabilitation strategies.

Dysphagia in the elderly: focus on rehabilitation strategies.

Aging Clin Exp Res. 2015 Nov 20;

Authors: Di Pede C, Mantovani ME, Del Felice A, Masiero S

Abstract
Prevalence of oropharyngeal dysphagia among the elderly is high, but underestimated and underdiagnosed. It may give raise to relevant complications impacting on morbidity, hospital length of stay and health care costs. Dysphagia evaluation and management is a multidisciplinary task; it includes a detailed history taking, clinical and instrumental exams, and identification of the risk of aspiration. Long-standing individual abilities and impairments determine the goals of an ad hoc rehabilitation program. Currently there are no standard algorithmic approaches for the management of dysphagia in the elderly. Education of health professionals on early diagnosis and improvement of therapeutic strategies are mainstays to allow maximal recovery potential in this population. This narrative review summarizes the current rehabilitation approaches for dysphagia in the elderly. The aim is to inform the treating health care professionals, whether caring physician, physical medicine doctor, speech/swallowing therapist or nurse, on the state-of-the-art and stimulate discussion in the scientific community.

PMID: 26589905 [PubMed - as supplied by publisher]

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Combined endonasal and neurosurgical resection of a congenital teratoma with pharyngeal, intracranial and orbital extension: Case report, surgical technique and review of the literature.

Combined endonasal and neurosurgical resection of a congenital teratoma with pharyngeal, intracranial and orbital extension: Case report, surgical technique and review of the literature.

Int J Pediatr Otorhinolaryngol. 2015 Nov 4;

Authors: Moreddu E, Pereira J, Vaz R, Lena G, Triglia JM, Nicollas R

Abstract
OBJECTIVES: This study reports a patient with a large teratoma involving the oropharynx, the nasopharynx and the left orbit, with intracranial extension. This case represents one of the first reported instances of such an association. A literature review reporting head and neck teratomas with intracranial involvement is also presented.
CASE REPORT: The authors describe a case of a neonate presenting with a huge teratoma causing respiratory distress due to upper airway obstruction. The child was operated on at 3 months of age with a combined neurosurgical and endonasal endoscopic-assisted approach. After more than 1-year follow-up, the child has no recurrence and no complications of surgery.
DISCUSSION: This type of teratoma is very rare and surgical morbidity is common. The diagnosis may be apparent before birth, which will facilitate the planning of respiratory management. The combined neurosurgical and otolaryngologic approach for a neonatal teratoma has not previously been described. Using an endoscopic-assisted approach for intranasal tumors removal in neonates and infants is a very rare surgical challenge.
CONCLUSION: Large nasopharyngeal teratomas of infancy with sinonasal and intracranial extension may be managed using a combined endoscopic-assisted endonasal and neurosurgical procedure.

PMID: 26590006 [PubMed - as supplied by publisher]

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Applied anatomy of the anterior cranial fossa: what can fracture patterns tell us?

Applied anatomy of the anterior cranial fossa: what can fracture patterns tell us?

Int J Oral Maxillofac Surg. 2015 Nov 14;

Authors: Stephens JR, Holmes S, Evans BT

Abstract
The skull base is uniquely placed to absorb anteriorly directed forces imparted either via the midfacial skeleton or cranial vault. A variety of skull base fracture classifications exist. Less well understood, however, is fracture extension beyond the anterior cranial fossa (ACF) into the middle and posterior cranial fossae. The cases of 81 patients from two UK major trauma centres were studied to examine the distribution of fractures across the skull base and any relationship between the vector of force and extent of skull base injury. It was found that predominantly lateral force to the craniofacial skeleton produced a fracture that propagated beyond the ACF into the middle cranial fossa in 77.4% of cases, significantly more (P<0.001) than for predominantly anterior force (12.0%). Fractures were significantly more likely to propagate into the posterior fossa with a lateral vector of impact compared to an anterior vector (P=0.049). This difference in energy transfer across the skull base may, in part, be explained by the local anatomy. The more delicate central ACF acts as a 'crumple zone' in order to absorb force. Conversely, no collapsible interface exists in the lateral aspect of the ACF, thus the lateral ACF behaves like a 'buttress', resulting in increased energy transfer.

PMID: 26589135 [PubMed - as supplied by publisher]

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The MAO-B inhibitor deprenyl reduces the oral tremor and the dopamine depletion induced by the VMAT-2 inhibitor tetrabenazine.

The MAO-B inhibitor deprenyl reduces the oral tremor and the dopamine depletion induced by the VMAT-2 inhibitor tetrabenazine.

Behav Brain Res. 2015 Nov 15;

Authors: Podurgiel SJ, Yohn SE, Dortche K, Correa M, Salamone JD

Abstract
Tetrabenazine (TBZ) is prescribed for the treatment of chorea associated with Huntington's disease. Via inhibition of the vesicular monoamine transporter (VMAT-2), TBZ blocks dopamine (DA) storage and depletes striatal DA; this drug also has been shown to induce Parkinsonian motor side effects in patients. Recently, TBZ was shown to induce tremulous jaw movements (TJMs) in rats and mice. TJMs are an oral tremor that has many of the characteristics of Parkinsonian tremor in humans. The present study focused upon the ability of the well-estabilished anti-Parkinsonian agent deprenyl to attenuate the behavioral and neurochemical effects of 2.0mg/kg TBZ. Deprenyl is a selective and irreversible inhibitor of monoamine oxidase-B, and administration of deprenyl produced a dose-related suppression of TBZ-induced TJMs. A second experiment employed in vivo microdialysis to examine extracellular DA levels in the ventrolateral striatum, the neostriatal region most closely associated with the production of TJMs, after administration of TBZ and deprenyl. Consistent with the behavioral data, TBZ alone produced a biphasic effect on extracellular DA, with an initial increases followed by a prolonged decrease during the period in which TJMs are displayed. Co-administration of deprenyl with TBZ increased DA levels compared to rats treated with TBZ alone. These results provide support for use of TBZ as a rodent model of Parkinsonism, and future studies should utilize this model to evaluate putative anti-Parkinsonian agents.

PMID: 26590367 [PubMed - as supplied by publisher]

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Combined endonasal and neurosurgical resection of a congenital teratoma with pharyngeal, intracranial and orbital extension: Case report, surgical technique and review of the literature.

Combined endonasal and neurosurgical resection of a congenital teratoma with pharyngeal, intracranial and orbital extension: Case report, surgical technique and review of the literature.

Int J Pediatr Otorhinolaryngol. 2015 Nov 4;

Authors: Moreddu E, Pereira J, Vaz R, Lena G, Triglia JM, Nicollas R

Abstract
OBJECTIVES: This study reports a patient with a large teratoma involving the oropharynx, the nasopharynx and the left orbit, with intracranial extension. This case represents one of the first reported instances of such an association. A literature review reporting head and neck teratomas with intracranial involvement is also presented.
CASE REPORT: The authors describe a case of a neonate presenting with a huge teratoma causing respiratory distress due to upper airway obstruction. The child was operated on at 3 months of age with a combined neurosurgical and endonasal endoscopic-assisted approach. After more than 1-year follow-up, the child has no recurrence and no complications of surgery.
DISCUSSION: This type of teratoma is very rare and surgical morbidity is common. The diagnosis may be apparent before birth, which will facilitate the planning of respiratory management. The combined neurosurgical and otolaryngologic approach for a neonatal teratoma has not previously been described. Using an endoscopic-assisted approach for intranasal tumors removal in neonates and infants is a very rare surgical challenge.
CONCLUSION: Large nasopharyngeal teratomas of infancy with sinonasal and intracranial extension may be managed using a combined endoscopic-assisted endonasal and neurosurgical procedure.

PMID: 26590006 [PubMed - as supplied by publisher]

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Intracranial venous sinus thrombosis as a complication of otitis media in children: Critical review of diagnosis and management.

Intracranial venous sinus thrombosis as a complication of otitis media in children: Critical review of diagnosis and management.

Int J Pediatr Otorhinolaryngol. 2015 Nov 5;

Authors: Zanoletti E, Cazzador D, Faccioli C, Sari M, Bovo R, Martini A

Abstract
OBJECTIVES: Otogenic lateral sinus thrombosis (LST) is a rare intracranial complication of acute otitis media (AOM), which can lead to severe neurological sequelae and death. The aim of this study was to analyze the clinical presentation, management and outcome of LST in children, investigating a possible correlation between clinical aspects, radiological findings and anatomical variations.
METHODS: At a tertiary Italian hospital, a retrospective review was conducted on the medical records of eight patients diagnosed with otogenic LST over a 3-year period. Four children were males and mean age was 4.7 years.
RESULTS: All patients had a history of otitis media at diagnosis and 4/8 presented also with more than one neurological sign or symptom. Mastoiditis signs were detected in 5/8 patients. Thrombosis was diagnosed by computed tomography, enhanced magnetic resonance and magnetic resonance venography. Treatment was medical, alone or combined with surgery. Medical treatment consisted in anticoagulants eventually combined with anti-edema medication on clinical basis. Mastoidectomy and/or myringotomy±trans-tympanic drainage placement were performed in 7/8 patients. Complete vessel recanalization was obtained in 6/8 children after a median follow-up time of 4.8 months. No complications, neither clinical sequelae occurred. In our series, neurological signs and symptoms were significantly associated with the presence of hypoplasia of the contralateral venous sinus (p=0.029).
CONCLUSION: LST is a severe condition occurring even in absence of otological signs, and despite adequate antibiotic therapy for AOM, which should be ruled out and promptly treated. A dominant neurological presentation is associated in our series with anatomical variations of cerebral sinus venous drainage patterns. This should be carefully evaluated and considered in diagnosis, treatment planning and prognosis.

PMID: 26590005 [PubMed - as supplied by publisher]

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Oral morphine for pain management in paediatric patients after tonsillectomy and adenotonsillectomy.

Oral morphine for pain management in paediatric patients after tonsillectomy and adenotonsillectomy.

Int J Pediatr Otorhinolaryngol. 2015 Oct 24;

Authors: Oremule B, Johnson M, Sanderson L, Lutz J, Dodd J, Hans P

Abstract
OBJECTIVES: The withdrawal of codeine for use in children following tonsillectomy enforced a change in our practice of providing regular paracetamol and ibuprofen, with codeine for breakthrough pain relief. Our objectives were to; examine the effectiveness of paracetamol and ibuprofen; examine the effectiveness of the addition of rescue (PRN) morphine to regular paracetamol and ibuprofen.
METHODS: A 2 cycle prospective audit was conducted on our unit. Telephone consultations were conducted with parents of 74 children undergoing tonsillectomy and adenotonsillectomy. Cycle 1 (C1, without morphine) contained 24 consecutive patients and cycle 2 (C2, with morphine) contained 50 consecutive patients. Postoperative health service contact and outcome was recorded: worst pain scores on days 4 and 7 were obtained using validated pain assessment tools scoring 0-10. Cycle 2 results underwent subgroup analysis by method of surgery i.e. coblation (C2C) and cold steel dissection (C2D) groups.
RESULTS: More than half of parents felt simple analgesia was not effective enough in both cycles, this number was significantly higher in both 2nd cycle groups (C1=54%, C2C=74%, p=0.003, C2D=84%, p=0.0001). Mean worst pain reported at day 4 was similar for all groups, but the morphine groups reported higher pain at day 7 (C1 1.6, C2C 3.59, p=0.017, C2D 3.90, p=0.002). Antibiotic prescribing for children contacting a GP after surgery was significantly lower in the morphine groups (C1 24%, C2C 7%, p=0.0014, C2D 5%, p=0.0002). There was no difference in measured outcomes between the 2nd cycle groups.
CONCLUSION: This service evaluation found that postoperative morphine on an as-required basis, in addition to regular paracetamol and ibuprofen, did not significantly alter initial pain profile, worst pain scores or rate of health service contact when compared to regular paracetamol and ibuprofen alone. The majority of children in this study felt additional analgesia required. Children in the morphine groups experienced significantly less pharmacological intervention when contacting the GP after surgery.

PMID: 26590004 [PubMed - as supplied by publisher]

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Fetal distress and circulatory disturbance in monochorionic twins: Possible risk factors for sialadenitis?

Fetal distress and circulatory disturbance in monochorionic twins: Possible risk factors for sialadenitis?

Int J Pediatr Otorhinolaryngol. 2015 Nov 9;

Authors: Korček P, Straňák Z

Abstract
Neonatal sialadenitis is a rare condition. The vast majority of cases are caused by Staphylococcus aureus with predominant involvement of the parotid gland and need for long-term antimicrobial therapy. We reviewed three distinct cases of submandibular sialadenitis in preterm infants from monochorionic pregnancies. The association with neonatal sialadenitis is unproven. We speculate about the role of fetal distress and circulatory compromise in monochorionic twins as a risk factor in the development of this serious condition.

PMID: 26590003 [PubMed - as supplied by publisher]

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Cochlear sensitivity in children with chronic kidney disease and end-stage renal disease undergoing hemodialysis.

Cochlear sensitivity in children with chronic kidney disease and end-stage renal disease undergoing hemodialysis.

Int J Pediatr Otorhinolaryngol. 2015 Nov 10;

Authors: Renda R, Renda L, Selçuk ÖT, Eyigör H, Yılmaz MD, Osma Ü

Abstract
OBJECTIVES: Auditory system abnormalities commonly occur in patients with chronic renal disease and end-stage renal disease undergoing hemodialysis. The aim of this study was to determine the relationship between cochlear sensitivity and hemodialysis in dialytic and non-dialytic chronic kidney disease patients.
METHODS: The study included children aged 6-18 years that were divided into 3 groups: 36 non-dialytic patients with chronic kidney disease, 16 end-stage renal disease patients undergoing hemodialysis, and 30 healthy controls. Blood urea nitrogen, serum cystatin C levels, duration of chronic kidney disease, and the duration of hemodialysis were compared between the chronic kidney disease patients and end-stage renal disease patients undergoing hemodialysis. Hearing health was measured via tympanometry, pure-tone audiometry and distortion product otoacoustic emissions testing.
RESULTS: Distortion product otoacoustic emission amplitudes and signal-to-noise ratios were significantly lower at all frequencies tested in the non-dialytic and dialytic groups than in the control group (p<0.05). Patients with normal hearing had significantly lower distortion product otoacoustic emission amplitudes and signal-to-noise ratios than the healthy controls (p<0.05). The duration of CKD, the cystatin C level, and the blood urea level were not associated with hearing loss. The present findings suggest that there was a significant association between the duration of HD and hearing loss.
CONCLUSION: The present findings show that there was impaired cochlear function in the dialytic and non-dialytic patient groups, regardless of hearing loss, as compared to the control group. Patients with chronic renal disease-both dialytic and non-dialytic-should be monitored to prevent any further deterioration by avoiding potential ototoxic agents, even if their hearing thresholds are within normal limits.

PMID: 26590002 [PubMed - as supplied by publisher]

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A novel predictive marker for the viscosity of otitis media with effusion.

A novel predictive marker for the viscosity of otitis media with effusion.

Int J Pediatr Otorhinolaryngol. 2015 Nov 5;

Authors: Boztepe OF, Demir M, Gün T, Bilal N, Ensari NA, Doğru H

Abstract
OBJECTIVES: To evaluate the significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for the prediction of the viscosity of otitis media with effusion.
METHODS: This retrospective study was performed on 81 patients who were admitted to the otolaryngology clinic.The patients were divided into two groups according to their effusion type, as serous or mucoid, which was defined intraoperatively after myringotomy. The NLR and PLR were calculated as a simple ratio between the absolute neutrophil/platelet and absolute lymphocyte counts.Tympanostomy tube insertion was performed for all cases.Under direct visualization, the effusion was aspirated and classified as serous or mucous.
RESULTS: We postulated that an NLR value of less than 1.38 may show mucoid effusion and if the PLR value is less than 97.96, the effusion is mucoid.
CONCLUSIONS: We speculate that a useful predictor of viscosity for a middle ear effusion could prevent unnecessary surgeries and additional costs in the treatment of EMO. Additional studies are needed to confirm our results.

PMID: 26590001 [PubMed - as supplied by publisher]

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Primary glottic malignant melanoma of the larynx (PGMML): a very rare entity.

Primary glottic malignant melanoma of the larynx (PGMML): a very rare entity.

BMJ Case Rep. 2015;2015

Authors: Aggarwal S, Kaushal V, Singla S, Sen R

Abstract
Primary glottic malignant melanoma of the larynx (PGMML) is a very rare clinical entity with less than 20 cases reported in the literature so far. The most frequently reported subsite in primary malignant melanomas of the larynx is the supraglottic larynx. The vocal cord as a subsite for primary malignant melanoma is very rare. The present case is a primary glottic malignant melanoma involving both vocal cords. PGMML may present early due to associated hoarseness of voice, unlike other non-cutaneous melanomas in the head and neck. Non-cutaneous malignant melanomas in the head and neck are historically very aggressive in nature and known for poor outcomes and survival. Most non-cutaneous melanomas described in the literature have been superficial spreading or ulcerative in nature, unlike the present case, in which proliferative, polypoidal growth was seen. No associated risk factor was present in this case. Every reported case of this rare entity further adds to the better understanding of tumour biology and expression.

PMID: 26590185 [PubMed - as supplied by publisher]

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Mixed primary squamous cell carcinoma, follicular carcinoma, and micropapillary carcinoma of the thyroid gland: A case report.

Mixed primary squamous cell carcinoma, follicular carcinoma, and micropapillary carcinoma of the thyroid gland: A case report.

Auris Nasus Larynx. 2015 Nov 14;

Authors: Dong S, Song XS, Chen G, Liu J

Abstract
Primary squamous cell carcinoma of the thyroid gland is rare, and mixed squamous cell and follicular carcinoma is even rarer still, with only a few cases reported in the literature. The simultaneous presentation of three primary cancers of the thyroid has not been reported previously. Here we report a case of primary squamous cell carcinoma of the thyroid, follicular thyroid carcinoma, and micropapillary thyroid carcinoma. A 62-year-old female patient presented with complaints of pain and a 2-month history of progressively increased swelling in the anterior region of the neck. Fine-needle-aspiration cytology of both lobes indicated the possibility of the presence of a follicular neoplasm. Total thyroidectomy with left-sided modified radical neck dissection was performed. Postoperative pathological examination confirmed the diagnosis of thyroid follicular carcinoma with squamous cell carcinoma and micropapillary carcinoma of the thyroid. Thyroid-stimulating hormone suppressive therapy with l-thyroxine was administered. Radioiodine and radiotherapy also were recommended, but the patient did not complete treatment as scheduled. The patient remained alive more than 9 months after operation. The present case report provides an example of the coexistence of multiple distinct malignancies in the thyroid.

PMID: 26589365 [PubMed - as supplied by publisher]

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Pseudoadenoid dysplasia in proliferative verrucous leukoplakia.

Pseudoadenoid dysplasia in proliferative verrucous leukoplakia.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Nov 13;

Authors: Ide F, Ito Y, Saito I

PMID: 26589076 [PubMed - as supplied by publisher]

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Safety evaluation of MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate) for allergic rhinitis.

Related Articles

Safety evaluation of MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate) for allergic rhinitis.

Expert Opin Drug Saf. 2015 Nov 19;

Authors: Klimek L, Jean B, David P

Abstract
INTRODUCTION: As a chronic disease, allergic rhinitis (AR) requires regular use of allergy medications for the effective management of symptoms. It is therefore imperative that AR treatments not only provide adequate symptom control, but are also well-tolerated. Area covered: MP29-02 (Dymista, Meda, Solna, Sweden) is the first new class of AR medication (WHO ATC R01AD58) since the introduction of intranasal corticosteroids (INS) almost 50 years ago. It is a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) delivered in a single spray. Here we review all the safety information relevant to MP29-02, from the initial Phase I bioavailability and disposition data, to the Phase III 14-day and 52-week data, to Phase IV safety data collected during MP29-02 use in routine clinical practice. Expert Opinion: MP29-02 is the first real therapeutic advance in AR since the introduction of INS and has the potential to change the way this disease is managed, simplifying AR treatment regimens to a single puff in each nostril twice a day. Patients will benefit from superior symptom relief MP29-02 compared to INS with the added assurance that the safety of MP29-02 has been confirmed in the short- and long-term as well as in real life.

PMID: 26581312 [PubMed - as supplied by publisher]

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