Monday, October 28, 2013

Does inhaling steam cause injury and / or death?

Does inhaling steam cause injury and / or death?

Steam inhalation is commonly used to treat the upper respiratory tract infections, including sinusitis in children. The inhalation facilitates efficient heat transfer to the upper tract. However, the remedy may have serious consequences. We have reviewed the available literature exploring the consequences. Here are the key findings and conclusions of four studies:
B.l. Bhootra and J. Kitinya. (2005). Deaths from accidental steam inhalation during traditional therapy. Journal of Clinical Forensic Medicine.
  • Death due to steam inhalation is rare. The report highlighted that two children succumbed to superheated steam inhalation in a closed room. The post-mortem examination revealed that congestion of lungs and epiglottis and petechial hemorrhages in the hearts, lungs and brains led to hypoxia (inadequate supply of oxygen) and thereafter death.
  • The respiratory tract mucosa is sensitive to superheated steam vapors.
  • Inhaling steam in a closed space cause deadly hypoxia within minutes.

David J.A. Orr, Dylan Murray, Siun M. Murphy, and Susan Smith. (2004). Burns caused by steam inhalation for respiratory tract infections in children. British Medical Journal.

The researchers observed a group of children who received treatment for scalds at Dublin’s Children Hospital during July 1-December 31, 2002. The age varied from nine months to ten years. The scalds affected 3-6% area of the body surface. A direct contact between the face and hot water or steam burned the skin. Some children were given steam inhalation therapy on the doctor’s recommendation.
The authors concluded that the popular steam inhalation method that involves holding the head under a towel wrapped around a container containing very hot water is a risky process. Chances of getting burns are high, especially in case of young patients.  They recommended that a safer method should be used for the inhalation.

Balakrishnan C, Gordon DM, Prasad JK, and Tijunelis AD. (1996). Burns and inhalation injury caused by steam. Burns. Elsevier.

They concluded that steam inhalation might injure the respiratory tract in rare cases. However, the inhalation often causes acute pulmonary insufficiency. The injured alveolar epithelium increases pulmonary edema, pulmonary capillary permeability and gas exchange abnormalities.

Akhavani MA and Baker RHJ. (2005). Steam inhalation treatment for children. British Journal of General Practice.

The authors attended some children with scalds in January 2005. The children were less than five years old. They got burns because they kicked steaming hot water container, spilling the water on the chests and feet. The burnt area varied from one to three percent of the body surface area. Steam inhalation was a prescription by the doctor.
The authors also cited a Welsh research in the article. The research states that the incidences of scalds in children have gone up. The increase is ascribed to spilling hot beverage and steam inhalation. The authors advised against inhalation because evidences supporting the therapeutic value of inhalation are not enough.
Be careful while inhaling steam!

Tuesday, October 22, 2013

Can wet hair be a cause of sinus headache?

Can wet hair be a cause of sinus headache?

Yes, wet hair, especially in cold weather, may cause a sinus headache.
You may wonder how wet hair can lead to the headache.

Medical community has observed that wet hair not only become a cause of sinus headache but also trigger posterior eye pain in cold weather.
Abullah Kaya and Halil Caliskan, medical professionals working for Department of Ophthalmology, GATA Haydarpasa Training Hospital in Istanbul, Turkey, have suggested a mechanism justifying the observations. Their research report “Does wet hair in cold weather cause sinus headache and posterior eye pain? A possible mechanism through selective brain cooling system” published in December 2012 issue of Medical Hypotheses features the suggested hypothesis.

Suggested Hypothesis

Their hypothesis revolves around selective brain cooling (S.B.C.) mechanism that may cause the pain and headache if hairs are left wet in cold weather.

What is S.B.C. and what does it do?

The mechanism involves upper respiratory system consisting of paranasal sinuses and nose and skin of the head. The cooling protects the brain from abnormally high body temperature conditions called hyperthermia.
From the mucous membranes of paranasal sinuses and nose and the skin of head, cool venous blood flows into intracranial dural sinuses, cooling the brain.  However, an exposure to hypothermia (abnormally low body temperature) conditions such as wet hair in the cold weather cools the brain excessively.
The authors believe that to counter the excessive cooling of the brain, conditions in paranasal sinuses change. For example,
  1. The resulting closure of sinus ostia may lead to mucus accumulation and thus decrease air supply within the sinuses.
  2. Vasomotor alterations may occur to curtail loss of heat.
The authors’ hypothesis states that the changes within the sinuses control brain temperature when head skin is exposed to hypothermia. An extremely thin bony layer separates the subarachnoid space and the posterior ethmoid air sinus. Slim bony plates create a boundary between cavernous sinuses and carotid artery and sphenoidal sinuses. The layer and plates directly aid in brain cooling process. The sphenoidal and posterior ethmoid sinuses play an important role in S.B.C. and therefore the changes may affect these sinuses more than any other paranasal sinuses. These conditions may cause sinus headache and the eye pain. The symptoms may be diagnosed as sinusitis, which is incorrect.
In fine, excessive cooling of head skin due to wet hair in cold weather may become a cause of sinus headache that is confused with sinusitis.

Thursday, October 10, 2013

Itching sensation after Nasodren?

Why I could feel some itching sensation after Nasodren?

Nasodren acts physiologically, physically stimulating the terminal endings of the trigeminal nerve in the nasal mucosa. This specific mechanism of action can produce some itching, sneezing, a brief sensation of burning sensation in the nasopharynx and more rarely, a brief lacrimation and flushing of the face.
These are manifestations of the positive response to the product. The intensity of these sensations varies from one person to another and normally these effects usually diminish during the course of treatment.

It is important not to inhale the product as it can make these sensations more intense.
Nasodren is a very safe product since its active ingredient, saponins, is not absorbed and consequently they do not reach bloodstream and don’t produce systemic side effects, i.e. do not affect the liver, the kidneys or other organs. Obviously, Nasodren not produce any alteration of nasal or paranasal mucosas.

Thursday, October 3, 2013

Drug-induced rhinitis. New possibilities of conservative therapy

Drug-induced rhinitis. New possibilities of conservative therapy.

Key messages from this study
  • Nasal obstruction is a very common symptom that many patients try to solve using decongestants (vasopressors).

  • Rhinitis medicamentosa (RM) is one of the serious problems of rhinology and accounts for 12,5% of the diseases of the nose and paranasal sinuses. Clinical manifestations are nasal congestion, nasal breathing difficulties and psychological dependence of the drug.
    The main cause of RM is the use of decongestants; using vasopressors for more than 5-7 days develops rebound syndrome.

  • The performed study shows the effectiveness of Sinuforte in the treatment of RM in patients applying decongestants for up to 12 months that gives a reason to recommend this product as the drug of choice for the treatment of this group of patients.

  • When patients are aware of side effects that Sinuforte®/Nasodren® may produce because of its mechanism of action (burning sensation, itching, sneezing etc.), most of them tolerate and complete treatment course, which reinforce the importance of training pharmacists, and ENTs if called, in an appropriate and continued way.

Study Design: Simple open study

Objective: Evaluate the efficacy, safety and tolerability of Sinuforte (Nasodren®) in patients with rhinitis medicamentosa (RM).
In addition, the study also included the analysis of long-term efficacy (after 45 and 72 days of treatment ending) of a 15-day course application of Sinuforte® (Nasodren®).

Patients: 40 patients aged from 15 to 60 years with rhinological symptomatology of at least 10 points.

Study method: The functional characteristics of the nasal cavity were evaluated by rhinomanometry (assess respiratory function) and saccharin test (measures transport function of ciliated epithelium).
Training the patients to properly use the drug was a mandatory element of the study. Importantly, the study doctor explained to the patients that undesirable effects (burning sensation, sneezing, watery eyes...) are characteristic of the mechanism of action of Sinuforte and should not be feared.


The analysis of the impact of Sinuforte® on the difficulty of nasal breathing has shown with a decrease in the score of the symptom after the treatment.
The evaluation of disorders of smell is quite interesting. If before the treatment 10 patients reported reduction of smell, at the end of the treatment all 34 patients evaluated their olfactory function from 0 to 4 points (0-10 points scale, being 0 perfect smell and 10 no smell at all).
Out of the 18 patients having used vasopressors from 1 to 6 months, 14 people abandoned them accounting for 77%. Seven of the eight patients (87.5%) having used decongestants from 6 to 12 months also stopped using them. Among the four patients having used vasopressors from 12 to 36 months only one stopped using them. Four patients who had experience of applying decongestants for more than 36 months continued using them even during the treatment with Sinuforte (concomitant use may explain the lack of efficacy in the patient who dropped out).
After the treatment of RM with Sinuforte® all the studied functional indicators have improved significantly.
Long-term results (assessed after 45 and 72 days):
93% of the patients who had been using decongestants for up to 6 months reported a lack of dependence on them.
86% of the patients who had been using decongestants for up to 12 months reported a lack of dependence on them.
The only patient who had an "experience" of up to 36 months also noticed a lack of dependence.


It should be noted that despite the existence of undesirable effects from the nasal cavity and the lacrimal passages, only six patients withdrew from the study (3 of them due to reasons not related with the product). The remaining 34 patients took the study in accordance with the protocol.

V.S. Kozlov, N.G. Chuchueva.
Vestn Otolaryngology. 2012; (6): 71 –75