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Background. A prolonged course of antibiotic therapy is often initiated for chronic rhinosinusitis (CRS) based on symptomatology. We examined differences in clinical manifestations and underlying conditions in patients with symptoms typical for CRS. CT scan abnormality of the sinuses was the gold standard for diagnosis of CRS. Methods. We performed a prospective observational study of 125 adults with classic symptoms of CRS undergoing nasal endoscopy and sinus CT. Results. The patients were classified into 2 groups: (1) those with radiographic evidence of sinusitis by CT (Sx + CT) (75) and (2) those with normal CT scans of the sinus (Sx - CT) (50). Decreased smell was significantly more common in Sx + CT than in Sx - CT patients, (P = .003). Paradoxically, headache, facial pain, and sleep disturbance occurred significantly more frequently in patients with Sx - CT than in patients with Sx+CT (P< .05). The absence of mucopurulence on endoscopy proved to be highly specific for Sx - CT patients (100%). On the other hand, sensitivity was low; only 24% of Sx + CT patients demonstrated mucopurulence by endoscopy. Improvement in response to antibiotics was similar between both CRS categories. Conclusions. Most symptoms considered to be typical for CRS proved to be nonspecific. Interestingly, symptoms that were more severe were significantly more likely to occur in younger patients who were Sx - CT. The efficacy of antibiotic therapy was uncertain. We suggest that objective evidence of mucopurulence assessed by endoscopy or CT should be obtained if antibiotics are to be given for prolonged duration. We recommend a moratorium for the widespread practice of a prolonged course of empiric antibiotics in patients with presumed CRS. [ABSTRACT FROM AUTHOR]

Background. Over the past 20 years, the use of zinc as an over-the-counter alternative therapy for the common cold has vastly grown in popularity. Recent reports of potentially permanent anosmia caused by intranasal zinc therapy warrant careful analysis of the therapeutic effects of zinc. Methods. A search of the Medline database (including articles published during 1966-2006) for studies of zinc and the common cold produced 105 published reports. Fourteen were randomized, placebo-controlled studies that examined the effect of zinc lozenges, nasal sprays, or nasal gels on naturally acquired common colds. Eleven features of experimental design affecting signal quality, chance, bias, and blinding were used to evaluate the 14 placebo-controlled studies. These criteria were validated case definition, quantifiable hypothesis, sample size calculation, randomized assignment, double blinding, proof of blinding, measurement of compliance, measurement of dropout rate, analysis by intent to treat, description of methods of analysis, and measurements of probability. Equal weight was given to each criterion, because failure to meet any one could potentially invalidate the findings of a clinical trial. Results. Four studies met all 11 criteria. Three of these studies reported no therapeutic effect from zinc lozenge or nasal spray. One study reported positive results from zinc nasal gel. Of the remaining 10 studies, 6 reported a positive effect and 4 reported no effect. Intent-to-treat analysis was the most common criterion not met. Conclusions. This structured review suggests that the therapeutic effectiveness of zinc lozenges has yet to be established. One well-designed study did report a positive effect of zinc nasal gel. [ABSTRACT FROM AUTHOR]

Background. Echinacea is a herbal preparation that is frequently used to treat the common cold. Spending on echinacea in the United States has risen to >$300 million annually. Methods. A total of 322 articles related to echinacea and colds, including 9 placebo-controlled clinical trials, were identified using the Medline and PubMed databases. Eleven features of experimental design that affect the accuracy of the measurement of features of interest, the probability of a chance relationship, bias, and blinding were used to evaluate the 9 placebo-controlled studies. The criteria were validated case definition, quantifiable hypothesis, sample-size calculation, randomized assignment, double blinding, proof of blinding, measurement of compliance, measurement of drop-out rate, analysis by intention to treat, description of the methods of analysis, and measurement of probability. Equal weight was given to each criterion, since failure to meet any one of them could potentially invalidate the findings of a clinical trial. Results. Of the 9 studies, 2 met all 11 criteria. The results of both studies were judged to be negative by the people who performed the studies. Of the remaining 7 studies, 6 were judged to have positive results, and 1 was judged to have negative results. The criterion most commonly not met was proof of blinding. Conclusions. This structured review suggests that the possible therapeutic effectiveness of echinacea in the treatment of colds has not been established. [ABSTRACT FROM AUTHOR]

A randomized, controlled, double-masked clinical trial was conducted with a combination antiviral-antimediator treatment for experimental rhinovirus colds. In all, 150 healthy men and women (aged 18-51 years) were randomly assigned to 1 of 3 groups: intranasal interferon (IFN)-α2b (6 × 10[sup 6] U every 12 h × 3) plus oral chlorpheniramine (12 mg extended release) and ibuprofen (400 mg) every 12 h for 4.5 days (n = 59 subjects); intranasal placebo plus oral chlorpheniramine and ibuprofen (n = 61 subjects); or intranasal and oral placebos (n = 30 subjects). Treatment was started 24 h after intranasal viral challenge. During the 4.5 days of treatment with IFN-α2b, chlorpheniramine, and ibuprofen, the daily mean total symptom score was reduced by 33%-73%, compared with placebo. Treatment reduced the severity of rhinorrhea, sneezing, nasal obstruction, sore throat, cough, and headache and reduced nasal mucus production, nasal tissue use, and virus concentrations in nasal secretions. IFN-α2b added to the effectiveness of chlorpheniramine and ibuprofen and was well tolerated. [ABSTRACT FROM AUTHOR]

Attempts to relieve the misery of the common cold have been made since long before current understanding of its viral origin. Although current symptomatic therapies provide some relief, any effective treatment must incorporate an antiviral to address the infection. Symptom production is related not only to viral cytopathic effect but also to the early activation of several inflammatory pathways. Antiviral treatment alone may not be able to prevent these events. Combining an antiviral with selected therapeutic agents that block these inflammatory pathways has been shown to improve the effectiveness of cold treatment. Early diagnosis and initiation of treatment combined with regular dosing until symptoms subside appears to be the most effective treatment strategy to maximize therapeutic outcomes. This strategy reduces viral shedding in nasal fluid, provides treatment for the period of maximum symptom burden, and may reduce the frequency and severity of the sinus disease that accompanies colds. [Copyright &y& Elsevier]

Viral respiratory tract infections, also known as colds, are the most common infection in humans. The majority of these infections are caused by rhinoviruses. Rhinovirus deposition in the nose or the eye initiates infection. The virus attaches to the host cell intercellular adhesion molecule—1 (ICAM-1) receptors in the back of the throat. Subsequent viral replication triggers the release of inflammatory mediators and activation of neurogenic pathways, which lead to symptoms. Symptoms occur within 10 to 16 hours after virus entry into the nose and peak on days 2 to 3 of infection. Symptom duration is typically 1 week, although 25% of cases last longer. Understanding the chronology of these events is important in the timing of treatment. Because of the rapidity of symptom onset, early treatment is the key to reducing viral replication and illness. Also, early treatment may reduce the risk of transmission. [Copyright &y& Elsevier]

Measures intranasal pressures in adults during nose blowing, sneezing, and coughing. Mathematical modeling of nasal fluid flow; Computed tomography examinations with intranasal contrast medium; Epithelial lining of the maxillary sinus.

State and trait negative affect (NA) were measured in healthy people immediately before an illness was induced through exposure to a respiratory virus. State NA, disease-specific health complaints (e.g., runny nose, congestion, and sneezing), and an associated objective marker of disease severity (mucus secretion weights) were assessed daily during the illness. Baseline trait and state NA were both associated with increased numbers of subsequent complaints. Although greater numbers of complaints among people high in state NA were explicable in terms of greater disease severity, the association of trait NA and symptoms was independent of objective disease. The trait NA complaint association was also independent of state NA and hence not attributable to trait-elicited state affect. Greater trait NA was associated with biases in complaining during but not before illness. This suggested failure to discriminate between symptoms rather than increased sensitivity or hypochondriacal response. [ABSTRACT FROM AUTHOR]

Focuses on a study which examined whether naproxen, a propionic acid inhibitor of cyclooxygenase, alters the course of experimental rhinovirus colds. Experimental design; Interventions; Measurements; Results and discussion.

Provides information on a study that determined whether hand contact/self inoculation will transmit experimental rhinovirus infections between volunteers and to compare the efficiency of spread by this method to that of the aerosol routes. Methodology of the study; Results and discussion on the study.

Prospective surveillance for influenza was performed during the 2002 Salt Lake City Winter Olympics. Oseltamivir was administered to patients with influenza like illness and confirmed influenza, while their close contacts were given oseltamivir prophylactically. Influenza A/B was diagnosed in 36 of 188 patients, including 13 athletes. Prompt management limited the spread of this outbreak. [ABSTRACT FROM AUTHOR]

Background: The concentration of rhinovirus in nasal wash specimens from infected volunteers peaks at 48–72 h after inoculation. The volume of expelled nasal fluid peaks at the same time, raising the question of whether the viral concentration in nasal wash reflects viral replication in nasal cells or merely the production of an increased volume of nasal fluid during a cold. Objectives: To determine the amount of rhinovirus in nasal lining fluid during colds before the nasal fluid has been diluted in a nasal wash. Study design: Rhinovirus titers were determined in nasal wash specimens collected daily for five days from 14 subjects with type16 rhinovirus infection. The urea concentration in nasal lining fluid equals that in blood. By determining the urea concentration in a nasal wash and comparing it to the urea concentration in blood from the same subject, it was possible to determine the amount of dilution of the nasal lining fluid. The dilution factor (reciprocal of the dilution) was then used to calculate the viral concentration in undiluted nasal lining fluid. Results: The dilution factor in 70 nasal washes varied from 5 to 64. The viral GMTs (+S.E.) in nasal washes were 1.79 (+0.3) TCID50/ml at 24 h, 3.11 (+0.15) at 48 h, and 2.61 (+0.3) at 72 h. The viral GMTs in nasal lining fluid, based on urea adjusted values, paralleled those in nasal washes but were approximately one log higher. Virus concentrations returned to near baseline values by day 5. Conclusions: The temporal pattern of rhinovirus shedding observed in nasal wash specimens, with a peak in virus concentration at 48–72 h after infection, is a true indication of virus production in nasal cells and not an artifact of the increased amount of nasal fluid produced during the early phase of a cold. [Copyright &y& Elsevier]

Examines the nasal fluid of 11 young adults with experimentally induced rhinovirus colds and that of four control subjects for the presence of fibrin. Analysis of the time course of plasma exudation that results in increases in albumin and f colds; Measures necessary to reduce or solubilize fibrin in secretion.

Presents a letter by the authors in response to a letter to the editor about the efficacy of Echinacea treatment on common cold.

This study examined the role of personality in the reporting of symptoms and illness not supported by underlying pathology. After assessment of the Big Five personality factors, 276 healthy volunteers were inoculated with a common cold virus. On each of the following 5 days, objective indicators of pathology, self-reported symptoms, and self-reported illness onset were assessed. Neuroticism was directly associated with reports of unfounded (without a physiological basis) symptoms in individuals at baseline and postinoculation in those with and without colds. Neuroticism was also indirectly associated with reports of unfounded illness through reports of more symptoms. Openness to Experience was associated with reporting unfounded symptoms in those with verifiable colds, whereas Conscientiousness was associated with reporting unfounded illness in those who were not ill. [ABSTRACT FROM AUTHOR]