Klinik und Therapie der Schwangerschafts-Rhinopathie

 

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Zusammenfassung

Als Schwangerschafts-Rhinopathie oder Rhinopathia gravidarum bezeichnet man eine mehrwöchige, schwangerschaftsbegleitende Behinderung der Nasenluftpassage ohne Hinweis auf eine Raumforderung, Infektion oder Allergie und das rasche Verschwinden der Symptome nach der Geburt. Das Krankheitsbild betrifft etwa 20 bis 30 % aller Schwangeren und kann zu jedem Zeitpunkt der Gravidität auftreten. Pathophysiologisch werden vor allem hormonelle Einflüsse verantwortlich gemacht. Raucherinnen sowie Patientinnen mit vorbestehender Milbenallergie und chronischer Sinusitis besitzen ein erhöhtes Risiko daran zu erkranken. Im Folgenden wird ein stufentherapeutisches Konzept für die Behandlung der Rhinopathia gravidarum vorgestellt.

Abstract

Pregnancy rhinitis is a common condition with long-lasting nasal congestion without signs of infection, allergy or tumor, starting at any time during pregnancy and disappearing completely within 2 weeks of delivery. Risk factors are smoking, sensitisation to house dust mites and chronic sinusitis. Hormonal influences are most likely; however, a definitive pathophysiological concept does not exist. Various treatment options are presented and a stepwise therapeutic strategy for pregnancy rhinitis is developed.

• 1 MacKenzie J N. The physiological and pathophysiological relations between the nose and the sexual apparatus of man.  Alienist Neurol. 1898;  19 219-239
  PubMedGoogle Scholar
• 2 Mabry R L. Intranasal steroid injection during pregnancy.  South Med J. 1980;  73 1176-1179
  PubMedGoogle Scholar
• 3 Mabry R L. Rhinitis of pregnancy.  South Med J. 1986;  79 965-971
  PubMedGoogle Scholar
• 4 Ellegård E, Hellgren M, Toren K, Karlsson G. The incidence of pregnancy rhinitis.  Gyn Obstet Invest. 2000;  49 98-101
  PubMedGoogle Scholar
• 5 Ellegård E, Karlsson G. Nasal congestion during pregnancy.  Clin Otolaryngol. 1999;  24 307-311
  CrossrefPubMedGoogle Scholar
• 6 Derkay C S. Eustachian tube and nasal function during pregnancy: a prospective study.  Otolaryngol Head Neck Surg. 1988;  99 558-566
  PubMedGoogle Scholar
• 7 Ellegård E, Karlsson G. IgE-mediated reactions and hyperreactivity in pregnancy rhinitis.  Arch Otolaryngol Head Neck Surg. 1999;  125 121-1125
  PubMedGoogle Scholar
• 8 Juniper E F. Measuring health-related quality of life in rhinitis.  J Allergy Clin Immunol. 1997;  99 S742-749
  CrossrefPubMedGoogle Scholar
• 9 Franklin K A, Holmgren P A, Jonsson F, Poromaa N, Stenlund H, Svanborg E. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus.  Chest. 2000;  117 137-141
  CrossrefPubMedGoogle Scholar
• 10 Wolff H G, Wolf S, Grace W J. et al . Changes in form and function of mucous membranes occurring as part of protective reaction patterns in man during periods of life stress and emotional conflict.  Trans Assoc Am Physicians. 1948;  61 313-334
  PubMedGoogle Scholar
• 11 Holmes T H, Goodell H, Wolf S, Wolff H G. The relation of nasal to sexual function.  In: The nose: An experimental study on reactions within the nose in human subjects during varying life experiences. Springfield; III Charles C Thomas Publisher 1950: 89-100
  Google Scholar
• 12 Mortimer H, Wright R P, Collip J B. The effect of the administration of oestrogenic hormones on the nasal mucosa of the monkey (Macaca mulatta).  Can Med Assoc J. 1936;  35 503-512
  PubMedGoogle Scholar
• 13 Taylor M. An experimental study of the influence of the endocrine system on the nasal respiratory mucosa.  J Laryngol Otol. 1961;  75 972-977
  CrossrefPubMedGoogle Scholar
• 14 Toppozada H, Michaels L, Toppozada M, El-Ghazzawi I, Talaat M, Elwany S. The human respiratory nasal mucosa in pregnancy.  J Laryngol Otol. 1982;  96 613-626
  CrossrefPubMedGoogle Scholar
• 15 Mabry R L. The management of nasal obstruction during pregnancy.  ENT journal. 1983;  62 16-19
  PubMedGoogle Scholar
• 16 Lekas M D. Rhinitis during pregnancy and rhinitis medicamentosa.  Otolaryngol Head Neck Surg. 1992;  107 845-849
  PubMedGoogle Scholar
• 17 Reynolds S RM, Foster F I. Acetylcholine-equivalent content of the nasal mucosa in rabbits and cats, before and after administration of estrogen.  Am J Physiol. 1940;  131 422-425
  PubMedGoogle Scholar
• 18 Kojda G. Weibliche Sexualhormone, Östrogene. In Kojda. G Pharmakologie Toxikologie Systematisch. 2. Auflage 2002 Uni-Med Verlag Bremen; pp.: 363-369
  Google Scholar
• 19 Kühnel T. Hormonelle Rhinitis in Kapitel Nase und Nasennebenhöhlen. Praxis der HNO-Heilkunde, Kopf- und Halschirurgie (Hrsg. Strutz J und Mann W). Thieme Stuttgart; 2001
  Google Scholar
• 20 Toppozada H, Toppozada M, El-Ghazzawi I, Elwany S. The human respiratory nasal mucosa in females using contraceptive pills.  J Laryngol Otol. 1984;  98 43-51
  CrossrefPubMedGoogle Scholar
• 21 Bende M, Hallgarde U, Sjögren C, Uvnäs-Moberg K. Nasal congestion during pregnancy.  Clin Otolaryngol. 1989;  14 385-387
  PubMedGoogle Scholar
• 22 Ellegård E, Oscarsson J, Bougoussa M, Igout A, Hennen G, Eden S, Karlsson G. Serum level of placental growth hormone is raised in pregnancy rhinitis.  Arch Otolaryngol Head Neck Surg. 1998;  124 439-443
  PubMedGoogle Scholar
• 23 Haeggstrom A, Ostberg B, Stjerna P, Graf P, Hallen H. Nasal mucosal swelling and reactivity during a menstrual cycle.  ORL J Otorhinolaryngol Relat Spec. 2000;  62 39-42
  PubMedGoogle Scholar
• 24 Bowser C, Riederer A. Detection of progesterone receptors in connective tissue cells of the lower nasal turbinates in women.  Laryngorhinoontologie. 2001;  80 182-186
  PubMedGoogle Scholar
• 25 Schatz M, Zeiger R S. Diagnosis and management of rhinitis during pregnancy.  Allergy Proc. 1988;  9 545-554
  PubMedGoogle Scholar
• 26 Skinner D W, Richards S H. Acromegaly: the mucosal changes within the nose and paranasal sinuses.  J Laryngol Otol. 1988;  102 1107-1110
  CrossrefPubMedGoogle Scholar
• 27 Zondeck B, Bromberg Y M. Endocrine allergy - clinical reactions of allergy to endogenous hormones and their treatment.  J Obstet Gynecol Br Emp. 1947;  54 1-19
  PubMedGoogle Scholar
• 28 Sorri M, Harikainen-Sorri A, Kärja J. Rhinitis during pregnancy.  Rhinology. 1980;  18 83-86
  PubMedGoogle Scholar
• 29 Hellin M, Ruiz C V, Ruiz F M. The influence of pregnancy on mucociliary nasal transport.  An Otorrinolaringol Ibero Am. 1994;  21 595-601
  PubMedGoogle Scholar
• 30 Ellegård E, Karlsson G. Nasal mucociliary transport in pregnancy.  Am J Rhin. 2000;  14 375-378
  PubMedGoogle Scholar
• 31 Turnbull G L, Rundell O H, Rayburn W F, Jones R K, Pearman C S. Managing pregnancy-related nocturnal nasal congestion. The external nasal dilator.  J Reprod Med. 1996;  41 897-902
  PubMedGoogle Scholar
• 32 Graf P, Hallén H. Effect of the nasal mucosa of long-term treatment with oxymetazoline, benzalkonium chloride and placebo nasal sprays.  Laryngoscope. 1996;  106 605-609
  CrossrefPubMedGoogle Scholar
• 33 Schaefer C h, Spielmann H. Arzeneiverordnung in Schwangerschaft und Stillzeit. 6. Auflage Urban & Fischer Verlag München und Jena; 2001
  Google Scholar
• 34 Scadding G K, Lund V J, Jacques L A, Richards D H. A placebo-controlled study of fluticasone propionate aqueous nasal spray and beclomethasone dipropionate in perennial Rhinitis: efficacy in allergic and non-allergic perennial Rhinitis.  Clin Exp Allergy. 1995;  25 737-775
  PubMedGoogle Scholar
• 35 Mygind N. Effects of corticosteroid therapy in non-allergic rhinosinusitis.  Acta Otolaryngol. 1996;  116 164-166
  CrossrefPubMedGoogle Scholar
• 36 Mabry R L. Evaluation of systemic absorption of intraturbinally injected triamcinolone.  Otolaryngol Head Neck Surg. 1981;  89 268-270
  PubMedGoogle Scholar
• 37 Van As A, Bronsky E, Grossman J, Meltzer E, Ratner P, Reed C. Dose tolerance study of fluticasone propionate aqueous nasal spray in patients with seasonal allergic rhinitis.  Ann Allerg. 1991;  67 156-162
  PubMedGoogle Scholar
• 38 Wilson A M, Sims E J, McFarlane L C, Lipworth B J. Effects of intranasal corticosteroids on adrenal, bone, and blood markers of systemic activity in allergic rhinitis.  J Allerg Clin Immunol. 1998;  102 598-604
  PubMedGoogle Scholar
• 39 Allen D B. Systemic effects of intranasal steroids: an endocrinologist's perspective.  J Allergy Clin Immunol. 2000;  106 S179-190
  CrossrefPubMedGoogle Scholar
• 40 Ellegård E, Hellgren M, Karlsson N G. Fluticasone propionate aqueous nasal spray in pregnancy rhinitis.  Clin Otolaryngol. 2001;  26 394-400
  CrossrefPubMedGoogle Scholar
• 41 O'Connell M, Welsch G. Unbound plasma cortisol during pregnancy.  J Clin Endocrinol. 1969;  29 563-568
  PubMedGoogle Scholar
• 42 Hager G, Heise G. A severe complication with permanent practical blindness of one eye following an intranasal injection.  HNO. 1962;  10 325-328
  PubMedGoogle Scholar
• 43 McCleve D E, Goldstein J, Silver S. Corticosteroid injections of the nasal turbinates: past experience and precautions.  Otolaryngology. 1978;  86 851-857
  PubMedGoogle Scholar
• 44 Onrust S V, Lamb H M. Mometasone furoate. A review of its intranasal use in allergic rhinitis.  Drugs. 1998;  56 725-745
  CrossrefPubMedGoogle Scholar
• 45 Storms W W. Risk-benefit assessment of fluticasone propionate in the treatment of asthma and allergic Rhinitis.  J Asthma. 1998;  35 313-336
  PubMedGoogle Scholar
• 46 Hallen H, Enerdal J, Graf P. Fluticasone propionate nasal spray is more effective and has a faster onset of action than placebo in treatment of rhinitis medicamentosa.  Clin Exp Allergy. 1997;  27 552-558
  CrossrefPubMedGoogle Scholar
• 47 Naclerio R M. Optimizing treatment options.  Clin Exp Allergy. 1998;  28 Suppl 6 54-59
  CrossrefPubMedGoogle Scholar

Priv. Doz. Dr. med. Thomas K. Hoffmann

Universitäts-HNO-Klinik

Klinikum der Universität Düsseldorf

Moorenstr. 5

40225 Düsseldorf

Phone: 0211 811 7570

Fax: 0211 811 8880

Email: tkhoffmann@uni-duesseldorf.de