Tonic stimulation of the pharyngeal mucosa causes pain and a reversible increase of inflammatory mediators
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Inflammation Research
ORIGINAL RESEARCH PAPER
Tonic stimulation of the pharyngeal mucosa causes pain and a reversible increase of inflammatory mediators Bertold Renner • Gabi Ahne • Elke Grosan Birgit Kettenmann • Gerd Kobal • Adrian Shephard
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Received: 12 March 2013 / Accepted: 26 August 2013 / Published online: 15 September 2013 Ó The Author(s) 2013. This article is published with open access at Springerlink.com
Abstract Objective and design To develop a model of the inflammatory component of non-infectious sore throat using tonic stimulation and quantification of inflammatory mediators in pharyngeal lavage fluid. Material or subjects Forty-five healthy volunteers. Treatment Cold dry air. Method Tonic stimulation of the pharynx was achieved using a constant stream of cold dry air to the back of the throat. Following optimization of stimulation conditions (phase 1), pharyngeal pain, irritation, and swallowing discomfort were assessed using visual analog scales, and the concentration of inflammatory markers were measured in pharyngeal lavage fluid (phase 2). Results Optimum conditions for tonic pharyngeal stimulation were cold dry air at 12 °C, relative humidity 20 %, at a flow rate of 12 L/min for 15 min. Analysis of pharyngeal
Responsible Editor: Michael J. Parnham. B. Renner and G. Ahne contributed equally to this work.
Electronic supplementary material The online version of this article (doi:10.1007/s00011-013-0663-7) contains supplementary material, which is available to authorized users. B. Renner (&) G. Ahne E. Grosan B. Kettenmann G. Kobal Department of Experimental and Clinical Pharmacology, University of Erlangen-Nuremberg, Krankenhausstr. 9, 91054 Erlangen, Germany e-mail: [email protected] G. Kobal Altria Client Services Inc., Richmond, VA, USA A. Shephard Reckitt Benckiser Healthcare Ltd, Slough, UK
lavage fluid collected 5 min after stimulation showed significant increases in prostaglandin E2 (P = 0.018), thromboxane B2 (P \ 0.001), and substance P (P \ 0.001), but no increase in peptidoleukotriene. When the stimulus was removed, the level of inflammatory markers in pharyngeal lavage fluid returned to baseline by 30 min poststimulation. These objective measures mirrored subjective pain ratings. Conclusions Tonic stimulation of the pharyngeal mucosa with cold dry air causes pain and an increase of inflammatory mediators which are reversible. Keywords Cold dry air Experimental model Inflammation Sore throat Pharyngitis
Introduction Pharyngitis (sore throat) can be caused by infectious agents (viruses, bacteria, and fungi) or physico-chemical (such as smoking, snoring, shouting, tracheal intubation, medications, or concomitant illness) or environmental (including indoor and outdoor air pollutants, temperature and humidity, and hazardous or occupational irritants) factors [1]. However, the underlying pathophysiology of noninfectious sore throat is not well understood, and experimental models with defined conditions and objective endpoints are needed to study the
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