What are the Cotton criteria for medical treatment?

Cotton Criteria

The term "Cotton criteria" does not refer to a standardized medical diagnostic or treatment framework in the reviewed evidence. However, the literature references several distinct medical contexts where "Cotton" appears:

Cotton Test for Empty Nose Syndrome

The Cotton test is a validated office-based diagnostic procedure for identifying Empty Nose Syndrome (ENS) patients. 1

Test Procedure

• Cotton is placed in the nasal cavity during office examination 1
• Patients complete the Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) in three conditions: pre-cotton, cotton in situ, and post-cotton 1
• ENS patients show normalization of ENS6Q scores when cotton is in place, indicating symptomatic improvement 1

Diagnostic Interpretation

• The minimal clinically important difference (MCID) for the ENS6Q is a 7-point change from baseline 1
• Mean change between "a little better" and "about the same" was 4.25 (SD = 5.79), establishing an MCID of 6.25 1
• Significant differences (P < .001) in all ENS6Q questions between ENS patients and controls normalize with cotton placement 1

Cotton Osteotomy in Foot Surgery

The Cotton osteotomy is a medial cuneiform opening wedge osteotomy originally described by Frederic Cotton in 1936 2

Surgical Indications

• Adjunctive procedure in flatfoot reconstruction to correct forefoot varus deformity 3
• Treatment of metatarsus primus elevatus in hallux valgus and hallux limitus 2
• Restoration of medial column deformity in pes planus 2
• Correction of first ray elevatus, either primary or iatrogenic after base wedge osteotomy 3

Patient Selection Criteria

• Avoid in patients with medial column joint instability, concomitant hallux valgus deformity, or degenerative joint disease of the medial column—these conditions are better treated with arthrodesis 3
• Appropriate for patients requiring preservation of first ray length and medial column motion 2

Outcomes

• Radiographic graft incorporation achieved in 97.3% of cases at 10 weeks 3
• Meary's angle improved an average of 17.75°, from -17.24° ± 8.00° to 0.51° ± 3.81° (p < .01) 3
• Complication rate of 8.1%, including neuritis (5.4%) and delayed union (2.7%) 3

Cotton in Physical Restraint Protocols

In psychiatric settings, "cotton" refers to sterile materials used during physical restraint procedures 4

Safety Requirements

• Sterile cotton rolls and balls must be available during restraint procedures 4
• Physical restraint requires a minimum of two staff members per child 4
• Average restraint duration is 20-30 minutes 4

Cotton in Drug Preparation (Harm Reduction Context)

In substance use harm reduction guidelines, "cotton" refers to filters used in drug preparation 4

Harm Reduction Recommendations

• Use a new filter ("cotton") to prepare drugs—never reuse or share 4
• Use a new or disinfected container ("cooker") with each preparation 4
• These recommendations apply to patients who continue injection drug use despite counseling to stop 4