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Xavier R. Peak Nasal Inspiratory Flow (PNIF) for Nasal Breathing Evaluation. Facial Plast Surg 2024; 40:310-313. [PMID: 38158212 DOI: 10.1055/a-2236-4581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Measuring nasal airflow and nasal breathing has been a major goal of rhinology. Many objective methods for measuring nasal airflow or nasal airway resistance or dimensions provide valuable data but are time-consuming and require expensive equipment and trained technicians, thus making these methods less practical for clinical practice. Peak nasal inspiratory flow (PNIF) measurement is fast, unexpensive, noninvasive, and able to provide an objective evaluation of nasal airflow in real-time. Unilateral PNIF measurements allow separated evaluation of each side of the nasal airway and may prove particularly useful when clinical assessment detects significant asymmetry between both nasal cavities.PNIF measurements are most useful for assessing changes in nasal airflow achieved by any form of therapy, including surgical treatment of the nasal airway. These measurements generally correlate with other objective methods for nasal airway evaluation, but not unequivocally with patient-reported evaluation of nasal breathing. Nevertheless, as low PNIF values prevent the sensation of a suitable nasal breathing, PNIF measurement may also prove useful to optimize the decision of how to best address patients with complaints of nasal airway obstruction.
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Rossi Meyer MK, Most SP. Quantifying the Subjective Experience of Nasal Obstruction: A Review. Facial Plast Surg 2024; 40:336-340. [PMID: 37625460 DOI: 10.1055/a-2160-4998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Nasal obstruction is an exceedingly common problem and challenging to treat due to its multifactorial etiology. Therefore, measuring treatment outcomes of nasal obstruction can be equally complex yet vital to appropriately assessing symptom improvement or resolution. Both physiologic and anatomic assessments of the nasal airway exist in addition to validated patient-reported outcome measures (PROMs), which objectify subjective nasal obstruction and sinonasal symptoms. Correlation between objective and subjective treatment outcome measures is controversial with clinical guidelines favoring the use of PROMs for surgical treatment of nasal obstruction. In this review, the anatomic and physiologic measurements of the nasal airway and validated PROMs will be discussed, as well as the rationale for implementing PROMs into the rhinoplasty surgeon's practice.
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Affiliation(s)
- Monica K Rossi Meyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Hildebrandt T, Heppt WJ. Nasal Breathing Assessment Using Computational Fluid Dynamics: An Update from the Rhinologic Perspective. Facial Plast Surg 2024; 40:331-335. [PMID: 38198818 DOI: 10.1055/s-0043-1777838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
An objective assessment of nasal breathing is currently insufficiently achievable. The application of computational fluid dynamics for this purpose is increasingly gaining attention. However, the suggested specific frameworks can differ considerably. To the best of our knowledge, there is not yet a widely accepted clinical usage of computational fluid dynamics. In this article, selected aspects are addressed that might be crucial for future development and possible implementation of computational fluid dynamics in rhinology.
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Affiliation(s)
| | - Werner Johannes Heppt
- Department of Otorhinolaryngology-Head and Neck Surgery, Facial Plastic Surgery, Academic Teaching Hospital, Staedtisches Klinikum, Karlsruhe, Germany
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Ozdem A, Ozturan O, Sutcu AO, Dogan R, Senturk E. Medial flap middle turbinoplasty for solid middle turbinate hypertrophy: improving airway, speeding healing and preserving olfaction. Eur Arch Otorhinolaryngol 2024; 281:805-816. [PMID: 37843616 DOI: 10.1007/s00405-023-08264-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/25/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE The techniques to be performed for bullous middle turbinates are well-defined and widely accepted in the literature. However, in the case of solid middle turbinate hypertrophy, information on surgical techniques that take into account function and sense of smell is very limited in the literature. The aim of this study was to compare the airway patency and olfaction results of patients diagnosed with solid middle turbinate hypertrophy, who underwent subtotal (transverse) resection or medial flap turbinoplasty of the middle turbinates. METHODS Thirty-five adult patients who were diagnosed with solid middle turbinate hypertrophy were divided into two groups, namely medial flap middle turbinoplasty (study group = 17) and transverse resection to the middle turbinate (control group = 18). Acoustic rhinometry, anterior rhinomanometry, peak nasal inspiratory flowmeter test, odor identification test, and n-butanol threshold measurements were performed before and 3 months after the surgery. In addition, preoperative and postoperative nasal obstruction and olfactory senses of the patients were evaluated with visual analog scale and nasal obstruction symptom evaluation scale. RESULTS Visual analog scores for olfaction were significantly higher in the study group compared to the control group. In odor identification test, a significant improvement was observed in the study group, while a decrease was observed in the control group. While there was a decrease in the n-butanol thresholds values in the study group, there was an increase in the control group. CONCLUSIONS Medial mucosal flap technique is an effective and functional turbinoplasty technique that can be used in solid hypertrophy of the middle turbinate, which offers advantages in terms of enhanced airway healing and olfactory results.
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Affiliation(s)
- Abdullah Ozdem
- Department of Otorhinolaryngology, Pendik Training and Research Hospital, Marmara University Medical Faculty, Pendik, Istanbul, Turkey.
| | - Orhan Ozturan
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Ahmet Onur Sutcu
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Remzi Dogan
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Erol Senturk
- Department of Otorhinolaryngology, Faculty of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
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Kumar A, Joshi D. Effect of ambient temperature and respiration rate on nasal dominance: preliminary findings from a nostril-specific wearable. J Breath Res 2023; 17:046011. [PMID: 37611568 DOI: 10.1088/1752-7163/acf339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/23/2023] [Indexed: 08/25/2023]
Abstract
The nasal dominance (ND) determination is crucial for nasal synchronized ventilator, optimum nasal drug delivery, identifying brain hemispheric dominance, nasal airway obstruction surgery, mindfulness breathing, and for possible markers of a conscious state. Given these wider applications of ND, it is interesting to understand the patterns of ND with varying temperature and respiration rates. In this paper, we propose a method which measures peak-to-peak temperature oscillations (difference between end-expiratory and end-inspiratory temperature) for the left and right nostrils during nasal breathing. These nostril-specific temperature oscillations are further used to calculate the nasal dominance index (NDI), nasal laterality ratio (NLR), inter-nostril correlation, and mean of peak-to-peak temperature oscillation for inspiratory and expiratory phase at (1) different ambient temperatures of 18 °C, 28 °C, and 38 °C and (2) at three different respiration rate of 6 bpm, 12 bpm, and 18 bpm. The peak-to-peak temperature (Tpp) oscillation range (averaged across participants;n= 8) for the left and right nostril were 3.80 ± 0.57 °C and 2.34 ± 0.61 °C, 2.03 ± 0.20 °C and 1.40 ± 0.26 °C, and 0.20 ± 0.02 °C and 0.29 ± 0.03 °C at the ambient temperature of 18 °C, 28 °C, and 38 °C respectively (averaged across participants and respiration rates). The NDI and NLR averaged across participants and three different respiration rates were 35.67 ± 5.53 and 2.03 ± 1.12; 8.36 ± 10.61 and 2.49 ± 3.69; and -25.04 ± 14.50 and 0.82 ± 0.54 at the ambient temperature of 18 °C, 28 °C, and 38 °C respectively. The Shapiro-Wilk test, and non-parametric Friedman test showed a significant effect of ambient temperature conditions on both NDI and NLR. No significant effect of respiration rate condition was observed on both NDI and NLR. The findings of the proposed study indicate the importance of ambient temperature while determining ND during the diagnosis of breathing disorders such as septum deviation, nasal polyps, nosebleeds, rhinitis, and nasal fractions, and in the intensive care unit for nasal synchronized ventilator.
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Affiliation(s)
- Amit Kumar
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Deepak Joshi
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
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Bora A, Aslan Y, Durmuş K, Demirkıran BB, Altuntas EE. Do Mean Values of the Peak Inspiratory Nasal Flowmeter Vary According to the Severity, Direction and Type of Nasal Septum Deviation? Indian J Otolaryngol Head Neck Surg 2022; 74:1675-1682. [PMID: 36452731 PMCID: PMC9702492 DOI: 10.1007/s12070-021-02809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/08/2021] [Indexed: 11/28/2022] Open
Abstract
The aim is to investigate the contribution of the PNIF test in daily clinical practices in the objective evaluation of the early postoperative functional results of septoplasty and the effect of the severity, direction, and type of nasal septum deviation on mean PNIF values. Nasal septum deviation (NSDs) of the cases were grouped according to the Mladina classification and the severity of NSDs. An objective evaluation of the nasal airway was conducted via a peak flowmeter device in the preoperative and postoperative first month. When examining the mean PNIF values according to genders, it was observed that the values determined in male cases in the preoperative and postoperative period were higher. In the intragroup evaluation performed according the Mladina classification, a statistically significant increase was observed in the preoperative and postoperative PNIF values of the cases in Types 1-4. In the intragroup evaluation performed according to the severity of NSD, there was a significant increase in the preoperative and postoperative PNIF values of the mild and moderate cases. When comparing the preoperative and postoperative PNIF values of the groups in terms of the severity of NSD, it was observed that there was a significant difference. The PNIF can be used in routine clinical practices to evaluate the septoplasty results objectively. In the evaluation of functional results, the change in the mean PNIF values may also vary according to the direction and severity of septum deviation and the Mladina classification other than age, gender and ethnic origin.
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Affiliation(s)
- Adem Bora
- Department of Otolaryngology, Faculty of Medicine, Sivas Cumhuriyet University, 58140 Sivas, Turkey
| | - Yasin Aslan
- Department of Otolaryngology, Faculty of Medicine, Sivas Cumhuriyet University, 58140 Sivas, Turkey
| | - Kasım Durmuş
- Department of Otolaryngology, Faculty of Medicine, Sivas Cumhuriyet University, 58140 Sivas, Turkey
| | - Berat Baturay Demirkıran
- Department of Otolaryngology, Faculty of Medicine, Sivas Cumhuriyet University, 58140 Sivas, Turkey
| | - Emine Elif Altuntas
- Department of Otolaryngology, Faculty of Medicine, Sivas Cumhuriyet University, 58140 Sivas, Turkey
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Widodo DW, Asmoro SDP, Wardani RS, Affandi DA, Oriza IID. Functional and Esthetic Outcomes of L-Shaped Augmentation Rhinoplasty in Indonesian Noses. Ann Otol Rhinol Laryngol 2022; 132:492-496. [PMID: 35656788 DOI: 10.1177/00034894221100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We investigated the satisfaction and nasal airway function of patients who underwent L-shaped augmentation rhinoplasty using rhinoplasty outcomes evaluation (ROE). Nasal obstruction was evaluated using the nasal obstruction symptom evaluation (NOSE) and peak nasal inspiratory flowmeter (PNIF) score. We explored the correlation between tip projection, ROE, NOSE, and PNIF scores. METHODS We conducted a pre-and post-experimental study of 16 adult Indonesian patients who underwent L-shaped augmentation rhinoplasty. We used the neurotic scale to rule out patients with body dysmorphic disorder (BDD), and patients with low-to-moderate neurotic scores were included as participants. RESULTS For all patients who underwent augmentation rhinoplasty, the median score of the NOSE questionnaire decreased from 12.5 to 5 after surgery (P = .005). The ROE median satisfaction scores also increased from 7.00 to 14.00 postoperatively (P = .001). The median PNIF preoperative score increased from 92 (70-130) to 115 (105-155) postoperatively. There was an increase in tip projection from 1.5 (1.1-2) preoperative to 2.05 (1.8-2.5) postoperative. There was a significant correlation between ∆ tip projection and ∆ NOSE (P = .048), with a moderate correlation (r = .502). However, there was no significant correlation between ∆ tip projection and ∆ PNIF (P = .080) and ∆ ROE (P = .302). CONCLUSION The increase in ROE and PNIF, and the decrease in NOSE score after surgery revealed that the augmented L-shaped rhinoplasty technique has high satisfaction rates in both the nasal esthetics and functions of patients. The tip projection increment was proven to elevate nasal function subjectively in a certain range of tip height difference evaluated by the NOSE score.
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Affiliation(s)
- Dini Widiarni Widodo
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine Universitas Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Satria Dipo Putra Asmoro
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine Universitas Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Retno Sulistyo Wardani
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine Universitas Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dewo Aksoro Affandi
- Department of Otorhinolaryngology-Head and Neck Surgery, Tria Dipa Hospital, Jakarta, Indonesia
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Aydoğdu I, Bayram AA, Aydoğdu Z. Assessment of Functional Outcomes of an Autospreader Flap and Spreader Graft in Rhinoplasty. J Craniofac Surg 2022; 33:e257-e260. [DOI: 10.1097/scs.0000000000008044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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de Oliveira GMM, Correia Júnior MADV, Costa EC, Lira GVDAG, Rizzo JÂ, Hunter S, Gaua N, Sarinho ESC. Accuracy of peak nasal flow to determine nasal obstruction in patients with allergic rhinitis. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:155-161. [PMID: 35612507 PMCID: PMC9131999 DOI: 10.14639/0392-100x-n1617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022]
Abstract
Objective Methods Results Conclusions
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Nasal airway function after Le Fort I osteotomy with maxillary impaction: A prospective study using the Nasal Obstruction Symptom Evaluation scale. Arch Plast Surg 2021; 48:61-68. [PMID: 33503746 PMCID: PMC7861989 DOI: 10.5999/aps.2020.01431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/10/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This study evaluated changes in nasal airway function following Le Fort I osteotomy with maxillary impaction according to the Nasal Obstruction Symptom Evaluation (NOSE) scale. METHODS This cohort study included 13 patients who underwent Le Fort I osteotomy with maxillary impaction. Nasal airway function was evaluated based on the NOSE scale preoperatively and at 3 months postoperatively. The change in the NOSE score was calculated as the preoperative score minus the postoperative score. If the normality assumptions for changes in the NOSE score were not met, a nonparametric test (the Wilcoxon signed-rank test) was used. Differences in NOSE score changes according to patient characteristics and surgical factors were evaluated using the Kruskal-Wallis test and the Mann-Whitney test. RESULTS Patients ranged in age from 18 to 29 years (mean±standard deviation [SD], 23.00±3.87 years). Three were men and 10 were women. Eleven patients (84%) had an acquired dentofacial deformity with skeletal class III malocclusion. The preoperative NOSE scores ranged from 40 to 90 (mean±SD, 68.92±16.68), and the postoperative NOSE scores ranged from 25 to 80 (53.84±18.83). The cohort as a whole showed significant improvement in nasal airway function following maxillary impaction (P=0.028). Eleven patients (84%) had either improved (n=8) or unchanged (n=3) postoperative NOSE scores. However, nasal airway function deteriorated in two patients. Patient characteristics and surgical factors were not correlated with preoperative or postoperative NOSE scores. CONCLUSIONS Nasal airway function as evaluated using the NOSE scale improved after maxillary impaction.
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Comparison of Early and Long-Term Effects of Piezosurgery With Conventional Techniques for Osteotomies in Rhinoplasty. J Craniofac Surg 2021; 31:1539-1543. [PMID: 32877155 DOI: 10.1097/scs.0000000000006337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Osteotomy is a critical step of rhinoplasty. Various osteotomy techniques have been developed to reduce postoperative edema and ecchymosis and achieve optimal aesthetic results. In this study, we aimed to compare the early and long-term effects of piezoelectric surgery with conventional osteotomy. METHODS In this prospective study, 72 rhinoplasty patients were randomly divided into 2 groups according to osteotomy technique used, either conventional osteotomy or piezosurgery. These 2 groups were compared for postoperative edema, ecchymosis, and pain on the first and seventh postoperative days. The sinonasal outcome test-22 (SNOT-22), peak nasal flowmetry, and Connecticut Chemosensory Clinical Research Center test were applied to all patients before and 8 weeks after surgery. RESULTS The study consisted of 72 patients, 42 of whom were female and 30 were male. The mean age was 28.1 ± 6.5 (range 18-49 years). On the first postoperative day, edema and ecchymosis were significantly less in the piezosurgery group (P < 0.001). VAS results showed that only the piezosurgery group experienced less pain on the first postoperative day (P < 0.001). Nasal airflow of the patients was evaluated preoperatively and postoperatively, nasal airflow decreased postoperatively in both groups, but this decrease was not statistically significant, and no significant difference was found between the groups. The preoperative and postoperative comparison of odor functions was similar in both groups after the operation, and there was no significant difference between the groups. CONCLUSION Piezosurgery in the early period after rhinoplasty has been shown to decrease eyelid edema, periorbital ecchymosis, and pain compared to conventional osteotomy techniques. However, the superiority of piezosurgery in terms of nasal airflow, olfactory functions and quality of life were not found in the long term.
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Cengiz AB, Tansuker HD, Ozyilmaz C, Eroglu S, Ogreden S, Oktay MF. Role of Peak Nasal Inspiratory Flow for Measuring the Effectiveness of Surgery in Children with Adenoidal Hypertrophy. Cureus 2020; 12:e12378. [PMID: 33532146 PMCID: PMC7845784 DOI: 10.7759/cureus.12378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Nasal airway obstruction in children is a frequent problem in otolaryngology practice. Adenoidal hypertrophy (AH) is the most common pathology in childhood that requires surgery. Nasal patency can be evaluated by subjective and objective methods. Unlike other methods, peak nasal inspiratory flow (PNIF) is portable and easy to perform. The need for patient compliance is the most important disadvantage of this method. We aimed to analyze the significance of PNIF for measuring the effectiveness of adenoidectomy as well as to compare PNIF with other subjective methods. Methods Two-hundred forty-five (245) patients aged between six and 11 years were evaluated. Seventy-seven (77) of them formed the study group and 168 formed the control group. Pre and post-surgery PNIF measurements, adenoid scores, and simple visual analog scale (sVAS) were recorded. Results The average PNIF value has significantly increased to 70.65 L/min from 33.02 L/min after adenoidectomy (p<0.01). The average PNIF value was 71.66 L/min in control subjects. High PNIF values were significantly correlated with low sVAS and adenoid scores postoperatively in the study group as compared with those of preoperative data (p<0.01). Conclusions PNIF has a satisfying correlation with nasal examination findings and other subjective methods to evaluate nasal obstruction and may provide unique and complementary information helpful for evaluating and improving the effects of adenoidectomy in children.
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Affiliation(s)
- Abdurrahman B Cengiz
- Otolaryngology - Head and Neck Surgery, Bagcilar Training and Research Hospital, Istanbul, TUR
| | - Hasan Deniz Tansuker
- Otolaryngology - Head and Neck Surgery, Bagcilar Training and Research Hospital, Istanbul, TUR
| | - Cemal Ozyilmaz
- Otolaryngology - Head and Neck Surgery, Bagcilar Training and Research Hospital, Istanbul, TUR
| | - Sinan Eroglu
- Otolaryngology - Head and Neck Surgery, Bahcelievler State Hospital, Istanbul, TUR
| | - Sahin Ogreden
- Otolaryngology - Head and Neck Surgery, Basaksehir Cam and Sakura State Hospital, Istanbul, TUR
| | - Mehmet F Oktay
- Otolaryngology - Head and Neck Surgery, Bagcilar Training and Research Hospital, Istanbul, TUR
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Rowan NR, Soler ZM, Mace JC, Camilon MP, Palmer C, Jones RH, Smith TL, Schlosser RJ. Lack of impact of radiologic septal measurements upon patient symptoms and performance of septoplasty during endoscopic sinus surgery. Rhinology 2020; 58:323-332. [PMID: 32175530 DOI: 10.4193/rhin19.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recent literature suggests that concurrent septoplasty during endoscopic sinus surgery (ESS) improves patient outcomes, however, the underlying indications for performing concurrent septoplasty are unknown. The objective of this study was to investigate the relationship between objective radiologic measures of nasal septal deviation with preoperative patient symptomatology and measures of CRS disease severity. We also sought to understand the association of objective radiologic measurements with surgeon performance of concurrent septoplasty during ESS. METHODOLOGY Seventy-four patients with CRS undergoing ESS were prospectively enrolled. Angles of septal deviation, intranasal areas and volumes were assessed on preoperative computed tomography (CT) scans and correlated with a robust battery of patient reported outcomes measures (PROMs), objective measures of CRS severity including olfaction scores, radiologic and endoscopic staging, and performance of septoplasty. RESULTS Intranasal areas and volumes demonstrated only weak linear associations with patient-reported nasal congestion, however, angles of septal deviation alone did not correlate with congestion or any other PROM measure. Meanwhile, radiologic septal-related measurements did not correlate with objective measures of CRS disease severity or the performance of a concurrent septoplasty. CONCLUSIONS Though prior studies demonstrate improved patient outcomes in the setting of concurrent septoplasty during ESS, this study failed to establish an association between preoperative radiologic septal-related measurements and patient symptomatology or surgeon decision to perform septoplasty. Although objective factors to identify patients most likely to benefit from concurrent septoplasty remain unidentified, the potential improvement of surgical recommendations and patient outcomes makes this an important area of continued investigation.
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Affiliation(s)
- N R Rowan
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA; The Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD, USA
| | - Z M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - J C Mace
- Oregon Health and Science University, Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus/Skull Base Surgery, Portland, OR, USA
| | - M P Camilon
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - C Palmer
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - R H Jones
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - T L Smith
- Oregon Health and Science University, Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus/Skull Base Surgery, Portland, OR, USA
| | - R J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA; Department of Surgery, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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Hosseini S, Schuman TA, Golshahi L. Correlations to Estimate the Key Anatomical Dimensions of Pediatric Nasal Airways using Minimally Invasive Measurements of Intranasal Pressure Gradient. J Aerosol Med Pulm Drug Deliv 2020; 34:171-180. [PMID: 32833574 DOI: 10.1089/jamp.2019.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Understanding the morphology of nasal airways is important in determining the nasal airway deposition of inhaled aerosol. Moreover, objective assessment of the anatomy of human nasal airways is useful to develop a database of reference or normal values as a resource to investigate anatomical abnormalities of airways. Current methods for the objective assessment of the nasal airways are either limited to very few dimensions or can only be performed by specialized researchers. Thus, the main objective of this study was to determine the correlations between the intranasal pressure gradient (Δp) and the key anatomical dimensions of the pediatric nasal airways, which could in turn allow the extrapolation of nasal airway morphology based on simple minimally invasive measurements of pressure. Methods: The anatomical data and Δp were obtained from in vitro studies with nasal airway models of 11 infants ages 3-18 months and 13 children ages 4-14 years old. Key anatomical dimensions were identified based on both rhinology and aerosol dosimetry literature. These anatomic data, including the volume, V, surface area, As, length, L, and the minimum cross-sectional area of the replicas, Amin, were then analyzed for correlation with Δp and flow parameters, using Bernoulli's principle and dimensional analysis. Results: Strong correlations were found between Δp and As/L for children, and between Δp and V/As for infants. Additional pressure gradient correlations were developed with Amin, V/As, V∕L, and L. Conclusions: The correlations identified between anatomic data and Δp have clinical implications in pediatric rhinology, suggesting that certain aspects of airway anatomy in infants and children can be predicted through the measurement of Δp. The airway dimensions, predicted using Δp measurement, may be used in tandem with aerosol nasal deposition correlations that account for nasal airway dimensions.
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Affiliation(s)
- Sana Hosseini
- Department of Mechanical and Nuclear Engineering and Virginia Commonwealth University, Richmond, Virginia, USA
| | - Theodore A Schuman
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Laleh Golshahi
- Department of Mechanical and Nuclear Engineering and Virginia Commonwealth University, Richmond, Virginia, USA
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Mo S, Gupta SS, Stroud A, Strazdins E, Hamizan AW, Rimmer J, Alvarado R, Kalish L, Harvey RJ. Nasal Peak Inspiratory Flow in Healthy and Obstructed Patients: Systematic Review and Meta-Analysis. Laryngoscope 2020; 131:260-267. [PMID: 32386248 DOI: 10.1002/lary.28682] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/07/2020] [Accepted: 03/13/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Nasal peak inspiratory flow (NPIF) is a practical and affordable tool that measures maximum inspiratory flow rate through both nostrils. Although NPIF values for healthy controls and patients appear to differ considerably, a generally expected value for populations with and without nasal obstruction has yet to be established. The aim of this systematic review and meta-analysis was to determine the mean NPIF value in populations with and without nasal obstruction. METHODS Medline (1946-) and Embase (1947-) were searched until July 1, 2017. A search strategy was used to identify studies that reported NPIF values for defined healthy or disease states. All studies providing original data were included. The study population was defined as having either normal nasal breathing or nasal obstruction. A meta-analysis of the mean data was presented in forest plots, and data were presented as mean (95% confidence interval [CI]). RESULTS The search yielded 1,526 studies, of which 29 were included. The included studies involved 1,634 subjects with normal nasal breathing and 817 subjects with nasal obstruction. The mean NPIF value for populations with normal nasal breathing was 138.4 (95% CI: 127.9-148.8) L/min. The mean value for populations with nasal obstruction was 97.5 (95% CI: 86.1-108.8) L/min. CONCLUSIONS Current evidence confirms a difference between mean NPIF values of populations with and without nasal obstruction. The mean value of subjects with no nasal obstruction is 138.4 L/min, and the mean value of nasally obstructed populations is 97.5 L/min. Prospective studies adopting a standardized procedure are required to further assess normative NPIF values. Laryngoscope, 131:260-267, 2021.
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Affiliation(s)
- Shirley Mo
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Sai S Gupta
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna Stroud
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Erika Strazdins
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Aneeza W Hamizan
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,Department of Otolaryngology-Head and Neck Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Janet Rimmer
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,St. Vincent's Clinic, St. Vincent's Hospital, Sydney, New South Wales, Australia.,The Woolcock Institute, Sydney University, Sydney, New South Wales, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Larry Kalish
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology-Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Mirmohamadsadeghi H, Zanganeh R, Barati B, Tabrizi R. Does maxillary superior repositioning affect nasal airway function? Br J Oral Maxillofac Surg 2020; 58:807-811. [PMID: 32376038 DOI: 10.1016/j.bjoms.2020.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/16/2020] [Indexed: 11/25/2022]
Abstract
This study aimed to assess nasal airflow, nasal resistance, and the cross-sectional area of the nasal cavity in patients who have had maxillary superior repositioning (MSR). This is a cross-sectional study, and nasal airflow, nasal resistance, and the cross-sectional area of the nasal cavity were evaluated by rhinometry and acoustic rhinometry techniques in patients who had had MSR. Thirty-two patients were studied, and the mean (SD) MSR was 5.03 (1.61) (range 3-8) mm. There was a significant correlation between the mean MSR and the mean change in nasal airflow and nasal resistance (p=0.001 and p=0.005, respectively). There was also a correlation between MSR and the change in the cross-sectional area of the inferior concha (p=0.001), but there was no correlation between the mean MSR and the change in cross-sectional area of the isthmus (p=0.07). Nasal airflow increases when the mean MSR is less than 6.5mm, and when maxillary impaction is 6.5mm or more, nasal airflow decreases. It seems, therefore, that MSR of less than 6.5mm was associated with an improvement in nasal airflow. When maxillary impaction was more than 6.5mm, nasal airflow and the cross-sectional area of the nasal cavity decreased, and nasal resistance increased.
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Affiliation(s)
| | - R Zanganeh
- Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - B Barati
- Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - R Tabrizi
- Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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17
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Chellaa R, Soumya MS, Inbaraj G, Nayar R, Saidha PK, Menezes VH, Rajeeva HN. Impact of Hatha Yoga on the Airway Resistances in Healthy Individuals and Allergic Rhinitis Patients. Indian J Otolaryngol Head Neck Surg 2019; 71:1748-1756. [PMID: 31763238 DOI: 10.1007/s12070-017-1098-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/31/2017] [Indexed: 11/28/2022] Open
Abstract
There have been limited studies on Hatha yoga training as a complementary therapy to manage the symptoms of Allergic Rhinitis. The main Aim of the study was to check the impact of Hatha yogasanas on the Airway resistances in Healthy volunteers, a baseline data can be established and also to study the impact of Hatha yogasanas on the Airway resistances in Allergic Rhinitis patients in Bangalore, India. This is a prospective case series of 51 healthy volunteers (18 Males and 33 Females) Group 1 and 51 Allergic Rhinitis patients (18 Males and 33 Females) Group 2. The Objective analysis of the upper airway resistance was measured using a rhinomanometer and the lower airway resistance was measured using a spirometer. Then the subjects practiced specific Hatha yogasanas for three months. Then the airway resistance tests were again done at 3 months interval. The subjective analysis was done pre yoga and post yoga using the Short form-12 (SF-12) and Sino Nasal Outcome Test (SNOT) Questionnaires to assess the quality of life. The data was analyzed by doing a Paired (2-tailed) T Test, using SPSS (Software Package for Social Sciences) version 16. Total Nasal Airway Resistance pre yoga and post yoga in 51 healthy volunteers had significantly reduced at 150 Pa and the Forced Vital Capacity(FVC) pre yoga and post yoga had significantly increased,Forced Expiratory volume (FEV1) & % Residual standard deviation (%RSD) had increased but not significant. The Physical component score (PCS) and Mental component score (MCS) of the SF-12 health survey questionnaire had significantly improved with and the SNOT questionnaire score had significantly reduced. The Total Nasal Airway Resistance in 51 Allergic Rhinitis had significantly reduced at 150 Pa and the FVC pre yoga and post yoga showed increase but change was not significant, FEV1 pre yoga and post yoga had significantly increased, %RSD pre yoga and post yoga had significantly increased. The PCS and MCS of the SF-12 health survey questionnaire had significantly increased and the SNOT questionnaire score had significantly decreased. The scientific documentation of the impact of Hatha Yoga on the airway resistances can be an eye opener in the management of several other diseases of the airways.
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Affiliation(s)
- R Chellaa
- 1St. John's Research Institute, St John's National Academy of Health Sciences, Sarjapur Road, Bangalore, 560034 India
| | - M S Soumya
- 2Department of Otorhinolaryngology, St John's National Academy of Health Sciences, Sarjapur Road, Bangalore, 560034 India
| | - G Inbaraj
- 1St. John's Research Institute, St John's National Academy of Health Sciences, Sarjapur Road, Bangalore, 560034 India
| | - Ravi Nayar
- 3HCG Hospitals, HCG Towers, No. 8, P. Kalinga Rao Road, Sampangiram Nagar, Bangalore, Karnataka 560027 India
| | - Poonam K Saidha
- 2Department of Otorhinolaryngology, St John's National Academy of Health Sciences, Sarjapur Road, Bangalore, 560034 India
| | - Vishma Hydie Menezes
- 1St. John's Research Institute, St John's National Academy of Health Sciences, Sarjapur Road, Bangalore, 560034 India
| | - H N Rajeeva
- 1St. John's Research Institute, St John's National Academy of Health Sciences, Sarjapur Road, Bangalore, 560034 India
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Comparison of nasal and olfactory functions between two surgical approaches for the treatment of concha bullosa: a randomised clinical trial. The Journal of Laryngology & Otology 2019; 133:913-917. [DOI: 10.1017/s0022215119001968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveConcha bullosa may be associated with paranasal sinus infections and nasal obstruction. Middle concha mucosa membranes have olfactory neurofibrils. This study investigated the impact of routinely used concha bullosa surgery techniques – crushing and lateral laminectomy – on nasal and olfactory functions.MethodsForty-three adult patients who had undergone surgery for a symptomatic concha bullosa completed the odour test, nasal obstruction visual analogue scale, 22-item Sino-Nasal Outcome Test, and peak nasal inspiratory flow test, pre-operatively and three months post-operatively. The pre- and post-operative results within and between the two treatment groups were compared.ResultsIntragroup comparison of mean pre- versus post-treatment changes revealed statistically significant findings for the nasal obstruction visual analogue scale, Sino-Nasal Outcome Test, peak nasal inspiratory flow and olfaction tests (allp< 0.05). However, there were no statistically significant changes when comparing the scores between the groups (intergroup comparison).ConclusionLateral laminectomy and crushing in concha bullosa surgery have no negative effects on olfactory function. Concha bullosa surgery provides positive outcomes regarding nasal complaints in symptomatic patients.
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19
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Islamoglu Y, Kesici GG, Bulut KS, Ozer EA, Canan Teleke Y, Babademez MA. New wand coblation turbinator vs coblation radiofrequency. Am J Otolaryngol 2019; 40:650-652. [PMID: 31130268 DOI: 10.1016/j.amjoto.2019.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/20/2019] [Accepted: 05/17/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION İnferior turbinate hypertrophy is a common reason of nasal obstruction. One of the most preferred surgical metod is radiofrequency tecnique. Coblation submucosal reduction turbinator (SCT);new surgical device; started to use recently. Since the method is new, very few study has been done yet. We compare coblation radiofrequency (CR) with SCT. MATERIAL AND METHODS Patients with only inferior turbinate hypertrophy but no other diseases included in study. Paranasal CT was made to all patient to rule out turbinate bone hypertrophy. Group 1 32 patient; performed CR. Group 2 25 patients performed SCT. To all patients preoperative and 3 weeks later post operative mucosiliary activity test was performed. Nasal flow was measured with nasal flow meter preoperatively and 3 weeks post operatively. VAS and NOSE was measured. Results compared between two groups. SCT performed under general; CR performed under local anesthesia. RESULTS There was significant nasal flow changes in CR group. (p < 0.001) There was no difference in pre-and-post operatively saccharin test results in CR group. (p = 0.385) There was slightly nasal flow gain in SCT group but this was not statistically significant. (p < 0.192) Also there was no statistically significant changes in pre-and-post operatively saccharin test results in SCT group. (p = 0.167) There was no difference between two groups in terms of post operative nasal flow values and mucociliary activity. (respectively p = 0.562, p = 0.355). (Table 2). Both two tecnique has significant increase in VAS and NOSE scores. (p < 0.001). CONCLUSIONS According to our study two tecnique is suitable and safe for nasal mucociliary activity. Tecniques has positive effect on nasal flow, VAS and NOSE scores.
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20
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Comparison of Olfactory Function and Quality of Life With Different Surgical Techniques for Nasal Septum Deviation. J Craniofac Surg 2019; 30:433-436. [PMID: 30615000 DOI: 10.1097/scs.0000000000005109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To assess the nasal functions, nasal resistance, olfactory function, and quality of life in different surgical techniques for nasal septum deviation STUDY DESIGN:: Randomized controlled trial. METHODS This prospective controlled study was carried out on patients who underwent septoplasty. Patients participating in the study were divided into 2 groups; group 1: classic septoplasty (n: 25) and group 2: extracorporeal septoplasty (n: 14). The sinonasal outcome test-22 (SNOT-22), peak nasal flowmetry, and Connecticut Chemosensory Clinical Research Center test were applied to all patients before and 8 weeks after surgery. Surgical outcomes also assessed to evaluate complications 6 months after surgery. RESULT In total, 39 (27 males, 12 females) patients diagnosed with nasal septum deviation were included in this study. A septoplasty was performed in all patients: 25 of them (18 males, 7 females; mean age = 29.4 [range, 23-50] years) underwent classic septoplasties and 14 (9 males, 5 females; mean age = 31.3 [range, 23-50] years) underwent extracorporeal septoplasties. Airway openness was achieved in all patients. As a result, the SNOT-22 scores, peak nasal inspiratory flowmeter results, and smell function scores showed significant improvements (P < 0.001). CONCLUSION All corrective surgical methods for a septum deviation have positive effects on nasal airflow, quality of life, and olfaction. The rates of complications were not significantly different between 2 treatment groups.
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21
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Affiliation(s)
- Fabian Sommer
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospital Ulm, Ulm 89081, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospital Ulm, Ulm 89081, Germany.
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22
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Silva PFDS, Dornelas de Andrade A, de Andrade LC, de Souza HCM, Alcoforado L, Reinaux CMA, Paiva DN, Rizzo JÂ, Sarinho ESC. Impact of moderate-severe persistent allergic rhinitis on thoraco-abdominal kinematics and respiratory muscle function. J Asthma 2019; 57:21-27. [PMID: 30656995 DOI: 10.1080/02770903.2018.1543433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To assess thoraco-abdominal kinematics, respiratory muscle strength and electromyographic activity of the diaphragm (EAdi) in moderate-severe allergic rhinitis (AR) patients. Methods: A cross-sectional study involving 40 individuals (20 in the AR group) and 20 in the control group [CG]) was conducted. Ventilatory pattern and chest wall volume distribution (optoelectronic plethysmography), respiratory muscle strength (manovacuometry and sniff nasal inspiratory pressure [SNIP]), and EAdi were assessed in both groups. Results: The AR patients had impaired thoraco-abdominal kinematics (reduced total chest wall volume) (p = 0.004), lower values of total respiratory cycle time (p = 0.014) and expiratory time (p = 0.006). They also presented an increase of percentage contribution of the abdominal rib cage (p = 0.475) and respiratory rate (p = 0.019). A positive correlation among pulmonary rib cage tidal volume and MIP (r = 0.544; p < 0.001), SNIP (r = 0.615; p < 0.001), and MEP (r = 0.604; p < 0.001) was observed. After adjusting for age, BMI and gender through multivariate analysis, the individuals with AR presented lower values of MIP (β = -24.341; p < 0.001), MEP (β = -0.277; p < 0.001), SNIP (β = -34.687; p < 0.001) and RMS (β = -0.041; p = 0.017). Conclusions: The individuals with moderate-severe persistent AR had worse respiratory muscle strength, diaphragm activation and chest wall volume distribution with a higher abdominal contribution to tidal volume than the control group. These findings reinforce the notion that the upper and lower airways work in an integrated and synergistic manner.
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Affiliation(s)
| | | | | | | | - Luciana Alcoforado
- Postgraduate Program in Physiotherapy, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Dulciane Nunes Paiva
- Postgraduate Program in Physiotherapy, Universidade Federal de Pernambuco, Recife, Brazil
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23
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Parrilla C, Salvati A, Mastrapasqua RF, Artuso A, Paludetti G, Galli J. Functional and aesthetic results after septorhinoplasty and concomitant radiofrequency of the inferior turbinate: is there a role for patient reported outcome measures (PROMs)? Eur Arch Otorhinolaryngol 2019; 276:745-751. [PMID: 30604059 DOI: 10.1007/s00405-018-05269-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/24/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Functional and aesthetic results after septorhinoplasty (SRP) are often not clearly demonstrated. There is still an open topic in the literature about analysis of aesthetic, functional results and patients' satisfaction after SRP. The aim of our study is to determine patients' satisfaction after SRP and concomitant radiofrequency of the inferior turbinate (RF) regarding nose appearance and improvement of symptoms, using patient reported outcome measures (PROMs). METHODS ROE questionnaire and the NOSE scale were used for a retrospective evaluation to assess patient's satisfaction in 369 patients undergoing SRP surgery from 2003 to 2016. Two additional questions were asked to confirm satisfaction following surgery. RESULTS 258 patients completed the questionnaires (71.7%). The global average ROE score was 18.14 (75.6%). The percentage of satisfaction of aesthetic result was 87.3%, in particular 10.5% were very happy, 57% very much satisfied and 19.8% moderately satisfied. The global post-operative average NOSE score was 13.1 with the resolution of nasal obstruction in 72.1% cases and a marked improvement in 9.3%. The results of the two additional questions showed that 81% of patients would undergo the procedure again if required and 72.1% of patients were globally satisfied. CONCLUSIONS Our study demonstrates the utility of PROMs in evaluating aesthetic and functional results after SRP and simultaneous RF. In our series, the patients undergoing SRP and RF are generally satisfied by the functional and aesthetic results. This kind of assessments should be the most common post-operative evaluation methods in this surgery.
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Affiliation(s)
- Claudio Parrilla
- Otolaryngology Institute-Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Antonio Salvati
- Otolaryngology Institute-Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Rodolfo Francesco Mastrapasqua
- Otolaryngology Institute-Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Alberto Artuso
- Otolaryngology Institute-Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Gaetano Paludetti
- Otolaryngology Institute-Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Jacopo Galli
- Otolaryngology Institute-Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
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Unilateral and Bilateral PNIF in Quality Control of Nasal Septal Surgery. Int J Otolaryngol 2018; 2018:7846843. [PMID: 30410542 PMCID: PMC6206571 DOI: 10.1155/2018/7846843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/24/2018] [Accepted: 10/02/2018] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to explore the usefulness of unilateral, combined unilateral (left + right), and bilateral peak nasal inspiratory flow (PNIF) measurements in assessing the results of nasal septal surgery. Nasal obstruction was recorded subjectively and objectively before and 4 months after nasal septoplasty using a visual analogue scale (VAS) and a PNIF meter. Nasal septoplasty (58 patients) and septoplasty with turbinoplasty (68 patients) were performed on 126 patients (85 males; 41 females) with a mean age of 32.8 years. The results showed a significant improvement in VAS scores, as well as unilateral, combined unilateral, and bilateral PNIF values after both septoplasty and septoplasty with turbinoplasty. Septoplasty with turbinoplasty showed better improvement in VAS and PNIF scores than septoplasty alone and this was significant for bilateral PNIF scores. The best unilateral pre- and postoperative correlations between VAS and PNIF measurements were found using the lower of the two unilateral PNIF scores, irrespective of side. In the total material, VAS/PNIF correlations were mostly significant, but weak (all r<0.30). We found VAS and PNIF to be useful instruments in reporting results of surgery. The weak correlations between VAS and PNIF measurements suggest that these subjective and objective instruments may target different aspects of nasal obstruction.
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25
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Widiarni D, Paramyta WW, Wardani RS, Bachtiar A. Comparison of nasal obstruction symptom evaluation, peak nasal inspiratory flowmeter, and rhinomanometry in patients with nasal deformities. ACTA ACUST UNITED AC 2018. [DOI: 10.1088/1742-6596/1073/2/022024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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26
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Abstract
Methods of measuring nasal obstruction outcomes include both objective anatomic and physiologic measurements, as well as subjective patient-reported measures. Anatomic measurements include acoustic rhinometry, imaging studies, and clinician-derived examination findings. Physiologic measures include rhinomanometry, nasal peak inspiratory flow, and computational fluid dynamics. Patient-reported outcome measures (PROMs) are self-reported assessments of disease-specific quality-of-life outcomes. Several studies attempted correlation of these outcome measures; however, few show strong correlation. Expert opinion favors determining successful surgical outcomes using PROMs. This review provides a summary of current nasal obstruction outcome measures.
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Affiliation(s)
- Emily Spataro
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
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27
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Karataş A. Pretreatment Prediction of the Outcomes of Intranasal Steroid Sprays in Cases with Inferior Turbinate Hypertrophy. Turk Arch Otorhinolaryngol 2018; 55:105-110. [PMID: 29392066 DOI: 10.5152/tao.2017.2443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/05/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Intranasal steroid sprays (INSS) are frequently prescribed for treating inferior turbinate hypertrophy (ITH). Complications due to the long-term application of INSS such as crusting, epistaxis, nasal mucosa dryness, and septal perforation may occur. Predicting patients who would benefit from INSS early might lower treatment costs and complication rates. We examined the predictive value of nasal decongestant response rates for the outcomes of INSS in ITH. Methods Fifty patients with bilateral ITH were included in two groups: patients benefiting from INSS and those not benefiting. Nasal airflow was assessed by peak nasal inspiratory flow (PNIF) measurement in all cases. Measurements were taken three times: before and after the application of nasal decongestant sprays and after the application of INSS. Results In both groups, the nasal air flow rates significantly increased after the application of nasal decongestant sprays; however, the nasal decongestant response rates were higher in the group with patients benefiting from INSS. There was a strong correlation between the nasal air flow rates measured after the application of nasal decongestant sprays and after the application of INSS. The cut-off value for the relationship between increased nasal air flow rates after the application of nasal decongestant sprays and outcomes of INSS was 23%. Conclusion Measurement of nasal airflow increase rate after the application of nasal decongestant sprays is a simple and easy method for the early prediction of the outcomes of INSS in ITH. A higher than 23% increase in nasal air flow rates after the application of nasal decongestant sprays indicates much better outcomes of INSS for patients.
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Affiliation(s)
- Abdullah Karataş
- Clinic of Otorhinolaryngology, Haseki Training and Research Hospital, İstanbul, Turkey
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28
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Boelke G, Berger U, Bergmann KC, Bindslev-Jensen C, Bousquet J, Gildemeister J, Jutel M, Pfaar O, Sehlinger T, Zuberbier T. Peak nasal inspiratory flow as outcome for provocation studies in allergen exposure chambers: a GA 2LEN study. Clin Transl Allergy 2017; 7:33. [PMID: 28932387 PMCID: PMC5604509 DOI: 10.1186/s13601-017-0169-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 09/04/2017] [Indexed: 12/24/2022] Open
Abstract
Background The GA2LEN chamber has been developed as a novel mobile allergen exposure chamber (AEC) allowing standardized multicenter trials in allergy. Hitherto, subjective nasal symptom scores have been the most often used outcome parameter, but in standardized modern trials objective parameters are preferred. Despite its practicability, the objective parameter peak nasal inspiratory flow (PNIF) has been rarely used for allergy trials in the setting of allergen exposure chambers. This study aims to evaluate PNIF as an outcome parameter for provocation studies in AECs. Methods In a randomized controlled blinded setting subjects suffering from allergic rhinitis were exposed to grass pollen, birch pollen, house dust mite and/or placebo in the GA2LEN chamber. Different allergen concentrations were used to evaluate symptom severities. Patients had to perform PNIF before and every 30 min during a challenge using a portable PNIF meter. Results 86 subjects participated in 203 challenges, altogether. House dust mite provocations caused the greatest reduction in PNIF values, followed by grass pollen and birch pollen. Provocations with every allergen or pollen concentration led to a significant decrease (p < 0.05) in PNIF compared to baseline. Furthermore, positive correlations were obtained between PNIF and peak expiratory flow, height and weight, and inverse correlations between PNIF and total nasal symptom score, nasal congestion score and visual analog scale of overall subjective symptoms. Conclusion PNIF is a helpful and feasible tool for conducting provocation trials with allergens, especially grass pollen and house dust mite, in an AEC. Electronic supplementary material The online version of this article (doi:10.1186/s13601-017-0169-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Georg Boelke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology and Allergy, Allergy-Center-Charité, Berlin, Germany
| | - Uwe Berger
- Department of Otorhinolaryngology, Aerobiology and Pollen Information Research Unit, Medical University of Vienna, Vienna, Austria
| | - Karl-Christian Bergmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology and Allergy, Allergy-Center-Charité, Berlin, Germany
| | | | - Jean Bousquet
- CHRU, Montpellier University Hospital Center, Montpellier, France
| | | | - Marek Jutel
- ALL-MED Medical Research Institute, Wrocław, Poland.,Department of Clinical Immunology, Wroclaw Medical University, Wrocław, Poland
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Torsten Zuberbier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology and Allergy, Allergy-Center-Charité, Berlin, Germany
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Bailey RS, Casey KP, Pawar SS, Garcia GJM. Correlation of Nasal Mucosal Temperature With Subjective Nasal Patency in Healthy Individuals. JAMA FACIAL PLAST SU 2017; 19:46-52. [PMID: 27918749 DOI: 10.1001/jamafacial.2016.1445] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Historically, otolaryngologists have focused on nasal resistance to airflow and minimum airspace cross-sectional area as objective measures of nasal obstruction using methods such as rhinomanometry and acoustic rhinometry. However, subjective sensation of nasal patency may be more associated with activation of cold receptors by inspired air than with respiratory effort. Objective To investigate whether subjective nasal patency correlates with nasal mucosal temperature in healthy individuals. Design, Setting, and Participants Healthy adult volunteers first completed the Nasal Obstruction Symptom Evaluation (NOSE) and a unilateral visual analog scale to quantify subjective nasal patency. A miniaturized thermocouple sensor was then used to record nasal mucosal temperature bilaterally in 2 locations along the nasal septum: at the vestibule and across from the inferior turbinate head. Main Outcomes and Measures Nasal mucosal temperature and subjective patency scores in healthy individuals. Results The 22 healthy adult volunteers (12 [55%] male; mean [SD] age, 28.3 [7.0] years) had a mean (SD) NOSE score of 5.9 (8.4) (range, 0-30) and unilateral VAS score of 1.2 (1.4) (range, 0-5). The range of temperature oscillations during the breathing cycle, defined as the difference between end-expiratory and end-inspiratory temperatures, was greater during deep breaths (mean [SD] change in temperature, 6.2°C [2.6°C]) than during resting breathing (mean [SD] change in temperature, 4.2°C [2.3°C]) in both locations (P < .001). Mucosal temperature measured at the right vestibule had a statistically significant correlation with both right-side visual analog scale score (Pearson r = -0.55; 95% CI, -0.79 to -0.17; P = .008) and NOSE score (Pearson r = -0.47; 95% CI, -0.74 to -0.06; P = .03). No other statistically significant correlations were found between mucosal temperature and subjective nasal patency scores. Nasal mucosal temperature was lower (mean of 1.5°C lower) in the first cavity to be measured, which was the right cavity in all participants. Conclusions and Relevance The greater mucosal temperature oscillations during deep breathing are consistent with the common experience that airflow sensation is enhanced during deep breaths, thus supporting the hypothesis that mucosal cooling plays a central role in nasal airflow sensation. A possible correlation was found between subjective nasal patency scores and nasal mucosal temperature, but our results were inconsistent. The higher temperature in the left cavity suggests that the sensor irritated the nasal mucosa, affecting the correlation between patency scores and mucosal temperature. Future studies should consider noncontact temperature sensors to prevent mucosa irritation. Level of Evidence NA.
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Affiliation(s)
- Ryan S Bailey
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee2Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Kevin P Casey
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Sachin S Pawar
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Guilherme J M Garcia
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee2Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
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Evaluation of Patient Satisfaction After Nasal Septoplasty Operation Using Peak Nasal Inspratuar Flow and Nasal Obstruction Symptom Score Questionare. J Craniofac Surg 2017; 27:1289-91. [PMID: 27391500 DOI: 10.1097/scs.0000000000002748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the usefulness of the peak nasal inflamatuar flow (PNIF) and Nasal Obstruction Symptom Score (NOSE) questionnaire in the diagnosis and follow-up of nasal septum deviation surgery. METHODS Sixty patients diagnosed with nasal septum deviation were included in the study. Nasal Obstruction Symptom Score scales of patients, PNIF and is measured preoperatively and 14 days after surgery. RESULTS Preoperative NOSE scores were 14.9 ± 2.7 and PNIF scores were 129.6 ± 15.5 L/min in study group. Postoperatively NOSE scores were 7.9 ± 1.8 and PNIF scores were 154.2 ± 9.2 L/min in study group. Nasal Obstruction Symptom Score scores were 3.3 ± 2.3 and PNIF scores were 169.3 ± 13.5 L/min in control group. CONCLUSION Anterior and anteroposteriorly located nasal septum deviation (NSD) had statistically higher degrees of NOSE scores and lower levels of PNIF scores. Posterior located NSD PNIF scores changed postoperatively but NOSE scores do not change statistically. There was a statistically significant correlation in Pearson correlation analysis between NOSE and PNIF scores. The authors recommend using PNIF and NOSE scores in NSD patients.
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Andrews PJ, Choudhury N, Takhar A, Poirrier AL, Jacques T, Randhawa PS. The need for an objective measure in septorhinoplasty surgery: are we any closer to finding an answer? Clin Otolaryngol 2016; 40:698-703. [PMID: 25943502 DOI: 10.1111/coa.12455] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the reliability of nasal inspiratory peak flow (NIPF) in providing a clinically accurate objective measure following functional septorhinoplasty by comparing it to the validated disease-specific quality-of-life questionnaire, SNOT-22. Studies so far have demonstrated poor correlation between bilateral NIPF and symptom-specific nasal questionnaires following septorhinoplasty. DESIGN To perform a prospective comparative analysis between NIPF and the validated disease-specific quality-of-life questionnaire SNOT-22 and to determine whether a correlation exists following septorhinoplasty surgery. SETTING The Royal National Throat Nose and Ear Hospital, London. PARTICIPANTS A total of 122 patients (78 males, 44 females; mean age 33.5 ± 12.2 years) were recruited from the senior authors rhinology clinic and underwent functional septorhinoplasty surgery. MAIN OUTCOME MEASURES Preoperative and postoperative nasal inspiratory peak flow (NIPF) measurements were performed in addition to the completion of three subjective quality-of-life and symptom assessment tool questionnaires; Sinonasal Outcome Test 22 (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE) and Visual Analogue Scale (VAS: 0-10). RESULTS The mean preoperative NIPF was 88.2 L/min, and the postoperative value was 101.6 L/min and showed a significant improvement following surgery (P = 0.0064). The mean total SNOT-22 score improved significantly from 48.6 to 26.6 (P < 0.0001); the NOSE score from 14.1 to 6.6 (P < 0.0001); and the Visual Analogue Scale (VAS) blockage score from 6.9 to 3.2 (P < 0.0001). All individual domains assessed showed improvements postoperatively, but no correlation was found between the NIPF and SNOT-22 score. Equally, we did not find a correlation between NIPF and the symptom-specific NOSE questionnaire and the nasal blockage domain on the Visual Analogue Scale (VAS) scale. CONCLUSION We have demonstrated that NIPF does not correlate with the SNOT-22 disease-specific questionnaire, although both outcomes significantly improve postoperatively. At present, we are still lacking a clinically accurate objective measure of nasal function for the evaluation of patients undergoing septorhinoplasty surgery.
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Affiliation(s)
- P J Andrews
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK.,The Ear Institute, UCL, London, UK
| | - N Choudhury
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - A Takhar
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - A L Poirrier
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - T Jacques
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK
| | - P S Randhawa
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, UK
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Kita S, Oshima M, Shimazaki K, Iwai T, Omura S, Ono T. Computational Fluid Dynamic Study of Nasal Respiratory Function Before and After Bimaxillary Orthognathic Surgery With Bone Trimming at the Inferior Edge of the Pyriform Aperture. J Oral Maxillofac Surg 2016; 74:2241-2251. [PMID: 27425883 DOI: 10.1016/j.joms.2016.06.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to evaluate the influence of maxillary impaction orthognathic surgery on nasal respiratory function and the efficacy of bone trimming at the inferior edge of the pyriform aperture. MATERIALS AND METHODS The participants were 10 patients (3 male and 7 female patients) with mandibular prognathism who underwent bimaxillary orthognathic surgery with maxillary impaction. The surgical procedures performed were Le Fort I osteotomy with bone trimming at the inferior edge of the pyriform aperture and bilateral sagittal split osteotomy. Three-dimensional models of the nasal cavity were reconstructed from preoperative and postoperative computed tomography images. Furthermore, we remodeled the nasal valve region based on the postoperative models by adding a 1-mm and 2-mm stenosis to investigate the effects of bone trimming at the inferior edge of the pyriform aperture on the pressure effort. The 3-dimensional models were simulated with computational fluid dynamics, and the results of the pressure effort and the cross-sectional area (CSA) were compared for the anterior, middle, and posterior parts of the nasal cavity. The Wilcoxon signed rank test and Spearman rank correlation coefficients were used for statistical comparisons (P < .05). RESULTS In the preoperative and postoperative models, there were considerable correlations between the CSA and the pressure effort in each part of the nasal cavity. The postoperative pressure effort showed a tendency to decrease and the CSA showed a tendency to increase in each part of the nasal cavity. In four 2-mm stenosis models, the pressure effort in the anterior nasal cavity was larger than the preoperative pressure effort and the CSA of the anterior nasal cavity was smaller than the preoperative CSA. CONCLUSIONS Bone trimming at the inferior edge of the pyriform aperture appears to be useful for avoiding nasal respiratory complications with maxillary impaction.
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Affiliation(s)
- Soma Kita
- Postgraduate Student, Department of Orthodontic Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan.
| | - Marie Oshima
- Professor, Institute of Industrial Science, The University of Tokyo, Komaba, Meguro-ku, Tokyo, Japan
| | - Kazuo Shimazaki
- Assistant Professor, Department of Orthodontic Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Toshinori Iwai
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Susumu Omura
- Professor, Department of Oral and Maxillofacial Surgery, Yokohama City University Medical Center, Urafunecho, Minami-ku, Yokohama, Kanagawa, Japan
| | - Takashi Ono
- Professor, Department of Orthodontic Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
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Hsu HC, Tan CD, Chang CW, Chu CW, Chiu YC, Pan CJ, Huang HM. Evaluation of nasal patency by visual analogue scale/nasal obstruction symptom evaluation questionnaires and anterior active rhinomanometry after septoplasty: a retrospective one-year follow-up cohort study. Clin Otolaryngol 2016; 42:53-59. [PMID: 27102375 DOI: 10.1111/coa.12662] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the efficacy of septoplasty and the correlation between the subjective evaluations of a visual analogue scale (VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and active anterior rhinomanometry of the nasal airway after septoplasty. DESIGN A retrospective, individual cohort study. SETTING Ear, Nose and Throat Department, Taipei City Hospital, Taipei, Taiwan. PARTICIPANTS Fifty patients with chronic nasal obstruction were enrolled in the study. All 50 patients underwent septoplasty because of nasal septal deviation. Another 28 patients without nasal symptoms served as controls. MAIN OUTCOME MEASURES VAS, NOSE and active anterior rhinomanometry were used to measure the sensation of nasal obstruction. All measurements were performed in both groups preoperatively and then repeated on three postoperative visits (3, 6 and 12 months). RESULTS The mean VAS score, NOSE score and the nasal resistance in the narrow side of the nose in the study group showed reduced symptoms at 3, 6 and 12 months postoperatively compared with the respective preoperative measurements (P < 0.001, all). The VAS and NOSE scores did not significantly correlate with total nasal resistance preoperatively or postoperatively. The VAS and nasal resistance in the obstructed nasal cavity correlated significantly preoperatively (P < 0.05), but not postoperatively. CONCLUSIONS The subjective and objective symptoms of nasal obstruction had improved 1 year after septoplasty. A significant correlation between VAS scores and nasal resistance in the narrow side of the nose was found before surgery. The subjective and objective measurements of nasal obstruction lacked significant correlation postoperatively.
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Affiliation(s)
- H C Hsu
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - C D Tan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taiwan National University, Taipei, Taiwan
| | - C W Chang
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - C W Chu
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - Y C Chiu
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - C J Pan
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - H M Huang
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan.,Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Saliba J, Fnais N, Tomaszewski M, Carriere JS, Frenkiel S, Frasnelli J, Tewfik MA. The role of trigeminal function in the sensation of nasal obstruction in chronic rhinosinusitis. Laryngoscope 2016; 126:E174-8. [DOI: 10.1002/lary.25952] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Joe Saliba
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Naif Fnais
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Department of Otolaryngology-Head and Neck Surgery; King Saud University; Riyadh Saudi Arabia
| | - Marcel Tomaszewski
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | | | - Saul Frenkiel
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Johannes Frasnelli
- Research Chair for Chemosensory Neuroanatomy, Department of Anatomy; University of Quebec in Trois-Rivières; Trois-Rivières Quebec Canada
- Center for Advanced Research in Sleep Medicine; Sacré-Coeur Hospital; Montreal Quebec Canada
| | - Marc A. Tewfik
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
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Secondary Improvement in Static Facial Reanimation Surgeries: Increase of Nasal Function. J Craniofac Surg 2016; 26:e335-7. [PMID: 26080255 DOI: 10.1097/scs.0000000000001769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to measure the effect of the static reanimation operation administered to patients with facial paralysis on nasal function area by comparing patients' preoperative and postoperative subjective perception of the nasal airflow. MATERIALS AND METHOD We applied the Nasal Obstruction Symptom Evaluation (NOSE) scale to 13 patients who underwent static reanimation because of facial palsies, both preoperatively and postoperatively, and results were compared statistically. The changes in nasal base angulation were recorded and compared based on the photographs of patients taken before and after the surgery. RESULTS Following the static reanimation operation, 76% (10/13) of the patients reported a subjective improvement in the nasal airflow, whereas 24% (3/13) did not report any change. Mean preoperative and postoperative NOSE scale scores were 66.92 ± 9.90 and 36.15 ± 9.61, respectively. The change in mean NOSE scale score was statistically significant (P < 0.001). In the preoperative and postoperative comparison of the photographs taken from the front view of the patients, a decreased nasal base angulation compared with preoperative period was detected in 8 (61.6%) patients. CONCLUSIONS A statistically significant increase in subjective perception about nasal function was observed after the static facial reanimation; however, it is not certain whether this effect can be considered persistent. Long-term studies conducted on a larger patient population will provide beneficial results.
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Ottaviano G, Fokkens WJ. Measurements of nasal airflow and patency: a critical review with emphasis on the use of peak nasal inspiratory flow in daily practice. Allergy 2016; 71:162-74. [PMID: 26447365 DOI: 10.1111/all.12778] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 12/26/2022]
Abstract
Objective measures can be used to assist the clinician to diagnose and treat nasal obstruction and also to quantify nasal obstruction in research. Objective measurements of nasal obstruction are as important as objective measurements of lung function. peak nasal inspiratory flow (PNIF), acoustic rhinometry (AR) and rhinomanometry (RM), with their specific peculiarity, assess different aspects of nasal obstruction. From the studies available in the literature, it seems that these methods roughly correlate with each other and that all of them can be alternatively utilized very well in research as well as in clinical practice. This review describes the various methods that can be used to measure nasal patency, airflow and resistance, mainly peak nasal inspiratory flow, rhinomanometry and acoustic rhinometry. PNIF has been demonstrated to be reproducible and as good an indication of objective nasal patency as formal rhinomanometry and has the advantage to be cheap, simple and suitable for serial measurements and for home use even in the paediatric population. PNIF normative data are available for children, adults and elderly subjects, and the availability of unilateral PNIF normal values allows evaluation of nasal sides separately. Just as in the lower airways, objective and subjective evaluation gives different information that together optimizes the diagnosis and the treatment of our patients. We argue that PNIF should be used regularly in every outpatient clinic that treats patients with nasal obstruction.
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Affiliation(s)
- G. Ottaviano
- Otolaryngology Section; Department of Neurosciences; University of Padova; Padova Italy
| | - W. J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam The Netherlands
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Functional Outcome Evaluation of Septorhinoplasty for Nasal Obstruction. Indian J Otolaryngol Head Neck Surg 2015; 68:218-23. [PMID: 27340641 DOI: 10.1007/s12070-015-0899-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022] Open
Abstract
A prospective single blinded interventional study was held in Otorhinolaryngology Clinic, Universiti Kebangsaan Malaysia Medical Centre in August 2010 until November 2012 to evaluate the functional outcome of septorhinoplasty objectively and subjectively. Objective assessment was done using rhinomanometry and subjective assessment using Nasal Obstruction Symptoms Evaluation (NOSE) scale and Health-Related Quality of Life Questionnaires (HRQOL) in Rhino Surgery. All measurements were taken preoperatively and 3 months postoperatively. A total of 29 patients were enrolled and completed the study. Septorhinoplasty was commonly performed in Malays and Indians and rare amongst Chinese, with age ranged from 18 to 54 years. Majority had no history of trauma. Twisted nose was the most common external nose abnormality followed by crooked and saddle nose. All patients had internal valve insufficiency. There were significant improvement of the total and of all the parameters in the NOSE scale post septorhinoplasty (p < 0.05). Furthermore, there were significant improvement in total and in all parameters in HRQOL score post septorhinoplasty (p < 0.05). There were improvements in the rhinomanometry data bilaterally during inspiration and expiration, but were not statistically significant (p > 0.05). Significant correlations were noted in the improvement between the two subjective assessments (NOSE scale and HRQOL score). However, there was no significant correlation in the improvement between the subjective (NOSE scale and HRQOL score) with objective (rhinomanometry score) assessments. Septorhinoplasty improves the nasal airflow and quality of life of patients with nasal obstruction.
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Abstract
Nasal obstruction can be evaluated by objective and subjective methods. We sought to determine normative peak nasal inspiratory flow meter (PNIF) measurements of a healthy population in Turkey and to investigate the importance of PNIF in surgery for nasal septal deviation as well as to investigate the correlation of PNIF with subjective methods. In a total of 269 patients, 50 patients underwent septoplasty and 219 control subjects were enrolled in the study. Data on preoperative and postoperative PNIF measurements, nasal septal indices, and subjective measurements (visual analogue scale, VAS) were recorded. Mean PNIF value was 137.8 L/min in control subjects. Postoperative PNIF, VAS, and nasal septal index data were statistically significantly higher in the study group as compared with those of preoperative data. We found PNIF, VAS, and nasal septal indices of the control group to be consistent with postoperative data and to be higher than preoperative data of the study group. We identified a normal PNIF range for the healthy Turkish population and we saw that the data were compatible with VAS scores. PNIF seems to be a very effective method in the evaluation of nasal obstruction and in deciding operation.
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Kirtsreesakul V, Leelapong J, Ruttanaphol S. Nasal peak inspiratory and expiratory flow measurements for assessing nasal obstruction in allergic rhinitis. Am J Rhinol Allergy 2015; 28:126-30. [PMID: 24717950 DOI: 10.2500/ajra.2014.28.4008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although nasal peak flow measurements have been proposed as a simple alternative method to assess nasal patency, which of nasal peak expiratory flow or nasal peak inspiratory flow (NPEF/NPIF) or the peak expiratory flow index or peak inspiratory flow index (PEFI/PIFI; the ratios between nasal and oral PEF or nasal and oral PIF, respectively) is the more accurate method is unclear. The aim of this study was to evaluate the correlation between NPEF, NPIF, PEFI, and PIFI, and blocked nose score (BNS) and mucociliary clearance time (MCCT) in diagnostic and follow-up assessments. METHODS Ninety-nine allergic rhinitis (AR) patients were treated with 220 micrograms once daily of intranasal triamcinolone acetonide for 28 days. BNS, NPEF, NPIF, PEFI, and PIFI and MCCT were used to evaluate treatment outcome. Correlations of initial visit scores and score changes after treatment between peak flow rates and BNSs and MCCTs were analyzed. RESULTS All nasal symptoms, peak flows, and MCCTs showed statistically significant improvements after the nasal steroid treatment. PEFI showed the best negative correlation with BNS and MCCTs, followed by PIFI, NPEF, and NPIF. Nasal peak flows showed better correlations with MCCTs than BNSs. Mean changes of peak flow rates between visits showed better correlation with BNSs and MCCTs than absolute values of peak flow rates at the initial visit. CONCLUSION Among nasal peak flow measurements, PEFI is the most appropriate objective tool for assessing nasal patency in AR. Peak flows can indicate underlying mucosal inflammation and are more sensitive to assess score changes after treatment than cross-sectional assessment at the initial visit.
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Affiliation(s)
- Virat Kirtsreesakul
- Department of Otolaryngology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Kumral TL, Yıldırım G, Çakır O, Ataç E, Berkiten G, Saltürk Z, Uyar Y. Comparison of two partial middle turbinectomy techniques for the treatment of a concha bullosa. Laryngoscope 2014; 125:1062-6. [PMID: 25448024 DOI: 10.1002/lary.25065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/02/2014] [Accepted: 11/05/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the nasal functions, nasal resistance, and olfactory function in middle turbinate surgery. STUDY DESIGN Randomized controlled trial. METHODS This prospective controlled study was carried out on patients who underwent laminectomy for aeration of the middle turbinate. Patients participating in the study were divided into two groups-group 1: medial laminectomy (n = 34) and group 2: lateral laminectomy (n = 38). Patients underwent the preoperative visual analogue score, sinonasal outcome test-22 (SNOT-22), peak nasal inspiratory flowmeter, and Connecticut Chemosensory Clinical Research Center smell test. All patients were reevaluated 3 months after the operation. RESULTS The study group comprised 72 consecutive patients. The mean age of the patients was 31.03 ± 9.7, with a range of 17 to 54 years. A total of 47.2 % (n = 34) had medial and 52.8% (n = 38) had lateral laminectomy. Bilateral turbinate intervention was performed in 27.8% (n = 20), whereas unilateral middle turbinate intervention was performed in 72.3% (n = 52). Overall, both groups showed strong significant improvement over time in visual analogue scale results, SNOT-22 scores, peak flowmeter results, and olfactory function between preoperative and postoperative scores (P < 0.001). There was no significant difference between the groups for all parameters (P > 0.05). CONCLUSIONS This study revealed that medial laminectomy for aeration of the middle turbinate was as effective as lateral laminectomy. LEVEL OF EVIDENCE 1b. Laryngoscope, 125:1062-1066, 2015.
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Affiliation(s)
- Tolgar L Kumral
- Department of Otorhinolaryngology-Head and Neck Surgery, Okmeydanı Training and Research Hospital, Istanbul, Turkey
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Jalali MM. Comparison of effects of spreader grafts and flaring sutures on nasal airway resistance in rhinoplasty. Eur Arch Otorhinolaryngol 2014; 272:2299-303. [PMID: 25315469 DOI: 10.1007/s00405-014-3327-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
Abstract
Cephalic resection of the lateral crura of the alar cartilages, lateral osteotomies, and removal of the nasal hump during rhinoplasty may cause collapse of the internal nasal valve angle. This study was performed to compare preventive effects of two techniques (spreader grafts and flaring sutures) on rhinoplasty by rhinomanometry. Two hundred and forty-eight patients participated in this semi-experimental study. The patients were assigned into two groups. 28 of them were not available for follow-up. All patients had a straight nose in the midline and no severe septal deviations. 87 of 220 patients underwent the spreader grafts technique and the flaring sutures technique was performed in 133 patients. The nasal airway resistance was calculated by active anterior rhinomanometry on admission to hospital and again between 3 and 6 months following surgery. The mean of follow-up was 20.9 ± 2.9 weeks. After rhinoplasty, nasal airway resistance decreased in 46 patients (52.9 percent) of spreader grafts group and in 84 patients (63.2 percent) of flaring sutures group. The median nasal airway resistance difference (before-after surgery) of spreader grafts and flaring sutures groups was 0.027 Pa/ml/s (range -110 to 130) and 0.017 Pa/ml/s (range -0.690 to 0.790), respectively. The difference of nasal airway resistance between before and after rhinoplasty in two groups was insignificance (Mann-Whitney U test, P = 0.5). The spreader grafts and flaring sutures move the dorsal border of the upper lateral cartilage in a lateral direction and had similar preventive effect on nasal airway resistance after rhinoplasty.
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Affiliation(s)
- Mir Mohammad Jalali
- Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, 41396-38459, Iran,
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Melo DDLE, Santos RVM, Perilo TVDC, Becker HMG, Motta AR. Avaliação do respirador oral: uso do espelho de Glatzel e do peak nasal inspiratory flow. Codas 2013; 25:236-41. [DOI: 10.1590/s2317-17822013000300008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 02/18/2013] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Comparar o uso do espelho de Glatzel e do peak nasal inspiratory flow na avaliação de indivíduos respiradores orais, bem como analisar a correlação dos dois instrumentos. MÉTODOS: Foram avaliadas 64 crianças, sendo 32 respiradoras orais e 32 respiradoras nasais, na faixa etária de 4 a 12 anos. Os respiradores orais, diagnosticados de acordo com equipe multiprofissional, foram subdivididos de acordo com a causa da obstrução. Foram utilizados o espelho de Glatzel e o peak nasal inspiratory flow nos dois grupos para avaliação da permeabilidade e fluxo aéreo nasal. Os dados foram submetidos à análise estatística. RESULTADOS: O espelho de Glatzel diferenciou o modo respiratório considerando-se os estratos gênero, faixa etária, peso, altura e índice de massa corporal da amostra. Entretanto, não foi capaz de dar indícios sobre a causa da respiração oral. Com o uso do peak nasal inspiratory flow, não foi possível diferenciar o modo respiratório e tampouco a causa da respiração oral. Na amostra pesquisada, não houve correlação entre os instrumentos utilizados. CONCLUSÃO: O espelho de Glatzel mostrou ser capaz de identificar indivíduos com e sem obstrução nasal, embora não tenha sido possível diferenciar os subgrupos de respiradores orais entre si com o uso do instrumento. Já o peak nasal inspiratory flow mostrou-se capaz de diferenciar apenas respiradores nasais de respiradores orais cirúrgicos. Foi encontrada baixa correlação entre os dois instrumentos.
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Reversible nasal airway obstruction: does change in nasal peak inspiratory flow following decongestion predict response to topical steroids in chronic rhinosinusitis patients? The Journal of Laryngology & Otology 2012; 126:1238-40. [PMID: 23057871 DOI: 10.1017/s0022215112002150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Predicting which chronic rhinosinusitis patients have nasal obstruction due to reversible mucosal inflammation could prevent unnecessary surgery. AIM To investigate whether the change in nasal peak inspiratory flow following maximal decongestion (i.e. mucosal reversibility) at first visit predicts the response to topical steroids in chronic rhinosinusitis patients, as measured by the 22-item Sinonasal Outcome Test. METHODS Prospective study of 128 consecutive new adult patients presenting with nasal obstruction due to chronic rhinosinusitis (January 2008 to July 2010). The 22-item Sinonasal Outcome Test questionnaire was administered and the nasal peak inspiratory flow assessed. Following maximal nasal decongestion, the nasal peak inspiratory flow was again tested and the difference calculated. Topical steroids were administered for at least six weeks. The 22-item Sinonasal Outcome Test was then repeated and the difference calculated. RESULTS Data were analysed using means and correlation studies (Spearman's rank correlation). There was no correlation between the pre- versus post-decongestion nasal peak inspiratory flow difference and the pre- versus post-steroid 22-item Sinonasal Outcome Test difference, in chronic rhinosinusitis patients with or without nasal polyps. CONCLUSION The difference between pre- and post-decongestion nasal peak inspiratory flow does not predict chronic rhinosinusitis patients' response to topical steroids.
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Nasal airway function after maxillary surgery: a prospective cohort study using the nasal obstruction symptom evaluation scale. J Oral Maxillofac Surg 2012; 71:343-50. [PMID: 22883318 DOI: 10.1016/j.joms.2012.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/01/2012] [Accepted: 05/02/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine nasal airway function using a disease-specific quality-of-life survey instrument in subjects undergoing Le Fort I osteotomy without simultaneous rhinosurgical procedures. MATERIALS AND METHODS We conducted a prospective cohort study of nasal airway function in consecutive Le Fort I osteotomy patients, who had not received simultaneous rhinosurgical procedures, between 2007 and 2008 at Kaiser Permanente Oakland Medical Center. We administered the Nasal Obstruction Symptom Evaluation (NOSE) survey before and 3 months after surgery. Clinical and radiographic examinations were performed, and the relevant medical and demographic factors were analyzed. RESULTS The initial study sample comprised 55 patients, of whom 5 were excluded. Of the remaining 50 patients (median age 21 years, 60% women), the maxilla was advanced (median 4 mm, interquartile range 3 to 5) with minimal vertical change. During the follow-up period (median 5.5 months), significant improvement was seen in the NOSE scores for the cohort, with a median decrease of 10 units (P = .0005). Patients with moderate nasal obstruction (preoperative NOSE score >25) had the greatest improvement (P < .001). Those with severe nasal obstruction (preoperative NOSE score >50) improved, however, this did not reach statistical significance (P < .0625). The NOSE scores worsened in 10 patients; of these, 6 had minimal change. However, 4 had significant worsening, with 2 having symptomatic complaints. No predictor variables were identified in this small subgroup; however, individual case analyses revealed 1 subject with postoperative turbinate inflammation on the side of maxillary segmentalization and 1 had nasal septal buckling. CONCLUSIONS Our overall findings have suggested that nasal airway function improved after maxillary advancement and that subjects with greater preoperative NOSE scores (>25) were more likely to experience relief of nasal obstructive symptoms.
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Gupta S, Bansal A, Ramnani S, Kumar S, Goyal NK. Assessment of nasal airflow resistance in the healthy population of chattisgarh by active anterior rhinomanometry. Indian J Otolaryngol Head Neck Surg 2011; 64:338-40. [PMID: 24294574 DOI: 10.1007/s12070-011-0300-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 08/23/2011] [Indexed: 11/30/2022] Open
Abstract
The aim of present study was to define a normal range of total nasal airflow resistance in the healthy population of Chattisgarh. This study was conducted at the Department of Otorhinolaryngology, Medical College Raipur, Chattisgarh over 93 healthy adults. A proper otolaryngology examination was done prior to the study and all the subjects were free from any type upper respiratory tract infection. This was the main inclusion criteria for the present study. All the subjects were distributed according to age and sex. Active Anterior Rhinomanometry is the best recommended method for evaluating the objective assessment of nasal airflow resistance; it was preferred for the assessment of total nasal airway resistance in present study also. The present study concluded that the mean value of total nasal airway resistance was 0.21 at 150 Pa pressure. However the range of total nasal airway resistance was from 0.142 to 0.34 Pa/cm(3)/s at the same pressure. The present study presents the normal range and mean value of total nasal airway resistance for the healthy adult population of Chattisgarh. Total nasal airway resistance is independent of age and sex.
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Affiliation(s)
- Shailendra Gupta
- Department of ENT, Pt. J. N. M. Medical College and Dr. B. R. A. M. Hospital, Raipur, Chhattisgarh India
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Abstract
INTRODUCTION We present a review of nasal-air conditioning, a process essential to undisturbed gas exchange and cleansing of the respiratory mucosa in the nose. METHODS A selective literature review was made on the basis of in vivo measurements and computer simulation of the upper airways as well as the authors' own clinical and experimental data. RESULTS AND DISCUSSION Healthy subjects normally breathe through the nose, although the nasal airways have significantly higher airway resistance compared to the oral cavity, which is opened for breathing during exercise, in the case of nasal airway blockage, or in allergic rhinitis. In addition to olfaction, the main tasks of nasal breathing include: cleansing, defense, and conditioning (i.e., humidification and heating). The current knowledge of nasal conditioning processes will be discussed. In addition, research activities of particular relevance for diagnosis and intervention in various pathologies of the upper airways will be presented.
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Beule AG. Physiology and pathophysiology of respiratory mucosa of the nose and the paranasal sinuses. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2011; 9:Doc07. [PMID: 22073111 PMCID: PMC3199822 DOI: 10.3205/cto000071] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this review, anatomy and physiology of the respiratory mucosa of nose and paranasal sinuses are summarized under the aspect of its clinical significance. Basics of endonasal cleaning including mucociliary clearance and nasal reflexes, as well as defence mechanisms are explained. Physiological wound healing, aspects of endonasal topical medical therapy and typical diagnostic procedures to evaluate the respiratory functions are presented. Finally, the pathophysiologies of different subtypes of non-allergic rhinitis are outlined together with treatment recommendations.
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Affiliation(s)
- Achim G Beule
- Department of Otorhinolaryngology, Head and Neck Surgery, University Greifswald, Germany
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Choi H, Park IH, Yoon HG, Lee HM. Wireless Patient Monitoring System for Patients with Nasal Obstruction. Telemed J E Health 2011; 17:46-9. [DOI: 10.1089/tmj.2010.0105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hyuk Choi
- Department of Biomedical Engineering, Brain Korea 21 Project for Biomedical Science, College of Medicine, Korea University, Seoul, Korea
- Medical Devices Clinical Trial Center, Guro Hospital, Korea University, Seoul, Korea
| | - Il-Ho Park
- Department of Otorhinolaryngology—Head and Neck Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Hu Geun Yoon
- Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul, Korea
| | - Heung-Man Lee
- Medical Devices Clinical Trial Center, Guro Hospital, Korea University, Seoul, Korea
- Department of Otorhinolaryngology—Head and Neck Surgery, College of Medicine, Korea University, Seoul, Korea
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Pawar SS, Garcia GJM, Kimbell JS, Rhee JS. Objective measures in aesthetic and functional nasal surgery: perspectives on nasal form and function. Facial Plast Surg 2010; 26:320-7. [PMID: 20665410 DOI: 10.1055/s-0030-1262314] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The outcomes of aesthetic and functional nasal surgery are difficult to assess objectively because of the intricate balance between nasal form and function. Despite historical emphasis on patient-reported subjective measures, objective measures are gaining importance in both research and the current outcomes-driven health care environment. Objective measures currently available have several shortcomings that limit their routine clinical use. In particular, the low correlation between objective and subjective measures poses a major challenge. However, advances in computer, imaging, and bioengineering technology are now setting the stage for the development of innovative objective assessment tools for nasal surgery that can potentially address some of the current limitations. Assessment of nasal form after aesthetic surgery is evolving from two-dimensional analysis to more sophisticated three-dimensional analysis. Similarly, assessment of nasal function is evolving with the introduction of computational fluid dynamics techniques, which allow for a detailed description of the biophysics of nasal airflow. In this article, we present an overview of objective measures in both aesthetic and functional nasal surgery and discuss future trends and applications that have the potential to change the way we assess nasal form and function.
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Affiliation(s)
- Sachin S Pawar
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
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Sertel S, Bergmann Z, Ratzlaff K, Baumann I, Greten HJ, Plinkert PK. Acupuncture for nasal congestion: a prospective, randomized, double-blind, placebo-controlled clinical pilot study. Am J Rhinol Allergy 2009; 23:e23-8. [PMID: 19769799 DOI: 10.2500/ajra.2009.23.3380] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nasal congestion is one of the most common complaints dealt with in otorhinolaryngology. Side effects of decongestants are frequently seen in patients with chronic nasal congestion. This leads to an increasing demand of alternative treatments such as acupuncture. Future studies on acupuncture should aim at objectifying effects by both physical measuring and double blinding. Therefore, we were interested in whether these effects can potentially be measured as increase in nasal airflow (NAF) in ventus ("wind") disease of traditional Chinese medicine (TCM). METHODS Twenty-four patients with a history of nasal congestion due to hypertrophic inferior turbinates or chronic sinusitis without polyposis were additionally diagnosed according to the Heidelberg model of TCM. They were asked to score the severity of their nasal congestion on a visual analog scale (VAS). The acupuncturist was blinded according to the Heidelberg blinding assay. NAF was measured by using active anterior rhinomanometry (ARM). Specific verum acupoints according to the Chinese medical diagnosis were tested against nonspecific control acupoints. VAS and NAF were scored and measured before and 15 and 30 minutes after acupuncture. RESULTS Control acupuncture showed a significant improvement in VAS and a deterioration of NAF. Verum acupuncture showed highly significant improvements in VAS and NAF. In addition, verum acupuncture improved NAF and VAS significantly over time. CONCLUSION Our control and verum acupoints fulfill the condition of a control and verum treatment, respectively. Measuring NAF by RRM and scoring VAS are possible and reflect acupuncture effects in vivo.
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Affiliation(s)
- Serkan Sertel
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany.
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