The effects of endoscopic sinus surgery on the nasal cycle as assessed by acoustic rhinometry

[Definition and illustration of the different types of nasal cycle using long-term rhinometry]

BACKGROUND

A reciprocal swelling of the nasal mucosa is often referred to as the classical nasal cycle; however, reports in the literature suggest a more complex picture. Most of the research on the nasal cycle is based on individual measurements. The long-term rhinometry (LRM) now makes it possible to continuously examine the cyclic swelling of the nasal mucosa over 24 h. The aim of this study was therefore to evaluate the nasal cycle with LRM over 24 h.

MATERIAL AND METHODS

An LRM was performed in 55 rhinologically healthy subjects over 24 h using the portable measuring system Rhino-Move© (Happersberger Otopront; Hohenstein, Germany).

RESULTS

In addition to the expected strictly reciprocal swelling of the nasal mucosa in the sense of the classical nasal cycle, the following cycle types were detected: in-concert type with simultaneous rise and drop of the air flow on both sides of the nose, the one-sided type with significant congestion and decongestion of the mucous membrane only on one side and no detectable changes on the other side of the nose and the non-cycle type without any change in airflow on both sides. Most subjects showed a complex picture with multiple cycle types within the 24 h measurement (mixed nasal cycle). The types often differed during the day and night.

CONCLUSION

This study confirms the assumption that the nasal cycle measured over 24 h is much more complex than often described in the literature. Most subjects showed several of the 5 cycle types described here. The LRM has proven to be an easy to- use and reliable measurement method. The relationship between cycle type and physical activity as well as other factors remains to be investigated.

The Nasal Obstruction Balance Index: A Novel Approach to Improving Correlation Between Unilateral Nasal Airway Measurements and Evaluating Nasal Airway Asymmetry

OBJECTIVES/HYPOTHESIS

Demonstrate that the Nasal Obstruction Balance Index (NOBI) model fulfils the unmet need of improving unilateral correlation between subjective and objective nasal obstruction outcome measures and identifying the more obstructed side. Improve correlation between unilateral objective nasal airway measurements (nasal inspiratory peak flow [NIPF] and acoustic rhinometry [AR]) and subjective Visual Analogue Scale for nasal obstruction (VAS-NO) scores. Improve assessment of nasal airway asymmetry by evaluating unilateral measurements both before and after the application of nasal decongestant; which the patient could better understand. NOBI represents a ratio calculated by taking the difference between left and right nasal airway measurements and divided by the maximum unilateral measurement. It is based on Poiseuille's law and aims to reduce the confounding variables which challenge nasal airway measurement.

STUDY DESIGN

Prospective cohort study.

METHODS

Forty-three controls and 34 patients with nasal obstruction underwent both unilateral and bilateral NIPF, AR and VAS-NO measurements; these were repeated after the application of nasal decongestant. The NOBI values for unilateral NIPF, AR, and VAS-NO were calculated both before and after decongestant.

RESULTS

The correlation between unilateral NIPF and AR measurements was enhanced considerably (r = 0.57, P < .01) when NOBI was applied. The NOBI metric significantly increased the correlation between unilateral NIPF, AR, and VAS-NO scores. Postdecongestant NOBI for NIPF and AR measurements correctly identified the more obstructed side in 82.4% and 94.1% of the deviated nasal septum (DNS) cases, respectively.

CONCLUSION

The NOBI model provides a better correlation between unilateral subjective and objective measurements and identifies the more obstructed side.

LEVEL OF EVIDENCE

Prospective cohort study (level III) Laryngoscope, 2021.

Relationship Between Nasal Cycle, Nasal Symptoms and Nasal Cytology

Background

The nasal cycle is the spontaneous congestion and decongestion of nasal mucosa that happens during the day. Classically, 4 types of nasal cycle patterns have been described: (1) classic, (2) parallel, (3) irregular, and (4) acyclic. Hypothalamus has been considered as the central regulator even if several external factors may influence its activity.

Objective

The aim of the study was to evaluate the presence of a correlation between nasal cycle pattern, nasal cytology and nasal symptoms.

Methods

Thirty healthy volunteers have been enrolled in the study. All subjects completed a Sino-Nasal Outcome Test-22 questionnaire and a Visual Analog Scale (VAS) for nasal obstruction. The nasal cycle was studied by means of peak nasal inspiratory flow. Nasal cytology has been used to evaluate the presence of local nasal inflammation.

Results

Nineteen subjects showed a parallel nasal cycle pattern, while 11 showed a regular one. A parallel pattern was present in 60% of asymptomatic subjects and in 67% of the symptomatic one ( P = 1). VAS for nasal obstruction did not show a significant difference between the 2 patterns of the nasal cycle ( P = .398). Seventeen subjects had a normal rhinocytogram, while 13 volunteers showed a neutrophilic rhinitis; 53.8% of the subjects with a neutrophilic rhinitis showed a parallel pattern, while the remaining 46.2% had a regular one. In the case of a normal cytology, 70.6% of the volunteers had a parallel pattern and 29.4% had a regular one. Differences between the 2 groups were not statistically significant ( P = .575).

Conclusion

Rhinitis with neutrophils seems to not influence the nasal cycle pattern. Based on the present results, the pattern of nasal cycle does not influence subjective nasal obstruction sensation.

Effects of radiofrequency thermal ablation on the nasal cycle measured using rhinomanometry

OBJECTIVE

This study was designed to research the effects of radiofrequency thermal ablation (RFTA) surgery on the nasal cycle, with anterior rhinomanometry being used for assessment.

METHODS

Thirty patients with inferior concha hypertrophy and 13 healthy volunteers were included in this study. An anterior rhinomanometry was performed on each of the patients before surgery and at 1 month and 6 months after surgery, and on the volunteers in the control group, simultaneously.

RESULTS

Nineteen of the 30 patients and 8 of the 13 healthy participants showed a distinct type of nasal cycle at different periods of measurement. The mean of the total nasal airflow of the patients was lower before RFTA surgery but increased at a rate of 71.07%, closer to the value of the control group, after RFTA surgery. After RFTA, the unilateral nasal airflow (fmin and fmax) values increased at ratios of 22.36% and 94.44%, respectively. The amplitude (fmax-fmin) showed a statistically significant decrease in the postoperative period (108.43 ± 54.37), when compared with that of the preoperative period (202.80 ± 81.24) (P < .01).

CONCLUSION

We conclude that the RFTA is a useful method for treating inferior concha hypertrophy, because it positively affects the nasal physiology, increasing the total nasal airflow without changing the nasal cycle time.

Nasal conditioning after endonasal surgery in chronic rhinosinusitis with nasal polyps

BACKGROUND

Endoscopic sinus surgery (ESS) is a frequently performed operation for chronic rhinosinusitis (CRS). The aim of this study was to investigate nasal conditioning after ESS with/without septoplasty and turbinoplasty in patients with CRS with nasal polyps and to determine its relation to nasal patency and geometry.

METHODS

Twenty-one patients were enrolled into this study. Nasal conditioning, AAR, and acoustic rhinometry were measured before and 4-8 months after endonasal surgery.

RESULTS

The temperature and humidity gradient across the nose increased significantly after operation. High nasal volumes and patency were positively correlated with elevated nasal conditioning. No correlation between preoperative and postoperative changes in nasal geometry and nasal airflow with changes in conditioning values was found.

CONCLUSION

Patients with CRS with nasal polyps seem to profit from ESS with/without septoplasty and turbinoplasty because nasal conditioning is improved postoperatively. Properly performed ESS has its importance within the variety of nasal surgical procedures ensuring improved nasal function.

Study of nasal cycles in children by acoustic rhinometry

BACKGROUND

Studies concerning nasal cycle physiology in children are still rare, and controversies exist about its existence. This study was ascertained to evaluate the dynamic behavior of inferior turbinates in children by acoustic rhinometry.

METHODS

Sixteen volunteer patients, aged 2-11 years old (mean, 6.25 years), were evaluated between April and July 2003. The patients submitted to periodic acoustic rhinometry, with triplicate measurements (each 30 minutes) for 3 hours.

RESULTS

All evaluated children presented nasal cycles, with five children presenting a classic pattern (31.25%), three children presenting a concert pattern (18.75%), and eight children presenting an irregular pattern (50%).

CONCLUSION

This study suggests that children present nasal cycles, as well as adults. Nevertheless, the most prevalent pattern in children was the irregular pattern, whereas in adults the most frequently detected is the classic pattern.