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Wang Z, Chen D. Impact of different fracture types in the pyriform buttress area on nasal airway function. Eur Arch Otorhinolaryngol 2024; 281:1301-1306. [PMID: 37863857 PMCID: PMC10857949 DOI: 10.1007/s00405-023-08290-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Fractures in the pyriform buttress area adversely affect facial appearance and nasal airway patency. Nasal airway function has received less attention than aesthetic problems in the literature. This retrospective study classified the different fracture types in this area and determined their impact on nasal airway function. MATHODS Three-dimensional computed tomography images of patients with fractures in the pyriform buttress area were analyzed to identify the exact fracture pattern. The nasal airway functions were evaluated and compared between patients with different fracture patterns using acoustic rhinometry, rhinomanometry, and the nasal obstruction symptom evaluation scale. RESULTS Overall, 47 patients, including 16 with type I fractures (high fracture line; group I), 16 with type II fractures (intermediate fracture line; group II), and 15 with type III fractures (low fracture line; group III), were included in the study. The mean minimal cross-sectional area (MCA), total nasal inspiratory resistance (Tri) and total nasal expiratory resistance (Tre) of group I were 0.51 ± 0.06 cm2, 1.67 ± 0.11 kPa L-1 s-1, and 1.66 ± 0.12 kPa L-1 s-1, respectively; those of group II were 0.48 ± 0.07 cm2, 1.89 ± 0.15 kPa L-1 s-1, and 1.88 ± 0.14 kPa L-1 s-1, respectively; and those of group III were 0.36 ± 0.04 cm2, 1.94 ± 0.21 kPa L-1 s-1, and 2.01 ± 0.34 kPa L-1 s-1, respectively. The nasal obstruction symptom evaluation (NOSE) scale scores for groups I, II, and III were 7.188, 9.813, and 13.27, respectively. CONCLUSION Therefore, the severity of the nasal airway obstruction depends on the displacement of the fractured bones in patients with fractures in the pyriform buttress area. The most profound nasal obstruction occurs in patients with the lowest fracture line.
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Affiliation(s)
- Zhongying Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine On Ear and Nose Diseases, Shanghai, China
| | - Dong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Key Laboratory of Translational Medicine On Ear and Nose Diseases, Shanghai, China.
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2
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Matsumoto FY, Tranquillini Gonçalves TR, Solé D, Wandalsen GF. Local allergic rhinitis in children: identification and characterization in a specialty outpatient clinic. Eur Ann Allergy Clin Immunol 2024. [PMID: 38258826 DOI: 10.23822/eurannaci.1764-1489.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Summary Background. Local Allergic Rhinitis (LAR) is a phenotype defined by rhinitis symptoms with negative responses to systemic sensitization tests but with an exclusively nasal allergic inflammatory response. Data on the pediatric age group is scarce, and no Latin American data has been published so far. Methods. Nasal Allergen Challenge (NAC) was performed with Dermatophagoides pteronyssinus and Blomia tropicalis in six- to 18-year-old patients diagnosed with rhinitis and no systemic sensitization. NAC was monitored using subjective parameters and acoustic rhinometry. The study aimed to identify LAR in child and adolescent subjects previously diagnosed with non-allergic rhinitis (NAR) in a Brazilian specialty outpatient clinic (Allergy and Immunology). Results. During the study period, we analyzed 758 skin prick tests (SPT). Of those, 517 (68.2%) were diagnosed with rhinitis. Among those, 18.4% (95/517) had a negative SPT, meeting the criteria for inclusion in the study. Twenty-five patients underwent NAC, and 40% (10/25) of them, previously considered to have NAR, had a positive test and were reclassified as having LAR. Based on the analyzed characteristics, clinically differentiating LAR from NAR was impossible. Conclusions. This study represents the first investigation of LAR in child and adolescent subjects in Latin America, contributing significantly to the understanding of its prevalence and characteristics in this geographic area. Among a subgroup of patients lacking systemic sensitization submitted to NAC, 40% (10/25) demonstrated a positive NAC with Dermatophagoides pteronyssinus and Blomia tropicalis, warranting their reclassification to LAR. NAC with multiple allergens has been proven safe and viable in pediatric populations, affirming its critical role in the accurate diagnosis of LAR.
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Affiliation(s)
- F Y Matsumoto
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - T R Tranquillini Gonçalves
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - D Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - G F Wandalsen
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
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Min HJ, Park JY. Usefulness of nasal cavity evaluation before high-resolution esophageal manometry in high-risk patients. Korean J Intern Med 2024; 39:86-94. [PMID: 38031365 PMCID: PMC10790053 DOI: 10.3904/kjim.2023.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/10/2023] [Accepted: 07/21/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND/AIMS A catheter is inserted through the nasal cavity during high-resolution esophageal manometry (HRM), which may cause adverse events such as pain or epistaxis. Despite these possible safety considerations, studies on this subject are very limited. We aimed to investigate the usefulness of nasal cavity evaluation before HRM to reduce the risk of adverse events and test failure. METHODS Patients who underwent HRM after consultation with the ear-nose-throat department for nasal evaluation were retrospectively enrolled between December 2021 and May 2022. The included patients had a previous history of sinonasal disease or surgery or had subjective nasal discomfort. All patients answered the Sino-Nasal Outcome Test (SNOT-22) questionnaire, and subjective nasal discomfort was scored using a visual analog scale. Nasal endoscopy and acoustic rhinometry were performed for disease evaluation and volumetric assessment. RESULTS The analysis included 22 patients with a mean age of 58.9 years. The mean SNOT-22 score was 24.2, and 16 patients (72.7%) complained of subjective nasal obstruction. The HRM catheter was successfully inserted in 20 patients (90.9%), without any significant adverse events. The objective measurement outcomes of acoustic rhinometry and sinus endoscopy did not always correspond to subjective symptoms. Narrowed nasal airways unresponsive to decongestants were observed in two patients with failed catheter insertion. CONCLUSION To reduce the risk of adverse events and test failure during HRM, a site-specific questionnaire to evaluate nasal obstruction might be helpful. When nasal obstruction is suspected, objective nasal cavity evaluation could be recommended for the safe and successful performance of HRM.
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Affiliation(s)
- Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Yong Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Kim SY, Nam HJ, Byeon JY, Choi HJ. Effectiveness of out-fracture of the inferior turbinate with reduction nasal bone fracture. World J Clin Cases 2023; 11:6374-6382. [PMID: 37900224 PMCID: PMC10601012 DOI: 10.12998/wjcc.v11.i27.6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/28/2023] [Accepted: 08/23/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The nasal bone, being the most protruding bone in the center of the facial bones, is particularly susceptible to damage. Nasal bone fractures can often result in secondary deformation and dysfunction of the nose, including septal fractures. Studies on functional or intra-nasal complications have been rarely reported after nasal bone fracture reduction. AIM To evaluate the severity of nasal obstruction and its improvement following nasal bone fracture reduction using inferior turbinoplasty. METHODS We conducted a retrospective review of data from 50 patients with symptomatic nasal obstruction between January to December 2010. All patients underwent preoperative Computed tomography evaluation, and symptom changes and nasal cavity volume were analyzed using a visual analog scale and acoustic rhinometry before and after surgery. Closed reduction and out-fracture of both inferior turbinates performed by the same surgeon. Treatment outcomes were assessed by comparing changes in the nasal airway volume measured using acoustic rhinometry before and after surgery. The minimal cross-sectional area (MCA) was also analyzed based on the Stranc classification. RESULTS Before reduction, the mean MCA for all cases was 0.59 ± 0.06 cm2, which represented an 11% decrease compared to the average size of a Korean adult (0.65 ± 0.03 cm2). The MCA for frontal impact was 0.60 ± 0.02 cm2 and for lateral impact, it was 0.58 ± 0.03 cm2. After reduction via inferior turbinoplasty, the MCA improved to 0.64 ± 0.04 cm2. CONCLUSION This study suggests that turbinoplasty is helpful in addressing nasal obstruction. Out-fracture of the inferior turbinate is an effective and durable technique that can be easily performed to enlarge the nasal airway with minimal morbidity.
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Affiliation(s)
- Se-Young Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Gumi Hospital, Gumi-si 39371, South Korea
| | - Ha-Jong Nam
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Gumi Hospital, Gumi-si 39371, South Korea
| | - Je-Yeon Byeon
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan-si 31151, South Korea
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Cheonan-si 31151, South Korea
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Hupp LC, Verius M, Kolk A, Steinbichler TB, Heppt H, Giotakis AI. The long-term effect of maxillary advancement and impaction on subjective and objective nasal patency: A retrospective case-control study. J Craniomaxillofac Surg 2023:S1010-5182(23)00081-1. [PMID: 37355368 DOI: 10.1016/j.jcms.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/01/2023] [Accepted: 05/21/2023] [Indexed: 06/26/2023] Open
Abstract
The aim of this study was to investigate the change of nasal patency after maxillary advancement and impaction (MAXADV + IMP) in subjects with skeletal class III malocclusion (cases) and after removal of maxillary cysts in close proximity to the nasal floor in subjects that served as controls. NOSE score, volume derived by computed tomography (VOL), and acoustic rhinometry and rhinomanometry were retrospectively evaluated, before and one year after surgery. The movement of specific landmarks was also measured. NOSE score did not change after surgery, neither in 17 cases (p = 0.10) nor in 17 controls (p = 0.14). In cases, VOLpostop (10088 ± 4200 mm3) was significantly higher than VOLpreop (7807 ± 3721 mm3; p = 0.036). Maxillary advancement and inferior displacement of the ventral maxilla were noted by the movement of incisive foramen in the coronal (3.9 ± 5.4; p = 0.011) and Frankfurt Horizontal plane (2.2 ± 2.0; p = 0.001), respectively. In controls, VOLpostop (9749 ± 3654 mm3) was also significantly higher than VOLpreop (8473 ± 2624 mm3; p = 0.050). Cross-sectional areas, nasal flow and nasal resistance changed significantly after surgery in cases (6/30 pairs; p < 0.018), but not in controls (all p > 0.066). MAXADV + IMP increased nasal patency, but did not change the feeling of nasal breathing. Physicians should proceed with caution when informing patients about improvement of nasal breathing after MAXADV + IMP.
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Affiliation(s)
- Linus C Hupp
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Verius
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Teresa B Steinbichler
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Helen Heppt
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Aris I Giotakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria.
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Naito K, Horibe S, Tanabe Y, Kato H, Yoshioka S, Tateya I. Objective assessment of nasal obstruction. Fujita Med J 2023; 9:53-64. [PMID: 37234397 PMCID: PMC10206903 DOI: 10.20407/fmj.2021-029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/10/2022] [Indexed: 05/28/2023]
Abstract
There are many methods and types of equipment for measuring the nasal airway, but there is no consensus regarding the results of various clinical studies on nasal obstruction. In this review, we discuss the two major methods of objectively assessing the nasal airway: rhinomanometry and acoustic rhinometry. The Japanese standard of rhinomanometry in Japanese adults and children was established by the Japanese Standardization Committee on Rhinomanometry in 2001 and 2018, respectively. However, the International Standardization Committee has proposed different standards because of differences in race, equipment, and social health insurance systems. The standardization of acoustic rhinometry in Japanese adults is making progress in several Japanese institutes, but the international standardization of acoustic rhinometry has not yet begun. Rhinomanometry is the physiological expression of nasal airway breathing, whereas acoustic rhinometry is the anatomic expression. In this review, we introduce the history and methods of the objective assessment of nasal patency and the physiological and pathological issues regarding nasal obstruction.
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Affiliation(s)
| | | | - Yosuke Tanabe
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Hisayuki Kato
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Satoshi Yoshioka
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Ichiro Tateya
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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Giotakis AI, Widmann G, Mallien E, Riechelmann F, Heppt H, Riechelmann H. CT analysis of the anterior nasal airway based on the direction of nasal airflow in patients with nasal obstruction and trauma controls. Eur Arch Otorhinolaryngol 2023; 280:1765-1774. [PMID: 36242609 DOI: 10.1007/s00405-022-07703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The anterior nose is the nasal segment with the highest resistance to airflow. In a hospital-based case-control study, we compared cross-sectional areas of the nasal cavities anterior to the piriform aperture determined by computed tomography (CT-CSA) in patients with nasal obstruction (cases) and unselected patients with trauma unrelated to the head and face (controls). METHODS CT-CSA could be reproducibly identified at angles of 0o, 30°, 60°, and 90° to the nasal floor approximately perpendicular to the arcuate direction of nasal airflow using bony landmarks. CT-CSA were manually segmented and compared in cases and controls. In cases, we compared CT-CSA at 30° (CT-CSA30-narrow) with the minimum cross-sectional area determined by acoustic rhinometry (AR-MCA1-narrow), each on the narrower side. RESULTS CT-CSA ranged from 7 to 250 mm2 with an average of 100 mm2 per nasal side. Side differences of the nasal airways indicating asymmetry of the nasal airways were greater in 40 cases than in 44 controls (p < 0.003). Moreover, bilateral CT-CSA were significantly smaller in cases than in controls (p < 0.001). CT-CSA30-narrow did not significantly correlate with AR-MCA1-narrow (r = 0.33; p = 0.07) and on average was 58% smaller than AR-MCA1-narrow. CONCLUSIONS Cross-sectional areas of the anterior nose perpendicular to the direction of nasal airflow, which is considered relevant in terms of flow physics, can be reliably measured using CT. Anterior nasal cavities in patients with nasal obstruction were more asymmetric and, as a whole, narrower than in controls, the latter of which is not corrected by routine septoplasty.
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Affiliation(s)
- Aris I Giotakis
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Gerlig Widmann
- Department of Radiology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Erik Mallien
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Felix Riechelmann
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Helen Heppt
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Agarwal SS, Datana S, Sahoo NK, Bhandari SK. Correlating Nasal Patency with Obstructive Sleep Apnea in Obese Versus Non-Obese Patients: An Acoustic Rhinometry Study. Indian J Otolaryngol Head Neck Surg 2022; 74:1483-1491. [PMID: 36452587 PMCID: PMC9701976 DOI: 10.1007/s12070-021-02623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to correlate nasal patency with Obstructive Sleep Apnea (OSA) in obese versus non-obese patients using Acoustic Rhinometry (AR). Eccovision® Acoustic Rhinometer equipment was used to compare nasal cross-sectional areas (CSA1,2 & 3 corresponding to nasal valve region, anterior portion of middle & inferior turbinate and posterior portion of middle & inferior turbinate respectively) and volume in age and gender matched sample divided into three groups: Group 1: Non-obese patients without OSA (25 patients, 13 males and 12 females); Group 2: Non-obese patients with OSA (25 patients, 14 males and 11 females); Group 3: Obese patients with OSA (25 patients, 13 males and 12 females). The mean nasal cross-sectional areas and volume were lower in Group 2 compared to Group 1 but statistically non-significant (P value > 0.05 for all). The mean nasal cross-sectional areas and volume were significantly lower in Group 3 as compared to Groups 1 and 2 (P value < 0.05 for all). BMI showed a statistically significant positive (direct) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). The nasal cross-sectional areas and volume showed a statistically significant negative (inverse) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). OSA diagnosed cases with high BMI may not present with an obvious nasal obstruction; the nasal patency may still be compromised due to reduced nasal lumen secondary to obesity. AR, being cost-effective and non-invasive modality; is advocated to evaluate pre-treatment nasal patency, as well as follow up evaluation to ascertain improvement after the intervention.
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Affiliation(s)
- Shiv Shankar Agarwal
- Department of Orthodontics and Dentofacial Orthopedics, Armed Forces Medical College, Pune, India
| | - Sanjeev Datana
- Department of Orthodontics and Dentofacial Orthopedics, Armed Forces Medical College, Pune, India
| | - N. K. Sahoo
- Department of Oral and Maxillofcial Surgery, Armed Forces Medical College, Pune, India
| | - S. K. Bhandari
- Department of Oral and Maxillofcial Surgery, Armed Forces Medical College, Pune, India
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Gokce G, Gode S, Ozturk A, Kirazlı T, Veli I. Evaluation of the effects of different rapid maxillary expansion appliances on airway by acoustic rhinometry: A randomized clinical trial. Int J Pediatr Otorhinolaryngol 2022; 155:111074. [PMID: 35189449 DOI: 10.1016/j.ijporl.2022.111074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/25/2022] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this 3-arm parallel trial was to compare the effects of tooth tissue-borne (TTB), tooth-borne (TB) and bone-borne (BB) rapid maxillary expansion (RME) appliances on nasal airway with acoustic rhinometry (AR). SETTING AND SAMPLE POPULATION Forty-six 12- to 14-year-old patients with narrow maxilla were randomly allocated into 3 study groups accordingly the type of expander: TTB, TB and BB. The participants were recruited from the Department of Orthodontics, Izmir Katip Celebi University. MATERIALS AND METHODS All patients had RME with an initial activation of two-quarter turns a day (0.5 mm) for an average of 8 days followed by 1 quarter turns per day for an average of 10 days. Disguised group allocation using opaque sealed envelopes was made with a computer-generated randomization program. The primary outcome was changes on the minimal nasal cross-sectional area (MCA). Secondary outcome included the assessment of nasal cavity volume. AR measurements were obtained at baseline (T0), immediately after the expansion (T1), and at 3 months-follow-up (T2). One-way analysis of variance (ANOVA) and Bonferroni test were used for inter-group comparison and two-way ANOVA was used for intra-group evaluation. RESULTS There were significant increases in MCA 1, 2 and nasal Vol in all groups after the treatment (95% [CI], P < 0.05) whereas in inter-group comparisons; MCA 1, 2 and nasal Vol, the changes were found to be similar (95% [CI], P > 0.05). HARMS No serious harm was observed except for mild gingivitis due to plaque accumulation. CONCLUSIONS RME treatment increased minimal nasal cross-sectional areas and nasal volume irrespective of appliance design. TRIAL REGISTRATION This trial was registered at Clinicaltrials.gov (Identifier NCT04529057). PROTOCOL The protocol was not published. FUNDING This trial was financed by Izmir Katip Celebi University, Scientific Research Projects Unit [grant number 2016-TDR-SABE-0024].
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Affiliation(s)
- Gokcenur Gokce
- Izmir Katip Celebi University, Faculty of Dentistry, Department of Orthodontics, Turkey.
| | - Sercan Gode
- Department of Otolaryngology, Ege University School of Medicine, Turkey.
| | - Arın Ozturk
- Department of Otolaryngology, Ege University School of Medicine, Turkey.
| | - Tayfun Kirazlı
- Department of Otolaryngology, Ege University School of Medicine, Turkey.
| | - Ilknur Veli
- Izmir Katip Celebi University, Faculty of Dentistry, Department of Orthodontics, Turkey.
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Letzel J, Darbinjan A, Hummel T. The nasal cycle before and after nasal septoplasty. Eur Arch Otorhinolaryngol 2022; 279:4961-4968. [PMID: 35286439 DOI: 10.1007/s00405-022-07322-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Septoplasty is one of the most frequently performed operations in patients with septal deviation of the nose. The aim of this surgical intervention is to reduce nasal obstruction and to achieve a physiological nasal breathing. The nasal cycle plays a crucial role in this. The aim of this study was to investigate nasal breathing and the nasal cycle after septoplasty over a long period of time and under everyday conditions. METHODS We examined 22 healthy subjects and 19 patients with nasal septal deviation. They participated in two sessions separated by an interval of three months. Shortly after the first session patients received nasal septoplasty. Testing included multiple questionnaires regarding nasal breathing and olfactory function, anterior rhinoscopy, rhinomanometry, acoustic rhinometry, and long-term rhinoflowmetry over 24 h. RESULTS Nasal septoplasty was associated with subjectively improved nasal breathing and nasal patency comparable to that in healthy subjects. The severity of nasal obstruction was reduced. Nasal airflow and the hydraulic diameter increased on the deviated side of the nose while the inspiratory resistance did not significantly change. In addition, the number of phases of the nasal cycle decreased on the nondeviated side. Hence, the surgery was associated with a more even distribution of phases on both sides of the nose. CONCLUSION Nasal septoplasty leads to a subjectively satisfactory result in patients with pathological septal deviation of the nose. In particular, septoplasty appears to be accompanied by a more even distribution of the nasal cycle across the two nasal cavities.
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Affiliation(s)
- Justus Letzel
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Alexander Darbinjan
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Thomas Hummel
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Elwany S, Bahgat AY, Ibrahim M, Bazak R. Surgical correction of nasal obstruction in obstructive sleep apnea improves CPAP outcomes and compliance. Ir J Med Sci 2022; 191:2723-2728. [PMID: 35083644 DOI: 10.1007/s11845-021-02896-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although continuous positive airway pressure (CPAP) therapy curtails most of the negative impacts of obstructive sleep apnea (OSA), its efficacy is limited by its low long-term adherence. Nasal obstruction contributes to OSA pathophysiology and necessitates high CPAP titration pressures which reduce CPAP compliance. AIM This study aims at elucidating the outcomes of surgical correction of nasal obstruction in patients intolerant to CPAP therapy. METHODS Forty-nine patients with severe OSA intolerant to CPAP secondary to surgically correctable nasal obstruction were operated upon. Patients were evaluated preoperatively and at least 3 months after the surgical intervention. Subjective assessment entailed the Nasal Obstruction Symptom Evaluation score (NOSE) and the Epworth Sleepiness Scale (ESS). Objectively the patients were assessed by acoustic rhinometry and standard polysomnography. RESULTS Nasal surgical intervention resulted in an a statistically significant decrease in the mean NOSE score, ESS and optimal CPAP titration pressure. In addition, the minimal cross-sectional area (MCA1&2) increased significantly postoperatively. There was a positive correlation between the improvement in NOSE score as well as the MCA1& 2 and the postoperative decrease in CPAP titration pressure. Surgical correction of nasal obstruction improved CPAP outcomes and compliance in all patients. CONCLUSIONS Nasal surgery in OSA objectively assessed by acoustic rhinometry improved nasal obstruction with a resultant decrease in the CPAP pressure requirements. Given that lower CPAP pressures improve adherence to CPAP therapy, surgical alleviation of nasal obstruction should be considered a crucial intervention in the management armamentarium of OSA.
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Affiliation(s)
- Samy Elwany
- Department of Otolaryngology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Ahmed Yassin Bahgat
- Department of Otolaryngology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Mahmoud Ibrahim
- Department of Chest, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Remon Bazak
- Department of Otolaryngology, Alexandria Faculty of Medicine, Alexandria, Egypt.
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Verkest V, Pingnet L, Fransen E, Declau F. Piezo-assisted Turbinoplasty Versus Partial Turbinectomy in External Septorhinoplasty: A Prospective Comparative Study in 100 Patients. Aesthetic Plast Surg 2022; 46:1323-1331. [PMID: 35022839 DOI: 10.1007/s00266-021-02662-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the outcome of the piezo-assisted turbinoplasty with a partial turbinectomy technique in the treatment of chronic nasal obstruction due to inferior turbinate enlargement. STUDY DESIGN This is a prospective randomized single-center study in a cohort of 100 consecutive patients which underwent external septorhinoplasty and concomitant hybrid type of turbinoplasty. METHODOLOGY Patients were randomly assigned into two groups. The first group included 50 patients who underwent piezo-assisted outfracturing of the inferior turbinates in combination with bipolar coagulation. The second group included 50 patients who underwent a treatment based on turbinate bipolar coagulation and partial resection of the inferior border of the turbinate. The severity of nasal obstruction was measured in both patient groups with a patient-related outcome questionnaire (NOSE) and objective measures (anterior rhinomanometry and acoustic rhinometry). Assessments were conducted prior to surgery and 3 months after the surgery. RESULTS There was a significant improvement in the values of the NOSE questionnaire with no relevant difference between the two study groups. Acoustic rhinometry and rhinomanometry also showed no statistically significant differences between the two study groups. No differences in postoperative healing were found, and postoperative complications were comparable low in both groups. However, the piezo-assisted procedure was quicker to perform with only minimal bleeding. CONCLUSION During septorhinoplasty, the combination of thermo-coagulation with piezo-assisted turbinoplasty was as efficient as with partial turbinectomy to establish normal nasal breathing. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Valérie Verkest
- Department of Otorhinolaryngology, Head & Neck Surgery, Sint-Vincentius Hospital, GZA-Ziekenhuizen, Antwerp, Belgium.
| | - Laura Pingnet
- Department of Otorhinolaryngology, Head & Neck Surgery, Sint-Vincentius Hospital, GZA-Ziekenhuizen, Antwerp, Belgium
| | - Erik Fransen
- StatUa, Center of Statistics, University of Antwerp, Antwerp, Belgium
| | - Frank Declau
- Department of Otorhinolaryngology, Head & Neck Surgery, Sint-Vincentius Hospital, GZA-Ziekenhuizen, Antwerp, Belgium
- Department of Otorhinolaryngology, Head & Neck Surgery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Gelis S, Rueda M, Pascal M, Fernández-Caldas E, Abel Fernández E, Araujo-Sánchez G, Bartra J, Valero A. Usefulness of the Allergen Specific Nasal Provocation Test in the Diagnosis of Shellfish Allergy. J Investig Allergol Clin Immunol 2021; 32:460-470. [PMID: 34489219 DOI: 10.18176/jiaci.0736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Shellfish allergy is an important cause of food allergy and anaphylaxis worldwide. Several allergenic proteins have been described in the last few years, but the only diagnostic tool that allows discrimination between allergic and non-allergic sensitized subjects is still the oral food challenge (OFC). Objective: The aim of this study was to evaluate the usefulness of nasal allergen provocation test (NAPT) as a diagnostic tool in the diagnosis of shellfish allergy. MATERIAL AND METHODS Forty-five subjects with confirmed sensitization to shrimp by a positive skin prick test (SPT) to a commercial shrimp extract were recruited and classified as Sensitized-Allergic or non-Allergic based on current tolerance to shrimp intake, the result of an OFC with a freeze-dried cooked shrimp mixture extract, or recent history of anaphylaxis from shrimp ingestion. These subjects and ten controls without shrimp sensitization were subjected to a NAPT with a freeze-dried cooked shrimp mixture extract. The response was evaluated by means of acoustic rhinometry (AcRh) and visual analogue scale scores (VAS). RESULTS Significant differences (p=.001) were found between the Sensitized-Allergic group (18/20 positive NAPT, 90%) compared to both Sensitized-non-Allergic (2/18 positive NAPT, 11.1%) and Control (0/10 positive NAPT) groups. NAPT allows differentiation between allergic and non-allergic subjects with a S: 90%, E: 89%, PPV: 90% and NPV: 89%. CONCLUSIONS According to the study results NAPT may be a useful diagnostic tool that allows differentiating sensitized symptomatic subjects from sensitized tolerant. It could be a valuable test to consider when conducting a shrimp allergy study.
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Affiliation(s)
- S Gelis
- Department of Pneumology and Allergy, Hospital Clínic. Institut d'Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS). Universitat de Barcelona. Barcelona, Spain
| | - M Rueda
- Allergology Department, Hospital Quirónsalud, Barcelona, Spain
| | - M Pascal
- Immunology Department, Hospital Clínic. Institut d'Investigacions Biomèrdiques Agustí Pi I Sunyer (IDIBAPS). Universitat de Barcelona. Barcelona, Spain.,RETICS ARADyAL Network, Instituto de Salud Carlos III, Spain
| | - E Fernández-Caldas
- Immunotek SL, Madrid, Spain.,University of South Florida College of Medicine, Tampa, Florida, USA
| | | | - G Araujo-Sánchez
- Department of Pneumology and Allergy, Hospital Clínic. Institut d'Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS). Universitat de Barcelona. Barcelona, Spain
| | - J Bartra
- Department of Pneumology and Allergy, Hospital Clínic. Institut d'Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS). Universitat de Barcelona. Barcelona, Spain.,RETICS ARADyAL Network, Instituto de Salud Carlos III, Spain
| | - A Valero
- Department of Pneumology and Allergy, Hospital Clínic. Institut d'Investigacions Biomèdiques Agustí Pi I Sunyer (IDIBAPS). Universitat de Barcelona. Barcelona, Spain
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14
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Harju T, Numminen J. The effect of inferior turbinate surgery on nasal symptoms and inferior turbinate contractility. Am J Otolaryngol 2021; 42:102778. [PMID: 33137675 DOI: 10.1016/j.amjoto.2020.102778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to compare radiofrequency ablation (RFA), diode laser, and microdebrider-assisted inferior turbinoplasty (MAIT) in the treatment of chronic nasal obstruction in a one-year follow-up, and to pay special attention to the effect of the procedures on the contractility capacity of the inferior turbinates. METHODS The patients filled a Visual Analogue Scale (VAS) questionnaire regarding nasal symptoms pre- and postoperatively. Saccharin transit time (STT) evaluation and acoustic rhinometry were also performed. A total of 77 patients attended the one-year control visit and had technically reliable acoustic rhinometry results. RESULTS All the examined techniques decreased the VAS score for the severity of nasal obstruction statistically significantly. There was no deterioration found in the symptoms of crusting, nasal discharge, and sneezing, nor in mucociliary function in any of the groups. All the three techniques increased the non-decongested total V2-5 cm values and decreased the decongested total V2-5 cm values statistically significantly. The V2-5 cm change (%) values decreased statistically significantly in the RFA, diode laser, and the MAIT groups following the operations, the mean changes being -57 percentage points (pp), -53 pp, and -73 pp respectively. CONCLUSION All three techniques decreased the severity of nasal obstruction significantly in the one-year follow-up. Although submucosal fibrosis seemed to increase, all the techniques increased the anterior nasal cavity volume significantly. Inferior turbinate contractility decreased to the normal level from the preoperative congested state following the surgery with every examined technique.
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15
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Wang JJ, Chen CY, Liang KL, Jiang RS. Predictors of nasal bacterial culture rates in patients with chronic rhinosinusitis. Eur J Clin Microbiol Infect Dis 2019; 39:711-716. [PMID: 31828684 DOI: 10.1007/s10096-019-03775-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022]
Abstract
All nontechnical factors were analyzed to predict nasal bacterial culture results in patients with chronic rhinosinusitis (CRS). Four hundred and ninety-six CRS patients, who underwent functional endoscopic sinus surgery (FESS), were enrolled. Prior to FESS, the severity of each patient's CRS was evaluated using a questionnaire, endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and CT scan. Nasal bacterial cultures were collected from both middle meati using a cotton-tipped stick. Our results showed that the symptom severity complained of by patients and their loss of smell function did not influence the bacterial culture rate. We discovered that the bacterial culture rate was significantly higher in nostrils with nasal polyps than those without polyps, along with nostrils experiencing thick, purulent discharge as opposed to those without discharge. Additionally, this result also occurred in nostrils with a saccharin transit time of more than 30 min than it did in those with a saccharin transit time of less than or equal to 30 min. Both the total endoscopic score and anterior group CT score were significantly higher in nostrils with positive culture than those with negative culture, while the second minimal cross-sectional area (MCA2) of the nasal cavity was significantly lower in nostrils with positive culture than those with negative culture. Multiple logistic regression analysis showed that both nasal polyps and MCA2 were the predictors for positive nasal bacterial culture results. It was concluded that nasal polyps and MCA2 were the predictors for positive nasal bacterial culture results in CRS patients.
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Affiliation(s)
- Jing-Jie Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Departments of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Yi Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Kai-Li Liang
- Departments of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, National Yang-Ming Medical University, Taipei, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Rong-San Jiang
- Departments of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan. .,Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
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16
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Distinguin L, Louis B, Baujat G, Amaddeo A, Fauroux B, Couloigner V, Simon F, Leboulanger N. Evaluation of nasal obstruction in children by acoustic rhinometry: A prospective study. Int J Pediatr Otorhinolaryngol 2019; 127:109665. [PMID: 31526938 DOI: 10.1016/j.ijporl.2019.109665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/29/2019] [Accepted: 08/29/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION acoustic rhinometry (AR) is a non-invasive method measuring the nasal volume (NV) and the nasal minimal cross-sectional area (MCA), reflecting nasal obstruction. The first objective of this study was to measure and compare NV and MCA between 3 groups of children: "achondroplasia", "Down syndrome" and "control". The control group corresponded to children with suspicion of sleep disorder disease and without cranio-facial malformation. The second objective was to correlate AR measurements with the obstructive apnea-hypopnea index (OAHI). METHODS prospective study between February and July 2017, in a tertiary care center. The following data were collected: demographic characteristics, medical and surgical history, NV, MCA, and OAHI. RESULTS 83 children were included. The mean NV was lower in achondroplasia group compared to control group: 2.75 cm3 vs 3.60 cm3 (p = 0.02, 95% CI [0.0694, 0.7456]). Negative correlation was found between the NV and the OAHI for children with achondroplasia (T = -0.37; p = 0.02). CONCLUSIONS AR is an effective tool for assessing nasal obstruction in children. Nasal obstruction was correlated to OAHI in achondroplasia. AR could become a routine tool in the management of nasal obstruction of children with cranio-facial malformations.
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Affiliation(s)
- Léa Distinguin
- Oto-rhino-laryngologie et chirurgie cervico-faciale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France; Faculté de Médecine, Université Paris est, Créteil, France; Inserm U955 eq 13, Créteil, France.
| | - Bruno Louis
- Faculté de Médecine, Université Paris est, Créteil, France; Inserm U955 eq 13, Créteil, France; CNRS ERL 7000, Créteil, France
| | - Geneviève Baujat
- Service de génétique, Centre de Référence Maladies Osseuses Constitutionnelles, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France; Université Paris Descartes, Paris, France
| | - Alessandro Amaddeo
- Unité de Ventilation Non Invasive et du Sommeil de l'enfant, Hôpital Necker-Enfants Malades, Paris, France
| | - Brigitte Fauroux
- Université Paris Descartes, Paris, France; Unité de Ventilation Non Invasive et du Sommeil de l'enfant, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Oto-rhino-laryngologie et chirurgie cervico-faciale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France; Université Paris Descartes, Paris, France
| | - François Simon
- Oto-rhino-laryngologie et chirurgie cervico-faciale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France; Université Paris Descartes, Paris, France
| | - Nicolas Leboulanger
- Oto-rhino-laryngologie et chirurgie cervico-faciale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France; Inserm U955 eq 13, Créteil, France; Université Paris Descartes, Paris, France
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17
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Masala C, Käehling C, Fall F, Hummel T. Correlation between olfactory function, trigeminal sensitivity, and nasal anatomy in healthy subjects. Eur Arch Otorhinolaryngol 2019; 276:1649-1654. [PMID: 30843174 DOI: 10.1007/s00405-019-05367-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/01/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Few studies have investigated the correlation between chemosensory function (trigeminal and olfactory) and nasal volume in humans, even though nasal anatomy is crucial for the sense of smell. Aim of this study was to evaluate these correlations in normosmic subjects. METHODS Two hundred and fifty-six healthy volunteers (age range 19-69 years) participated. Olfactory function was investigated for (the rose-like) phenylethyl alcohol odor threshold and odor identification (OI) using the Sniffin' Sticks test, while nasal structure was evaluated by acoustic rhinometry (AR); trigeminal sensitivity was assessed in terms of detection "thresholds" for the odorless carbon dioxide (CO2). RESULTS There were negative correlations between olfactory sensitivity at threshold level and minimum cross-sectional area (MCSA) in both nostrils. No significant correlations were found between OI and nasal anatomy. Similar to olfactory sensitivity, with regard to the trigeminal stimulus CO2 for the right nostril subjects were the more sensitive the smaller the MCSA. CONCLUSIONS The current results emphasize the significance of nasal anatomy for trigeminal/olfactory threshold perception. Interestingly, correlations were not found between suprathreshold odor identification and nasal anatomy. Other than odor identification, odor thresholds appear to depend on subtle differences in nasal anatomy.
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Affiliation(s)
- Carla Masala
- Section of Physiology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy.
- Interdisciplinary Center Smell and Taste, Department of Otorhinolaryngology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.
| | - C Käehling
- Interdisciplinary Center Smell and Taste, Department of Otorhinolaryngology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - F Fall
- Interdisciplinary Center Smell and Taste, Department of Otorhinolaryngology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - T Hummel
- Interdisciplinary Center Smell and Taste, Department of Otorhinolaryngology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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18
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Nilsen AH, Thorstensen WM, Helvik AS, Nordgaard S, Bugten V. Improvement in minimal cross-sectional area and nasal-cavity volume occurs in different areas after septoplasty and radiofrequency therapy of inferior turbinates. Eur Arch Otorhinolaryngol 2018; 275:1995-2003. [PMID: 29869709 DOI: 10.1007/s00405-018-5022-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Septoplasty and radiofrequency therapy for inferior turbinate hypertrophy (RFIT) are common techniques used to improve nasal patency. Our aim was to compare nasal geometry and function using acoustic rhinometry and peak nasal inspiratory flow (PNIF) in three patients groups undergoing surgery for nasal obstruction, and to investigate if the improvement in minimal cross-sectional area (MCA) and nasal-cavity volume (NCV) occurred in different cavity areas in the groups. Finally, we evaluated the correlation between the objective measurements and the patients' assessment of nasal obstruction (SNO). METHODS This prospective, observational study investigated 148 patients pre-operatively and 6 months post-operatively. Fifty patients underwent septoplasty (group 1), 51 underwent septoplasty combined with RFIT (group 2), and 47 underwent RFIT alone (group 3). The MCA and NCV were measured at two distances (MCA/NCV0-3.0 and MCA/NCV3-5.2), in addition to measuring PNIF and SNO. RESULTS Pre-operatively, groups 1 and 2 had narrower MCA0-3.0 on one side than group 3 (0.31 ± 0.14 and 0.31 ± 0.14) versus (0.40 ± 0.16) cm2. Post-operatively, total MCA0-3.0 and MCA/NCV3-5.2 increased in group 1. In group 2, MCA/NCV0-3.0 at the narrow side and total MCA/NCV3-5.2 increased, while total MCA/NCV3-5.2 increased in group 3. PNIF improved from 106 ± 49 to 150 ± 57 l/min post-operatively. We found a correlation between increased MCA and NCV and less SNO in the septoplasty group (p < 0.01). CONCLUSION Surgery produced an improvement in MCA and NCV in all groups. The improvement occurred in different areas of the nasal cavity in the patient groups. Both anterior and posterior areas increased in the septoplasty groups, while only the posterior area increased in the RFIT group. PNIF improved in all three patient groups, indicating that surgery produced an improvement in nasal patency.
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Affiliation(s)
- Ann Helen Nilsen
- Department of Otolaryngology-Head and Neck Surgery, St Olav's University Hospital of Trondheim, 7006, Trondheim, Norway. .,Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway.
| | - Wenche Moe Thorstensen
- Department of Otolaryngology-Head and Neck Surgery, St Olav's University Hospital of Trondheim, 7006, Trondheim, Norway.,Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
| | - Anne-Sofie Helvik
- Department of Otolaryngology-Head and Neck Surgery, St Olav's University Hospital of Trondheim, 7006, Trondheim, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Staale Nordgaard
- Department of Otolaryngology-Head and Neck Surgery, St Olav's University Hospital of Trondheim, 7006, Trondheim, Norway.,Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
| | - Vegard Bugten
- Department of Otolaryngology-Head and Neck Surgery, St Olav's University Hospital of Trondheim, 7006, Trondheim, Norway.,Department of Neuromedicine and Movement Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
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19
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Wartelle S, Simon F, Louis B, Couloigner V, Denoyelle F, Garabedian N, Leboulanger N. Endonasal measurements by acoustic rhinometry in children: A preliminary study. Int J Pediatr Otorhinolaryngol 2018; 107:93-96. [PMID: 29501319 DOI: 10.1016/j.ijporl.2018.01.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 12/01/2022]
Abstract
UNLABELLED The acoustic reflection method (ARM) is a non-invasive technique which uses the reflection of acoustic waves to measure the cross sectional area of nasal cavities in adults and patency of endotracheal tubes. Characteristics and volume of normal nasal cavities in pre-school children has so far not been studied. OBJECTIVE The aim of this study was to determine the optimal ARM recording and the minimal cross-sectional area (MCA) and volume (NV) values in healthy children. DESIGN Prospective monocentric study using the ARM in pre-school children (<6 years of age). RESULTS - DISCUSSION Seventy children (age 2 to 5) were included in the study. Reliable measures were difficult to obtain in children younger than 2 years of age. The use of a standard nosepiece and a single-use surgical filter enabled reliable, serial recordings. Mean MCA values were 0.46, 0.53 and 0.58 cm2 in the 24-35, 36-47 and 48-60 months-old age groups, respectively. Mean NV values were 2.14, 2.59, and 2.86 cm3 in the same age groups. The MCA and NV values were significantly correlated with height, age and weight. In conclusion, the ARM is feasible in children over the age of 2 and seems to be a promising non-invasive tool to study the nasal cavity patency, anatomy, and volume.
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Affiliation(s)
- Sébastien Wartelle
- Pediatric Otolaryngology, Head and Neck Surgery Department, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015 Paris, France; INSERM U955 Team 13, IMRB, 8 rue Du Général Sarrail, 94010 Créteil, France; Paris V René Descartes University, Paris, France; CNRS, ERL 7240, 94010 Créteil, France
| | - François Simon
- Pediatric Otolaryngology, Head and Neck Surgery Department, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015 Paris, France; Paris V René Descartes University, Paris, France
| | - Bruno Louis
- INSERM U955 Team 13, IMRB, 8 rue Du Général Sarrail, 94010 Créteil, France; Paris-Est University, Créteil, France; CNRS, ERL 7240, 94010 Créteil, France
| | - Vincent Couloigner
- Pediatric Otolaryngology, Head and Neck Surgery Department, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015 Paris, France; Paris V René Descartes University, Paris, France
| | - Françoise Denoyelle
- Pediatric Otolaryngology, Head and Neck Surgery Department, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015 Paris, France; Paris V René Descartes University, Paris, France
| | - Noël Garabedian
- Pediatric Otolaryngology, Head and Neck Surgery Department, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015 Paris, France; Paris V René Descartes University, Paris, France
| | - Nicolas Leboulanger
- Pediatric Otolaryngology, Head and Neck Surgery Department, Necker Enfants Malades Hospital, 149 rue de Sèvres, 75015 Paris, France; INSERM U955 Team 13, IMRB, 8 rue Du Général Sarrail, 94010 Créteil, France; Paris V René Descartes University, Paris, France; CNRS, ERL 7240, 94010 Créteil, France.
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20
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Valero A, Navarro AM, Del Cuvillo A, Alobid I, Benito JR, Colás C, de Los Santos G, Fernández Liesa R, García-Lliberós A, González-Pérez R, Izquierdo-Domínguez A, Jurado-Ramos A, Lluch-Bernal MM, Montserrat Gili JR, Mullol J, Puiggròs Casas A, Sánchez-Hernández MC, Vega F, Villacampa JM, Armengot-Carceller M, Dordal MT. Position paper on nasal obstruction: evaluation and treatment. J Investig Allergol Clin Immunol 2018; 28:67-90. [PMID: 29345622 DOI: 10.18176/jiaci.0232] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care and may affect up to 30%-40% of the population. It affects quality of life (especially sleep) and lowers work efficiency. The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment. NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized according to the underlying disease is also advisable. NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary.
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Affiliation(s)
- A Valero
- Servicio de Neumología y Alergia, Hospital Clínic; Immunoal·lèrgia Respiratòria Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); CIBERES Barcelona, Spain
| | - A M Navarro
- UGC Alergología, Hospital El Tomillar AGS Sur Sevilla, Spain
| | - A Del Cuvillo
- Unidad de Rinología y Asma, UGC Otorrinolaringología, Hospital de Jerez, Cádiz, Spain
| | - I Alobid
- Unitat de Rinologia i Clínica de l'Olfacte, Hospital Clínic, Barcelona, Spain
| | - J R Benito
- Unidad de Rinología, UGC ORL, Hospital Universitario Puerto Real, Cádiz, Spain
| | - C Colás
- Hospital Clínico-Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - G de Los Santos
- Unidad de Rinología y Base del cráneo anterior, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - A García-Lliberós
- Servicio de Otorrinolaringología, Sección de Rinología, Hospital de Manises, Valencia, Spain
| | - R González-Pérez
- Unidad de Alergia, Hospital del Tórax, Complejo Hospital Universitario Nuestra S. de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | | | - J R Montserrat Gili
- Sección de Rinología del Servicio de ORL, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - J Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d' ORL, Hospital Clínic i Universitari; Immunoal•lèrgia Respiratòria Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); CIBERES, GA2LEN, EUFOREA, Barcelona, Spain
| | | | | | - F Vega
- Servicio de Alergia, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria - Hospital Universitario de La Princesa (IP), Madrid, Spain
| | - J M Villacampa
- Servicio de Otorrinolaringología y Patología Cérvico-facial, Hospital Universitario Fundación Jiménez Díaz IDC, Madrid, Spain
| | - M Armengot-Carceller
- Servicio de Otorrinolaringología, Hospital Universitari i Politècnic la Fe, Universitat de València, Valencia, Spain
| | - M T Dordal
- Unitat d'Al·lèrgia, Badalona Serveis Assistencials, Badalona, Spain.,Servei d'Al·lèrgia, Sant Pere Claver Fundació Sanitària, Barcelona, Spain
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Lai D, Qin G, Pu J, Liu L, Yang Y. Pre- and post-operative application of acoustic rhinometry in children with otitis media with effusion and with or without adenoid hypertrophy-a retrospective analysis. Int J Pediatr Otorhinolaryngol 2017; 103:51-54. [PMID: 29224765 DOI: 10.1016/j.ijporl.2017.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/01/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is no standardized scheme for preoperative evaluation of adenoid hypertrophy or a consensus on surgical indications for adenoidectomy in children with otitis media with effusion (OME), especially for young children intolerant to nasal endoscopic assessment. The aim of this study was to evaluate the efficacy and reliability of acoustic rhinometry (AR) in evaluating benefits from adenoidectomy in children with OME. METHOD Children with OME who were scheduled for surgical intervention were reviewed and AR tests performed preoperatively and postoperatively. The patients were divided into two groups based on the surgical strategy (Group I: tympanostomy tube placement alone; Group II: tympanostomy tube placement plus adenoidectomy). Correlation and regression analyses were performed to assess the relationship between findings of AR and nasal endoscopy. AR parameters including minimal nasal cross-sectional area (MCA), and nasopharyngeal volume (NPV), as well as scores of subjective symptoms were obtained to evaluate the utility of AR pre- and post-surgery. RESULTS Sixty-five children aged 4-10 years who met the inclusion criteria were included. No significant differences in gender or age distribution were observed between Group I and Group II. MCA, as well as NPV significantly decreased in Group II when compared with Group I (p = 0.000). A significant inverse correlation was observed between NPV and choanal obstruction ratio in both groups I (r = -0.625, p < 0.001) and II (r = -0.570, p < 0.001). A significant difference between preoperative and postoperative NPV and subjective symptom scores was observed in group II after adenoidectomy (p = 0.000). CONCLUSION AR parameters showed a good clinical correlation with findings of nasal endoscopy and thus may be useful for evaluating candidacy for surgical adenoidectomy among children with OME, especially in whom preoperative nasal endoscopic examination is not feasible. Additionally, AR can reveal the changes occurring within the nasopharyngeal passage before and after adenoidectomy.
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Affiliation(s)
- Dan Lai
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China.
| | - Gang Qin
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Junmei Pu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Lu Liu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Yiying Yang
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
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Unsal O, Ozkahraman M, Ozkarafakili MA, Akpinar M, Korkut AY, Kurt Dizdar S, Uslu Coskun B. Does the reduction of inferior turbinate affect lower airway functions? Braz J Otorhinolaryngol 2017; 85:43-49. [PMID: 29174644 PMCID: PMC9442891 DOI: 10.1016/j.bjorl.2017.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/21/2017] [Accepted: 10/16/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction Although the nose and lungs are separate organs, numerous studies have reported that the entire respiratory system can be considered as a single anatomical and functional unit. The upper and lower airways affect each other either directly or through reflex mechanisms. Objective In this study, we aimed to evaluate the effects of the radiofrequency ablation of persistent inferior turbinate hypertrophy on nasal and pulmonary function. Methods Twenty-seven patients with bilateral persistent inferior turbinate hypertrophy without septal deviation were included in this study. All of the patients were evaluated using anterior rhinoscopy, nasal endoscopy, acoustic rhinometry, a visual analogue scale, and flow-sensitive spirometry on the day before and 4 months after the radiofrequency ablation procedure. Results The post-ablation measurements revealed that the inferior turbinate ablation caused an increase in the mean cross-sectional area and volume of the nose, as well as in the forced expiratory volume in 1 s, forced vital capacity, and peak expiratory flow of the patients. These differences between the pre- and post-ablation results were statistically significant. The post-ablation visual analogue scale scores were lower when compared with the pre-ablation scores, and this difference was also statistically significant. Conclusion This study demonstrated that the widening of the nasal passage after the reduction of the inferior turbinate size had a favorable effect on the pulmonary function tests.
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Affiliation(s)
- Ozlem Unsal
- Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Otorhinolaryngology, Istanbul, Turkey.
| | - Mehtap Ozkahraman
- Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Otorhinolaryngology, Istanbul, Turkey
| | - Mufide Arzu Ozkarafakili
- Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Pulmonary Diseases, Istanbul, Turkey
| | - Meltem Akpinar
- Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Otorhinolaryngology, Istanbul, Turkey
| | - Arzu Yasemin Korkut
- Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Otorhinolaryngology, Istanbul, Turkey
| | - Senem Kurt Dizdar
- Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Otorhinolaryngology, Istanbul, Turkey
| | - Berna Uslu Coskun
- Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Otorhinolaryngology, Istanbul, Turkey
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Dogan R, Senturk E, Ozturan O, Yildirim YS, Tugrul S, Hafiz AM. Conchal contractility after inferior turbinate hypertrophy treatment:A prospective, randomized clinical trial. Am J Otolaryngol 2017; 38:678-682. [PMID: 28844494 DOI: 10.1016/j.amjoto.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 07/11/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the effects of these two methods (Nasal corticosteroids (NCS) and radiofrequency (RF) application) on conchal contractility utilizing objective rhinologic measurement parameters. METHODS 82 patients were presented with the complaint of nasal obstruction and diagnosed with inferior turbinate hypertrophy and were included in the study. Patients in Group 1 received NCS for 12weeks. Patients in Group 2 were administered RF to their inferior turbinates. Acoustic rhinometry and rhinomanometry tests with and without decongestant were performed. RESULTS In the evaluation of the contractility difference of rhinometry parameters, there was not a significant difference among pre and postoperative acoustic rhinometric parameters in Group 1. Whereas in Group 2, postoperative contractility difference was significantly decreased compared to preoperative values. In the evaluation of the contractility difference of rhinomanometric parameters, no significant difference was found between pre and postoperative values in Group 1. However, postoperative contractility difference was significantly decreased compared to preoperative values in Group 2 in terms. CONCLUSION Because the RF procedure produces fibrosis in the vascular tissues, inferior turbinates do not have a shrinking response to decongestant administration. Administration of NCS administration maintains the contractility function compared to RF application.
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İriz A, Düzlü M, Köktürk O, Kemaloğlu YK, Eravcı FC, Zorlu ME, Karamert R. Does nasal congestion have a role in decreased resistance to regular CPAP usage? Eur Arch Otorhinolaryngol 2017; 274:4031-4034. [PMID: 28921034 DOI: 10.1007/s00405-017-4744-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
Nasal obstruction is known to cause resistance to continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea syndrome (OSAS). In this paper, short- and long-term nasal congestion in OSAS patients receiving CPAP treatment were evaluated with acoustic rhinometry (AR). A total of 36 patients with moderate-to-severe OSAS, diagnosed with polysomnography were included in the study. Ten healthy subjects without OSAS constituted the control group. Pre-treatment nasal patency were measured with AR in all participants. 26 patients used the recommended CPAP treatment. Ten patients did not accept CPAP treatment. The AR test was repeated for all the subjects after 1 and 3 months except the 3rd month's measurements of the control group. There was no statistically significant difference between the initial minimum cross-sectional area (MCA) measurements of OSAS patients, using or not using CPAP, and the control group (P > 0.05). However, the first month MCA measurements of patients receiving CPAP were found to be significantly decreased compared with the initial values (P < 0.001). There was no significant change in the first and third months MCA values in the control group and patients who did not use CPAP (P > 0.05). No significant difference revealed in the 3rd month MCA measurements of the patients using CPAP compared with the initial values (P > 0.05). In this study, the increased nasal congestion, which is thought to be the cause of CPAP resistance, was objectively demonstrated in OSAS patients using CPAP. In addition, the nasal congestion developing at the first month was shown to disappear over time, supporting the opinion that patient compliance in CPAP treatment is expected to increase after regular device usage.
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Affiliation(s)
- Ayşe İriz
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Gazi University, Beşevler, 06500, Ankara, Turkey
| | - Mehmet Düzlü
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Gazi University, Beşevler, 06500, Ankara, Turkey.
| | - Oğuz Köktürk
- Department of Pulmonary Disease, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Yusuf Kemal Kemaloğlu
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Gazi University, Beşevler, 06500, Ankara, Turkey
| | - Fakih Cihat Eravcı
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Gazi University, Beşevler, 06500, Ankara, Turkey
| | - Mehmet Ekrem Zorlu
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Gazi University, Beşevler, 06500, Ankara, Turkey
| | - Recep Karamert
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Gazi University, Beşevler, 06500, Ankara, Turkey
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Sofia OB, Castro Neto NP, Katsutani FS, Mitre EI, Dolci JE. Evaluation of pre- and post-pyriform plasty nasal airflow. Braz J Otorhinolaryngol 2017; 84:351-359. [PMID: 28549875 PMCID: PMC9449221 DOI: 10.1016/j.bjorl.2017.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/10/2017] [Accepted: 03/28/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Nasal obstruction is a frequent complaint in otorhinolaryngology outpatient clinics, and nasal valve incompetence is the cause in most cases. Scientific publications describing surgical techniques on the upper and lower lateral cartilages to improve the nasal valve are also quite frequent. Relatively few authors currently describe surgical procedures in the piriform aperture for nasal valve augmentation. We describe the surgical technique called pyriform plasty and evaluate its effectiveness subjectively through the NOSE questionnaire and objectively through the rhinomanometry evaluation. Objective To compare pre- and post-pyriform plasty nasal airflow variations using rhinomanometry and the NOSE questionnaire. Methods Eight patients submitted to pyriform surgery were studied. These patients were screened in the otorhinolaryngology outpatient clinic among those who complained of nasal obstruction, and who had a positive response to Cottle maneuver. They answered the NOSE questionnaire and were submitted to preoperative rhinomanometry. After 90 days, they were reassessed through the NOSE questionnaire and the postoperative rhinomanometry. The results of these two parameters were compared pre- and postoperatively. Results Regarding the subjective measure, the NOSE questionnaire, seven patients reported improvement, of which two reported marked improvement, and one patient reported an unchanged obstructive condition. Regarding the rhinomanometry assessment, of 96 comparative measurements between the preoperative and postoperative periods, we obtained 68 measurements with an increase in nasal airflow in the postoperative period, 26 negative results, and two cases that remained unaltered between the preoperative and postoperative periods. Conclusion When analyzing the results obtained in this study, we can conclude that the piriform plasty surgical procedure resulted in nasal airflow improvement in most of the obtained measurements.
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Affiliation(s)
| | - Ney P Castro Neto
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | | | - Edson I Mitre
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - José E Dolci
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
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Peroz R, Holmström M, Mani M. Can objective measurements of the nasal form and function represent the clinical picture in unilateral cleft lip and palate? J Plast Reconstr Aesthet Surg 2017; 70:653-658. [PMID: 28325563 DOI: 10.1016/j.bjps.2017.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The present study aimed to evaluate the potential correlations between objective measurements of nasal function and self-assessed nasal symptoms or clinical findings at nasal examination among adults treated for unilateral cleft lip and palate (UCLP), respectively. METHODS All UCLP patients born between 1960 and 1987 (n = 109) treated at a tertiary referring center were invited. Participation rate was 76% (n = 83) at a mean of 37 years after the initial surgery. All participants completed the same study protocol including acoustic rhinometry (AR), rhinomanometry (RM), anterior rhinoscopy, and questionnaires regarding self-experienced nasal symptoms. RESULTS A reduced volume of the anterior nasal cavity on the operated side (measured by AR) correlated to an expressed wish by the patient to change the function of the nose. A similar correlation was seen for the minimal cross-sectional area of anterior nasal cavity on the operated side. Furthermore, correlations were found between smaller volume and area of nasal cavity and a greater frequency of nasal obstruction. No further correlations were found. CONCLUSION Objective measurements partly correlate to the clinical picture among adults treated for UCLP. However, these need to be combined with findings at clinical examination and patient self-assessment to represent the complete clinical picture.
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Affiliation(s)
- Roshan Peroz
- Department of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Mats Holmström
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Mani
- Department of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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Wandalsen GF, Mendes AI, Matsumoto F, Solé D. Acoustic Rhinometry in Nasal Provocation Tests in Children and Adolescents. J Investig Allergol Clin Immunol 2016; 26:156-60. [PMID: 27326982 DOI: 10.18176/jiaci.0036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To standardize acoustic rhinometry (AR) in nasal provocation tests (NPTs) with histamine in children and adolescents. PATIENTS AND METHODS We performed a cross-sectional validation to compare AR with anterior active rhinomanometry (AAR) during histamine NPT in 20 children and adolescents with persistent allergic rhinitis and 20 controls. Changes in total nasal resistance (AAR) were compared with changes in nasal volume in the first 5 cm (V5). RESULTS Compared with controls, patients with rhinitis had significantly higher mean total nasal resistance (0.34 Pa/cm3/s vs 0.21 Pa/cm3/s; P=.01) and lower mean V5 values (8.20 cm3 vs 9.24 cm3; P=.04) at baseline. The mean histamine concentration necessary to increase total nasal resistance by at least 100% was significantly lower in the rhinitis group than in the control group (0.72 mg/mL vs 2.4 mg/mL; P<.001). At the end of the NPT a mean increase of 126% in total nasal resistance and a mean decrease of 24.3% in V5 were observed in the rhinitis group. When compared with the AAR criteria, the highest sensitivity and specificity values were observed for a cutoff represented by a 19%-21% drop in V5. CONCLUSIONS We found AR to be a feasible and sensitive tool for monitoring nasal response in children and adolescents undergoing histamine NPT. The best AR cutoff for ending the NPT was a 19%-21% drop in V5.
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Affiliation(s)
- G F Wandalsen
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - A I Mendes
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - F Matsumoto
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - D Solé
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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28
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Garcia GJM, Hariri BM, Patel RG, Rhee JS. The relationship between nasal resistance to airflow and the airspace minimal cross-sectional area. J Biomech 2016; 49:1670-1678. [PMID: 27083059 PMCID: PMC4885785 DOI: 10.1016/j.jbiomech.2016.03.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 02/29/2016] [Accepted: 03/28/2016] [Indexed: 10/22/2022]
Abstract
The relationship between nasal resistance (R) and airspace minimal cross-sectional area (mCSA) remains unclear. After the introduction of acoustic rhinometry, many otolaryngologists believed that mCSA measurements would correlate with subjective perception of nasal airway obstruction (NAO), and thus could provide an objective measure of nasal patency to guide therapy. However, multiple studies reported a low correlation between mCSA and subjective nasal patency, and between mCSA and R. This apparent lack of correlation between nasal form and function has been a long-standing enigma in the field of rhinology. Here we propose that nasal resistance is described by the Bernoulli Obstruction Theory. This theory predicts two flow regimes. For mCSA>Acrit, the constriction is not too severe and there is not a tight coupling between R and mCSA. In contrast, when mCSA Acrit (estimated to be 0.37cm(2)), this theory suggests that airway constrictions are rarely an exclusive contributor to nasal resistance, which may explain the weak correlation between mCSA and subjective nasal patency.
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Affiliation(s)
- Guilherme J M Garcia
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, United States; Biotechnology and Bioengineering Center, Medical College of Wisconsin, United States.
| | - Benjamin M Hariri
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, United States; Biotechnology and Bioengineering Center, Medical College of Wisconsin, United States
| | - Ruchin G Patel
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, United States; Biotechnology and Bioengineering Center, Medical College of Wisconsin, United States
| | - John S Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, United States
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29
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Jalessi M, Farhadi M, Asghari A, Hosseini M, Amini E, Pousti SB. Impact of endoscopic endonasal pituitary surgery on nasal airway patency. Med J Islam Repub Iran 2016; 30:379. [PMID: 27493923 PMCID: PMC4972059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/03/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Nose is used as a corridor in endoscopic endonasal transsphenoidal approach (EETSA) for pituitary adenoma. Thus, it may affect the nasal airway patency, function and sinonasal-related quality of life. The aim of this study is to objectively and subjectively evaluate these effects. METHODS In this prospective study, 43 patients with pituitary adenoma who were candidates for EETSA from March 2012 to October 2013 were enrolled. The patients were evaluated preoperatively using acoustic rhinometry and rhinomanometry (with/without the use of decongestant drops) and asked to complete the 22-Item Sinonasal Outcome Test (SNOT-22) questionnaire. The tests were repeated at one and three months postoperatively. The preoperative data were compared with the first and second postoperative ones using paired-sample t-test. RESULTS Without the use of decongestant drops, the total airway resistance increased significantly (p=0.016), and the nasal airflow decreased significantly (p=0.031) in the first postoperative evaluation. However, in the 3rd postoperative month, the difference was not significant. With the use of decongestant drops, the objective parameters showed no significant changes compared to preoperative data even at the first evaluation. The SNOT- 22 scores also did not differ significantly in 1st and 3rd postoperative months. The first postoperative SNOT-22 showed a strong correlation with the second minimal cross-sectional area on simultaneous evaluation, and with the preoperative total airway resistance. CONCLUSION EETSA has a transient adverse effect on the nasal patency that quickly improves, making it a safe approach for the sinonasal system. Rhinomanometry is the most sensitive test for detecting these nasal functional changes objectively.
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Affiliation(s)
- Maryam Jalessi
- MD, Associate Professor of Otolaryngology- Head and Neck Surgery, Skull Base Research Center, ENT and Head & Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Farhadi
- MD, Professor of Otolaryngology- Head and Neck Surgery, ENT and Head & Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Alimohamad Asghari
- MD, Associate Professor of Otolaryngology- Head and Neck Surgery, ENT and Head & Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Maryam Hosseini
- MD, Research Assistant, ENT and Head & Neck Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Elahe Amini
- MD, Research Assistant, Skull Base Research Center, ENT and Head & Neck Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Seyyed Behzad Pousti
- MD, Associate Professor of Otolaryngology- Head and Neck Surgery, ENT and Head & Neck Research Center and Department, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Leaker BR, Scadding G, Jones CR, Barnes PJ. Using magnetic resonance imaging to quantify the inflammatory response following allergen challenge in allergic rhinitis. Immun Inflamm Dis 2015; 3:445-54. [PMID: 26733348 PMCID: PMC4693719 DOI: 10.1002/iid3.86] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/18/2015] [Accepted: 09/02/2015] [Indexed: 11/10/2022]
Abstract
Current rhinometric and flow assessments measure nasal patency and are often poorly correlated with rhinitis symptoms. To evaluate magnetic resonance imaging (MRI) as a new method to measure inflammatory changes in nasal and sinus mucosa following nasal allergen challenge. A pilot study (n = 6) determined the optimal technical settings for MRI to measure inflammatory change which were then adopted for the main study. This study was a single blind, placebo‐controlled, three‐way crossover trial in 14 subjects with seasonal allergic rhinitis. Effects of cetirizine, cetirizine and pseudoephedrine (Cet+PE), or placebo on total nasal symptom scores (TNSS), peak nasal inspiratory flow (PNIF), nasal nitric oxide (nNO), acoustic rhinometry, and MRI end points following nasal intranasal allergen challenge were measured. There were significant changes in all parameters after allergen challenge (P < 0.01), except for nNO. MRI end points were less variable and more consistent than PNIF and acoustic rhinometry in detecting changes after allergen challenge. Total nasal airspace volume was the most sensitive and reproducible MRI measurement, with a mean reduction from −5.37 cm3 (95%CI −7.35, −3.38; P < 0.001), which was maximal 60 min after allergen challenge. A change of one in TNSS corresponded to a change in MRI volume of −0.57 cm3. There was an improvement in all parameters (except nNO) in subjects taking Cet+PE compared with placebo, however this did not achieve significance probably because of the small study size (overall analysis P > 0.07; comparison of active versus placebo P > 0.09). MRI provides novel insights into the anatomical inflammatory changes post allergen challenge and provides a new method for assessment of nasal patency and objective measurement of inflammatory responses.
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Affiliation(s)
| | - Glenis Scadding
- Royal National Throat Nose and Ear Hospital London WC1X 8DA UK
| | | | - Peter J Barnes
- National Heart and Lung Institute Imperial College London SW3 6LY UK
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Passali D, Loglisci M, Politi L, Passali GC, Kern E. Managing turbinate hypertrophy: coblation vs. radiofrequency treatment. Eur Arch Otorhinolaryngol 2015; 273:1449-53. [PMID: 26321749 DOI: 10.1007/s00405-015-3759-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/21/2015] [Indexed: 11/27/2022]
Abstract
The role of inferior turbinate hypertrophy in the reduction of nasal airflow is well established. Although chronic nasal obstruction is not life- threatening, it significantly impairs patients' quality of life, affecting many aspects of daily activities; therefore, patients seek medical intervention. 40 patients were selected (27 males and 13 females) between 27 and 64 years of age with a symptom of nasal obstruction. The patients were divided in two groups: Group 1: coblation, 25 patients (18 males and 7 females); Group 2: radiofrequency, 15 patients (7 males and 6 females). These 40 patients were followed for 3 years. Patients were analyzed using both subjective and objective methods. The visual analog scale (VAS) subjective data and objective data including both active anterior rhinomanometry and acoustic rhinometry were recorded and analyzed. Data were collected pre-operatively and at 1 and 3 years post-operatively. According to our data, both coblation and radiofrequency turbinate reduction benefit patients with good results. The complications, found during the follow-up, are limited to minimal bleeding and crusting. Coblation and radiofrequency were significantly less painful than others procedures during the early post-operative period. In our study, both coblation and radiofrequency provide an improvement in nasal airflow with a reduction in nasal obstructive symptoms in the short term, but their efficacy tended to decrease within 3 years.
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Affiliation(s)
- D Passali
- ENT Department, University of Siena, Siena, Italy.
| | - M Loglisci
- ENT Department, University of Siena, Siena, Italy
| | - L Politi
- ENT Department, University of Siena, Siena, Italy
| | - G C Passali
- ENT Department, Catholic University of Sacred Heart, Rome, Italy
| | - E Kern
- Mayo Clinic, Rochester, USA
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Melo ACCD, Gomes ADODC, Cavalcanti AS, Silva HJD. Acoustic rhinometry in mouth breathing patients: a systematic review. Braz J Otorhinolaryngol 2014; 81:212-8. [PMID: 25618769 PMCID: PMC9449077 DOI: 10.1016/j.bjorl.2014.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 08/01/2014] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION When there is a change in the physiological pattern of nasal breathing, mouth breathing may already be present. The diagnosis of mouth breathing is related to nasal patency. One way to access nasal patency is by acoustic rhinometry. OBJECTIVE To systematically review the effectiveness of acoustic rhinometry for the diagnosis of patients with mouth breathing. METHODS Electronic databases LILACS, MEDLINE via PubMed and Bireme, SciELO, Web of Science, Scopus, PsycInfo, CINAHL, and Science Direct, from August to December 2013, were consulted. 11,439 articles were found: 30 from LILACS, 54 from MEDLINE via Bireme, 5558 from MEDLINE via PubMed, 11 from SciELO, 2056 from Web of Science, 1734 from Scopus, 13 from PsycInfo, 1108 from CINAHL, and 875 from Science Direct. Of these, two articles were selected. RESULTS The heterogeneity in the use of equipment and materials for the assessment of respiratory mode in these studies reveals that there is not yet consensus in the assessment and diagnosis of patients with mouth breathing. CONCLUSION According to the articles, acoustic rhinometry has been used for almost twenty years, but controlled studies attesting to the efficacy of measuring the geometry of nasal cavities for complementary diagnosis of respiratory mode are warranted.
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Affiliation(s)
| | - Adriana de Oliveira de Camargo Gomes
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo (HRAC-USP), São Paulo, SP, Brazil; Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
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Irander K, Borres MP, Ghafouri B. The effects of physical exercise and smoking habits on the expression of SPLUNC1 in nasal lavage fluids from allergic rhinitis subjects. Int J Pediatr Otorhinolaryngol 2014; 78:618-22. [PMID: 24512783 DOI: 10.1016/j.ijporl.2014.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/11/2014] [Accepted: 01/14/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Palate lung nasal epithelial clone (PLUNC) is a family of proteins, which are proposed to participate in the innate immune defense against infections in the upper aero-digestive tract. The aim of this study was to investigate the expression of SPLUNC1 in allergic rhinitis subjects with considerations taken to the mucosal function and smoking habits. METHODS The participants, recruited from a cohort followed from infancy, were re-examined at the age of 18 years regarding allergy development. Based on medical histories and skin prick tests the participants were classified into groups with persistent allergic rhinitis (n=18), intermittent allergic rhinitis (n = 8) and healthy controls (n = 13). Seven subjects (3, 2 and 2 in each group, respectively) reported smoking habits. The SPLUNC1 levels in nasal lavage fluids were analyzed by Western blot. Changes in the volume of the proper nasal cavity before and after physical exercise (Vol2(increase)) were analyzed by acoustic rhinometry. RESULTS Compared to the control group the SPLUNC1 level was significantly lower in the persistent allergy group (3.8 ± 3.4 OD vs. 1.3 ± 1.5 OD; p = 0.02), but not in the intermittent allergy group without current exposure to allergens (3.6 ± 4.7 OD). No differences were found in Vol2(increase) between any of the allergy groups and controls. In smokers Vol2(increase) was significantly reduced (p < 0.01) and the SPLUNC1 levels were lower compared to non-smokers. A significant correlation was found between SPLUNC1 and Vol2(increase) (p < 0.01; r = 0.53) in non-smokers. CONCLUSIONS Current allergen exposure has an impact on SPLUNC1 expression in nasal lavage fluid, why allergy ought to be considered in study populations where analyses of SPLUNC1 levels are included in the reports. The normal nasal decongestion after exercise was not affected by allergy in contrast to smoking habits. The correlation between SPLUNC1 levels and Vol2(increase) in non-smokers may indicate involvement of SPLUNC1in the regulation of the normal function of the nasal mucosa. Complementary studies are needed to confirm the smoke-related reduction of SPLUNC1 expression and to analyze the possible participation of SPLUNC1 in the nasal mucosa regulation.
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Affiliation(s)
- K Irander
- Allergy Center, ENT Section, University Hospital, Linköping, Sweden
| | - M P Borres
- Department of Women's and Children's Health, Uppsala University, Sweden; Thermo Fisher Scientific, Uppsala, Sweden
| | - B Ghafouri
- Department of Medical and Health Sciences, Division of Community Medicine Rehabilitation Medicine, Faculty of Health Sciences, Linköping University, and Pain and Rehabilitation Centre, County Council of Östergötland, Linköping, Sweden; Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, and Centre of Occupational and Environmental Medicine, County Council of Östergötland, Linköping, Sweden.
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Albu S, Trombitas V, Nagy A. Endoscopic microdebrider-assisted inferior turbinoplasty with and without posterior nasal neurectomy. Auris Nasus Larynx 2014; 41:273-7. [PMID: 24355583 DOI: 10.1016/j.anl.2013.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/01/2013] [Accepted: 11/22/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Endoscopic microdebrider-assisted inferior turbinoplasty (EMAIT) has been recognized as an efficient surgical technique in the management of hypertrophied inferior turbinate. In an attempt to further increase surgical successful outcomes, posterior nasal neurectomy (PNN) was developed. The aim of this retrospective case-control study was to assess the position of PNN in the surgery of hypertrophied turbinate. METHODS Seventy patients were assigned to the two treatment groups: Group A (EMAIT) and Group B (EMAIT and PNN). Subjective outcomes were represented by symptom score and quality of life scores (Rhinoconjunctivitis Quality of Life Questionnaire - RQLQ). Objective outcomes were nasal resistance, saccharin transit time and acoustic rhinometry parameters. RESULTS The survey demonstrated that symptoms and objective parameters improved postoperatively in both groups, with no statistical significant differences in objective and subjective outcomes between the surgical groups. CONCLUSION The addition of PNN appears to offer no additional benefit in the subjective and objective outcome related with surgery of hypertrophied inferior turbinate. However, longer follow-up studies and larger number of patients are required in order to validate our results.
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Kukwa A, Dymek A, Galazka A, Krzeski A, Kukwa W. A new approach to studying the nasal and oral breathing routes. Otolaryngol Pol 2013; 68:112-8. [PMID: 24837905 DOI: 10.1016/j.otpol.2013.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 10/28/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Nasal obstruction is often reported by patients. It is a consequence of a subjective feeling of impaired airflow through the nasal cavity. Currently, objective measures of nasal patency rates are very limited. Functional tests only analyze nasal breathing; they do not simultaneously assess airflow through the mouth. OBJECTIVE The aim of this study is to present a new functional test that assesses a single-stage nasal and oral breathing route. METHODS The NOFA (Nasal-Oral Flow Analyzer) is a three-channel flow meter used to perform continuous and simultaneous measurements of nasal and oral respiratory parameters. We present the application of the device and the proposed study protocol. RESULTS The respiratory tracks of four selected patients are presented. Different breathing patterns are visible: exclusive nasal, exclusive oral, and mixed nasal-oral ventilation pattern. CONCLUSIONS The preliminary results suggest the potential use of the NOFA in ENT practice. Further studies are necessary to evaluate the usefulness of this device in the diagnosis of patients with upper respiratory tract disorders.
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Affiliation(s)
- Andrzej Kukwa
- Department of Otorhinolaryngology, Czerniakowski Hospital, Medical University of Warsaw, Head: prof. dr hab. n. med. Antoni Krzeski, Warsaw, Poland; Department of Otolaryngology and Head and Neck Disease, University of Varmia and Masuria School of Medicine, Head: dr hab. n. med. Anna Doboszyńska, prof. UWM, Olsztyn, Poland
| | | | - Adam Galazka
- Department of Otorhinolaryngology, Czerniakowski Hospital, Medical University of Warsaw, Head: prof. dr hab. n. med. Antoni Krzeski, Warsaw, Poland
| | - Antoni Krzeski
- Department of Otorhinolaryngology, Czerniakowski Hospital, Medical University of Warsaw, Head: prof. dr hab. n. med. Antoni Krzeski, Warsaw, Poland
| | - Wojciech Kukwa
- Department of Otorhinolaryngology, Czerniakowski Hospital, Medical University of Warsaw, Head: prof. dr hab. n. med. Antoni Krzeski, Warsaw, Poland.
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Yepes-Nuñez J, Bartra J, Muñoz-Cano R, Sánchez-López J, Serrano C, Mullol J, Alobid I, Sastre J, Picado C, Valero A. Assessment of nasal obstruction: correlation between subjective and objective techniques. Allergol Immunopathol (Madr) 2013; 41:397-401. [PMID: 23140913 DOI: 10.1016/j.aller.2012.05.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 05/12/2012] [Accepted: 05/17/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nasal sensation of airflow describes the perception of the passage of air through the nose. Nasal obstruction can be assessed using subjective techniques (symptom scores and visual analogue scales [VAS]) and objective techniques (anterior rhinomanometry [RMN], acoustic rhinometry [AR], and peak nasal inspiratory flow [PNIF]). Few studies have evaluated the correlation between these techniques. OBJECTIVE The primary objective of our study was to determine the degree of correlation between subjective and objective techniques to assess nasal obstruction. MATERIALS AND METHODS Nasal obstruction was assessed using a symptom score, VAS, RMN, AR (minimal cross-sectional area [MCSA] and volume), and PNIF in 184 volunteer physicians. Spearman's rho was recorded. Correlations were considered weak if r ≤ 0.4, moderate if 0.4 < r < 0.8, and strong if r > 0.8. RESULTS Mean (SD) age was 37.1 (6.9) years (range, 25-56 years); 61% were women. We found a strong correlation (r > 0.8; p = 0.001) between the different parameters of RMN and a moderate correlation between symptom score and VAS (r = 0.686; p = 0.001) and between MCSA and RMN (resistance) (r = 0.496; p = 0.001) and PNIF (r = 0.459; p = 0.001). The correlations were weak or non-significant for the remaining comparisons. CONCLUSION Nasal obstruction can be assessed using subjective and objective approaches. The correlations between objective techniques were moderate to strong. In addition, between subjective techniques we reported a moderate correlation. Finally, the correlations between the subjective and objective techniques were weak and absent. These findings suggest that each of the techniques assesses different aspects of nasal obstruction, thus making them complementary.
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Raza MT, Wang DY. Is nasal cavity geometry associated with body mass index, height and weight? Indian J Otolaryngol Head Neck Surg 2013; 64:266-9. [PMID: 23998033 DOI: 10.1007/s12070-011-0309-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 08/26/2011] [Indexed: 10/17/2022] Open
Abstract
It has been reported that nasal airflow rate and pressure increased with increasing body mass index (BMI). The purpose of this study is to determine if with an increased BMI, the nasal cavity geometry as measured by acoustic rhinometry (AR) increased in healthy adult Singaporeans. This is a population based study. Seventy-three healthy volunteers, 44 males and 29 females aged 18-64 years (mean 34.9 years) were selected. Their BMI was calculated from height and weight measurements. AR was used to measure the minimum cross-sectional area 1-5 cm from the nostril, cross-sectional area at 3.3 and 4 cm and volume 1-5 cm from the nostril of the nasal cavity. There was no statistically significant correlation between BMI, height and weight with all AR measurements. Our study demonstrates that nasal cavity geometry is not affected by increasing BMI, as well as height and weight individually, of healthy adult Singaporeans. Our study indicates that subject with obesity is potentially facing a long-term physiological risk for insufficient air-exchange, or burden of increasing the respiratory rate and/or volume of each breath.
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Affiliation(s)
- Md Tanveer Raza
- Department of Otolaryngology, The National University of Singapore, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
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Han JS, Park SH, Shin YD, Kwon E, Shim WS, Bae JH. The effect of xylometazoline spray for expansion of nasal cavity. Korean J Anesthesiol 2013; 65:132-5. [PMID: 24023995 PMCID: PMC3766778 DOI: 10.4097/kjae.2013.65.2.132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/24/2013] [Accepted: 02/01/2013] [Indexed: 11/10/2022] Open
Abstract
Background During nasotracheal intubation it is important to have proper pretreatment for nasal mucosa constriction and nasal cavity expanding. Nasal packing of epinephrine gauze is widely used as well as xylometazoline. The aim of this study was to compare and evaluate the efficacy of prophylactic intranasal spray of xylometazoline against epinephrine gauze packing in expanding the nasal cavity. Methods Volunteers (n = 32) in their twenties without nasal disease such as septal deviation or rhinitis were enrolled in the study. The more patent nostril in each subject was measured by acoustic rhinometry as the base value. After intranasal spray of xylometazoline, the same nostril was remeasured by same method. Twenty four hours later, intranasal packing of epinephrine gauze was done and the same treatment was done. Subject preferences about the procedures were asked. Results There were significant difference among treatments (base value: 0.582 ± 0.164 cm2, xylometazoline spray: 0.793 ± 0.165 cm2, epinephrine gauze packing: 0.990 ± 0.290 cm2) in acoustic rhinometry. While the epinephrine gauze packing showed more efficient mucosa constriction, subjects preferred xylometazoline spray. Conclusions Even though xylometazoline spray was less effective than epinephrine gauze packing, the simplicity and convenience compensated. In patients undergoing nasotracheal intubation, xylometazoline spray can be an alternative to epinephrine gauze packing.
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Affiliation(s)
- Jun-Sung Han
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
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Thorstensen WM, Sue-Chu M, Bugten V, Steinsvåg SK. Nasal flow, volumes, and minimal cross sectional areas in asthmatics. Respir Med 2013; 107:1515-20. [PMID: 23953957 DOI: 10.1016/j.rmed.2013.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/18/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The Unified Airways hypothesis suggests an involvement of the upper airways in asthma. Critical parameters of the nasal airway can be quantified objectively with acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF). OBJECTIVE We aimed to investigate nasal airway patency in asthmatics compared to non-asthmatic controls. Nasal volume, cross sectional area and flow were measured using acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) in 87 asthmatics and 93 non-asthmatic controls before and after decongestion with xylometazoline. Nasal congestion index (NCI) was calculated, and allergy status was assessed by skin prick test or specific IgE. RESULTS We found significantly smaller minimum cross sectional area and nasal cavity volume in asthmatics than controls, and the cross sectional area is at its minimum at 2-3 cm from the nasal orifice in both groups. AR and PNIF measurements are not different in allergic and non allergic subjects in either group. The effect of xylometazoline is not significantly different between the 2 groups with regard to AR, but there is a significant improvement in PNIF for the asthmatics when assessed by the NCI. CONCLUSION The present study demonstrates a significantly smaller nasal airway when assessed by minimum cross sectional area and nasal cavity volume in asthmatics than controls, and these findings apply to asthmatics and controls irrespective of allergy status.
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Affiliation(s)
- Wenche Moe Thorstensen
- Dept of Otolaryngology, Head and Neck Surgery, St Olavs Hospital, University Hospital of Trondheim, 7006 Trondheim, Norway; Institute of Neuroscience, Norwegian University of Science and Technology, 7006 Trondheim, Norway.
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Barchuk WT, Salapatek AM, Ge T, D'Angelo P, Liu X. A proof-of-concept study of the effect of a novel H3-receptor antagonist in allergen-induced nasal congestion. J Allergy Clin Immunol 2013; 132:838-46.e1-6. [PMID: 23791513 DOI: 10.1016/j.jaci.2013.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 04/29/2013] [Accepted: 05/08/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND H1-receptor inverse agonists are used effectively for treating several symptoms of allergic rhinitis, including nasal itching, rhinorrhea, and sneezing, although most agents are not very effective in treating nasal congestion. OBJECTIVE This study evaluated the relative efficacy of a novel selective H3-receptor antagonist, JNJ-39220675, in preventing nasal congestion induced by exposing participants with ragweed allergy to ragweed allergen in an environmental exposure chamber model. METHODS In this single-dose, patient-blind, double-dummy, placebo- and active-controlled, phase IIa cross-over study, 53 participants were randomized to JNJ-39220675 plus placebo, placebo plus pseudoephedrine, or only placebo. The primary efficacy assessment was change in nasal patency assessed by measuring the minimal cross-sectional area of the nasal cavity by using acoustic rhinometry. Secondary assessment included total nasal symptom scores (TNSSs) over the 8-hour environmental exposure chamber exposure period. RESULTS Smaller decreases in minimal cross-sectional area were observed after JNJ-39220675 (least square mean difference, -0.126; P = .06) and pseudoephedrine (least square mean difference, -0.195; P = .004) treatment compared with placebo. The means for the baseline-adjusted area under the curve of TNSSs were significantly smaller for JNJ-39220675 (P = .0003) and pseudoephedrine (P = .04) versus placebo. JNJ-39220675 was significantly effective in treating all 4 individual symptoms (P ≤ .05 for all scores) compared with placebo, whereas pseudoephedrine only showed a trend for improvement in individual symptom scores of the TNSS. Insomnia was the most frequent adverse event (17.3%) associated with JNJ-39220675 treatment. CONCLUSION Prophylactic treatment with the H3-antagonist JNJ-39220675 relieved allergen-induced nasal congestion by using standard nasal symptom scoring; however, in contrast to pseudoephedrine, it only showed a trend for increasing nasal patency by using objective measures.
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Dadgarnia MH, Baradaranfar MH, Mazidi M, Azimi meibodi SMR. Assessment of Septoplasty Effectiveness using Acoustic Rhinometry and Rhinomanometry. Iran J Otorhinolaryngol 2013; 25:71-8. [PMID: 24303423 PMCID: PMC3846266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 10/09/2012] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Septal deviation is the chief cause of chronic nasal obstruction. In order to treat such cases, nasal septoplasty surgery is usually performed based on patient complaints and a surgeon's examination, both of which are subjective. This study aims at using the objective parameters of acoustic rhinometry and rhinomanometry to evaluate the effectiveness of septoplasty surgery. MATERIALS AND METHODS A prospective study was performed in 30 candidate patients for septoplasty surgery. Acoustic rhinometry and rhinomanometry tests were performed on all patients both before and 3 months after the operation. The symptom recovery rate was recorded according to the patient's statements and anterior rhinoscopic examinations 3 months after surgery. Data were analyzed using a t-test and chi-square tests in a SPSS package. RESULTS A total of 26 of 30 patients returned for a post-procedure follow-up examination after 3 months. Patients were aged from 18 to 32 years (average, 25 years). In total 69.2% (18 patients) were satisfied with the results of the procedure. In addition, rhinomanometry resulted in a decrease in general nasal resistance if patients used decongestants (P=0.03). However, the decrease was not significant before the use of decongestants (P=0.12). Furthermore, according to the results from acoustic rhinomanometry, there was an increase in the nasal cross-sectional area on both the narrow and wide sides after the operation (P<0.05), although this increase was not so notable in the narrower side after using decongestants. There was, however, no significant relationship between the results from the objective tests and the patient's symptoms or clinical examinations (P>0.05). CONCLUSION The findings of this study show that although the objective tests confirm an improvement in general nasal resistance and an increase in the nasal cross-sectional area after surgery, no unambiguous relationship between the patient's symptoms and the clinical examinations is observed. Therefore, such objective tests do not prove to be sufficient diagnostic criteria for the effectiveness of septoplasty.
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Affiliation(s)
- Mohammad Hossein Dadgarnia
- Rhinology Research Center, Department of Otorhinolaryngology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Corresponding Author: Rhinology Research Center, Department of Otorhinolaryngology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Tel: +0989133190399; E-mail:
| | - Mohammad Hossein Baradaranfar
- Rhinology Research Center, Department of Otorhinolaryngology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Mona Mazidi
- Rhinology Research Center, Department of Otorhinolaryngology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Abstract
This study was designed to measure the efficacy of a nasal valve suspension technique and determine the adequate traction length without creation of nasofacial fullness in a cadaveric model. Seven fresh frozen cadaveric heads were evaluated. Minimal cross-sectional (MCA) areas were measured with a transient-signal acoustic rhinometer (Ecco Vision; Hood Instruments, Pembroke, MA) before and after suspension. The adequate traction length, which did not cause obvious changes, was determined. Five millimeters of lateral nasal valve traction was determined to be the maximal traction achievable without creating facial fullness. After lateral nasal suspension, average MCA increased by 13.7%. Average distance to the MCA from the nostril changed from 1.57 to 1.76 cm. Postsuspension values were significantly higher than the presuspension values (p < 0.05). Nasal valve suspension with 5 mm of lateral traction has a significant impact on nasal valve area without obvious nasofacial changes.
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Affiliation(s)
- Jung Ho Bae
- Department of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, and ; Department of Otorhinolaryngology, Ewha Women's University School of Medicine, Seoul, Korea
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Al Ahmari MD, Wedzicha JA, Hurst JR. Intersession repeatability of acoustic rhinometry measurements in healthy volunteers. Clin Exp Otorhinolaryngol 2012; 5:156-60. [PMID: 22977713 DOI: 10.3342/ceo.2012.5.3.156] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 01/27/2012] [Accepted: 02/28/2012] [Indexed: 12/03/2022] Open
Abstract
Objectives Acoustic rhinometry is a rapid, reliable and non-invasive technique for the evaluation of conditions associated with impaired nasal patency. This study aimed to examine the intersession repeatability of acoustic rhinometry measurements of unilateral and combined nasal parameters in a group of healthy volunteers. Methods Twenty healthy volunteers were studied. In each subject, acoustic rhinometry measurements were performed on five consecutive days, with multiple recordings. Five clinically relevant parameters were measured in each session and the intersession repeatability of these measurements was expressed in terms of mean coefficient of variation, intraclass correlation coefficient and inter-item correlations. Results Intraclass correlation coefficients showed a high, and greater repeatability over time for all the combined (mean) values compared to the unilateral values. All intraclass correlations for combined values were ≥0.80 confirming almost perfect agreement. All intraclass correlations and inter-item correlations were associated with P<0.001. The mean coefficient of variation was low (<10%) for all but the proximal minimum cross sectional area (MCA1) measurements. Conclusion Acoustic rhinometry provides highly repeatable measurements of nasal patency, which is best for combined (mean) nasal parameters. This property makes it suitable for use in the diagnosis and follow-up of conditions associated with nasal obstruction, either structural or functional.
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