Treatment of the Nose for Patients with Sleep Apnea

Nasal obstruction is common in patients with obstructive sleep apnea (OSA) and may variably impact symptoms and severity of OSA. It is associated with decreased continuous positive airway pressure (CPAP) compliance, and both medical and surgical management of nasal obstruction have resulted in increased CPAP adherence. Treatment of OSA with comorbid rhinitis via topical nasal steroids demonstrates a beneficial impact on daytime sleepiness. Isolated nasal surgery has been shown to result in decreased daytime sleepiness and snoring, with minimal effect on OSA severity.

Acoustic resonance therapy is safe and effective for the treatment of nasal congestion in rhinitis: A randomized sham-controlled trial

BACKGROUND

Acoustic resonance therapy (ART) is a novel vibrational treatment that delivers patient-specific resonant frequency acoustic energy to the sinonasal cavities. In a pilot study, ART was effective for the acute treatment of nasal congestion. We conducted a sham-controlled randomized trial to validate the efficacy of ART when administered daily for 2 weeks.

METHODS

A total of 52 adult patients were enrolled in a multi-center, randomized, double-blinded, sham-controlled, interventional study evaluating ART administered by a vibrational headband. Patients received either active treatment or a non-therapeutic sham treatment twice daily over 2 weeks. Clinical endpoints were the average change in nasal congestion sub-score of the Total Nasal Symptom Score (TNSS) and the average change in composite TNSS.

RESULTS

ART resulted in a significantly greater mean change in the nasal congestion sub-score compared to sham (-0.87 [95% confidence interval [CI] -1.11, -0.62] vs. -0.44 [95% CI -0.64, -0.23], p = 0.008). ART also resulted in a significantly greater reduction in the composite TNSS versus sham, (-2.85 [95% CI -3.85, -1.85], vs. -1.32 [95% CI -2.27, -0.36], p = 0.027). The response rate, determined by a nasal congestion sub-score minimal clinically important difference of 0.23, was 80.8% for ART and 46.2% for sham, with an adjusted risk ratio of 1.95 (95% CI 1.26, 3.02, p = 0.003) in favor of ART. Safety endpoints showed no adverse events.

CONCLUSION

ART is a safe and effective non-pharmacologic alternative for the treatment of nasal congestion.

Cost-effectiveness Analysis of Inferior Turbinate Reduction and Immunotherapy in Allergic Rhinitis

BACKGROUND

Allergic rhinitis (AR) is a common condition that is frequently associated with atopic inferior turbinate hypertrophy (ITH) resulting in nasal obstruction. Current guidelines support the use of subcutaneous allergen immunotherapy (SCIT) when patients fail pharmacologic management. However, there is a lack of consensus regarding the role of inferior turbinate reduction (ITR), a treatment that we hypothesize is cost-effective compared with other available treatments.

METHODS

We conducted a cost-effectiveness analysis comparing the following treatment combinations over a 5-year time horizon for AR patients presenting with atopic nasal obstruction who fail initial pharmacotherapy: (1) continued pharmacotherapy alone, (2) allergy testing and SCIT, (3) allergy testing and SCIT and then ITR for SCIT nonresponders, and (4) ITR and then allergy testing and SCIT for ITR nonresponders. Results were reported as incremental cost-effectiveness ratios (ICERs).

RESULTS

For patients who fail initial pharmacotherapy, prioritizing ITR, either by microdebrider-assisting submucous resection or radiofrequency ablation, before SCIT was the most cost-effective strategy. Probabilistic sensitivity analysis demonstrated that prioritizing ITR before SCIT was the most cost-effective option in 95.4% of scenarios. ITR remained cost-effective even with the addition of concurrent septoplasty.

CONCLUSION

For many AR patients who present with nasal obstruction secondary to atopic inferior turbinate hypertrophy that is persistent despite pharmacotherapy, ITR is a cost-effective treatment that should be considered prior to immunotherapy.

LEVEL OF EVIDENCE

NA - Laryngoscope, 2023 Laryngoscope, 134:1572-1580, 2024.

Nasal Disorders

Nasal obstruction, rhinorrhea, and epistaxis are common presenting concerns in primary care clinics. Nasal disorders affect the quality of life for many children and families. Rarely, these complaints may represent a life-threatening condition among infant obligate nasal breathers or cases of unusual pathology. The most common causes of rhinorrhea and nasal obstruction vary by age and include physiologic, infectious, allergic, foreign body, irritant, and traumatic causes. Less commonly, children may have congenital malformations, sinonasal masses, or autoimmune disease. The most common causes of epistaxis are inflammatory, environmental, and traumatic causes and medication misuse, but rarely, children may have predisposing anatomic, hematologic, or vascular abnormalities or even sinonasal tumors. In this article, we provide a thorough review of the common nasal disorders treated every day in primary care clinics and mention briefly some of the rare but serious cases that may be overlooked without considering a full differential diagnosis.

Management of Mechanical Nasal Obstruction Isolated or Associated to Upper Airway Inflammatory Diseases in Real Life: Use of both Subjective and Objective Criteria

PURPOSE OF REVIEW

Mechanical nasal obstruction (MNO) is a prevalent condition with a high impact on patient's quality-of-life (QoL) and socio-economic burden. The aim of this study was to determine the usefulness of both subjective and objective criteria in the appropriate management of MNO, either alone or associated to upper airway inflammatory diseases such as allergic rhinitis (AR) or chronic rhinosinusitis with nasal polyps (CRSwNP).

RECENT FINDINGS

A long debate persists about the usefulness of subjective and objective methods for making decisions on the management of patients with nasal obstruction. Establishing standards and ranges of symptom scales and questionnaires is essential to measure the success of an intervention and its impact on QoL. To our knowledge this is the first real-life study to describe the management of MNO using both subjective and objective criteria in MNO isolated or associated to upper airway inflammatory diseases (AR or CRSwNP). Medical treatment (intranasal corticosteroids) has a minor but significant improvement in MNO subjective outcomes (NO, NOSE, and CQ7) with no changes in loss of smell and objective outcomes. After surgery, all MNO patients reported a significant improvement in both subjective and objective outcomes, this improvement being higher in CRSwNP. We concluded that in daily clinical practice, the therapeutic recommendation for MNO should be based on both subjective and objective outcomes, nasal corrective surgery being the treatment of choice in MNO, either isolated or associated to upper airway inflammatory diseases, AR or CRSwNP.

Impact of antiallergy agents on CPAP therapy and sleep quality with spring pollinosis in Japanese

PURPOSE

Allergic rhinitis (AR) is associated with obstructive sleep apnea (OSA) and nasal obstruction causes decreased adherence to continuous positive airway pressure (CPAP). The purpose is to evaluate the effects of antiallergic agents on CPAP adherence and sleep quality.

METHODS

A longitudinal study was made of patients who use CPAP for OSA and treated with antiallergy agents for spring pollinosis. We compared the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), nasal symptoms scores (NSS), and data from CPAP before and after treatment. Then, we classified the subjects into two groups based on the baseline PSQI score: one group without a decreased sleep quality (PSQI < 6) and the other group with decreased sleep quality (PSQI ≥ 6).

RESULTS

Of 28 subjects enrolled, 13 had good sleep quality and 15 had poor sleep quality. PSQI showed significant improvements after medication (p = 0.046). ESS showed no significant differences after AR medication (p = 0.565). Significant improvement was observed after the prescription of antiallergy agents in all items of NSS (sneezing, p < 0.05; rhinorrhea, p < 0.01; nasal obstruction, p < 0.01; QOL, p < 0.01). The percentage of days with CPAP use more than 4 h increased significantly after the administration of rhinitis medication (p = 0.022). In the intragroup comparisons of PSQI ≥ 6 group, PSQI decreased significantly (p < 0.05). For the NSS in intragroup comparisons of PSQI ≥ 6 group, all parameters showed significant improvement (sneezing, p = 0.016; rhinorrhea, p = 0.005; nasal obstruction, p < 0.005; QOL, p < 0.005).

CONCLUSION

The use of antiallergy agents can improve CPAP adherence and sleep quality in patients with OSA on CPAP.

Congenital nasal pyriform aperture stenosis: Analysis of twenty cases at a single institution

OBJECTIVES

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal respiratory distress that is difficult to treat. The primary objective of this study was to identify factors that predict the need for initial and revision surgery for CNAPS. The secondary objective is to identify risk factors in maternal history associated with the development of CNPAS.

METHODS

Infants with CNPAS between 2010 and 2017 were identified by ICD- 9 and 10 codes. Demographics, maternal history, anatomic features on imaging and medical and/or surgical management were reviewed. Frequencies, means and standard deviations were calculated. A p-value <.05 was considered significant.

RESULTS

Twenty infants were included. All underwent flexible nasal endoscopy with inability to pass the scope in either nostril in 65% of infants. Nineteen had a CT scan and 13 had a MRI with midline defects in 76.3% and 53.8%, respectively. Solitary central mega-incisor was present in 65%. Half underwent surgical intervention at a mean age of 74.8 days, with 90% requiring revision surgery. There was no difference in pyriform aperture distance in the surgical and non-surgical patient subgroups (5.4 mm and 5.2 mm, p = .6 respectively). No specific variables were predictive of need for initial or revision surgery. Maternal diabetes mellitus (MDM) was found in 55% of mothers of infants with CNPAS.

CONCLUSION

Pyriform aperture distance was not a predictor of surgical intervention. MRI should be considered in all infants with CNPAS as the rate of intracranial complications is high. MDM may be a risk factor for CNPAS.

Septoplasty with or without concurrent turbinate surgery versus non-surgical management for nasal obstruction in adults with a deviated septum: a pragmatic, randomised controlled trial

BACKGROUND

Septoplasty (surgical correction of the deviated nasal septum) is the most frequently performed ear, nose, and throat operation in adults, but no randomised controlled trials or non-randomised comparative studies on the effectiveness of septoplasty have been published. Consequently, health-care providers, health insurance companies, and policy makers are concerned about the effectiveness of the procedure. We aimed to assess the effectiveness of septoplasty for nasal obstruction in adults with a deviated septum.

METHODS

We did this open, multicentre, pragmatic, randomised controlled trial in 16 secondary and two tertiary referral hospitals in the Netherlands. Adults (aged ≥18 years) with nasal obstruction, a deviated septum, and an indication to have septoplasty done were randomly allocated (1:1) to receive either septoplasty with or without concurrent turbinate surgery or non-surgical management. Patients were stratified by sex, age (<35 years or ≥35 years), and deviation severity (mild, moderate, or severe). The primary outcome was health-related quality of life, measured with the validated Glasgow Health Status Inventory at 12 months. Analyses were done on an intention-to-treat basis. The trial is registered with the Netherlands Trial Register, number NTR3868.

FINDINGS

Between Sept 2, 2013, and Dec 12, 2016, we randomly assigned 203 participants to receive either septoplasty with or without concurrent turbinate surgery (n=102) or non-surgical management (n=101). 189 participants were analysed at 12 months. At 12 months, mean score on the Glasgow Health Status Inventory of patients assigned to septoplasty was 72·2 (SD 12·2) and for those assigned to non-surgical management was 63·9 (SD 14·5, mean difference 8·3 [95% CI 4·5-12·1], favouring septoplasty). Septal abscess occurred in one surgical patient and septal perforation in two surgical patients. No side-effects of nasal medication were reported.

INTERPRETATION

Septoplasty is more effective than non-surgical management for nasal obstruction in adults with a deviated septum. This effect was sustained up to 24 months of follow-up.

FUNDING

The Netherlands Organisation for Health Research and Development (ZonMw).

Objective and Subjective Effects of a Prototype Nasal Dilator Strip on Sleep in Subjects with Chronic Nocturnal Nasal Congestion

Introduction

This exploratory study characterized the performance of a nasal dilator strip with improved spring forces in lowering nasal resistance during sleep and reducing sleep-disordered breathing in subjects with difficulty sleeping due to chronic nocturnal nasal congestion.

Methods

Subjects applied the strip at bedtime for 28 days (active phase; n = 70). Objective assessments included snoring variables, breathing route during sleep, and polysomnography measures compared with baseline. Nasal breathing, congestion, and sleep were measured subjectively using rating scales and questionnaires. During a crossover nasal resistance phase (n = 55), nasal resistance was measured using posterior rhinomanometry with the strip applied on one of two nights.

Results

In the active phase, breathing and sleep were perceived to improve, with less daytime sleepiness (P < 0.04) and increased ease of breathing, sleep quality, staying asleep, and feeling refreshed in the morning (all P < 0.0001). However, while objective polysomnography metrics were generally similar with and without the strip, median wake after sleep onset time was numerically reduced by ~ 11 min, and the spontaneous arousal rate fell by ~ 37%. In the nasal resistance phase (n = 55), median resistance (at 0.2–0.25 l/s) while asleep was 39.1% lower with (n = 37) versus without (n = 36) the strip (1.34 vs. 2.20 cmH₂O/l/s; P = 0.048).

Conclusions

This exploratory study supports a role for the improved spring force nasal dilator strip in alleviating sleep-related symptoms in subjects with chronic nasal congestion, potentially via lowering nasal resistance and reducing nocturnal awakenings. A larger study is indicated to confirm these preliminary data.

ClinicalTrials.gov identifier

NCT03105297.

Funding

GlaxoSmithKline Consumer Healthcare.

Plain Language Summary

Plain language summary available for this article.

Electronic supplementary material

The online version of this article (10.1007/s12325-019-00980-z) contains supplementary material, which is available to authorized users.

The clinical importance of the nasal valve

The nasal valve deserves relevant in patients presenting with nasal obstruction. In particular, the nasal valve plays an important role in nasal airflow control, it is relevant for the otolaryngologist to not only consider but also fully evaluate the nasal valve when seeing a patient with nasal obstruction. These data reported in this Supplement confirms the clinical relevance of the nasal valve in different groups of patients and normal subjects. In fact, an integrity of nasal valve is fundamental to ensure a physiological nasal breathing that in turn guarantees a correct pulmonary function. The possibility to use the non-surgical and well-accepted option constituted by the nasal internal dilator represent an interesting opportunity for both the physician and the patient.

Malocclusion and rhinitis in children: an easy-going relationship or a yet to be resolved paradox? A systematic literature revision

OBJECTIVE

The relation between nasal flow and malocclusion represents a practical concern to pediatricians, otorhinolaryngologists, orthodontists, allergists and speech therapists. If naso-respiratory function may influence craniofacial growth is still debated. Chronic mouth-breathing is reported to be associated also with a characteristic pattern of dental occlusion. On the other hand, also malocclusion may reduce nasal air flows promoting nasal obstruction. Hereby, the aim of this review was to describe the relationship between rhinitis and malocclusion in children.

METHODS

An electronic search was conducted using online database including Pubmed, Web of Science, Google Scholar and Embase. All studies published through to January 30, 2017 investigating the prevalence of malocclusion in children and adolescents (aged 0-20 years) affected by rhinitis and the prevalence of rhinitis in children with malocclusion were included. The protocol was registered at PROSPERO - International prospective register of systematic reviews under CRD42016053619.

RESULTS

Ten studies with 2733 patients were included in the analysis. The prevalence of malocclusion in children with rhinitis was specified in four of the studies ranging from as high as 78.2% to as low as 3%. Two out of the studies reported the prevalence of rhinitis in children with malocclusion with a rate ranging from 59.2 to 76.4%.

CONCLUSION

The results of this review underline the importance of the diagnosis and treatment of the nasal obstruction at an early age to prevent an altered facial growth, but the data currently available on this topic do not allow to establish a possible causal relationship between rhinitis and malocclusion.

Improvement of nasal breathing and patient satisfaction by the endonasal dilator Airmax®

BACKGROUND

Patients suffering from nasal obstruction due to external nasal valve dysfunction may benefit from either corrective surgery or a conservative approach with a nasal dilator. At present, devices for widening the external nasal valve region can be applied externally or endonasally. It remains unknown to what extent the en dona sal dilator Airmax® objectively improves the nasal flow and can be offered as an alternative for surgery.

METHODOLOGY

Thirty patients suffering from nasal obstruction due to external nasal valve problems were proposed to use the nasal dilator for 4 weeks as an alternative for corrective surgery. The improvement of nasal flow by the dilator was evaluated by measuring the peak nasal inspiratory flow (PNIF). Then, patients were asked for their willingness to continue to use the nasal dilator or to undergo nasal valve surgery.

RESULTS

The endonasal dilator improved the mean PNIF from baseline values with a mean increase of 176.1 o/o. After a 4 week trial period, 19 of 30 patients expressed the intention to continue the use of the nasal dilator. Inappropriate size, local irritation and/or aesthetic nasal complaints were mentioned by the other patients as reasons for discontinuation of using the nasal dilator.

CONCLUSION

The endonasal dilator Airmax® represents a powerful device to improve nasal breathing in the target patients and therefore represents a good alternative for corrective surgery.

Congenital nasal obstruction in infants: A retrospective study and literature review

OBJECTIVES

To identify etiologies of congenital nasal obstruction and describe clinical practice patterns in the evaluation, diagnosis, and treatment of symptomatic infants.

METHODS

An electronic chart review from 1/1/2006-10/1/2016 for all patients with a diagnosis of nasal obstruction within the first six months of life using ICD-9 and 10 codes 478.19 and J34.89.

RESULTS

A total of 34 patients were evaluated by the Division of Otolaryngology for this chief complaint. 38% of neonates were born premature and 32% were admitted to the NICU at birth, with a female-to-male ratio of 1:1.4. Presenting signs and symptoms included: stertor (44%), cyanosis (24%), stridor (24%), retractions (21%), rhinorrhea (21%), apnea (12%), and epistaxis (8%). 47% of patients received ancillary radiographic imaging (CT or MRI). Diagnoses observed include: midnasal stenosis (38%), pyriform aperture stenosis (21%), choanal stenosis (12%), dacryocystocele (6%), microrhinia (6%), septal deviation (6%), nasopharyngeal reflux (3%), nasopharyngeal teratoma (3%), neonatal rhinitis (3%), and pharyngeal wall collapse (3%). 71% of patients were noted to have bilateral nasal obstruction. 41% of infants were found to have an associated ear, nose, and throat anomaly. 15% of patients required surgical intervention. The mean time-to-resolution was 240 days.

CONCLUSION

Congenital nasal obstruction has a broad differential diagnosis: the timing, onset, and laterality of symptoms can provide insights into the source of upper airway compromise. Most infants improve through conservative management (i.e. suctioning, humidification) and medical therapies (i.e. intranasal drops, nasal sprays).

Clinical assessment, diagnosis and management of nasal obstruction

BACKGROUND

Nasal obstruction is among the most common complaints to the general practitioner (GP). Causes can be divided into mucosal causes or anatomical abnormalities. Most mucosal pathologies can be managed effectively in the primary care setting, with referral to the otolaryngologist in cases that are resistant to medical therapy and in cases of structural anomaly. In cases of allergy, referral to an immunologist may be beneficial.

OBJECTIVE

The aim of this article is to review the clinical assessment and management of nasal obstruction in the primary care setting. We consider the various causes of nasal obstruction, describe their management and define those cases that require specialist referral.

DISCUSSION

Nasal obstruction may be acute or chronic and is a manifestation of a wide range of disease processes, most of which are managed by the GP. In patients with persistent nasal obstruction and in those with structural abnormalities, specialist referral is warranted.

Congenital nasal pyriform aperture stenosis: Elaboration of a management algorithm from 25 years of experience

INTRODUCTION

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare disease presenting with neonatal respiratory distress, often associated with other anomalies.

MATERIALS AND METHODS

This study reports the clinical and radiological characteristics of the patients managed in The Department of Pediatric Otolaryngology Head and Neck Surgery of La Timone Children's Hospital in Marseille between 1988 and 2014. Pyriform aperture (PA) widths were measured on CT-scans, obtained by using hand calipers at the largest portion of the PA in a plan parallel to the Francfort plan.

RESULTS

10 patients were included. Average PA width was 6.6mm, 5/10 patients presented with single central maxillary median incisor, 6/10 patients had associated abnormalities. 8 patients underwent a surgical intervention and 2 patients were medically managed. All the patients had satisfactory nasal airway permeability on late follow-up. A management algorithm was elaborated. CNPAS should be evoked when breathing difficulties are associated with impossibility of passing fiberscope or nasogastric tube at the nasal inlet. Craniofacial CT-scanning is necessary to make the diagnosis and look for associated abnormalities. Medical treatment associating nasal wash and decongestants should be performed. Surgical intervention is necessary when failure of the medical management.

DISCUSSION AND CONCLUSIONS

Our results were close to those found in the literature in terms of clinical characteristics, associated abnormalities and PA width. However, no objective criterion to decide whether a surgical intervention is necessary or not, has been established so far. The algorithm we propose offers guidelines from diagnosis to treatment, but the management should be adapted based on clinical tolerance.

Effect of Nasal Obstruction on Continuous Positive Airway Pressure Treatment: Computational Fluid Dynamics Analyses

Objective

Nasal obstruction is a common problem in continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea and limits treatment compliance. The purpose of this study is to model the effects of nasal obstruction on airflow parameters under CPAP using computational fluid dynamics (CFD), and to clarify quantitatively the relation between airflow velocity and pressure loss coefficient in subjects with and without nasal obstruction.

Methods

We conducted an observational cross-sectional study of 16 Japanese adult subjects, of whom 9 had nasal obstruction and 7 did not (control group). Three-dimensional reconstructed models of the nasal cavity and nasopharynx with a CPAP mask fitted to the nostrils were created from each subject’s CT scans. The digital models were meshed with tetrahedral cells and stereolithography formats were created. CPAP airflow simulations were conducted using CFD software. Airflow streamlines and velocity contours in the nasal cavities and nasopharynx were compared between groups. Simulation models were confirmed to agree with actual measurements of nasal flow rate and with pressure and flow rate in the CPAP machine.

Results

Under 10 cmH₂O CPAP, average maximum airflow velocity during inspiration was 17.6 ± 5.6 m/s in the nasal obstruction group but only 11.8 ± 1.4 m/s in the control group. The average pressure drop in the nasopharynx relative to inlet static pressure was 2.44 ± 1.41 cmH₂O in the nasal obstruction group but only 1.17 ± 0.29 cmH₂O in the control group. The nasal obstruction and control groups were clearly separated by a velocity threshold of 13.5 m/s, and pressure loss coefficient threshold of approximately 10.0. In contrast, there was no significant difference in expiratory pressure in the nasopharynx between the groups.

Conclusion

This is the first CFD analysis of the effect of nasal obstruction on CPAP treatment. A strong correlation between the inspiratory pressure loss coefficient and maximum airflow velocity was found.

Pre-operative effects of the administration of systemic corticosteroids combined with antibiotics on a lobular capillary hemangioma in the nasal cavity

Lobular capillary hemangiomas (LCHs), also known as pyogenic granulomas, are benign, rapidly growing hemorrhagic lesions that usually develop in the oral or nasal cavities. In adults, LCHs occur in <5% of all pregnant women. A 30-year-old woman presented with a 4-month history of right-sided nasal obstruction and recurrent epistaxis 2 months post-partum. A fragile, pink-red lobulated tumor existed in the anterior portion of the right inferior turbinate; the biopsy revealed a LCH. Although the patient declined surgery using an external approach, treatment with systemic corticosteroids combined with antibiotics resulted in tumor regression and an endoscopic en bloc resection was possible. No recurrence has been noted to date (>1 year after surgery). Pre-operative treatment with systemic corticosteroids combined with antibiotics may be useful to induce tumor regression and to excise the lesion completely with an endoscopic approach.

Biodegradable nasal packings for endoscopic sinonasal surgery: a systematic review and meta-analysis

OBJECTIVES

To assess biodegradable nasal packing effectiveness for improving postoperative symptoms and mucosal healing after endoscopic sinonasal surgery as compared with conventional/non-packing groups.

METHODS

Relevant articles were searched on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials (RCTs) that compared biodegradable packings with conventional packings or no packing, reporting postoperative symptoms and/or mucosal healing outcomes.

RESULTS

This review included 19 studies, of which 11 compared biodegradable packings with conventional packings. Meta-analysis found that biodegradable packings significantly improved postoperative symptoms: bleeding at removal, pain at removal, pain in situ, and nasal blockage. Mucosal healing outcomes were inconsistent within studies, with no data could be pooled. Eight studies compared biodegradable packings with non-packing group. Postoperative symptom data in this comparison could not be pooled: A protective or equal effect on postoperative bleeding was reported in different studies; no difference was reported in pain status and nasal blockage. As for mucosal healing, meta-analysis showed that two arms of comparison had similar effect on synechiae, edema, infection and granulation at each time point.

CONCLUSION

The limiting evidence suggests that biodegradable nasal packings are statistically better than conventional packings in postoperative symptoms, and probably comparable to non-packing group, as in this comparison we could not carry out meta-analysis. No beneficial or detrimental effect on postoperative mucosal healing could be determined based on existing evidence.

Nasal congestion in infants and children: a literature review on efficacy and safety of non-pharmacological treatments

The most common causes of nasal obstruction and runny nose in infants and children are infections, mainly of viral origin, or allergies. In neonates and infants viral upper respiratory tract infections (URTI) are frequently observed during episodes of nasal obstruction. Saline irrigation of the nose is believed to alleviate URTI symptoms by helping to eliminate excess mucus, to reduce congestion and by contributing to improve breathing. Objective of the study was to review the efficacy and safety of non-pharmacological options for the treatment of nasal congestion and its sequelae, in infants and children, with a special focus on hypertonic and isotonic solutions and other medical devices, including nasal aspirators. Available data indicate that nasal symptoms in children with allergic rhinitis or acute sinusitis significantly improved following nasal saline irrigation. The use of medical devices is less documented. Nasal aspiration with a medical device, associated with an isotonic saline solution, during viral rhinitis, has been shown to lower the risk of developing acute otitis media and rhinosinusitis, in comparison with a group treated with physiological saline solution alone. Safety and tolerability have been evaluated and no serious adverse events have been reported. Literature data highlighted the good tolerability. The use of isotonic and hypertonic saline solutions to relief nasal congestion in infants and children is widespread; it is a safe and valuable therapeutic support, and can reduce the use of medications (antihistamines, decongestant, antibiotics, corticosteroids) during the treatment of URTIs.

Use of peak nasal inspiratory flowmetry and nasal decongestant to evaluate outcome of septoplasty with radiofrequency coblation of the inferior turbinate

BACKGROUND

To investigate the role of peak nasal inspiratory flowmetry (PNIF) in evaluating inspiratory improvements in patients who underwent both septoplasty and inferior turbinate coblation by radiofrequency (ITC-RF).

METHODS

One hundred and eight patients underwent both Cottle's septoplasty and ITC-RF. PNIF measurements were performed in all patients in the preoperative period and 6 months postoperatively. All measurements were made both before and after decongestion of the nasal cavity with oxymetazoline spray.

RESULTS

Mean preoperative PNIF measurements differed significantly: 104.3 ± 33.6 L/min vs 136.1 ± 27.7 L/min before and after oxymetazoline decongestion, respectively. Mean postoperative PNIF measurements were 139.2 ± 30.8 L/min and 151.2 ± 32.3 L/min before and after decongestion, respectively. Preoperatively the mean difference between before and after decongestion was 32.1 ± 16.3 L/min. Postoperatively the mean difference was 11.8 ± 11.1 L/min.

CONCLUSION

PNIF can be used in the assessment of ITC-RF outcomes with the aid of nasal decongestants, even in patients who also underwent septoplasty.

Improvement of nasal breathing and patient satisfaction by the endonasal dilator Airmax®

BACKGROUND

Patients suffering from nasal obstruction due to external nasal valve dysfunction may benefit from either corrective surgery or a conservative approach with a nasal dilator. At present, devices for widening the external nasal valve region can be applied externally or endonasally. It remains unknown to what extent the en dona sal dilator Airmax® objectively improves the nasal flow and can be offered as an alternative for surgery.

METHODOLOGY

Thirty patients suffering from nasal obstruction due to external nasal valve problems were proposed to use the nasal dilator for 4 weeks as an alternative for corrective surgery. The improvement of nasal flow by the dilator was evaluated by measuring the peak nasal inspiratory flow (PNIF). Then, patients were asked for their willingness to continue to use the nasal dilator or to undergo nasal valve surgery.

RESULTS

The endonasal dilator improved the mean PNIF from baseline values with a mean increase of 176.1 o/o. After a 4 week trial period, 19 of 30 patients expressed the intention to continue the use of the nasal dilator. Inappropriate size, local irritation and/or aesthetic nasal complaints were mentioned by the other patients as reasons for discontinuation of using the nasal dilator.

CONCLUSION

The endonasal dilator Airmax® represents a powerful device to improve nasal breathing in the target patients and therefore represents a good alternative for corrective surgery.

The efficacy of radiofrequency volumetric tissue reduction of hypertrophied inferior turbinate in simple snoring

BACKGROUND

Simple snoring represents a social problem, not only because it could affect the patient's married life, but it often goes along with sleep-disordered breathing. Chronic nasal obstruction has many sequel including snoring and the inferior turbinate hypertrophy (ITH) is its most common cause. The aim of the study is to evaluate the efficacy of video-assisted endoscopic radiofrequency volumetric tissue reduction (RFVTR) to reduce snoring in patients affected by chronic nasal obstruction due to ITH.

PATIENTS AND METHODS

This prospective study was conducted over 48 habitual snoring with persistent nasal obstruction due to bilateral ITH refractory to medical management received one time RFVTR of both it. Nasal symptoms were assessed both subjectively, by Visual Analog Scale (VAS) and NOSE Scale, and objectively by videorhinohygrometer. Snoring was measured by Snoring severity rated by the bed partner, in a longitudinal fashion, using VAS. All patients were evaluated pre-operatively, and after 45th day (range 35-50 days) post-operatively.

RESULTS

Thirty-two subjects completed study. All patients had significant symptomatic improvement in nasal breathing (5.53 ± 2.88 vs 1.87 ± 1.75; p < 0.05), confirmed by videorhinohygrometer values (p < 0.05). We had a significantly improvement of snoring in all patients (5.62 ± 2.80 vs 1.86 ± 1.43, p < 0.001) with a mean snoring Visual Analog Scale improvement of 77.4%.

CONCLUSIONS

Based on this study and literature review, it seems that RFVTR represents a safe, minimal invasive, easy performed, and time and cost effective surgery, which may decrease symptoms of snoring in patients with ITH, at least, in short-term follow-up.

Nasal obstruction in newborns

Nasal obstruction is a serious clinical scenario in the newborn infant with a large differential diagnosis. This article reviews the etiologies of nasal obstruction to aid the pediatrician in prompt evaluation, diagnosis, and treatment.

Congenital nasal pyriform aperture stenosis: diagnosis and management

BACKGROUND

Congenital nasal pyriform aperture stenosis is a rare and potentially lethal form of airway obstruction in newborns. Immediate recognition and appropriate therapy are mandatory for this potentially life-threating condition. This anomaly may present as an isolated malformation or may be associated with other cranial-facial anomalies. Clinically, CNPS shows unspecific symptoms of nasal airway obstruction such as apnoic crisis, episodic cyanosis and inability to nurse. The purpose of this report is to present author's experience in the surgical management of this rare pathology in 3 patients.

PATIENTS AND METHODS

Three cases of congenital nasal pyriform aperture stenosis were reviewed for presentation of the disorder, management and effectiveness of the surgical treatment.

RESULTS

All the patients underwent a surgical correction of the pyriform aperture stenosis using a sublabial approach followed by nasal stenting. During the follow-up no cases of restenosis, respiratory failure or cyanosis were detected.

CONCLUSIONS

Congenital pyriform aperture stenosis should be suspected in newborns with clinical signs of severe nasal obstruction associated with a difficulty to pass a small catheter though the anterior nasal valve. Timely recognition is mandatory to prevent a potential deadly outcome. Surgical correction of the stenosis though a sublabial approach followed by a nasal stenting revealed to be most effective treatment for these patients.

Powered-assisted partial turbinectomy versus mometasone furoate nasal spray for relief of nasal blockage in chronic or idiopathic rhinosinusitis

CONCLUSION

Power-assisted turbinectomy is a safe and reliable alternative for patients with nasal blockage if nasal corticosteroid spray therapy is not suitable.

OBJECTIVE

Powered-assisted partial turbinectomy was compared to the use of a corticosteroid nasal spray for relief of nasal obstruction in chronic or idiopathic rhinosinusitis.

METHODS

Patients were randomized to either power-assisted partial turbinectomy or daily use of mometasone furoate nasal spray for 6 months. Evaluation by peak nasal inspiratory flow (PNIF) and grading of symptoms by use of visual analog scale was done after 3 and 6 months. Grading of symptoms was also done by use of a questionnaire approximately 30 months after the last visit.

RESULTS

PNIF scores improved for all patients, although significantly only for patients on mometasone spray. Patients' self-reported symptoms decreased more for operated patients. Side effects were few and mild in both groups.

Nasal obstruction in neonates and infants

The main functions of the nasal airway are respiration and olfaction. The nose and sinuses condition air before reaching the lower respiratory tract by providing almost 100% humidification, warming, filtering and trapping of foreign particles. The airway epithelium contributes to the host defense system. Any alteration of this clearance system may produce significant problems, particularly in neonates, who are obligate nasal breathers until they are at least two months old. Nasal obstruction, and the inability to remove nasal secretion by nose blowing, may have serious consequences, such as respiratory distress or discomfort, altered sleep cycle, increased risk of obstructive apnoea and feeding difficulties. Most cases of nasal obstruction in neonates and infants are due to generalized nasal airway obstruction associated with neonatal rhinitis, viral upper respiratory tract infections, and possibly milk/soy allergies. Saline nasal lavage is recommended as an adjunct therapy for rhinosinusitis and allergic rhinitis, and in most cases of nasal congestion or obstruction in newborns, infants and children. In two recent experiences, was deemed to be the Narhinel method safe and effective for treatment of nasal congestion in babies with viral infections of the upper respiratory tract, or for the prevention of acute otitis media (AOM) and acute rhinosinusitis (AR) in children. Due to the efficacy, ease of use, tolerability and the lack of alternative medications in children younger than 12 years of age, nasal irrigation with physiological saline solution, followed by gentle aspiration, represent an effective method for the prevention and control of nasal congestion or obstruction in term or preterm neonates, infants and children.

Congenital unilateral nasal aperture stenosis

Congenital nasal aperture stenosis is an unusual cause of upper airway obstruction among neonates, and rarely presents as unilateral. Most commonly presents as choanal atresia. A CT evaluation is essential to confirm the diagnosis. Both surgical and conservative management can be applied, based on the severity of the associated clinical presentation; however, the very rare unilateral condition is usually treated conservatively. We present a case of a 30-day-old male baby (second twin, preterm 29 weeks pregnancy, and birth weight 1.070 kg) with difficult breathing since birth. The baby was referred for an ENT consultation. He was on a nasal cannula, not in respiratory distress, with no stridor, nor tachypnea. There were decreased breathing sounds in the left nostril. Nasogastric tubes size 8 French (Fr) and 6 Fr could not be introduced through the left nostril, which looked obstructed more anteriorly.

Computational fluid dynamics analysis of nasal flow

OBJECTIVES

Standard methods to examine nasal flow are experimental and do not yield locally detailed results. Using the Lattice-Boltzmann method (LBM), we computed nasal air flow and investigated the relationship between nasal obstruction and anatomical conditions. Because of its mathematical structure, the LBM can be immediately applied to various nasal cavities that are characterized by an extremely intricate geometry. In the present study, the higher efficiency of the LBM allowed for high resolution and detailed analysis of the flow structures in the nasal cavity.

METHODOLOGY

Based on a previously validated simulation of nasal airflow in an artificial model, we acquired the nasal geometry of an individual by computed tomography and applied the LBM to numerically solve Navier-Stokes equations and thereby determine nasal flow.

RESULTS

In contrast to frequently used standard finite-volume methods, our method facilitated grid generation and computational parallelisation. The grid modelling of the nasal cavity comprised 4.9 million nodes and the computational time on a high-performance computing cluster was less than 12 hours. The velocity and pressure of the calculated airflow was visualized in every tiny recess of the nasal cavity and areas of interest could be easily identified.

CONCLUSION

Computer-assisted visualization of patients' 3D nasal flow structures may be useful for diagnosis, and for planning surgical interventions. Although numerical analysis is far from real-time, and the generation of geometric models still requires a large amount of manual interaction, our simulation approach will be useful for nasal flow research.

Effect of an intra-oral nasal dilation appliance on 3-D nasal airway morphology in adults

To determine the effects of a nasal dilation appliance on 3-D nasopharyngeal airway patency. The sample comprised 187 adults (98 males, 89 females) with a history of sleep-disordered breathing. Acoustic rhinometry readings were taken from all patients before and after the intra-oral placement of a nasal dilation appliance (OASYS). The mean left and right nasopharyngeal airways were reconstructed in 3-D, and the data from the right and left nostrils were subjected to principal components analysis (PCA) and finite-element scaling analysis (FESA). Comparing the pre- and post-treatment 3-D mean, left nasopharyngeal airways using PCA, the first two eigenvalues accounted for 96% of the total shape change, and statistical differences were found (p < 0.01). Similarly, for the right side, significant differences were detected between the mean pre- and post-treatment 3-D nasopharyngeal airways (p < 0.01) using PCA. Using FESA to quantify and localize changes after the placement of the nasal dilation appliance, the 3-D mean, normalized, left nasopharyngeal airway was found to be 14% wider in the anterior nasal valve region and 28% wider in the distal regions, while the 3-D mean, normalized, right nasopharyngeal airway was 13% wider in the anterior nasal valve region and 27% wider further distally. The use of an intra-oral nasal dilation appliance may be useful in the management of nasopharyngeal conditions, such as snoring, upper airway resistance syndrome, sleep-disordered breathing, and obstructive sleep apnea, especially in cases where nasal obstruction is demonstrable.

What happens to patients with nasal stuffiness and pathological rhinomanometry left without surgery?

In this study we explored long term outcomes of patients with nasal stuffiness and high nasal airway resistance (NAR) that did not undergo nasal surgery. The same investigation was repeated on average 8 years after a baseline investigation with an ENT-examination, a rhinomanometric survey and a rhinomanometry. We did follow-up investigations in 44 out of 59 non-operated patients with a pathological NAR on at least one side. At follow-up 2 persons (4%) had no complaints, 14 (32%) had reduced, 22 (50%) unchanged, and 6 (14%) increased complaints of nasal stuffiness. Rhinomanometry showed that NAR values decreased significantly between baseline and follow-up on both wider and narrower sides after decongestion. There was no correlation between subjective nasal complaints and NAR-values. In logistic regression models increasing age and allergy prevalence at baseline were significantly associated with having no, or reduced nasal stuffiness at follow-up. The results show that both NAR and subjective nasal stuffiness decreased with age. Consequently, we suggest that NAR normal values should be age adjusted. Also, a wait and see policy towards nasal stuffiness seems relevant since 36% of our patients had no or reduced nasal stuffiness while their NAR-values were reduced after 8 years.

The effects of a hot drink on nasal airflow and symptoms of common cold and flu

Hot drinks are a common treatment for common cold and flu but there are no studies reported in the scientific and clinical literature on this mode of treatment. This study investigated the effects of a hot fruit drink on objective and subjective measures of nasal airflow, and on subjective scores for common cold/flu symptoms in 30 subjects suffering from common cold/flu. The results demonstrate that the hot drink had no effect on objective measurement of nasal airflow but it did cause a significant improvement in subjective measures of nasal airflow. The hot drink provided immediate and sustained relief from symptoms of runny nose, cough, sneezing, sore throat, chilliness and tiredness, whereas the same drink at room temperature only provided relief from symptoms of runny nose, cough and sneezing. The effects of the drinks are discussed in terms of a placebo effect and physiological effects on salivation and airway secretions. In conclusion the results support the folklore that a hot tasty drink is a beneficial treatment for relief of most symptoms of common cold and flu.

Effect of local nasal immunotherapy on nasal blockage in pollen-induced allergic rhinitis of Guinea pigs

BACKGROUND

As a non-injection route for immunotherapy, local nasal immunotherapy has been examined in allergic rhinitis patients. However, it is unclear how the immunotherapy affects sneezing, biphasic nasal blockage and nasal hyperresponsiveness. Thus, we evaluated the therapeutic effects of nasal immunotherapy on the symptoms of guinea pig allergic rhinitis. Additionally, we also evaluated whether the immunotherapy relieved pollen-induced allergic conjunctivitis.

METHODS

Sensitized animals were repeatedly challenged by pollen inhalation once every week. After the 7th challenge, the pollen extract was intranasally administered 6 times a week until the 30th challenge. Sneezing frequency was counted after each of the challenges. As an indicator of nasal blockage, changes in specific airway resistance were measured. Nasal hyperresponsiveness was assessed by measuring leukotriene D(4)-induced nasal blockage. Additionally, during the immunotherapy, we applied pollen onto the ocular surface to induce the allergic conjunctivitis symptoms.

RESULTS

At the 11th-30th challenges, the nasal immunotherapy showed inhibition or a tendency to inhibit the biphasic nasal blockage although the inhibitions were variable at respective challenges. The development of nasal hyperresponsiveness was markedly suppressed by the immunotherapy. Nevertheless, neither sneezing nor antigen-specific IgE antibody production was substantially influenced by the immunotherapy. On the other hand, the nasal immunotherapy did not affect the induction of allergic conjunctivitis symptoms.

CONCLUSIONS

Local nasal immunotherapy may be clinically useful for allergic nasal blockage associated with nasal hyperresponsiveness. The mechanisms responsible for this effectiveness might not be related to IgE production. Additionally, the effectiveness for nasal tissue was dissociated from that seen for the ocular tissue.

The effect of saline solutions on nasal patency and mucociliary clearance in rhinosinusitis patients

OBJECTIVE

To compare the effect of two saline nasal sprays on nasal patency and mucociliary clearance in patients with rhinosinusitis.

STUDY DESIGN

Randomized double-blind trial.

SUBJECTS AND METHODS

Eighty patients with rhinosinusitis at a tertiary care academic center had nasal patency and mucociliary clearance measured. Each patient was then treated with either physiological or hypertonic saline. Nasal patency and mucociliary clearance measurements were repeated after treatment. Subjective evaluation was also performed.

RESULTS

Both solutions improved saccharine clearance times (P < 0.0001). Buffered physiological saline significantly affected nasal airway patency (P = 0.006). Both solutions improved symptoms of nasal stuffiness (P < 0.0001) and nasal obstruction (P < 0.0001). Buffered hypertonic saline caused increased nasal burning/irritation compared with buffered physiological saline (P < 0.0001).

CONCLUSIONS

Buffered physiological and buffered hypertonic saline nasal sprays both improve mucociliary clearance, which is beneficial for treatment of rhinosinusitis. Additionally, buffered physiological saline improves nasal airway patency, whereas buffered hypertonic saline has no effect. Both solutions provide symptomatic relief, but buffered hypertonic saline is more irritating.

Grass allergen tablet immunotherapy relieves individual seasonal eye and nasal symptoms, including nasal blockage

BACKGROUND

Symptoms of allergic rhinitis have a considerable impact on the quality of life of the sufferer. Sneezing, runny nose, blocked nose and headache are some of the most common symptoms of allergic rhinitis, which affects work, home and social life for many patients. Sublingual immunotherapy has shown to induce a protective immune response and provide sustained symptom prevention for allergic patients. AIMS OF THE TRIAL: The overall aims were to investigate the efficacy and safety of a sublingual grass allergen tablet (Grazax) 75 000 SQ-T; ALK-Abelló A/S, Denmark). Reported here are the effects of Grazax on individual eye and nasal symptoms.

METHODS

The trial was a double-blind placebo-controlled trial including 634 participants with significant rhinoconjunctivitis because of grass pollen. Participants were randomized 1 : 1 to Grazax (a fast dissolving, once daily immunotherapy tablet for home administration) or placebo and received treatment for at least 16 weeks prior to and continuing during the grass pollen season of 2005. Four nasal symptoms and two eye symptoms were scored on a scale from 0 (no symptoms) to 3 (severe symptoms) every day during the entire grass pollen season. Nasal symptoms included runny nose, blocked nose, sneezing and itchy nose; eye symptoms included gritty feeling/red/itchy eyes and watery eyes.

RESULTS

Consistent and highly significant reductions in individual eye and nasal symptoms (from 22 to 44%) were observed following treatment with Grazax as compared with placebo (P < 0.0001).

CONCLUSIONS

Grazax has effects on multiple allergic symptoms, including nasal blockage, and is an effective treatment of rhinoconjunctivitis, thereby reducing the need for topical anti-allergic drugs.

Safety of use, efficacy and degree of parental satisfaction with the nasal aspirator Narhinel in the treatment of nasal congestion in babies

AIM

The aim of this study was to assess the safety, effectiveness and parental compliance with a medical device on the market in Europe for removing excess nasal secretions by aspiration in babies viral infections of the upper respiratory tract.

METHODS

A prospective observational noncomparative cohort study, as part of postmarketing and customer satisfaction surveillance was specifically performed among family paediatricians in Lombardy, Italy. Two hundred and forty patients were admitted from 22 different family pediatricians belonging to the Italian Federation of Paediatricians (Federa-zione Italiana Medici Pediatri, FIMP) in Lombardy. All patients took part in the safety assessment. Two hundred and twelve patients (104 females, 108 males, average age 9.6 months, age range 1.8-27.6 months) also underwent clinical efficacy assessment (28 patients were excluded). Upon admission and at the first outpatient examination (E1), parents were taught by their family pediatrician to clean their babies' noses by nasal aspiration 3 times a day for 7 consecutive days immediately before feeding. At the end of treatment, a second outpatient examination (E2) was carried out at which parents' treatment diaries were collected and the parents answered a satisfaction questionnaire. SAFETY of use was checked using: 1) Italian Health Ministry incident/near incident report forms and 2) treatment diaries where the parents noted any events that had occurred while using the device every day. EFFICACY was assessed by analysing various clinical parameters (anterior and posterior rhinorrhea, oral respiration, noisy nasal respiration, and nasally transmitted chest sounds) measured by the pediatrician at the two examinations (E1 and E2), and the entries in the parents' treatment diary regarding quality of sleep, feeding and respiration, and use of any drugs. Parental satisfaction and compliance were assessed through a questionnaire given to the parents at E2. The device is marketed in 2007 under the name of Narhinel in Italy, Spain and Portugal; Otrisalin in Greece; Prorhinel in France; Rhinomer in the Baltic countries (Lithuania, Latvia, Estonia); Otrivin Baby in Russia and Otri-Baby in Sweden.

SAFETY

no incidents were reported to the Italian Ministry of Health. There were 40 cases of mild side effects such as nose bleed (6), protracted crying (30), restlessness/irritation (2), vomiting and others (2).

EFFICACY

clear improvements were seen in all the clinical parameters assessed at the post-treatment examination (E2) when compared to E1: anterior rhinorrhea (decreased by 74%), posterior rhinorrhea (decreased by 80%), oral respiration (decreased by 78%), noisy respiration (decreased by 73%), and nasally transmitted chest sounds (decreased by 82%). The entries in the treatment diaries also showed progressive improvement in the children's' conditions during the treatment period: peaceful sleep increased by 67%, quality of feeding increased by 36%, respiration improved by 76%, and the administration of drugs decreased by 41%. The P values for each item (clinicians observations and parents' observations) are statistically significative P<0.001, between the day 1 and the day 8. Satisfaction and compliance were excellent: 92% of parents were satisfied (56% very and 42.7 fairly). Seventy-eight percent reported that the device was simple to use, and 86% of parents judged Narhinel to be more effective than other similar devices.

CONCLUSION

Narhinel proved to be a safe, effective and simple to use device. The parents of babies with nasal obstruction caused by upper respiratory infection were extremely satisfied.

Comparison of chemical cautery (AgNo3) and steroid spray against SMD (submucosal diathermy) in the treatment of symptomatic inferior turbinate hypertrophy (ITH)

OBJECTIVE

To compare the efficacy of chemical cautery (AgNo3) and steroid nasal spray against SMD (submucosal diathermy) in the treatment of symptomatic Inferior Turbinate Hypertrophy (ITH).

MATERIALS AND METHODS

Patients attending OPD in the department of ENT &HNS at KMCTH with symptomatic Inferior turbinate Hypertrophy were taken with their approval included for the study. Patients were divided into 2 Groups: in the first Group 25 patients were included and treated with chemical cautery (AgNo3) under Local Anaesthesia (LA), followed by steroid nasal spray for 3 months; in the second Group 25 patients were included and were treated with SMD (submucosal diathermy) under General Anaesthesia (GA).They all had history of use of topical nasal decongestant for different time period. Patients were followed up for 6 months.

RESULTS

In Group 1, 16 patients complain of burning sensation for first week and 8 patients complain of continuous nasal blockage for 6 weeks.1 patient complain about inosmia for 2 weeks. In Group 2, nasal pain was complained by 17 patient for 2 weeks. 3 patients complain of persistent nasal blockage for 4 weeks. 3 patients complain of anosmia for 4 weeks. After completion of 6 months in Group 1, 20 patient has recurrent nasal blockage, whereas in Group 2, 10 patient has recurrent nasal blockage. Besides these, other symptoms noticed during initial phase did not appear.

CONCLUSION

Chemical cautery (AgNo3) and steroid nasal spray is easy to follow, has less complication ,but failure rate is high, whereas SMD is procedure with less failure rate, but has to carried out under GA and has more discomfort postoperatively. For symptomatic inferior turbinate hypertrophy, where topical nasal decongestant has little role SMD is the choice of treatment for longer relief.

The way the wind blows: implications of modeling nasal airflow

Nasal airflow is important for the many physiological functions of the nose, which include the warming and humidifying of inspired air; the filtration of airborne pollutants; and the sense of smell and nasal pungency. Until recently, airflow properties in the nose could only be understood using qualitative in vitro models of humans or in vivo studies in rodents. Recent advances in constructing three-dimensional geometric models of human nasal passages from CT scans, coupled with computational fluid dynamic modeling, has been a valuable tool for quantifying airflow and transport of gases, heat, particles, and aerosols in the human nose. Additionally, these techniques hold significant promise for evaluating and predicting the impact and successful remediation of a variety of clinical conditions on olfaction and nasal patency and setting guidelines for safe levels of exposure to inhaled materials.

Orthodontist-otorhinolaryngologist: an interdisciplinary approach to solve otitis media

AIM

This was to investigate in oral breathing children with an associated atypical pattern of swallowing and otitis media, the effects of rapid maxillary expansion on nasal airway resistance and conductive hearing loss.

MATERIALS AND METHODS

This study examined 24 children (16 males and 8 females) in early mixed dentition period, with an age range of 6-8 years (mean age 7 years), diagnosed with otitis media from the otorhinolaryngology Department of "Tor Vergata" Hospital. The young patients were seen in the Department of Orthodontics, Faculty of Dentistry University of Rome "Tor Vergata". All the subjects had an open mouth breathing pattern with a secondary atypical swallowing mode and a conductive hearing loss resulting from otitis media. The therapeutic approach was to apply a RPE fixed appliance (Butterfly expander).

RESULTS

Follow up showed that after rapid maxillary expansion there was nasal resistance reduction, increased nasal airflow and improvement in conductive hearing loss. CONCLUSION Rapid maxillary expansion has been used for both dental and rhinological purposes in the belief that clinically significant reductions in nasal resistance to airflow and an improvement in conductive hearing loss occur predictably.

Effects of an external nasal dilator strip (ENDS) compared to xylometazolin nasal spray

Nasal blockage is a common complaint in Family Practice. Decongestive nosedrops are frequently employed therapeutic measures. Due to a considerable risk of abuse and side effects, alternatives are wanted. The purpose of this study was to elucidate to what extent ENDS might represent an alternative to decongestive nose sprays (DNS). The effects of DNS (xylometazolin) and ENDS (BreatheRight) on subjective and objective nasal blockage were compared in 89 patients. Main outcome measures were recordings of nasal symptom scores on visual analogue scales (VAS), minimal cross-sectional areas (MCA) and nasal cavity volumes (NCV) as measured by acoustic rhinometry (AR), and peak nasal inspiratory flow (PNIF). ENDS significantly increased the MCA and the NCV in the anterior 0.0-3.0 cm of the nose compared to DNS, but had no effect on MCA from 3.0 to 5.4 cm behind the nostrils. In contrast to DNS, ENDS had no effect on the posterior NCV. ENDS and DNS gave comparable increase in nasal inspiratory flow as measured by PNIF, and in the subject's own experience of nasal obstruction. ENDS may represent an alternative to DNS as a measure against nasal blockage.