Impact of different fracture types in the pyriform buttress area on nasal airway function

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.

Correlation between olfactory function, trigeminal sensitivity, and nasal anatomy in healthy subjects

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.

Severe deviated nose treatment: importance of preserving the dorsal septal remnant

PURPOSE

To compare the surgical outcomes of modified extracorporeal septoplasty and anterior septal reconstruction for the management of the severe deviated nose.

METHODS

In a prospective cohort study, we selected 86 patients referred for septorhinoplasty to a tertiary center in May 2015-April 2017 with a primary complaint of nasal obstruction and deformity. They had moderate-to-severe septal deviation and severely deviated noses, particularly in the dorsum. Forty-three patients underwent each procedure. The cohorts were age- and sex-matched, and were operated at a similar time point. Surgical outcome was assessed and compared using anthropometric measurement of photographs, acoustic rhinometry, and The Nasal Obstruction Septoplasty Effectiveness questionnaire (including a visual analog scale).

RESULTS

In all patients, MCA1 (initial minimum cross-sectional area) and MCA2 (minimum cross-sectional area after topical decongestion of the nasal mucosa), anthropometric angles (nasolabial, nasofacial and tip projection), and The Nasal Obstruction Septoplasty Effectiveness questionnaire significantly improved after surgery in both groups (p = 0001), with no significant difference in improvement between two groups. However, anthropometric angles and minimal cross-sectional area were better in anterior septal reconstruction group.

CONCLUSION

Both methods are effective in patients with a severely deviated nose for correction of deviation and obstruction. Anterior septal reconstruction is the preferable method in patients with more deviation.

Nasal response in patients with diisocyanate asthma

BACKGROUND

To date, no studies have assessed nasal and bronchial response to diisocyanates during specific inhalation challenges (SIC).

OBJECTIVES

This study was performed to assess nasal response during SIC with diisocyanates (nasal and oral breathing) in patients with suspected occupational asthma due to these agents.

METHODS

Fourteen patients with suspected clinical history of diisocyanate-induced asthma were challenged with diisocynates in a 7m3 chamber. Nasal response testing during challenges was assessed by acoustic rhinometry, peak nasal inspiratory flow (PNIF), and visual analog scale (VAS), alongside bronchial responses.

RESULTS

Eleven patients had a significant asthmatic response to diisocyanates. None reported clear work-related nasal symptoms. In patients with positive bronchial response to diisocyanates, nasal mean minimal cross-sectional area (MCA) decreased by 26.9%, nasal volume at 5 cm decreased by 33.5%, and PNIF decreased by 28.3%, all from baseline. A positive nasal response was elicited in 45%, 54%, and 45% of patients, respectively. A significant increase in VAS was observed in 4 patients. Three patients with negative bronchial response had a negative nasal response.

CONCLUSION

SIC revealed an objective nasal response in around 50% of patients with occupational asthma due to diisocyanates, in spite of the fact that none of them reported work-related nasal symptoms. The clinical significance of this finding is a poor association between nasal symptoms at work and an objective nasal response during positive SIC with diisocyanates.

Coblation nasal septal swell body reduction for treatment of nasal obstruction: a preliminary report

In this paper, we present the results of coblation nasal septal swell body (NSB) reduction for the treatment of nasal obstruction in patients with abnormally thickened NSB. The study design was a retrospective clinical series conducted at a single tertiary medical center. Eight patients underwent coblation NSB reduction. Pre-operative and post-operative nasal functions were evaluated by acoustic rhinometry and subjective symptom scales. We also analyzed pre-operative CT scan images and nasal endoscopic findings. The mean maximal NSB width was 16.4 ± 2.2 mm on pre-operative coronal CT scan images. The mean visual analog scale score for nasal obstruction was decreased from preoperative 7.63 ± 0.99 points to 3.88 ± 0.92 points (postoperative 3 months), 4.16 ± 0.78 points (postoperative 6 months), and 4.63 ± 0.69 points (postoperative 1 year). Six out of the eight patients were satisfied with the clinical outcome at 1 year after the procedure. To the best of our knowledge, coblation NSB reduction has not yet been reported in the medical literature. Our results show that it can be an effective treatment modality for nasal valve narrowing in patients with abnormally thickened NSB.

Nasometry, videofluoroscopy, and the speech pathologist's evaluation and treatment

The speech-language pathologist (SLP) plays an important role in the assessment and management of children with velopharyngeal insufficiency (VPI). The SLP assesses speech sound production and oral nasal resonance and identifies the characteristics of nasal air emission to guide the clinical and surgical management of VPI. Clinical resonance evaluations typically include an oral motor exam, identification of nasal air emission, and analysis of the speech sound repertoire. Additional elements include perceptual assessment of intra-oral air pressure, the degree of hypernasality, and vocal loudness/quality. Clinical speech and resonance evaluations are typically the gold-standard evaluation method until a child reaches 3-4 years of age, when sufficient compliance levels and speech-language abilities allow for participation in instrumental testing. At that time, objective assessment measures are introduced, including nasometry, videofluoroscopy, and/or nasopharyngoscopy. Nasometry is a computer-based tool that quantifies nasal air escape and allows comparison of the score against normative data. Videofluoroscopy is a radiographic tool used to assess the shaping of the velum and closure of the velopharyngeal mechanism during speech production. Evaluation findings guide decision making regarding surgical candidacy and/or the therapeutic management of VPI. Surgery should always be pursued first when an anatomic deficit prevents velopharyngeal closure. Therapy should always be pursued in children who present with velopharyngeal mislearning and/or motor planning issues resulting in VPI. It is not uncommon for children to receive a combination of surgical intervention and speech resonance therapy during their VPI management course. Collaborative decision making between the otorhinolaryngologist and the SLP provides optimal patient care.

Autospreading spring flap technique for reconstruction of the middle vault

BACKGROUND

Reconstruction of the middle third of the nose is crucial and middle vault insufficiency is possible following dorsal reduction in a primary rhinoplasty unless additional surgical measures are taken. The aim of this study was to define a novel suturing technique autospreading spring flap for middle vault reconstruction by suturing only the medial aspect of both upper lateral cartilages with septal quadrangular cartilage in a unique mattress suture and to mimic the natural anatomical configuration of the upper lateral and septal cartilages. This technique is intended to create functionality with aesthetic dorsal lines.

METHODS

Fifteen volunteers with a significant osseocartilaginous dorsal hump underwent open rhinoplasty. The middle vault was reestablished using the ASSF technique that appositions only the medial part of the upper lateral cartilages and suturing it to the dorsal septal cartilage. Appearance of the nose before and after the operation was evaluated by the patients using a visual analog scale. Acoustic rhinometry (AR) was carried out preoperatively and postoperatively to determine nasal valve patency. Preoperative and postoperative symptoms were evaluated and compared using the nasal obstruction symptom evaluation (NOSE) scale.

RESULTS

Patients (mean age=32.2±6.3 years) were followed for a mean of 12.6 months. The preoperative NOSE score was 65.0±13 and the postoperative NOSE score was 7.7±10. Cosmetic evaluation revealed the mean patient preoperative VAS score was 32.5±20 and the postoperative VAS score was 88±9. AR revealed a mean minimal cross-sectional area of 1.56 cm2 that increased to 2.16 cm2 postoperatively. Intranasal total volume increased from 16.3 to 24.8 cm3 postoperatively.

CONCLUSION

The newly defined autospreading spring flap suturing technique is a reliable method for reconstructing the nasal dorsum after humpectomy and for preventing middle vault and nasal valve collapse. The outcome was satisfactory, both aesthetically and functionally, but long-term follow-up is required.

LEVEL OF EVIDENCE IV

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 .

Efficacy of radiofrequency turbinate reduction: evaluation by computed tomography and acoustic rhinometry

BACKGROUND

Radiofrequency ablation (RFA) of the inferior turbinates is a popular surgical intervention that aims to reduce turbinate volume. However, in a few studies, the amount of volume loss was analyzed objectively.

OBJECTIVE

The aim of this study was to investigate the effects of RFA on the inferior turbinate by comparing its volume before and 6 weeks after surgery via computed tomography (CT) and the change in minimal cross-sectional areas (MCAs) via acoustic rhinometry objectively.

METHODS

Eighteen patients who underwent RFA with the diagnosis of isolated bilateral inferior turbinate hypertrophy were enrolled in the study. All patients were evaluated pre- and postoperatively with paranasal CT and acoustic rhinometry quantitatively for the assessment of inferior turbinate volume decrement and nasal cavity volume increment. Also, the subjective relief of obstructive symptoms was assessed with a visual analogue scale.

RESULTS

There were significant reductions in volume for both right and left turbinates in the tomographic evaluation (p  =  .007 and .004, respectively). Acoustic rhinometry revealed nonsignificant increments for both MCA1 and MCA2 values except MCA2 of the right side. We also indicated a statistically significant correlation between the mean volume reduction in CT and improvement in mean MCA2 volume (2 to 5 cm from the nostril) obtained from acoustic rhinometric data in 36 turbinates (r  =  .337, p  =  .044).

CONCLUSION

We showed that the use of RFA was highly effective in both reducing turbinate volume (demonstrated by radiologic findings and rhinometric analysis) and improving obstructive symptoms in patients with an isolated inferior turbinate.

Awake measures of nasal resistance and upper airway resistance on CPAP during sleep

STUDY OBJECTIVES

Since on CPAP, the nose is the primary determinant of upper airway resistance, we assess utility of noninvasive measures of nasal resistance during wakefulness as a predictor of directly assessed upper airway resistance on CPAP during sleep in patients with obstructive sleep apnea/hypopnea syndrome.

METHODS

Patients with complaints of snoring and excessive daytime sleepiness were recruited. 14 subjects underwent daytime evaluations including clinical assessment, subjective questionnaires to assess nasal symptoms and evaluation of nasal resistance with acoustic rhinometry (AR) and active anterior rhinomanometry (RM) in the sitting and supine positions. Patients underwent nocturnal polysomnography on optimal CPAP with measurements of supraglottic pressure to evaluate upper airway resistance. Comparisons were made between nasal resistance using AR and RM during wakefulness, and between AR and RM awake and upper airway resistance during sleep.

RESULTS

Our study shows that measures of awake nasal resistance using AR and RM had little or no correlation to each other in the sitting position, whereas there was significant but weak correlation in the supine position. Upper airway resistance measured while on CPAP during sleep did not show significant relationships to any of the awake measures of nasal resistance (AR or RM).

CONCLUSION

Awake measurements of nasal resistance do not seem to be predictive of upper airway resistance during sleep on CPAP.

Acoustic rhinometry evaluation in allergic rhinitis patients before and after turbinate radiofrequency ablation

OBJECTIVE

To evaluate the outcome of turbinate radiofrequency ablation (RFA) by acoustic rhinometry. MATEIAL AND METHOD: Thirty allergic rhinitis (AR) patients aged 19-62 years old were recruited for this cross sectional prospective study. They all underwent radiofrequency turbinate ablation for chronic nasal obstruction. The acoustic rhinometry evaluation, total nasal symptom score, and nasal obstruction score before and after surgery were analyzed at second, fourth, and eighth week.

RESULTS

The mean age of the 30 AR patients was 39.5 years old and two patients required a second operation. After surgery, the total nasal symptom score (TSS) and the difference mean of cross-section area (CSA) I were improved in 2-4 weeks and 4-8 weeks respectively but total nasal volume was not changed.

CONCLUSION

The authors can use acoustic rhinometry to evaluate short-term result of turbinate radiofrequency ablation. The subjective symptoms were prominently seen in 2-4 weeks after surgery and before the objective result by acoustic rhinometry shown at 4-8 weeks.

[Peak nasal inspiratory flowmeter in evaluation of nasal obstruction]

Nasal obstruction is one of the major reasons for patients with nasal pathology to visit physicians. Since nasal obstruction is a subjective complaint, objective methods may be used for diagnosis in addition to the history and physical examination. At present, acoustic rhinometry and rhinomanometry are the frequently preferred objective diagnostic modality. So far, no single diagnostic method is sufficient by itself for the evaluation of nasal obstruction. Peak nasal inspiratory flowmetry is a physiologic method for the measurement of peak flow in response to deep nasal inspiration. It is very economic, portable and easy to measure compared to other objective methods, and is getting routinely used more and more in European countries. Although its effectivity and wide usage are supported by a number of studies in the literature, it has not been used sufficiently in our country.

[Functional methods for nasal cavity examination in the work of outpatient health facilities]

Three methods for conducting objective functional studies in the ENT cabinet of an outpatient health facility are proposed. The methods may be helpful in the diagnose of acute and chronic disturbances of nasal mucosa.

[Acoustic rhinometry in the evaluation of intranasal aspirin challenge]

Nasal lysine aspirin (Lys-ASA) challenge is an alternative to oral and bronchial challenges in the diagnosis of aspirin (ASA) hypersensitivity. The aim of the study was to evaluate the acoustic rhinometry as an objective method of assessment of Lys-ASA nasal challenge.

MATERIAL AND METHODS

Twenty patients with aspirin induced asthma (ASA-S) and 10 controls (ASA-NS group: 5 patients with allergic rhinitis and 5 healthy subjects) were included. Nasal challenge was performed with placebo (saline) and 14.4 mg of Lys-ASA introduced as aerosol to both nostrils (total dose: 16 mg of acetylsalicylic acid). Measurements of nasal volume bilaterally were performed with the use of acoustic rhinometer before and 1, 2, 4 and 24 hours after the challenge. For further analysis the sum of both nasal cavities volume at the level of 2 to 5 cm from nostrils was used.

RESULTS

Mean total bilateral volume in ASA-S group after placebo was: 7.74, 6.21, 7.11, 7.12, 7.24 cm(3) and 7.24, 5.77, 6.31, 6.27, 6.98 cm(3) after Lys-ASA (before and after 1, 2, 4 and 24 hours, respectively; p = 0,048 and p = 0,02, in 2nd and 4th hour, Lys-ASA v. placebo, Wilcoxon's test). With cut off point of nasal volume decrease by 10% in the 1st hour the sensitivity of the test was 70%, specificity 60%, positive predictive value 77.78% and negative predictive value 50%.

CONCLUSIONS

In conclusion, acoustic rhinometry with measurement of nasal cavities volume changes at 2 to 5 cm from nostrils does not appear to be sufficiently sensitive and specific as a single method for evaluation of studied challenge method.

[Acoustic rhinometry and acoustic pharyngometry in the modeling of human upper respiratory tract]

Acoustic rhinometry and acoustic pharyngometry (AR/P) can quantify the upper airway condition of air draft by drawing a graph plotting the nasal cavity and pharyngeal cavity cross-sectional area. Based on CT medical images of volunteers, a 3-dimensional finite element model of upper respiratory tract was reconstructed by using the method of surface rendering. The veracity of the model was valued by comparison of the relevant areas between the model and the AR/P graph; and an AR/P was used to help improve and enrich the model. The combination of AR/ P and CT is useful in studying the medicine problem related to the anatomical structure of upper respiratory tract.

Influence of acoustic rhinometry, rhinoresistometry and endoscopic sinus surgery on voice quality

Twenty-one patients with documented chronic paranasal sinusitis, being in need of endoscopic endonasal sinus surgery were subjected to voice analysis. Tape recordings of sustained vowels were performed both pre- and postoperatively. All voice samples were examined with a system of sound spectrographic analysis. Patients with nasal obstruction, detected by active anterior rhinomanometry were excluded from further studies. Analysis of pre- and postoperative spectograms was focused on changes in center frequency as well as on a bandwidth of the initial four formants. The variations in specific differences of the formant frequencies and amplitudes were also estimated. The different subgroups of patients revealed significant alterations in the parameters studied. The vowels [a:] and [i:] showed inverse changes in measured values. Evaluation of the vowel [u:], on the other hand, was restricted due to artifactual scattering of individual values. In general, the bandwidths diminished postoperatively and energy peaks of formants increased proportinally. In 6 out of 21 patients, one third of the cases examined, after surgery the patients detected perceptual changes in speech. Based on our data obtained it is recommended to inform all patients as well as voice professionals about the possible speech alterations of the speech after endonasal sinus surgery.

Acoustic rhinometry evaluation of radiofrequency ablation of the turbinates

OBJECTIVES

The objective of this study is to determine if acoustic rhinometry (AR) can predict the outcome of radiofrequency ablation (RFA) of the inferior turbinates.

PATIENTS AND METHODS

Preoperative AR measurements of 19 subjects undergoing inferior turbinate RFA were analyzed before and after decongestant. The average total percentage change in cross sectional area (CSA) 1 and in total volume was calculated for each. Both the physician and patient assessed treatment success subjectively. If available, postoperative data was analyzed.

RESULTS

The congestion factor of CSA1 was 72.76+/-75.58 before surgery and 42.32+/-27.79 after surgery (p>0.05). There were no significant differences in CSA1, CSA2, CSA3 and total volume after the radiofrequency ablation surgery. All patients were satisfied with the results of the surgery. Physician assessment was 'satisfactory' for 18 patients and 'partially satisfactory' for one.

CONCLUSION

Nineteen patients had AR and RFA of the turbinate. Since all patients were satisfied with the operation, no conclusion can be drawn regarding the predictive value of AR. Although there was a trend to a larger volume postoperatively, none of the measured parameters were significantly different.

[Correlation between four-phase rhinomanometry and acoustic rhinometry]

OBJECTIVE

To obtain the normal values of four-phase rhinomanometry specific parameters of normal adult Chinese and analyze the correlation between four-phase rhinomanometry and acoustic rhinometry measurement results.

METHODS

Eighty-five normal adults were recruited. The HRR2 four-phase rhinomanometry was used to acquire the effective resistances in inspiration, expiration and total breathing process (Reffin, Reffex, Refft) and vertex resistance in the process of inspiration and expiration (Vrin and Vrex). The Eccovision acoustic rhinometry was used to measure the minimum cross-sectional area (MCA) and the nasal volume of 0-5 cm nasal cavity (V5).

RESULTS

Reffin (x(-) +/- s) was (1.28 +/- 1.02) Pa/(cm(3).s) for male, (1.55 +/- 1.03) Pa/(cm(3).s) for female; Reflex (x(-) +/- s) was (1.43 +/- 1.07) Pa/(cm(3).s) for male, (1.75 +/- 1.14) Pa/(cm(3).s) for female; Refft (x(-) +/- s) was (1.34 +/- 0.99) Pa/(cm(3).s) for male, (1.62 +/- 1.03) Pa/(cm(3).s) for female; Vrin (x(-) +/- s) was (1.31 +/- 1.03) Pa/(cm(3).s) for male; (1.60 +/- 1.03) Pa/(cm(3).s) for female, Vrex (x(-) +/- s) was (1.46 +/- 1.04) Pa/(cm(3).s) for male, (1.82 +/- 1.17) Pa/(cm(3).s) for female. No statistically significant difference was found between men and women (r = 0.661, -0.397, 0.127, 0.649, -0.684, P > 0.05, respectively). There was no significant correlation between Reffin, Reflex, Refft, Vrin, Vrex and age, height, weight, head circumference, body surface area, body mass index (P > 0.05, respectively). However, there was significant correlation between Reffin, Reflex, Refft, Vrin, Vrex and MCA, V5 (P < 0.05, respectively).

CONCLUSIONS

The results of four-phase rhinomanometry show significant correlation to acoustic rhinometry.

[The use of acoustic rhinometry for the assessment of adenoid hypertrophy: a clinical study]

OBJECTIVE

In our study, we employed the method of acoustic rhinometry for preoperative and postoperative (after adenoidectomy) evaluation of 25 children between 3-12 years of age who suffered from adenoid hypertrophy.

MATERIAL AND METHOD

This method showed with accuracy the changes of the dimensions of the nasal cavity following the operation. The parameters which were evaluated prior and subsequent to the operation were the diameter of the nasal cavity in the area of the adenoids and the total volume of the nasal passage.

RESULTS

As shown by acoustic rhinometry, the change of the cross-sectional area of the nasopharynx was 59.43% on average. Similarly, the augmentation of the volume of the nasal cavity was 46.39 % on average. The change of the dimensions of the nasal cavity paralleled the alteration of clinical symptoms.

CONCLUSIONS

In conclusion, we can assume that acoustic rhinometry can show with accuracy the dimensions of the nasal cavity, especially at the front part. It is also very useful in the assessment of the efficiency of the treatment in cases of nasal obstruction and especially of adenoid hypertrophy.

[Application of acoustic rhinometry in assessment of preschool children nasal cavity volume]

OBJECTIVE

Acoustic rhinometry (AR) was performed to standardize the measurement techniques, result interpretation and reference values of nasal cavity volume (NV) in preschool children.

METHOD

(1) Nasal cavity models were used to test the correlations between NV, minimal cross-sectional area (MCA), and nasal resistance. (2) There were 97 four-year-old and 137 five-year-old children underwent AR test.

RESULT

(1) Model tests showed that resist the nce were better correlated with the change of volume than the MCA. (2) The average bilateral NV in preschool children was (2.03 +/- 0.4) ml. No significant gender and age difference were observed (P>0.05).

CONCLUSION

Volume measurement appears more sensitive and reliable than the MCA in assessing nasal patency. The AR result interpretation and normative NV values in preschool children are introduced.

Changes in nasal cavity dimensions in children and adults by gender and age

OBJECTIVE

The aim of the study was to establish the dynamics of changes in the intranasal spaces of children and adults by gender and age.

MATERIALS AND METHODS

Each side of the nasal cavity was evaluated separately in 366 healthy subjects 9 to 74 years old. The following acoustic rhinometry parameters were analyzed: 1) I-C, distance between the isthmus nasi (I) and the head of the inferior turbinate (C); 2) CA-I, cross-sectional area at the isthmus nasi; 3) CA-C, at the head of the inferior turbinate; and 4) CA-F, the highest point on the rhinometric curve between points I and C.

RESULTS

Before age 11 years, the intranasal spaces were slightly larger in girls than in boys. After age 11 years the nasal parameters were larger in boys than in girls. The growth rates before age 17 years were as follows: I-C: 0.073 cm/yr, 0.135 cm/yr, CA-F: 0.055 cm2/yr, 0.133 cm2/yr (P < .00001), and CA-C: 0.010 cm2/yr, 0.034 cm2/yr (P < .02) in girls and boys, respectively. In subjects older than 16 years, the mean values of I-C were 1.707 cm, 1.934 cm (P < .0001), and of CA-C, 0.493 cm2, 0.611 cm2 (P < .0001) in women and men, respectively, and changed slightly over the year.

CONCLUSIONS

The parameters of intranasal spaces depend on age and gender. The dynamics of the changes is greater in boys than in girls and usually the growth is completed by the age of 16. After this age, nasal cavities are bigger in men than in women.

Acoustic rhinometry in preschool children

OBJECTIVE

The aim of this study was to measure nasal cavity volume (NV) in preschool children with the use of acoustic rhinometry (AR).

STUDY DESIGN AND SETTING

Prospective study: 1) Nasal cavity models were used to test the correlations between NV, minimal cross-sectional area (MCA), and nasal resistance; 2) 97 four-year-olds (48 boys, 49 girls) and 137 five-year-olds (68 boys, 69 girls) children were selected to undergo AR.

RESULTS

1. Model tests showed that the resistance correlated better with the changes of the volume than the MCA. 2. The average bilateral NV in preschool children was 2.03 +/- 0.4 mL. There was no significant difference in either gender (P = 0.2) or age (P = 0.197).

CONCLUSIONS

Volume measurement appears more sensitive and reliable than the MCA in assessing nasal patency. AR was easily performed on preschool children, and normative NV values were achieved.

SIGNIFICANCE

The results and conclusions can be used to establish a standardized technique for AR measurement and interpretation.

Influence of long-term airflow deprivation on the dimensions of the nasal cavity: a study of laryngectomy patients using acoustic rhinometry

We conducted a prospective study to investigate the long-term effect of nasal airflow deprivation on nasal dimensions after total laryngectomy. We evaluated 48 patients who had an initial diagnosis of laryngeal cancer; 6 were disqualified during follow-up, leaving us with data on 42 patients for our final analysis. Acoustic rhinometry was used to measure the minimum cross-sectional area (MCSA) and the volume of the nasal cavity on both the left and right sides before and after laryngectomy. In addition, patients underwent endoscopic nasal examinations and answered questionnaires pre- and postoperatively. At both the 1- and 2-year follow-ups, the mean MCSAs and the mean nasal volumes of both the left and right nostrils were significantly smaller than the preoperative values (p < 0.001). The endoscopic examinations revealed only a mild deterioration in the appearance of the nasal mucosa over the long term. Questionnaire responses obtained at the 2-year follow-up visit revealed that all 42 evaluable patients were experiencing a moderate degree of nasal obstruction while inhaling through the nose. Our data indicate that the dimensions of the nasal cavity appear to be substantially and permanently reduced after total laryngectomy. Our study had two important advantages over other similar studies. First, because ours was a prospective study, we were able to obtain preoperative data and use it to make postoperative comparisons of the same patients rather than using healthy controls as comparators. Second, we used acoustic rhinometry, while most other studies relied on anterior rhinoscopy or rhinomanometry, which are inferior methods ofmaking the evaluations in question. We believe that our findings represent a substantial contribution to our knowledge of the physiologic and functional alterations of the nasal cavity that occur as a result of a complete cessation of nasal airflow.

Expiratory nasal sound analysis as a new method for evaluation of nasal obstruction in patients with nasal septal deviation: comparison of expiratory nasal sounds from both deviated and normal nasal cavity

BACKGROUND

The reliability of nasal obstruction measurements could be improved, and several new techniques are being developed. Our objective was to investigate the use of a new software program, Odiosoft-Rhino, in the assessment of nasal obstruction via analysis of the sounds of nasal expiration.

METHODS

We compared the nasal symptom scores and Odiosoft-Rhino and acoustic rhinometry test results for 61 patients with known nasal septal deviation.

RESULTS

We found a significant difference, and a correlation, between Odiosoft-Rhino results at 2000-4000 Hz and 4000-6000 Hz intervals, and the minimal cross-sectional area 2.2 cm from the nostril, in the right nasal cavity in patients with right-sided deviations. Similar results were observed for the left nasal cavity in patients with left-sided deviations.

CONCLUSIONS

The Odiosoft-Rhino software test is noninvasive, requires minimal cooperation and experience, and provides results that can be saved as digital data. Additionally, data from the Odiosoft-Rhino test are strongly correlated with acoustic rhinometry results and visual analogue scores of nasal obstruction. It seems that sound intensity within the 2000-4000 Hz and 4000-6000 Hz intervals is more sensitive than other sound intensity intervals. Thus, we speculate that Odiosoft-Rhino testing could be used as a new diagnostic method in order to evaluate nasal airflow in clinical practice.

A validation study of nasal spectroscopy: Rhinolux

This study is the first to validate the Rhinolux against acoustic rhinometry in detecting nasal mucosal swelling when changing body position from sitting to supine. The Rhinolux (Rhios GmbH, Germany) is a new device using a light-absorption technique called nasal spectroscopy and to measure changes in nasal blood volume as a sign of nasal mucosal swelling in real time. The relationship between the changes in nasal blood volume measured with the Rhinolux and changes in nasal mucosal swelling has however, not previously been validated objectively. To evaluate this relationship we compared the Rhinolux to acoustic rhinometry following the change in body position from sitting to supine. The study population consisted of 20 healthy subjects (7 women, 13 men, mean age 34.7 +/- 9.3 years). The Rhinolux was applied sitting in the upright position followed by 5 min in the supine position. Acoustic rhinometry was measured sitting in the upright position and after 5 min in the supine position. In seven subjects the measurements were repeated on three different days to assess the repeatability. The mean change from baseline in minimal cross sectional area DeltaMCA measured with acoustic rhinometry was -0.12(+/-0.19) cm2 (right + left side), P = 0.013 but DeltaE (change in light extinction from baseline) measured with the Rhinolux was unchanged 0.02(+/-0.18) optical densities (OD), P = 0.56. There was no correlation between DeltaE and DeltaMCA r = 0.028, P = 0.9. The mean DeltaE result from repeated measurements on different days was 0.05(+/-0.08) OD, P = 0.09 and the DeltaMCA was -0.1(+/-0.11) cm2, P = 0.02. This study showed that the changes in nasal blood volume measured with the Rhinolux did not reflect changes in nasal mucosal swelling measured with acoustic rhinometry when changing body position from sitting to supine. The results indicate that the utility of the Rhinolux in assessing nasal mucosal reactions has to be evaluated further.

Comparison of Optical Rhinometry and Active Anterior Rhinomanometry Using Nasal Provocation Testing

OBJECTIVE

To investigate whether there is a correlation between active anterior rhinomanometry (RMM) and optical rhinometry (ORM) data in the detection of changes in nasal congestion.

DESIGN

In 70 subjects both ORM and RMM were performed. Changes in nasal congestion were induced by nasal provocation with histamine, allergens, solvent, and xylometazoline hydrochloride, 0.1%. Using visual analog scales, subjects rated the degree of nasal congestion and how comfortable each of the 2 measures was. In total, 136 measurements were evaluated.

SUBJECTS

Seventy subjects were included in the study. All had a normal otorhinolaryngologic status with no acute or chronic infections.

INTERVENTIONS

Nasal provocation tests with allergens, histamine, control solution, or xylometazoline were performed.

MAIN OUTCOME MEASURES

Congestion or decongestion of the nasal mucosa was measured via nasal resistance (RMM), changes in light absorption of the nasal tissue (ORM), and visual analog scale.

RESULTS

When comparing the relative change in light extinction in ORM with nasal airflow in RMM, we found correlation coefficients up to r = -0.69. Results from RMM were correlated with the subjects' ratings of nasal congestion (r = -0.63). In comparison, the correlation coefficient between these ratings and ORM was r = 0.84. In addition, ORM was rated to be more comfortable than RMM.

CONCLUSIONS

The subjects' ratings of nasal congestion correlated to a higher degree with the results from ORM than with those from RMM. In addition, ORM was rated as more comfortable than RMM. Overall, ORM appeared to be a valid technique for the assessment of changes in nasal congestion.

[Acoustic rhinometry in the diagnosis of children with obstructive sleep apnea-hypopnea syndrome]

OBJECTIVE

To explore the role of acoustic rhinometry in the diagnosis of children with obstructive sleep apnea-hypopnea syndrome (OSAHS).

METHOD

Thirty-six patients with OSAHS were measured with acoustic rhinometry before and 1 month after adenoidectomy. Twenty patients with adenoidectomy were measured before and after operation, the changes in volume recorded by acoustic rhinometry were compared with the adenoid volume obtained by the method of "drain off the water".

RESULT

The volume of nasopharynx of adenoid removal patients was significantly bigger than that of before operation. The adenoid volume of 20 patients obtained by the method of "drain off the water" was bigger than the calculated changes in nasopharynx volume recorded by acoustic rhinometry, however, they were found to be significantly interrelated.

CONCLUSION

Acoustic rhinometry is a better method to calculate the size of adenoid in children with OSAHS and it could become a routine examination before adenoidectomy.

Study of nasal cycles in children by acoustic rhinometry

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Nasal dilator strip therapy for chronic sleep-maintenance insomnia and symptoms of sleep-disordered breathing: a randomized controlled trial

To test the impact of nasal dilator strips (NDSs) on insomnia severity, sleep-disordered breathing (SDB) symptoms, sleep quality, and quality of life. Randomized, controlled trial of 4 weeks' duration. Community sample of nonobese, adults with a primary sleep complaint of chronic sleep-maintenance insomnia and mild to moderate SDB symptoms (treatment, n=42; control, n=38). Primary outcomes were four validated scales: Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes of Sleep Questionnaire (FOSQ), and Quality of Life Enjoyment and Satisfaction Questionnaire (QLESQ). Secondary outcomes were sleep indices, nonrestorative sleep ratings, and SDB symptoms, assessed retrospectively and prospectively. Both groups received nonspecific education about sleep disorders. Treatment group also received a brief SDB education and nasal strip instructions. At 4 weeks' follow-up, the treatment group demonstrated significant (p=.0001), large improvements in ISI and PSQI (mean Cohen's d=1.18) and significant (p<.02), medium-sized improvements in FOSQ and QLESQ (mean d=0.51) compared to small, nonsignificant changes in control group (Cohen's d range=0.36-0.09). Treatment group change scores among all four primary variables were significantly correlated (mean r=0.50, p=0.01). Secondary prospective and retrospective outcomes showed medium to large improvements in treatment compared to controls for sleep indices (mean d=0.52 vs 0.28), nonrestorative sleep ratings (mean d=0.69 vs 0.11), and sleep breathing symptoms (mean d=0.47 vs 0.09). Significance was obtained for prospective sleep indices (p=0.01), retrospective, and prospective nonrestorative sleep ratings (p=0.003, <0.05), and retrospective sleep breathing symptoms (p=0.03). SDB education and NDSs demonstrated therapeutic efficacy in a select sample of insomnia patients with SDB symptoms. Replication of results requires placebo controls and objectively confirmed SDB cases.

[The clinical application of Ephedrine Test in acoustic rhinometry]

OBJECTIVE

To discuss the clinical application of Ephedrine Test in acoustic rhinometry, we studied the method of quantitative evaluation for nasal mucosal state and discriminated the objective parameters between simple rhinitis and hypertrophic rhinitis.

METHOD

Nasal cavity of volunteers from normal, simple and hypertrophic rhinitis patients were tested by acoustic rhinometry, the Nasal Airway Resistance (NAR), Nasal Cavity Volume (NCV), Nasal Minimal Cross-section Area (NMCA) and Distance of the minimal Cross-sectional Area from the Nostril (DCAN), their difference value and variational rate of pre or post Ephedrine Test were analyzed and compared.

RESULT

The paired-samples data of pre-post Nasal Ephedrine Test showed that NAR, NCV, NMCA and DCAN had extremely significant difference (P < 0.01). NCV and NMCA had increased, NAR had reduced and DCAN had "shifted forward" after Ephedrine Test. All the parameters had extremely difference (P < 0.01) among multi-group at pre or post Ephedrine Test. Only NCV had significant difference before Ephedrine Test (P < 0.05). However, after Ephedrine Test, all of the parameters (include difference value and variational rate) had significant difference (P < 0.05 or P < 0.01) between simple and hypertrophic rhinitis patients. Compared with volunteers of normal nasal cavity: all of the parameters (include difference value and variational rate) had significant difference (P < 0.05 or P < 0.01) in simple rhinitis patients, but some of the parameters of their difference and variational rate had not significant in hypertrophic rhinitis patients.

CONCLUSION

The acoustic rhinometry test can objectively estimate the state of nasal mucosal and get more information combine with Ephedrine Test. It can expand the clinical application of acoustic rhinometry and is worth while recommending.

Effect of sleeping position on nasal patency in newborns

Sleeping posture has been implicated in the pathophysiology of sudden infant death syndrome. The effect of supine and lateral sleeping positions on nasal patency was investigated using acoustic rhinometry in 11 healthy newborns. The implications of the findings in sudden infant death syndrome are discussed.

[Documentation of endonasal changes in blood volume using optical rhinometry]

BACKGROUND

In optical rhinometry, the nose is transilluminated with light and the light absorption by the nasal tissue is measured continuously. Using this method, a real time documentation of changes in nasal blood volume is possible. The method has been evaluated using the nasal allergen provocation test. In this study, the ability of optical rhinometry to detect changes in the nasal blood volume due to various posture changes is examined.

METHODS

Optical rhinometry was tested on ten healthy probands, with several examinations being performed on each.

RESULTS

By bending the neck, lying down or stopping breathing, stronger light extinction was found. Standing up quickly caused a sudden but short decrease in light extinction. A small amount of exercise, such as making a fist several times, decreased light extinction. Harder exercise on an ergometer led to a stronger decrease in light extinction. In the Valsalva maneuver, an increase in light extinction for the duration of the maneuver was observed. Changes in breathing through the nose or mouth or counting from 1 to 100 had no influence.

CONCLUSIONS

Using the new method of optical rhinometry, it is possible to detect changes in endonasal blood volume caused by changes of intrathoracic pressure, changes in posture or physical exercise, non-invasively and in real time. This technique can therefore be used for further research on the regulation of the nasal blood flow.

Changes in urinary LTE4 and nasal functions following nasal provocation test with ASA in ASA-tolerant and -intolerant asthmatics

Aspirin-induced asthma (AIA) is a syndrome characterized by intolerance to aspirin (ASA), nasal polyps and bronchial asthma, the metabolic shift of arachidonic acid towards the lipoxygenase pathway and hyper-production of cysteinyl-leukotrienes (cys-LTs) being the current pathogenetic hypothesis. The research for both sensitive indicators and safe diagnostic tests is still attracting. Aim of the study was to measure changes in urinary LTE4 excretion and in nasal function (Resistance-Req, and Volume-Vol, assessed by acoustic rhinomanometry (AR)) following a nasal provocation test (NPT) with ASA:LTE4 measurements have been never previously used to our knowledge for assessing nasal responsiveness to ASA.

METHODS

After written consent, 118 mild-to-moderate asthmatics (48 males, mean age 41.8 years+/-11.9SD, range 25-70 years; basal FEV1=80.1% pred.+/-5.8SD) underwent NPT by nasal instillation of ASA (total maximal dose 25 mg). Spirometry, acoustic rhinomanometry (AR; TM Hood Lab., USA) and urinary LTE4 (pg/mg creatinine; Cayman Chemical, MI, USA) were measured in baseline and 2h after the ASA challenge.

STATISTICS

t-Test between means+/-sd, assuming P<0.05, and linear regression between all variables considered.

RESULTS

In 67 ASA-intolerant asthmatics, FEV1 did not change significantly following NPT (81.7% pred.+/-5.1SD in baseline, 80.5% pred.+/-4.1 after NPT, P=ns) even in the presence of a significant decrease of Vol (11.3 cm3+/-4.1SD in baseline, 5.9 cm3+/-4.2SD after NPT, P=0.003), a substantial increase of Req (0.88 cmH2O/l/min+/-0.11SD in baseline, 2.41 cmH2O/l/min+/-0.77 after NPT, P=0.002), and urinary LTE4 excretion (433.0 pg/mg+/-361.7 in bsln, 858.0 pg/mg+/-471.6 90 min after NPT with L-SA, P=0.04). NPT did not affect FEV1 also in 51 ASA-tolerant asthmatics (89.7% pred.+/-6.9 in bsln, 86.6% pred.+/-4.3 after NPT), but in these subjects also Vol (from 14.9 cm3+/-4.2sd to 14.6 cm3+/-3.8SD), Req (0.38 cmH2O/l/min+/-0.14 in bsln, 0.26 cmH2O/l/min+/-0.2 after NPT, P=ns), and urinary LTE4 (333.1 pg/mg+/-202.8 in bsln, 318.0 pg/mg+/-198.7 after NPT, P=ns) remained unchanged. Only pre-NPT LTE4 values proved related to pre-NPT Req and Vol values (r=0.54 and r=-0.71, respectively), but not to patients' age (R=-0.05), and basal FEV1 (r=0.01).

CONCLUSIONS

In ASA-intolerant patients, NPT with lysine-aspirin (L-ASA) only induces a substantial nasal obstruction and enhances urinary LTE4 excretion in the absence of any significant bronchial obstruction. Nasal ASA challenge proves a test absolutely safe for asthma patients suspected of ASA intolerance. Measures of urinary LTE4 excretion contributed significantly to magnify the discriminant and the diagnostic value of NPT.

Rapid maxillary expansion and surgically assisted rapid maxillary expansion effects on nasal volume

The purpose of this study was to compare the effects of rapid maxillary expansion (RME) and surgically assisted rapid maxillary expansion (SARME) on nasal volume using acoustic rhinometric methods. Two groups of subjects were used in the study. Group 1 consisted of 10 subjects (mean age 12.30 +/- 0.82 years) who were treated with RME, and group 2 consisted of 10 subjects (mean age 18.70 +/- 2.54 years) who were treated by SARME. In both groups, all cases had a maxillary width deficiency with bilateral crossbites. Nasal volume records were taken by the same otorhinolaryngologist with an AR device. AR recordings were performed for each patient with and without the use of a decongestant. The first record was taken before expansion, and the second record was taken at the end of retention. The data for both groups were evaluated using Wilcoxon signed rank test and Mann-Whitney U-test. The nasal volume showed a significant increase in both the RME and the SARME groups (P < .05). The measurement with the use of decongestant was similar to that without use of decongestant on the both groups (P < .05), but the different increments in nasal volume between the RME and the SARME groups were not statistically significant. Although the mean ages between the RME and the SARME groups were different, the increase in nasal volume was similar in both groups.

The effect of allergen provocation on the nasal cycle estimated by acoustic rhinometry

CONCLUSION

The overall duration and reciprocity of the nasal cycle were not changed after allergen provocation. The duration of immediate response was 38 min, but the amplitude of the nasal cycle was increased significantly after allergen provocation.

OBJECTIVE

Nasal airflow is asymmetrical and subjected to spontaneous reciprocal changes which are referred to as the nasal cycle. Limited information is available on how this is affected by allergens. The purpose of this study was to evaluate the effects of allergen provocation on the nasal cycle.

MATERIALS AND METHODS

This study was performed on 25 patients with allergic rhinitis and 25 subjects in a control group with no symptoms of allergic rhinitis. Acoustic rhinometry was used to test patients before and after allergen provocation. The patients underwent acoustic rhinometry at 15-min intervals for evaluation of nasal cycle and 3-min intervals for immediate response.

RESULTS

With the allergic patients, 21 of the 25 patients (84.0%) showed a nasal cycle and they still had a nasal cycle after the allergen provocation. In the study on the changes in the immediate responses, the average recovery time was 38 min and the reduction rate of the non-patent side was higher than that of the patent side. Also, the average period of the nasal cycle was 153 min before the allergen provocation and 140 min on average after the allergen provocation; there were no statistical differences. The amplitude of each nasal cycle increased after allergen provocation and the difference had statistical meaning.

Acoustic rhinometry: accuracy and ability to detect changes in passage area at different locations in the nasal cavity

OBJECTIVES

To evaluate the accuracy of acoustic rhinometry (AR) measurements, and to assess how well AR detects obstructions of various sizes at specific sites in the nasal cavity, we created a cast model from an adult cadaver nasal cavity.

METHODS

The actual cross-sectional areas of the cast model nasal passage were determined by computed tomography and compared with the corresponding areas measured by AR. To assess how nasal obstruction affects the AR results, we placed small wax spheres of different diameters at specific sites in the model (nasal valve, head of the inferior turbinate, head of the middle turbinate, middle of the middle turbinate, choana, and nasopharynx).

RESULTS

The AR-derived cross-sectional areas in the first 6.5 cm of the cast model nasal cavity were very close to the corresponding areas calculated from computed tomographic sections perpendicular to the presumed acoustic axis. However, AR overestimated the passage areas at locations posterior to the 6.5-cm point. Acoustic rhinometry gave an accurate indication of the passage area of the nasal valve and its distance from the nostril. The nasal valve and the choana were indicated by significant dips on the AR area-distance curve, whereas the curve was smooth throughout the region that included the head of the inferior turbinate, the head of the middle turbinate, the middle of the middle turbinate, and the nasopharynx. In other words, AR did not discretely identify these latter sites. Acoustic rhinometry detected the different-sized inserts (obstructions) more accurately at the nasal valve than at sites posterior to this location.

CONCLUSIONS

The results of the study show that AR is a valuable method for assessing the anterior nasal cavity. This technique is sensitive for detecting changes in passage area at the nasal valve region; however, the sensitivity is lower at sites posterior to this. The findings suggest that when there is substantial narrowing of the nasal valve, AR will not identify an obstruction at any location posterior to the nasal valve. In such situations, AR measurements beyond the abnormal nasal valve may easily lead to misinterpretation of the patient's nasal anatomy or condition.

[The influence of tree pollen on the adenoid size in children with periodic (seasonal) allergic rhinitis]

INTRODUCTION

Allergic sensitization of the airways occurs not only in the mucosa of the shock organ, but also in the lymphatic stations draining these structures. The lymphatic structure closest to the nasal mucosa in humans is the adenoid. Many researches show that in part of children allergic rhinitis can be a risk factor for adenoid hypertrophy.

MATERIAL AND METHODS

We used acoustic rhinometry and endoscopy to evaluate the influence of the birch pollination on the adenoid size in 67 children between 5 and 12 years old. Four separate groups of children were examined. The study group consisted of 28 children hypersensitive to tree pollen with seasonal allergic rhinitis (interview, positive skin-prick test results, presence of sIgE in the serum and positive nasal provocation test with birch pollen allergens). The first control group consisted of 14 atopic children hypersensitive to motherwort pollen. The second control group consisted of 15 non-atopic children. The third control group consisted of 10 children hypersensitive to tree pollen, they have got antiallergic treatment (topical nasal steroid and antihistaminic) a week before birch pollination. In all of the groups the adenoid size was examined before, during and after birch pollination. In the study group we examined the influence of specific nasal provocation test on the adenoid size too.

RESULTS

In most children from the study group (71.4%) we observed the significant increase of adenoid size in endoscopic examination and decrease of nasopharyngeal cavity volume in acoustics rhinometry (92.9%) during the birch pollination. The changes returned after pollination period in most children (90%). In the first and the second control group there were almost no changes observed (p > 0.05). The medical treatment used in the third control group avoided the increase of adenoid size during birch pollination season. In the study group there was no statistically significant correlation between the changes in nasopharyngeal volume during the pollination period and the results of nasal provocation test (r = 0.18).

CONCLUSION

The result of our study suggests that in children with seasonal allergic rhinitis the exposure on the allergenic factor can influence the adenoid size. Properly administered nasal glucocorticoid together with antihistaminic in standard doses can probably avoid this effect.

Acoustic rhinometric measurements in children undergoing rapid maxillary expansion

OBJECTIVE

To evaluate geometric changes of nasal cavities in children undergoing rapid maxillary expansion and to assess the effect of this procedure on nasal airway size by means of acoustic rhinometry.

METHOD

We recruited 14 mouth-breather children (mean age 8.2 years) presenting constricted maxillary arches and scheduled for rapid maxillary expansion in the orthodontics department of our hospital. Clinical history did not reveal any allergic diseases and ENT examination was completely normal with a well-aligned nasal septum. Nasal measurements were obtained using acoustic rhinometry, which was performed before the expansion treatment and after 1-year follow-up. A postero-anterior radiograph of the skull was also performed in all patients for cephalometric analysis before and 3 months after the treatment.

RESULTS

We observed a satisfactory increment in the transverse dimension of the maxilla in all patients but one who manifested a relapse after 4 months from the treatment and required a second procedure. Similarly, acoustic rhinometric measurements and cephalometric tracings showed a statistically significant increase respectively in decongested total nasal volumes (p=0.047) and in binasal cavity width (p=0.001). However, only eight children switched their respiration from oral to nasal breathing mode.

CONCLUSIONS

Rapid maxillary expansion is an effective method for increasing the width of narrow maxillary vault and it is also associated with a significant increment in nasal volumes and in the transverse diameter of the maxilla. With regard to breathing posture, the role of this procedure still remains debatable. To date this is the first study aimed at analysing the effects of rapid maxillary expansion on nasal dimensions by means of acoustic rhinometry.

[The influence of medical treatment of the perennial allergic rhinitis on the adenoid size in children]

BACKGROUND

Allergic sensitization of the airways occurs not only in the mucosa of the shock organ, but also in the lymphatic stations draining these structures. The lymphatic structure closest to the nasal mucosa in humans is the adenoid. Many researches show that in part of children allergic rhinitis can be a risk factor for adenoid hypertrophy.

MATERIAL AND METHODS

We examined changes in clinical symptoms score, and used acoustic rhinometry and endoscopy to evaluate the influence of three months anti-allergic treatment (topical nasal steroid and antihistaminic) on the adenoid size in children with adenoid hypertrophy. Three separate groups of children were examined. The study group consisted of 31 children with adenoid hypertrophy and perennial allergic rhinitis (interview, positive skin-prick test results, presence of sIgE in the serum and positive nasal provocation test with dust allergens). The first control group consisted of 23 atopic children hypersensitive to dust allergens (positive skin-prick test results, presence of sIgE in the serum) with adenoid hypertrophy but without signs of perennial allergic rhinitis and with negative nasal provocation test. This group was not treated. The second control group consisted of 20 non-allergic children with adenoid hypertrophy. The children were treated similar to the children from the study group.

RESULTS

In children from the study group we observed the most significant decrease of clinical symptoms and endoscopic adenoid size and increase of nasopharyngeal cavity in acoustics rhinometry after the treatment. In the first control group there were almost no changes and in the second control group, the improvement concern only 25% of children. The medical treatment had however no statistical important influence on the tympanometry results in all the examined groups.

CONCLUSION

Properly administered nasal glucocorticoid spray together with antihistaminic in standard doses can significantly reduce adenoidal hypertrophy and considerably eliminate airway obstructive symptoms in children with allergic rhinitis. Likely only in this children the antiallergic treatment can be a useful alternative to surgery.

Consensus report on acoustic rhinometry and rhinomanometry

With respect to acoustic rhinometry, new elements concern the problems related to the interpretation of the minimal cross-sectional area, and the presentation of a protocol for a multinational study, which aims to define a normal nose. Also, the previously issued recommendations for standardisation for technical specifications and standard operating procedures are briefly reviewed. For rhinomanometry, new insights into the field of fluid dynamics are highlighted, as well as their repercussion on more recent graphical representations for active anterior rhinomanometry such as four phases rhinomanometry and resistometry. For acoustic rhinometry as well as rhinomanometry, a more stringent standardisation of decongestive procedures is suggested.

Nasal wall compliance in vasomotor rhinitis

Nasal compliance is a measure related to the blood volume in the nasal mucosa. The objective of this study was to better understand the vascular response in vasomotor rhinitis by measuring nasal cross-sectional area and nasal compliance before and after mucosal decongestion in 10 patients with vasomotor rhinitis compared with 10 healthy subjects. Nasal compliance was inferred by measuring nasal area by acoustic rhinometry at pressures ranging from atmospheric pressure to a negative pressure of -10 cmH2O. Mucosal decongestion was obtained with one puff per nostril of 0.05% oxymetazoline. At atmospheric pressure, nasal cross-sectional areas were similar in the vasomotor rhinitis group and the healthy subject group. Mucosal decongestion did not induce any decrease of nasal compliance in patients with vasomotor rhinitis in contrast with healthy subjects. Our results support the hypothesis, already proposed, of an autonomic dysfunction based on a paradoxical response of the nasal mucosa in vasomotor rhinitis. Moreover, the clearly different behavior between healthy subjects and vasomotor rhinitis subjects suggests that nasal compliance measurement may therefore represent a potential line of research to develop a diagnostic tool for vasomotor rhinitis, which remains a diagnosis of exclusion.

Inspiratory and fixed nasal valve collapse: clinical and rhinometric assessment

BACKGROUND

Acoustic rhinometry (AR) has been used to assess nasal valve obstruction. Standard AR measurement of the cross-sectional area (CSA) of the nasal valve is done in the apneic phase, whereas collapse often occurs on inspiration. We used the ratio of the CSA obtained during active inspiration and during apnea to compute a more meaningful method of diagnosing nasal valve collapse.

METHODS

AR was performed in 40 patients without nasal valve obstruction and 47 patients diagnosed with nasal valve obstruction. Patients with septal deflection or anterior inferior turbinate hypertrophy were excluded. The internal and external nasal valve area was observed during apnea and on active inspiration. AR measurement of the CSA of both nasal valves was performed during the apneic phase and during active inspiration and the CSA (inspiratory)/CSA (apneic) ratio was calculated.

RESULTS

The CSA (inspiratory)/CSA (apneic) ratio was > or = 1 in normal patients and in patients with fixed nasal valve collapse. The ratio was <1 in patients with inspiratory collapse. Data from history, physical examination, and dual-mode AR testing successfully differentiated patients into (1) normal valves, (2) fixed valve collapse, and (3) inspiratory valve collapse. A large number of patients with collapse had both internal and external valve obstruction and a large number also had a combination of inspiratory and fixed collapse.

CONCLUSION

Dual-mode AR testing is an effective tool in more precisely identifying nasal valve obstruction and is the first objective test shown to be highly diagnostic of inspiratory nasal valve collapse.

Endonasal geometry changes in elderly people: acoustic rhinometry measurements

BACKGROUND

Skeletal nasal changes in elderly people have been extensively investigated, but data on variation of the endonasal architecture with age do not exist. We evaluated endonasal parameters in an elderly population as compared with those in a young group.

METHODS

Acoustic rhinometry measurements were performed on 165 participants in the age range of 20-93 years. The rhinograms provided the endonasal volume from the nostril entrance to a 7.0 cm cephalic point (V0-7) and the minimal cross-sectional areas (MCA1 and MCA2). Statistical analysis was performed by Pearson correlation and one-way analysis of variance, using age as a continuous or categorical variable.

RESULTS

There was no statistical difference in gender distribution within each age group. The results obtained for the left and right nostrils were similar. Endonasal volume V0-7 and the narrowing areas MCA1 and MCA2 significantly increase with age, except for men over 80 years in which a relative decrease was observed.

CONCLUSION

Acoustic rhinometry examination of the endonasal architecture in a healthy young and elderly population demonstrated a gradual increase of endonasal volumes and minimal cross-sectional areas with age.

Acoustic rhinometry in the objective evaluation of childhood septoplasties

OBJECTIVE

The aim of this study was to evaluate results of septoplasty during childhood objectively with the help of acoustic rhinometry (AR).

METHODS

Twenty-six children aged between 6 and 15 years who had septoplasty for nasal septal deviation during year 2002 were included in this study. Twenty-one patients who had no nasal septal deformities and nasal symptoms were included as control group. The study group was divided into two subgroups: Group 1 with only anterior septal deviation (8 patients) and Group 2 with both anterior and posterior septal deviations (18 patients). Acoustic rhinometry was performed one day preoperatively and 4 months postoperatively. Preoperative and postoperative minimal cross-sectional areas (MCSA), total volumes (TV), MCSA and TVs on pathologic side were compared. Acoustic rhinometry was performed 2 months interval in control group. Patients and parents were asked about the effectiveness of surgery subjectively.

RESULTS

There was a statistical significance between preoperative and postoperative MCSAs of Groups 2 and 1+2. There was no statistical significance for Group 1. There was statistical significance between control group and Groups 1, 2, 1+2 in terms of MCSAs, MCSAs on pathologic side and TVs on pathologic side. There was statistical significance in terms of preoperative and postoperative MCSAs, TVs, MCSAs and TVs on pathologic side in patients with subjective well being postoperatively. There was no statistical significance in patients without any subjective postoperative improvement in terms of preoperative and postoperative MCSAs and MCSAs on pathologic side while TVs and TVs on pathologic side were statistically significant.

CONCLUSIONS

Surgery is successful in children. But it should be restricted to only the pathologic area and should be conservative. Acoustic rhinometry is an objective method for the evaluation of nasal septal deformities and surgical success. Further studies are needed to see long-term success of septal surgery in children.

Acoustic rhinometry in humans: accuracy of nasal passage area estimates, and ability to quantify paranasal sinus volume and ostium size

A comprehensive study that compared acoustic rhinometry (AR) data to computed tomography (CT) data was performed to evaluate the accuracy of AR measurements in estimating nasal passage area and to assess its ability of quantifying paranasal sinus volume and ostium size in live humans. Twenty nasal passages of 10 healthy adults were examined by using AR and CT. Actual cross-sectional areas of the nasal cavity, sinus ostia sizes, and maxillary and frontal sinus volumes were determined from CT sections perpendicular to the curved acoustic axis of the nasal passage. Nasal cavity volume (from nostril to choana) calculated from the AR-derived area-distance curve was compared with that from the CT-derived area-distance curve. AR measurements were also done on pipe models that featured a side branch (Helmholtz resonator of constant volume but two different neck diameters) simulating a paranasal sinus. In the anterior nasal cavity, there was good agreement between the cross-sectional areas determined by AR and CT. However, posterior to the sinus ostia, AR overestimated cross-sectional area. The difference between AR nasal volume and CT nasal volume was much smaller than the combined volume of the maxillary and frontal sinuses. The results suggest that AR measurements of the healthy adult nasal cavity are reasonably accurate to the level of the paranasal sinus ostia. Beyond this point, AR overestimates cross-sectional area and provides no quantitative data for sinus volume or ostium size. The effects of paranasal sinuses and acoustic resonances in the nasal cavity are not accounted for in the present AR algorithms.

[The results of extra diagnostic methods in patients allergic to dust mites treated by specific immunotherapy]

BACKGROUND

In addition to allergen elimination, specific immunotherapy remains the only recognized causal treatment of allergic diseases. Nevertheless, there are no commonly accepted parameters and tests allowing for the evaluation and prediction of its efficacy. The aim of this study was to evaluate the results of readily available supplemental allergy tests and to attempt to associate those findings with the outcome of therapy for desensitized patients.

METHODS

This study was conducted in a group of 22 patients receiving specific immunotherapy for perennial allergic rhinitis to dust mites. The results of skin prick tests, sIgE levels, nasal eosinophilia levels as well as specific nasal provocation tests measured by acoustic rhinometry were compared prior to desensitization and two years following the therapy. The control group comprised 17 allergic patients treated without immunotherapy.

RESULTS

Apart from the confirmation of immunotherapy efficacy, a positive correlation between its results and the results of the nasal provocation test (correlation coefficient r = 0.85) were demonstrated in this study. No relationship was however found between the obtained result and the results of skin prick tests (r = 0.57) and serum sIgE levels (r = 0.59) or nasal eosinophilia (r = 0.57). The result of acoustic rhinometry corresponded well with clinical manifestations observed in nasal provocation tests.

CONCLUSIONS

The specific nasal provocation test is an easy method that may be used for monitoring the efficacy of immunotherapy, and acoustic rhinometry is a good method for measuring its results.

Nasal obstruction and sleep-disordered breathing: a study using acoustic rhinometry

BACKGROUND

The relationship between nasal airway function and sleep-disordered breathing (SDB) remains unclear. Although correction of nasal obstruction can significantly improve nighttime breathing in some patients, nasal obstruction may not play a role in all cases of SDB. An effective method of stratifying these patients is needed. Acoustic rhinometry (AR) is a reliable, noninvasive method of measuring the dimensions of the nasal airway.

METHODS

In 44 patients, we performed acoustic rhinometric measurements of nasal airway cross-sectional area, followed by hospital-based polysomnography and nasal continuous positive airway pressure (nCPAP) level titration. We compared anatomic nasal obstruction to perceived nasal obstruction, as well as respiratory distress index and nCPAP titration level, using the Pearson correlation and multiple linear regression analysis within body mass index groups.

RESULTS

Perceived nasal obstruction correlated significantly with objective anatomic obstruction as measured by AR (r = 0.45, p < 0.01). For certain subgroup analyses in patients with a body mass index below 25, AR measurements correlated significantly with both nCPAP titration pressure (r = 0.85, p < 0.01) and respiratory distress index (r = 0.67, p = 0,03).

CONCLUSION

Nasal airway function may be a significant component of SDB in some patients, perhaps playing a larger role in patients who are not overweight. The best responders to nasal surgery for SDB may be nonoverweight patients with nasal obstruction. AR along with nasal examination may be helpful in the evaluation and treatment of the SDB patient.

Specific nasal provocation tests in patients hypersensitive to mould allergens

BACKGROUND

In the case of allergies to outdoor mould spores and plant pollen allergens, which are often concomitant, doubts may arise as to the role of mould allergens in inducing specific clinical manifestations. Establishing their significance is crucial for qualifying the patient for specific immunotherapy. This information also helps to reduce the percentage of therapeutic failures.

MATERIAL/METHODS

The study population comprised 31 patients with seasonal allergic rhinitis who were allergic to both plant pollen allergens and mould spores. In each patient we performed a skin prick test, sIgE level determination, and a specific nasal provocation test using mould allergens, according to standard allergological diagnostic procedure, and the results were objectified using acoustic rhinometry.

RESULTS

Positive NPT results were obtained in 22 patients. The positive results were more frequent in persons allergic to Cladosporium herbarum (92.3%) than in those allergic to Alternaria alternata (55.5%); these differences were statistically significant (p = 0.039). No differences were found between the two subgroups in terms of the sIgE levels (p = 0.13). In the study group as a whole, a high correlation between the results of acoustic rhinometry and the intensity of clinical manifestations was observed after administration of the NPT (correlation coefficient of 0.9). The correlation between the sIgE levels and the results of the skin prick tests and the NPT was much lower (0.48 and 0.66, respectively).

CONCLUSIONS

The specific nasal provocation test is a safe and easy diagnostic modality, and acoustic rhinometry provides a good method of measuring it.

Acoustic rhinometry and its uses in rhinology and diagnosis of nasal obstruction

Acoustic rhinometry is a tool that can aid in the assessment of nasal obstruction. The test is noninvasive, reliable, convenient, and easy to perform. Common clinical and practical uses of acoustic rhinometry for the rhinologic surgeon include assessment of"mixed" nasal blockage, documentation of nasal alar collapse, and preoperative planning for reduction rhinoplasty. Acoustic rhinometry can also be used to document the positive effect of surgery on nasal airway obstruction.

[Optical Rhinometry. Continuous, direct measurement of swelling of the nasal mucosa with allergen provocation. Real-time monitoring of the nasal provocation test using optical rhinometry]

BACKGROUND

Various methods exist for measuring swelling of the nasal mucosa. This is necessary in order to make the nasal provocation test objective. With the new method of optical rhinometry, it is possible to measure swelling of the mucosa directly from outside of the nose in real-time. The measurement is carried out with monochromatic near-infrared light of different wavelengths, the intensity change of which are recorded and displayed during the swelling.

MATERIALS AND METHODS

With the help of a specially developed prototype of an optical rhinometer, we carried out measurements on 15 subjects having positive nasal provocation tests with histamine and allergens, negative provocation tests with allergens in non-allergics, negative provocation tests with control solution, and decongestion with xylometazoline.

RESULTS

We found significant differences between positive and negative provocation tests ( P<0.01). Decongestion was different from all other groups ( P<0.01). Nasal congestion subjectively reported by the subject always correlated with the optical rhinometry findings.

CONCLUSION

The objective assessment of nasal swelling using optical rhinometry seems reliable. The course of the endonasal swelling can thereby be monitored in real-time. The measurement is largely independent of the cooperation of the patient. The swelling is measured directly and not indirectly via air flow resistance.