Evaluation of nasal passage patency after antigen and histamine challenge in guinea pigs by acoustic rhinometry

Persistent pain after distal claviculectomy (the Mumford procedure) has been attributed to both inadequate and excessive clavicle resection or incomplete supraspinatus outlet decompression with continued impingement. A retrospective review of twenty glenohumeral arthroscopies done in shoulders with a previous Mumford procedure disclosed 15 cases, (75%) of superior glenoid labrum, long head biceps tendon (SLAP) lesions. Most of the distal calvicle resections 13 out of 15 (86%) had been done for "acromioclavicular arthritis." These patients were young, with an average age of 37 years (range 20 to 50) and most, 14 out of 15, had pain attributable to a specific traumatic event. Most had deep pain referable to the bicipital groove with cross chest adduction of the shoulder with the elbow extended and forearm pronated (thumb down). The discomfort improved with the forearm supinated (thumb up). It is concluded the SLAP lesion to be part of the differential diagnosis of acromioclavicular joint disease. In younger patients with a traumatic history, glenohumeral arthroscopy should be used to rule out SLAP pathology and possibly prevent an unnecessary distal clavicle resection.     

Evaluation of nasal patency: comparison of patient and clinician assessments with rhinomanometry

The correlation between the objective measurement of nasal resistance and nasal airflow sensation is usually regarded as poor. The aim of the study was to assess the relation between objective indices of nasal patency, as assessed by the occlusion method (RN) and the Youlten peak nasal inspiratory flow meter (PNIF), with subjective sensations of nasal blockade by either the patient or the clinician in groups of patients with rhinitis, asthma, rhinitis and asthma, nasal septal deformity and ill normal controls. We studied nasal airway patency in 254 subjects (37 women, 217 men), mean age 21 years (range 14-78) by RN and PNIF. Nasal resistance was also measured by the application of Ohm's law for parallel resistors (NRO) by estimating the unilateral resistance separately. Subjective sensation of nasal blockade was assessed either by the patient on a 10-point Borg scale (SUB), or the clinician (CLN) on a 6-point scale (3 for each side of the nose). The latter was done in a controlled fashion with the aid of reference sensations. Adjusting for age, height, smoking status and airway calibre, we found good correlation between RN and CLN (r=0.57, p=10(-4)), whereas the association between RN and SUB was moderate and of borderline significance (r=0.42. p=0.05). By logistic regression analysis, we found that the only independent predictors of abnormal nasal resistance at a cut-off value of 0.30 kPa/l/s were the nasal scores as assessed by the clinician (r-=0.26, odds=2.45). We conclude that PNIF measurement and SUB scores are of limited use as indices of nasal patency, although the latter showed an improved association in comparison to older studies. As there is a necessity for some sort of objective measurement to assess nasal patency, the described clinician evaluation may be clinically useful in place of PNIF, but due to its somewhat subjective nature and its inability to detect milder levels of nasal obstruction it cannot be recommended as an alternative to rhinomanometry.     

Evaluating the sensation of nasal obstruction with acoustic rhinometry and rhinomanometry

The relationships among subjective sensation of nasal obstruction, data of rhinomanometry and acoustic rhinometry between individuals or for each individual were explored. Thirty-nine subjects with nasal obstruction problems were examined using the visual analogue scale, nasal airflow resistance (NAR), nasal minimal cross-sectional area (MCA), and nasal cavity volume (NCV). No significant correlation was found between the sensation of unilateral or bilateral nasal obstruction to NAR, MCA, or NCV. Strong correlations between MCA and NAR, and NCV and NAR were noted in this study. Another 10 healthy volunteers were investigated and correlation was studied on each individual level. Strong correlations within subject were found more commonly in persons with short-term follow-up than with the long-term follow-up group. In the present study, rhinomanometry results were compatible with acoustic rhinometry results. However describing the sensation of nasal patency with only rhinomanometric or acoustic rhinometric measurements seems still inadequate.     

Evaluation of the effects of nasal decongestants with acoustic rhinometry

Acoustic rhinometry is a new method of evaluating the geometrical distributions of the cross-section and volume of the nasal cavity. Its characteristics are that of a nontraumatic procedure requiring minimal time for measurements. Eight males (27-39 years old) without nasal lesions were investigated with acoustic rhinometry before and after unilateral administrations of decongestants. Conventional nasal decongestants such as naphazolin nitrate 0.1% (Privina) and tetrahydrozoline hydrochloride 0.1%, as well as prednisolone 0.02% (Cor-tyzine), were used in solutions diluted 10 or 100 times. As to the method of decongestant application, we adopted the head tilt method, in the successive order of backward, lateral (toward the non-application side) tilt and backward. Each position was maintained for 30 seconds. Minimal cross sectional area of the nasal cavity, and nasal volume were evaluated with acoustic rhinometry. After the application of nasal drops, the minimal cross sectional area increased within 10 minutes, followed by a plateau level for one hour. With the application of nasal decongestants, an I-notch, corresponding to the nasal valve, was unchanged, whereas the C-notch, corresponding to the anterior and of the inferior turbinate, often shifted upwards. Thus, the minimal cross sectional area changed from an I-notch to a C-notch location. The volume of the nasal cavity increased within 10 minutes, and maintained a plateau level for one hour which was similar to that of the minimal cross sectional area. Changes in the ratio of the minimal cross sectional area were greater for less diluted solutions. Changes in the ratio of the nasal cavity were similar to those of the minimal cross sectional area.     

The effect of unilateral nasal patency on the contralateral side

This investigation was designed to verify the possible feed-back mechanism which works to compensate for changes in the nasal volume of one side by the other side. Acoustic rhinometry, with which nasal volume is easily evaluated, was used in this investigation. Acoustic rhinometry was performed at 4 points in time (immediately after, and three, six and nine minutes after, the setting of experimental conditions). This investigation was composed of two studies. In the first study, ten healthy subjects (nine males and one female, 26-49 years of age, mean age 30 years) were evaluated to estimate the effect of decreased unilateral nasal patency upon the other side. In this study, one nasal cavity was occluded with an acryle plug, and the nasal volume of the other side was evaluated by acoustic rhinometry before and after the occlusion. In the second study eight healthy subjects (five males and three females, 24-34 years of age, mean age 29 years) were evaluated to estimate the effect of increased unilateral nasal patency upon the other side. This study covered a period of three days. A small piece of cotton soaked in a vasoconstrictor solution (1/1000 adrenalin or 0.05% naphazolin nitrate) was put in one nasal cavity (the right on the first day, the left on the second day) and the other side was evaluated before and after administration of the solution. On the third day of the control study, a similar piece of cotton soaked in physiological saline solution was put in one nasal cavity, and the other side was evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)     

Detection of the nasal cycle with acoustic rhinometry: techniques and applications

Acoustic rhinometry is an appropriate method for detecting and recording the nasal cycle in normal subjects in terms of the cross-sectional areas and volume of the nasal cavity. In this study, we tried to detect and to define the nasal cycle in normal subjects so that we might develop a reliable and reproducible technique to be used in conjunction with studies on the physiology and pathology of nasal disease. We used normal volunteer adult subjects and performed bilateral acoustic rhinometry measurements every 15 minutes over 4 hours, along with the use of a visual analog scale for assessment of the subjective feeling of congestion (or patency) just before each acoustic rhinometry measurement. Volume and cross-sectional area changes were observed along with subjective patency-score changes in each subject. The subjective feeling of patency was not related to the volume and cross-sectional area changes measured simultaneously. The technique of recording the nasal cycle with acoustic rhinometry in nasal research is presented.     

Normative comparisons for the evaluation of clinical significance.

Normative comparisons are a procedure for evaluating the clinical significance of therapeutic interventions. This procedure, consisting of comparing data on treated individuals with that of normative individuals, is described, and a step-by-step statistical methodology for conducting normative comparisons in the context of treatment–outcome research is presented. Four examples of the methodology are outlined in detail. Attention is paid to potential theoretical, statistical, and methodological challenges to the implementation of normative comparisons, as well as to the advantages of normative comparisons in providing evidence for the beneficial gains of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An evaluation of predicting hearing loss from the acoustic reflex

Three different formulas used in predicting hearing level from acoustic reflex data have been suggested. Acoustic reflex information is also used in predicting slope of hearing loss. Seventy-four normal and hearing-impaired persons were tested, and predictions of level and slope of hearing were compared with pure tone hearing thresholds. The results indicate that the Niemeyer-Sesterhenn and Jerger unweighted formulas yield comparable results and are preferable to the Jerger weighted formula. Predictions of slope of hearing loss are equivocal.     

Aerodynamic and acoustic characteristics of a speaker with turbulent nasal emission: a case report

Aerodynamic and acoustic characteristics were determined from the speech of an adult female with mild mental retardation and severe velopharyngeal inadequacy. The speaker's productions of /s/ were characterized by consistent nasal grimacing and turbulent air emission. Aerodynamic assessment estimated the size of the velopharyngeal orifice to exceed 200 mm2 during plosive production. Nasal cross-sectional area was estimated to be 35 mm2 during quiet breathing. Nasometric evaluation indicated nasalance of 63% associated with the "Zoo" passage. Acoustic analysis of the separately recorded oral and nasal speech signals indicated spectral energies in the region of approximately 2.5 to 7.0 kHz associated with nasal emission during /s/ production. The occurrence of these frequencies suggested an acoustic/perceptual function of the nasal grimace. Pressure-flow evidence also suggested that the nasal grimace, perhaps with lingual assistance, functioned to enhance speech aerodynamics.     

Prediction of nasal obstruction based on clinical examination and acoustic rhinometry

Mandibulofacial dysostosis is readily recognized on the basis of a characteristic facial appearance caused by hard and soft tissue abnormalities of the face, including malformations of the ear. Generally, the abnormality is symmetrical. The psychological and social stigma associated with severe facial deformity makes this syndrome one of the most challenging reconstructive problems presented to the craniomaxillofacial surgeon.     

Computerized evaluation of tumor volume with MRI. Applications to the surveillance of acoustic neurinoma

Routine volume measurement techniques most often produce a rough approximate with poor accuracy for smaller structures. The results are generally improved by increasing the examination time, so that the technique then becomes unusable in daily practice. We propose a semiautomated volume calculation method with MRI, and its application to the surveillance of non-operated acoustic neuromas. This calculation technique, based on a threshold-setting method, allows accurately delineating the contours of the structures to be measured on each section and quickly calculating the total volume. After testing its reliability on control volumes, this techniques has been used to assess the evolutive nature of 16 acoustic neuromas with mild symptoms in 15 patients rejected for surgery. The radiological examinations were 428 days apart in average. On the basis of the obtained results, a theoretic tumor doubling time was calculated, thus allowing comparison between all patients. All controlled neuromas had a theoretic doubling time ranging from 427 to 4,884 days, corresponding to little- or non-evolutive lesions, which may be explained by the series selection bias excluding evolutive tumors referred to surgery. Owing to its rapidity and easy use, this semiautomated volume calculation technique for MRI seems to be very interesting as it allows reliably quantifying a volume variation that is usually estimated approximately.     

Nasal patency and biomarkers in nasal lavage--the significance of air exchange rate and type of ventilation in schools

OBJECTIVES: The aim of the present study was to examine the relationships between the ventilation rate and the type of ventilation system, on the one hand, and objective nasal measures, on the other. METHODS: A standardized investigation, including acoustic rhinometry and nasal lavage, was performed in the school environment. All 279 school personnel working in the main buildings of 12 randomly selected primary schools in the municipality of Uppsala were invited, and 234 (84%) participated. The dimensions of the nasal cavity were measured with acoustic rhinometry. Eosinophil cationic protein (ECP), myeloperoxidase (MPO), lysozyme, and albumin were analyzed in the lavage fluid. The air exchange rate and the room temperature were measured in the classrooms. Relationships between nasal symptoms, nasal patency, and the concentration of biomarkers, on the one hand, and the type of ventilation system, the air exchange rate, and the temperature, on the other, were analyzed by both crude bivariate analysis and multiple regression models, controlling for the type of ventilation, the air exchange rate, room temperature, age, gender, smoking, atopy, and the urban vicinity of the school. RESULTS: A lower degree of nasal patency as measured by acoustic rhinometry and increased levels of ECP and lysozyme in nasal lavage were associated with a lower air exchange rate in the schools. Although mechanically ventilated schools had higher air exchange rates, they were associated with more nasal symptoms, and nasal mucosal swelling and with increased lavage levels of ECP and lysozyme as compared with schools with natural ventilation only. In contrast, 12 subjects working in a school with mechanical displacement ventilation had more patent noses and lower levels of inflammatory markers as compared with the personnel in schools with natural ventilation only. CONCLUSION: Our results indicate that both a low air exchange rate and mechanical ventilation systems based on dilution can be associated with reduced nasal patency and an inflammatory biomarker response of the nasal mucosa among school personnel. The only school with sufficient ventilation according to the current Swedish recommendations had a displacement system and the fewest signs of nasal reactions among the personnel.     

Shunt patency after creation of a transjugular intrahepatic portosystemic shunt: evaluation with Doppler ultrasound

The presence of lactic acidosis in the cerebral spinal fluid of 50 patients with severe head injury was studied. The GCS scores of these patients were < or = 8. The patients were divided into two groups. We treated 25 patients with a dose of 4 to 5 ml/kg of THAM infused intravenously 2 to 3 times for daily administration. Other 25 patients who were not treated with THAM served as a control group. In each case, a ventricular pressure monitoring device was installed. The ICP was the contineously recorded. In addition, laboratory study, including lactate, pH, HCO-3 and BE in CSF was performed. THAM infusion was associated with improved survival, decreased ICP as compared to that in the control group. We believe that THAM treatment may significantly improve the prognosis of presence of lactic acidosis as a result of severe head injury.     

The effect of external nasal dilators as measured by acoustic rhinometry

The effect of a commercially available external nasal dilator, Breathe Right (CNS, Inc., Minneapolis, MN) was measured with acoustic rhinometry in 11 healthy subjects. The cross-sectional areas--1, 2 and 3--and nasal volume--from 0 to 6 cm2--were obtained in four situations: 1) pre-decongested with no dilator, 2) pre-decongested with dilator, 3) post-decongested without dilator, and 4) post-decongested with dilator. The device significantly increased cross-sectional area (CSA) 1, which corresponds to the nasal valve area in both the pre-decongestant and post-decongestant states (p = .0001 for both). The appliance also significantly increased the nasal volume in the pre-decongested state (p = .0002), but was not significant for the post-decongested state (p = .0707). The appliance caused a significantly greater increase in CSA 1 as compared to that achieved with decongestion alone. The results of this study indicate that the Breathe Right nasal dilator may be used ot increase the area of the nasal valve.     

Hysterosalpingographic evaluation of tubal patency in women treated for anovulatory infertility

During therapy of anovulatory infertility, percentage of pregnancies is lower than the ovulation rate. Cause of this phenomenon is connected as well with the inadequate corpus luteum as others anomalies of the genital tract. Hysterosalpingography was performed in 120 infertile women in whom pregnancy did not occur in spite of effective induction of ovulation. Patency of both tubes was observed in 79 percent of patients. Occlusion of right tube has occurred in 8 percent, left tube in 5 percent, and both tubes in 8 percent of women. Authors suggest that laparoscopy should be obligatory as diagnostic and therapeutic procedure in woman with concomitant ovarian failure and abnormal HSG results.     

The effect of leukotriene D4 on the patency of nasal passage in the guinea pig

BACKGROUND: Demodex folliculorum has been reported in rosacea in a number of clinical studies. As the Demodex mite is also present in many healthy individuals, it has been suggested that the mite may have a pathogenic role only when it is present in high densities. Moreover, some authors have proposed that a mite density above 5/cm2 may be a criterion for the diagnosis of inflammatory rosacea. In this study, the possible role of D. folliculorum and the importance of mite density in rosacea were investigated using a skin surface biopsy technique. METHODS: Thirty-eight patients with rosacea and 38 age-and-sex-matched healthy subjects entered the study. With the skin surface biopsy technique, we obtained samples from three facial sites. We then determined the mite positivities, the mean mite counts in both study groups, the mean mite densities at each facial site and in the rosacea subgroups, and the mite densities above 5/cm2. RESULTS: The mean mite count in the rosacea group (6,684) was significantly higher than that in controls (2,868; p < 0.05). The cheek was the most frequently and heavily infested facial region. Ten rosacea patients and five normal subjects had mite densities over 5/cm2; the difference was not statistically significant (p > 0.05). CONCLUSIONS: Rosacea is a disease of multifactorial origin, and individual properties may modify the severity of the inflammatory response to Demodex. We suggest that a certain mite density is not an appropriate criterion in the diagnosis of the disease; nevertheless, large numbers of D. folliculorum may have an important role in the pathogenesis of rosacea, together with other triggering factors.     

Evaluation of angular digits and comparisons with a conventional set.

"A new set of digits designed to make maximum use of easily discriminated forms was studied. Data on confusion errors are given. The legibility of the new digits is not independent of whether they are presented as black ground. At low illumination levels white on black is more legible, the reverse being true at high illumination levels. Comparisons with a conventional set, the Mackworth digits, at different illumination levels, exposure times, and angles of view, show the new set to be significantly more legible under all of these conditions." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An alternative to Marascuilo's "large-sample multiple comparisons" for proportions.

Comments on the original article by L. A. Marascuilo (see record 1966-07190-001) which discusses large-sample multiple comparisons. An alternative to Marascuilo's χ2 analogue of Scheffé's theorem for performing tests on multiple linear contrasts among proportions coming from K independent populations is described. Based on the arcsin transformation of p, the proposed alternative is suitable for small samples and is computationally simpler. Tests of complex contrasts are also exemplified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)