Characterization of nasal airflow

Nasal airflow and trans-nasal pressure difference was measured by active anterior rhinomanometry in 24 subjects. An analysis was undertaken to determine the 'goodness of fit' of two models used to characterize nasal airflow, one model by Broms and the other by O'Neill and Tolley. A judicious approach to choice of fit criterion led to the conclusion that the latter model provided a more accurate characterization of nasal airflow. Additionally this model may be useful to quantify alar valve stiffness. A portable computerized system incorporating the use of the model has been developed and is currently in use.     

Effects of Breathe Right on snoring: a polysomnographic study

The nasal vestibule is a major site of resistance to airflow in healthy subjects. A high nasal resistance may increase snoring. Activation of the alae nasi and alar retraction reduce resistance to airflow and improve ventilation. The Breathe Right (BR) device has been proposed to reduce or eliminate snoring by improving nasal breathing. We assessed the efficacy of BR on sleep quality and snoring during 2 full-night polysomnographies, the first without and the second with BR. Ten non-apnoeic snorers were studied. Snoring was present during 22-98% of total sleep time during the control night. Ear-nose-throat examination disclosed a nasal valve anomaly in five subjects, objectivated by anterior and posterior rhinomanometry. Quality of sleep and snoring were not influenced by BR, even when different sleep stages were analysed separately. No difference in snoring index was found between snorers with or without nasal valve anomaly. We conclude that BR is ineffective in relieving snoring in non-apnoeic snorers.     

Rhinomanometric analysis of vestibular stenoses of the nose

The distinction of the resistance in the nasal vestibule (valve area) and cavity (turbinates, septum deviations, crest, spine) is important for the settlement of the operative course in nasally impaired patients. Collapsed valves, free floating polyps, spines, and other turbulence producing factors in the nose are characterized in active anterior rhinomanometry (AAR) as decreased ?percentage of flow increase? (deltaV150-300). This parameter allows no distinction between underlying anatomical factors. Other patients have increased resistance in the vestibule area that is static; rhinomanometry is unable to document these instances. The aim of this study was to investigate the influence of the vestibule dilator on nasal flow, and to determine if the diagnostic findings of AAR could be improved by the data obtained from the measurement with the dilator. METHODS: To prove the influence of the vestibule dilator on the nasal airflow, we determined typical rhinomanometric parameters in 20 nasally healthy and 40 nasally impaired persons with and without the dilator. For the measurements, we used a computer-aided rhinomanometer (Rhinodat K, Heinemann Medizintechnik, D-Hamburg). Tubular vestibule dilators were produced from silicon guide rails of tracheal tubes (Rüschelit, Fa. Rüsch, D-Kernen) and individually adapted to the patient's vestibule, ensuring dilation between the external ostium and the nasal isthmus. RESULTS: Active interior rhinomanometry revealed a significant effect of the vestibule dilator in repeated application (mean variation 3%). Total nasal flow showed a mean increase of about 48% with the dilator. In AAR, we found 5 patients with decreased deltaV150-300 below 25%. To demonstrate the presence of vestibule stenosis, we compared the changes of deltaV150-300 is AAR with and without dilator. In rhinomanometry with the dilator, deltaV150-300 of patients with vestibule stenosis showed physiological values. In these patients, mean difference of deltaV150-300 between conventional rhinomanometry and rhinomanometry with a vestibule dilator was significantly higher (47,2%) than observed in all other persons (3,8%). The static vestibule resistance in the total nasal resistance was obtained by calculating the difference between nasal flows with and without the dilator. CONCLUSIONS; Stenosis in the nasal vestibule could be proved and measured via active anterior rhinomanometry using a vestibule dilator. Data obtained from this method are helpful in functional assessment of nasally impaired patients, particularly to answer the question of whether the vestibule requires surgical treatment.     

Magnetic resonance imaging of muscle in amyotrophic lateral sclerosis

In the present study we were interested to determine whether the maximum unilateral nasal airflow associated with the nasal cycle (Fmax physiol) was equivalent to the maximum unilateral nasal airflow that could be achieved by the application of a topical nasal decongestant (Fmax pharmacol). Eight healthy subjects (three male and five female, aged between 19-28 years) were recruited for this study. Unilateral nasal airflow was measured using posterior rhinomanometry at the inspiratory reference pressure of 75 Pa by alternately occluding each nostril with surgical tape. The study was run over 2 consecutive days. On day one, measurements of unilateral nasal airflow were performed every hour for 8 h in each subject and Fmax physiol was found to be 265 cm3/sec (147) (median and interquartile range). On day 2 the median unilateral nasal airflow before application of the nasal decongestant was 171 cm3/sec (140) and this increased to 251 cm3/sec (127) (p = 0.046) at 15 min and to 278 cm3/sec (134) (p = 0.005) at 45 min after application of the decongestant (Fmax pharmacol). A paired comparison of Fmax physiol and Fmax pharmacol showed that these nasal airflow measurements were not significantly different (p > 0.999). The results show that there was no difference between the maximum physiological decongestion produced during the course of the nasal cycle and that produced pharmacologically by a topical nasal decongestant. This indicates that the point of maximal sympathetic vasoconstrictor tone occurring during the nasal cycle causes a constriction of the nasal venous sinuses that is equal to the constrictor response that can be achieved by applying a topical sympathomimetic medication.     

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 results of delayed rhinoplasty in cleft lip and palate patients. Functional and aesthetic implications and factors that affect successful nasal repair

Patients born with cleft lip and palate (CLP) present with a variety of nasal deformities. These are either congenital or iatrogenic. Our aim was to establish a correlation between aesthetic and functional nasal impairments in patients with CLP whose nasal reconstruction had been delayed. Fifty-four randomly selected patients with CLP deformities, all of whom had delayed nasal repairs were evaluated objectively, aesthetically in three planes, and functionally for symptoms of nasal obstruction, chronic maxillary sinusitis, and olfactory disturbances. Aesthetically the patients were analysed from 1:1 life-size full face, profile, and submental-vertex photographs, and full skull cephalograms. Nasal patency was assessed by rhinomanometry. The presence of chronic maxillary sinusitis and olfactory disturbances were deduced from the history. The degree of nasal dismorphism correlated with the severity of nasal functional impairments. Delayed nasal repairs in patients with CLP did not produce satisfactory aesthetic or functional results, probably because growth was retarded and midfacial development was disturbed at the time of delayed rhinoplasty and resulted in asymmetry. In CLP the nose should be repaired during the early primary cheilorhinoplasty, as this is essential for the restoration of a normally functioning and aesthetically pleasing nose.     

Anamnestic and polygraphic parameters in obstructive sleep apnea syndrome patients with reduced nasal respiration during the day in comparison with obstructive sleep apnea patients with normal nasal respiration

Nasal obstruction is a predictive factor for snoring and may contribute to the development of an obstructive sleep apnea syndrome (OSAS). The aim of this study was to further evaluate the impact of nasal obstruction in OSAS. Therefore, we investigated 2 groups of OSAS-patients, matched pairs concerning gender, age, and BMI: OSAS-patients with nasal obstruction (N, n = 28), total nasal airflow < 500 ccm/s (referred to 150 pa pressure of difference or unilateral nasal resistance > 1 pa/ccm/s), and 28 OSAS-patients without nasal obstruction (control-group K, total nasal airflow > 700 ccm/s [referred to 150 pa pressure of difference or unilateral nasal resistance > 1 pa/ccm/s]). We performed anterior rhinomanometry, lung-function testing, cardio-respiratory polygraphy, and patients answered a standardized questionnaire. We found the following significant differences: 1) N complained more often (n = 17) about dyspnea at night than K (n = 7, p < 0.05, Chi2-test). 2) N had a higher apnea index (20.4 +/- 19.0/h) than K (9.6 +/- 10.0/h, p < 0.05, Student's t-test). There were, however, no significant differences concerning lung function, number of nocturnal hypopneas, nocturnal SaO2 and heart rate. Our results underline the importance of nasal ventilation in the pathogenesis of OSAS. At least in moderate cases of OSAS a therapy of nasal obstruction might be of success in order to abolish nCPAP-therapy or might reduce nasal problems during nCPAP-therapy and thus ameliorate patient's therapy compliance.     

The role of outfracture in correcting post-rhinoplasty nasal obstruction

Post-rhinoplasty nasal osbtruction is often related to narrowing in the region of the nasal valve. Correction of this obstruction can include inferior turbinectomy, septoplasty spreader grafts and nasal valvuloplasty. The authors have seen cases of severe valve stenosis related to infracture after osteotomy which did not respond to any of the aforementioned procedures. These patients were treated with revision osteotomy with outfracture. We discuss patient selection and surgical technique for revision osteotomy with outfracture as well as a cadaver dissection demonstrating the effects of infracture and outfracture on valve area. The clinical results, based on patient satisfaction and pre- and postoperative photographs, are presented. Revision osteotomy with outfracture should be included in the surgeon's armamentarium for the treatment of post-rhinoplasty nasal obstruction.     

Influence of atipamezole on effects of midsacral subarachnoidally administered detomidine in mares

BACKGROUND: The reliable interpretation of the nasal provocation test in allergy diagnosis requires objective and measurable monitoring parameters for clinical practice. The clinical usefulness of the nasal provocation test has been limited by scanty knowledge of the specificity and sensitivity of the test and a lack of reference values. OBJECTIVE: To test and compare three objective monitoring parameters of a nasal provocation test in occupational allergic rhinitis. To evaluate the magnitude of the nasonasal effects in a unilateral allergen challenge. METHODS: The monitoring parameters of the nasal reaction were derived from the minimum cross-sectional area on acoustic rhinometry, the nasal resistance on active anterior rhinomanometry and the amount of nasal secretion measured at 15 min intervals for 60 min. Twenty-three bovine-allergic dairy and beef cattle farmers and 19 exposed, non-allergic control subjects were challenged first with a control solution and then with the cow allergen. RESULTS: All the three monitoring parameters showed high specificity and sensitivity in finding allergic and non-allergic subjects. The secretion parameter was found to be slightly superior to the acoustic rhinometry and rhinomanometry parameters. The side difference in the nasal response between the allergen-challenged and the contralateral diluent-challenged cavity was significant for all the parameters among the allergic subjects. The contralateral secretion amount was 1/3 of the ipsilateral secretion, indicating the magnitude of the contralateral nasonasal reflex. A nasonasal reflex was also noted in the nasal patency monitoring. The coefficient of variation was significantly lower for the acoustic rhinometry than for the rhinomanometry (P=0.0001). The optimal threshold values for a positive test were a secretion amount of 100 mg, a 15% decrease in the minimum cross-sectional area and a 50% increase in the resistance for the observation period of 30 min and correspondingly 210 mg, 30% and 100% for 60 min. CONCLUSION: The low-pressure aspiration of the nasal secretion from the anterior part of the nasal cavity was found to be a reliable and practical monitoring parameter to be used together with acoustic rhinometry or rhinomanometry in the nasal provocation test for clinical purposes. Although significant nasonasal effects took place in the unilateral allergen challenge, the response was more prominent in the allergen-challenged than in the contralateral diluent-challenged nasal cavity in most allergic subjects.     

Rhinoresistometry versus rhinomanometry--an evaluation

Allergic nasal hyperreactivity is a common problem and many patients suffer from daily symptoms. Rhinomanometry is so far the only well established clinical method for objective assessment of nasal patency, although several expressions of nasal patency have been reported. Universal standardisation was achieved in 1983 in Brussels by Clement et al. [1], but many specialists are looking for a system giving more information on the functional aspects of the nose. A new development arising from active anterior rhinomanometry is rhinoresistometry. We tested this equipment, which has been introduced with new software for calculation and graphic presentation. 24 adult volunteers with proven allergy to grass pollen were examined immediately after long-term challenge in the Vienna Challenge Chamber [3] and 15 minutes after decongestion by application of 5% ephedrine solution. The similarity and differences between rhinomanometry and rhinoresistometry, as well as the value of the additional parameters are pointed out. Our data indicate that rhinoresistometry is a rapid, reproducible and non-invasive technique, which gives extended information in comparison to classic rhinomanometry. The results correlate very well with the findings obtained by the standard method. This pilot study demonstrates the benefit of the new parameters.     

Evaluation of acoustic rhinometry and posterior rhinomanometry as tools for inhalation challenge studies

Objective measures of upper respiratory function are needed to understand the effects of inhaled toxicants on the nasal passages. Acoustic rhinometry (AR) is a simple new technique that determines nasal volume by measuring the cross-sectional area of the upper airway as a function of the distance along the nasal passage. This study compares acoustic rhinometry with the more traditional posterior rhinomanometry (NAR) and correlates these objective measures with the symptom of nasal congestion. Healthy young adults (n = 29) were studied on 4 days, each separated by at least 1 wk, in a climate-controlled environmental chamber for 6 h, with exposure to clean air or sidestream tobacco smoke (SS) (2 h, 1, 5, and 15 ppm CO). The coefficient of variation for single measurements was 8-15% (AR) and 4% (NAR); for across-day measurements it was 15-25% (AR) and 13-15% (NAR); and for between days it was 19-27% AR and 17-21% (NAR). These coefficients were similar in subjects with a history of environmental tobacco smoke sensitivity (ETS-S) and those with no history of ETS sensitivity (ETS-NS). At baseline, the perception of unilateral nasal congestion was significantly correlated with unilateral nasal dimensions or nasal resistance; the symptom of baseline bilateral nasal congestion (estimated for both nasal passages simultaneously) correlated less well with objective measures of nasal patency. Under challenge conditions (SS at 1-15 ppm CO), there were typically significant correlations between changes in unilateral congestion and both unilateral rhinomanometry and acoustic rhinometry, but correlations of bilateral congestion and measurable dimensions were much lower. ETS-S and ETS-NS subjects differed in correlations between bilateral subjective and objective measures: ETS-S subjects showed significant correlation between baseline congestion and NAR; in contrast, ETS-NS subjects showed significant correlation between baseline congestion and acoustic rhinometry. These results indicate that NAR and AR are complementary tests for use in inhalation challenge studies and have different correlations with nasal congestion under baseline and challenge conditions.     

Comparison of CapiFlow and frame by frame analysis for the assessment of capillary red blood cell velocity

The aim of this study was to describe the aerodynamics related to velopharyngeal function during speech in bilabial, dental, and velar articulatory positions in Swedish speakers. Repeated syllables including voiceless stop consonants and sentences including combinations of voiceless stops and nasal consonants were uttered by 11 normal adults. Oropharyngeal pressure was assessed with a miniature pressure transducer positioned transnasally, in combination with measurement of nasal pressure and nasal airflow. The corresponding velopharyngeal opening area was estimated. The results suggest that the velopharyngeal function during stop consonants is similar in different articulatory positions. Differences in oropharyngeal pressure and nasal airflow between bilabial versus dental and velar positions were found, presumably due to differences in volume and compliance of the vocal tract.     

Changes in nasal tip projection and rotation after septorhinoplasty: a cephalometric analysis

PURPOSE: This prospective study reports on changes in nasal tip projection and nasal tip rotation before and after septorhinoplasty analyzed cephalometrically. PATIENTS AND METHODS: Forty patients undergoing primary septorhinoplasty were studied prospectively. Lateral cephalometric radiographs taken in the natural head position were obtained before and 6 to 45 months (mean, 17.1) after surgery. In 10 patients, serial radiographs were taken at 6 and 12 months, and in seven patients they were taken at 12 and 24 months after surgery. Nasal tip projection (NTP) was defined as the distance between articulare (Ar) and pronasion (PRN). Nasal tip rotation (NTR) was defined as the change in the angle (N-Ar-PRN) after surgery. A surgical goal to increase, decrease, or maintain NTP and NTR was assigned to each patient before surgery. RESULTS: NTP changed in the desired direction in 16 of 40 patients (40%). NTR changed in the desired direction in 25 of 40 patients (63%). In the patients studied serially, NTP decreased an average 0.7 mm between 6 and 12 months (P = .018), and 0.6 mm between 12 and 24 months (P = .071). CONCLUSIONS: Decreased NTP and NTR were the most easily achieved surgical objectives. Maintaining or increasing NTP is less predictable. Typically, there is a progressive loss of NTP after surgery independent of the surgical goal. Cephalometric analysis is a useful tool to measure changes in NTP and NTR after septorhinoplasty.     

Uterine inflammation as a noxious visceral stimulus: behavioral characterization in the rat

The aim of this study was to investigate the efficacy of pseudoephedrine as a nasal decongestant. Patients with nasal congestion associated with common cold received two doses of medication separated by 4 hours, either 60 mg pseudoephedrine (n = 20), or placebo (n = 20). Unilateral nasal airflow was measured over a 7-hour period to record the spontaneous changes in nasal airflow associated with the nasal cycle. Minimum (F MIN) and maximum (F MAX) unilateral nasal airflows were defined as the minimum and maximum nasal airflow values for each nasal passage recorded during the 7-hour period of the study. There was no significant difference in F MAX between the two treatment groups yet there was a significant difference in F MIN (p < 0.05). No difference in total nasal airflow (TNAF) between treatment groups was found, either before or after treatment (p > 0.05). The results demonstrate that (TNAF) is not as sensitive a measure of decongestion as F MIN. The findings of this study show that pseudoephedrine had no effect on the decongestion phase of the nasal cycle, but did significantly limit the congestion phase. The decongestant action may be explained by the sympathomimetic supplementing the natural sympathetic nervous activity to the nasal blood vessels.     

Chondrosarcoma of the nasal septum

A case of chondrosarcoma of the nasal septum is presented with the result of treatment. The patient was admitted for a growth in the nose of four years' duration. Fine needle aspiration for cytological examination was suggestive of squamous cell carcinoma. She was treated with lateral rhinotomy and wide excision followed by septorhinoplasty. Histological examination showed that the lesion was chondrosarcoma. The patient remained free of disease 26 months after surgery.     

A videofluoroscopic comparison of straw and cup drinking: the potential influence on dental erosion

Tracheostoma valves are often required in the rehabilitation process of speech after total laryngectomy. Patients are thus able to speak without using their hands to close the tracheostoma. The improved Groningen tracheostoma valve consists of a "cough" valve with an integrated ("speech") valve, which closes for phonation. The cough valve opens as the result of pressure produced by the lungs during a cough. The speech valve closes by the airflow produced by the lungs, thus directing air from the lungs into the esophagus at a deliberately chosen moment. An experimental setup with a computer-based acquisition program was developed to measure the pressure at which the cough valve opened and the flow at which the speech valve closed. In addition, the airflow resistance coefficient of the tracheostoma valve was defined and measured with an open speech valve. Both dry air from a cylinder and humid expired air were used. Results showed a pressure range of 1-7 kPa to open the cough valve and a flow range of 1.2-2.7 l/s to close the speech valve. These values were readily attained during speech, while the flow range occurred above values reached in quiet breathing. The device appeared to function well in physiological ranges and was optimally adjustable to an individual setting. No significant differences were measured between air from a cylinder and humid expired air. Findings showed that methods used to obtain results could be employed as a reference method for comparing aerodynamic characteristics of tracheostoma valves.     

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.     

Autonomic regulation of nasal vessels during changes in body position

The effects of postural changes on nasal airflow and nasal capillary blood flow were investigated in 15 healthy volunteers. Measurements were performed following nasal application of saline solution (control), the alpha-1 receptor antagonist prazosin, the alpha-2 receptor antagonist yohimbine, and after application of both prazosin and yohimbine. Nasal airflow in the control experiments did not significantly differ in the upright (362 +/- 166 ml/s), dorsally recumbent (350 +/- 167 ml/s) and 70 degrees head down position (311 +/- 167 ml/s). Following application of prazosin, nasal airflow was reduced to 223 +/- 121 ml/s in the upright position. Prazosin treatment significantly reduced nasal airflow to 177 +/- 111 ml/s when subjects were placed in dorsally recumbent positions and to 117 +/- 104 ml/s in 70 degrees head down positions (P < 0.001). Following application of yohimbine, nasal airflow remained stable when subjects were turned from upright (348 +/- 165 ml/s) to supine position (352 +/- 186 ml/s), whereas it was reduced to 199 +/- 137 ml/s in the head-down position. Application of both prazosin and yohimbine significantly increased nasal capillary blood flow in laser Doppler flowmetry measurements (P < 0.05). Changes in body position with or without application of the active drugs did not alter nasal capillary blood flow. These findings suggest that nasal congestion due to increased filling pressure in nasal capacitance vessels following postural changes is mainly prevented by alpha-1 adrenergic mechanisms.     

A comparison of a 3 day course with a 2 week course of oral prednisolone in patients with chronic asthma

This study was carried out as an attempt to evaluate the relationship between the results of nasal patency examinations and selected anthropometric measurements of nasal cavities in children with complete primary and secondary cleft palate. The examined group consisted of 130 children with cleft palate treated by means of surgery in early childhood owing to their clefts. Concerning the diagnostic methods the study group was divided into two subgroups. Group I consisted of 75 children in whom face photographs in frontal and axial projections towards the external nasal aperture were analysed. Group II consisted of 55 children in whom by means of P-A teleradiography projection the total area, the maximum height and width of nasal cavity were measured separately for the side with cleft and without cleft. The assessment of nasal patency tests using the objective method--active anterior rhinomanometry was carried out.     

Measuring pharyngeal pressure in patients with nCPAP ventilation

In 36 patients inspiratory and expiratory pressures in the pharynx were measured during nCPAP with pressures ranging from 5 to 20 mbar. The results were compared to the nasal resistance as measured by rhinomanometry and to minimal cross-sectional area of the nose as measured by acoustic rhinometry.