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Ottaviano G. Nasal Patency Measurement: State of the Art of Acoustic Rhinometry. Facial Plast Surg 2024; 40:304-309. [PMID: 38016661 DOI: 10.1055/a-2218-7297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Nasal obstruction is one of the main symptoms of different nasal pathologies. Many physiological and pathological conditions can produce nasal airflow impairment causing nasal obstruction and affecting patients' quality of life. There are different methods for the measurement of nasal obstruction, but in clinical practice the most common used are acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flow. This review describes the fundamentals of acoustic rhinometry, its normal values, the different physiological and pathological conditions that can modify nasal patency, and the utility of this instrument for the measurement of nasal obstruction in clinical practice. Acoustic rhinometry is a simple test, so it is suitable for measurements in the pediatric population, i.e., for evaluating adenoid hypertrophy. Acoustic rhinometry normal values are available, unilaterally and bilaterally for pediatric and adult populations. Acoustic rhinometry has been demonstrated to be reproducible and even superior to rhinomanometry when measuring nasal modifications during challenges. It is possible to use acoustic rhinometry before and after nasal surgery. Measuring nasal cavities volume and cross-sectional area, acoustic rhinometry is particularly indicated in rhinosurgery, especially for the evaluation of spreader grafts. Brief considerations about the correlation between nasal symptoms, in particular the subjective sensation of nasal obstruction, and the acoustic rhinometry results as well as the correlation of acoustic rhinometry with other methods for the measurement of nasal obstruction are also reported. Objective and subjective evaluation of nasal obstruction gives different information that together optimizes the diagnosis and the treatment of rhinologic patients. Acoustic rhinometry alone or in combination of other instruments for the measurement of nasal obstruction or patency should be used regularly in every outpatient clinic that treats patients with nasal obstruction as there is an increasing need of evidence-based therapies.
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Affiliation(s)
- Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy
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Ottaviano G, De Corso E, Saccardo T, D’Auria LM, Zampollo S, D’Agostino G, Mairani E, De Maio G, Scarpa B, Bacci C, Favero V. Effectiveness of Dupilumab in the Treatment of Adult and Older Adult Patients with Severe, Uncontrolled CRSwNP. J Pers Med 2023; 13:1241. [PMID: 37623491 PMCID: PMC10456067 DOI: 10.3390/jpm13081241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial disease that significantly impacts patients' quality of life. New therapeutic strategies and in particular biologic treatments are now available for these patients. It has been demonstrated that Dupilumab (an anti IL-4/IL-13 biologic drug) is effective in reducing the size of nasal polyps and in improving patients' symptoms and thus, quality of life. No real-world studies examining Dupilamab's efficacy in the elderly with respect to other adult age groups have as yet been carried out. The aim of this multicentric study was to evaluate Dupilumab's efficacy in young-middle adults as opposed to an older adult population affected by severe, uncontrolled CRSwNP. Of the 96 patients included in the study, 22 were 65 years old or older. Significant improvements were observed in all the parameters considered in both age groups after treatment was begun (T0 mean values for SNOT-22 = 58.5 ± 20.3, VAS NO = 7.6 ± 2.2, VAS smell = 8.6 ± 2.1, NPS = 5.6 ± 1.4, PNIF = 101.6 ± 59.4, S'S = 5.1 ± 3.1), T4 mean values for SNOT-22 = 15.1 ± 12.7, VAS NO = 1.7 ± 1.8, VAS smell = 2.4 ± 3, NPS = 1.7 ± 1.7, PNIF = 162.4 ± 43.2, S'S = 10.4 ± 3.7) (p < 0.0001). No differences in the variables considered were observed between the two age groups during the study, with the exception of the Peak Nasal Inspiratory Flow (PNIF), which was marginally higher; this was also the case according to multivariate analyses (p = 0.008) in the young-middle adult group with respect to the elderly one (p = 0.07). At multivariate analyses, asthma and the female sex negatively influenced the PNIF values (p = 0.001 and p = 0.012, respectively). Age negatively influenced the Visual Analog Scale (VAS) for nasal obstruction (p = 0.0032) and Endoscopic Sinus Surgery (ESS) negatively influenced the patents' olfactory performance (p = 0.028) to the same degree in both groups. Dupilumab was found to be effective to the same degree in both age groups. It can be considered a safe and reliable option for the treatment of elderly patients with severe, uncontrolled CRSwNP.
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Affiliation(s)
- Giancarlo Ottaviano
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (T.S.); (S.Z.); (E.M.)
| | - Eugenio De Corso
- Department of Otolaryngology, Policlinico Gemelli University Hospital IRCCS, 00168 Rome, Italy; (E.D.C.); (L.M.D.); (G.D.); (G.D.M.)
| | - Tommaso Saccardo
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (T.S.); (S.Z.); (E.M.)
| | - Leandro Maria D’Auria
- Department of Otolaryngology, Policlinico Gemelli University Hospital IRCCS, 00168 Rome, Italy; (E.D.C.); (L.M.D.); (G.D.); (G.D.M.)
| | - Sonny Zampollo
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (T.S.); (S.Z.); (E.M.)
| | - Giuseppe D’Agostino
- Department of Otolaryngology, Policlinico Gemelli University Hospital IRCCS, 00168 Rome, Italy; (E.D.C.); (L.M.D.); (G.D.); (G.D.M.)
| | - Edoardo Mairani
- Department of Neurosciences DNS, Otolaryngology Section, University of Padova, 35122 Padova, Italy; (T.S.); (S.Z.); (E.M.)
| | - Gabriele De Maio
- Department of Otolaryngology, Policlinico Gemelli University Hospital IRCCS, 00168 Rome, Italy; (E.D.C.); (L.M.D.); (G.D.); (G.D.M.)
| | - Bruno Scarpa
- Department of Statistical Sciences, University of Padova, 35122 Padova, Italy;
| | - Christian Bacci
- Unit of Dentistry, Department of Neurosciences, University of Padua, 35122 Padova, Italy;
| | - Vittorio Favero
- Unit of Maxillofacial Surgery and Dentistry, Head and Neck Department, University of Verona, 37134 Verona, Italy;
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Sawa A, Suzuki H, Niwa H, Oguchi S, Yagi T, Iwata Y, Makiyama Y, Chow CM, Komiyama O. Assessment of Screening for Nasal Obstruction among Sleep Dentistry Outpatients with Obstructive Sleep Apnea. Dent J (Basel) 2020; 8:dj8040119. [PMID: 33066402 PMCID: PMC7711851 DOI: 10.3390/dj8040119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023] Open
Abstract
Oral appliances (OA), a common treatment modality for obstructive sleep apnea (OSA), are not suitable for patients with nasal obstruction. Rhinomanometry, the gold standard technique to assess nasal airway resistance, is not readily available in sleep dentistry clinics. We demonstrate the use of a portable lightweight peak nasal inspiratory flow (PNIF) rate meter to objectively assess nasal airflow and utilized the Nasal Obstruction Symptom Evaluation (NOSE) scale to subjectively assess nasal obstruction in 97 patients with OSA and 105 healthy controls. We examined the correlations between the following variables between the groups: demographics, body mass index, PNIF, NOSE scale scores, apnea-hypopnea index (AHI), minimum SpO2 (SpO2min), Mallampati classification, and Epworth Sleepiness Scale (ESS) scores. Patients with OSA had significantly lower PNIF values and higher NOSE scores than controls. In the patient group, PNIF was not significantly correlated with AHI, SpO2min, Mallampati classification, or NOSE or ESS scores. Lower PNIF values and higher NOSE scores suggested impaired nasal airflow in the OSA group. As daytime PNIF measurement bears no relationship to AHI, this cannot be used alone in predicting the suitability of treatment for OSA with OA but can be used as an adjunct for making clinical decisions.
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Affiliation(s)
- Arisa Sawa
- Division of Oral Health Science, Department of Oral Function and Rehabilitation, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba 271-8587, Japan; (A.S.); (Y.I.); (O.K.)
| | - Hiroshi Suzuki
- Division of Oral Health Science, Department of Oral Function and Rehabilitation, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba 271-8587, Japan; (A.S.); (Y.I.); (O.K.)
- Correspondence:
| | - Hideo Niwa
- Department of Head and Neck Surgery, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba 271-8587, Japan; (H.N.); (Y.M.)
| | - Sumito Oguchi
- Department of Internal Medicine, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba 271-8587, Japan;
| | - Tatsuo Yagi
- Faculty of Law, Seiwa University, Kisarazu City, Chiba 292-8555, Japan;
| | - Yoshihiro Iwata
- Division of Oral Health Science, Department of Oral Function and Rehabilitation, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba 271-8587, Japan; (A.S.); (Y.I.); (O.K.)
| | - Yasuhide Makiyama
- Department of Head and Neck Surgery, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba 271-8587, Japan; (H.N.); (Y.M.)
| | - Chin Moi Chow
- Sleep Research Group, Charles Perkins Centre, University of Sydney, Sydney 2006, Australia;
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
| | - Osamu Komiyama
- Division of Oral Health Science, Department of Oral Function and Rehabilitation, Nihon University School of Dentistry at Matsudo, Matsudo, Chiba 271-8587, Japan; (A.S.); (Y.I.); (O.K.)
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Mo S, Gupta SS, Stroud A, Strazdins E, Hamizan AW, Rimmer J, Alvarado R, Kalish L, Harvey RJ. Nasal Peak Inspiratory Flow in Healthy and Obstructed Patients: Systematic Review and Meta-Analysis. Laryngoscope 2020; 131:260-267. [PMID: 32386248 DOI: 10.1002/lary.28682] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/07/2020] [Accepted: 03/13/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Nasal peak inspiratory flow (NPIF) is a practical and affordable tool that measures maximum inspiratory flow rate through both nostrils. Although NPIF values for healthy controls and patients appear to differ considerably, a generally expected value for populations with and without nasal obstruction has yet to be established. The aim of this systematic review and meta-analysis was to determine the mean NPIF value in populations with and without nasal obstruction. METHODS Medline (1946-) and Embase (1947-) were searched until July 1, 2017. A search strategy was used to identify studies that reported NPIF values for defined healthy or disease states. All studies providing original data were included. The study population was defined as having either normal nasal breathing or nasal obstruction. A meta-analysis of the mean data was presented in forest plots, and data were presented as mean (95% confidence interval [CI]). RESULTS The search yielded 1,526 studies, of which 29 were included. The included studies involved 1,634 subjects with normal nasal breathing and 817 subjects with nasal obstruction. The mean NPIF value for populations with normal nasal breathing was 138.4 (95% CI: 127.9-148.8) L/min. The mean value for populations with nasal obstruction was 97.5 (95% CI: 86.1-108.8) L/min. CONCLUSIONS Current evidence confirms a difference between mean NPIF values of populations with and without nasal obstruction. The mean value of subjects with no nasal obstruction is 138.4 L/min, and the mean value of nasally obstructed populations is 97.5 L/min. Prospective studies adopting a standardized procedure are required to further assess normative NPIF values. Laryngoscope, 131:260-267, 2021.
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Affiliation(s)
- Shirley Mo
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Sai S Gupta
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna Stroud
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Erika Strazdins
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Aneeza W Hamizan
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,Department of Otolaryngology-Head and Neck Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Janet Rimmer
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,St. Vincent's Clinic, St. Vincent's Hospital, Sydney, New South Wales, Australia.,The Woolcock Institute, Sydney University, Sydney, New South Wales, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Larry Kalish
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology-Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Carvalho V, Olej B, Rodrigo de Moraes J, Boechat JL. Mometasone furoate is not superior to saline for chronic rhinitis in the elderly. World Allergy Organ J 2019; 12:100064. [PMID: 31641400 PMCID: PMC6796772 DOI: 10.1016/j.waojou.2019.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/30/2019] [Accepted: 09/16/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Prevalence of diseases associated with ageing is rising; among these are the rhinologic problems. Chronic rhinitis appears as one of the most common worrisome nasal disorders in this age group. At the same time, the allergic form diminishes because of the immunosenescence. Objective This study aimed to evaluate the effect of a corticosteroid nasal spray (mometasone furoate) over nasal patency and the severity of rhinitis and its impacts on quality of life as compared with the saline nasal spray. Methods This open label-trial randomized subjects ≥60y with chronic rhinitis (allergic and nonallergic rhinitis) with mometasone spray 100mcg/d and isotonic saline nasal spray or saline alone for two weeks. The primary endpoint was the improvement in nasal patency evaluated by the peak nasal inspiratory flow (PNIF). Secondary outcomes included the severity of symptoms and the quality of life assessed by a visual analogic scale (VAS) and the sinonasal outcome test (SNOT-22), respectively. Results Forty patients underwent randomization, in equal number in each group of treatment, either with allergic (AR) and nonallergic rhinitis (NAR). At week 2, the mean PNIF score was 79.5 in the corticosteroid (CE) plus saline group and 82.0 in the saline group (p = 0.37). Also, SNOT-22 and VAS were not improved with the addition of mometasone furoate. Conclusions Treatment with mometasone furoate nasal spray plus isotonic saline is not superior to saline alone in elderly patients with rhinitis in respect of improving nasal patency, quality of life, and reducing the intensity of symptoms. Trial registration The trial is registered at the Brazilian Clinical Trials Registry (ReBEC) #RBR-498bnq. Registered 05 July 2017.
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Affiliation(s)
- Victor Carvalho
- Unidade de Pesquisa Clínica, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense. Rua Marquês do Paraná, 303, 4º andar, Niterói, 24033-900, Rio de Janeiro, Brazil
| | - Beni Olej
- Unidade de Pesquisa Clínica, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense. Rua Marquês do Paraná, 303, 4º andar, Niterói, 24033-900, Rio de Janeiro, Brazil
| | - José Rodrigo de Moraes
- Instituto de Matemática e Estatística, Universidade Federal Fluminense. Rua Professor Marcos Waldemar de Freitas Reis, Campus do Gragoatá, Niterói, Rio de Janeiro, Brazil
| | - Jose Laerte Boechat
- Departamento de Alergia e Imunologia, Faculdade de Medicina, Universidade Federal Fluminense. Rua Marquês do Paraná, 303, 2º andar, Niterói, Rio de Janeiro, Brazil
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Mohan S, Fuller JC, Ford SF, Lindsay RW. Diagnostic and Therapeutic Management of Nasal Airway Obstruction: Advances in Diagnosis and Treatment. JAMA FACIAL PLAST SU 2019; 20:409-418. [PMID: 29801120 DOI: 10.1001/jamafacial.2018.0279] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Nasal airway obstruction (NAO) is a common complaint in the otolaryngologist's office and can have a negative influence on quality of life (QOL). Existing diagnostic methods have improved, but little consensus exists on optimal tools. Furthermore, although surgical techniques for nasal obstruction continue to be developed, effective outcome measurement is lacking. An update of recent advances in diagnostic and therapeutic management of NAO is warranted. Objective To review advances in diagnosis and treatment of NAO from the last 5 years. Evidence Review PubMed, Embase, CINAHL, the Cochrane Library, LILACS, Web of Science, and Guideline.gov were searched with the terms nasal obstruction and nasal blockage and their permutations from July 26, 2012, through October 23, 2017. Studies were included if they evaluated NAO using a subjective and an objective technique, and in the case of intervention-based studies, the Nasal Obstruction Symptom Evaluation (NOSE) scale and an objective technique. Exclusion criteria consisted of animal studies; patients younger than 14 years; nasal foreign bodies; nasal masses including polyps; choanal atresia; sinus disease; obstructive sleep apnea or sleep-disordered breathing; allergic rhinitis; and studies not specific to nasal obstruction. Findings The initial search resulted in 942 articles. After independent screening by 2 investigators, 46 unique articles remained, including 2 randomized clinical trials, 3 systematic reviews, 3 meta-analyses, and 39 nonrandomized cohort studies (including a combined systematic review and meta-analysis). An aggregate of approximately 32 000 patients were reviewed (including meta-analyses). Of the subjective measures available for NAO, the NOSE scale is outstanding with regard to disease-specific validation and correlation with symptoms. No currently available objective measure can be considered a criterion standard. Structural measures of flow, pressure, and volume appear to be necessary but insufficient to assess NAO. Therefore, novel variables and techniques must continue to be explored in search of an ideal instrument to aid in assessment of surgical outcomes. Conclusions and Relevance Nasal airway obstruction is a clinical diagnosis with considerable effects on QOL. An adequate diagnosis begins with a focused history and physical examination and requires a patient QOL measure such as the NOSE scale. Objective measures should be adjunctive and require further validation for widespread adoption. These results are limited by minimal high-quality evidence among studies and the risk of bias in observational studies. Level of Evidence NA.
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Affiliation(s)
- Suresh Mohan
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Jennifer C Fuller
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Stephanie Friree Ford
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Robin W Lindsay
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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