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Burgos MA, Bastir M, Pérez-Ramos A, Sanz-Prieto D, Heuzé Y, Maréchal L, Esteban-Ortega F. Assessing nasal airway resistance and symmetry: An approach to global perspective through computational fluid dynamics. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3830. [PMID: 38700070 DOI: 10.1002/cnm.3830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/18/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
This study aimed to explore the variability in nasal airflow patterns among different sexes and populations using computational fluid dynamics (CFD). We focused on evaluating the universality and applicability of dimensionless parameters R (bilateral nasal resistance) and ϕ (nasal flow asymmetry), initially established in a Caucasian Spanish cohort, across a broader spectrum of human populations to assess normal breathing function in healthy airways. In this retrospective study, CT scans from Cambodia (20 males, 20 females), Russia (20 males, 18 females), and Spain (19 males, 19 females) were analyzed. A standardized CFD workflow was implemented to calculate R-ϕ parameters from these scans. Statistical analyses were conducted to assess and compare these parameters across different sexes and populations, emphasizing their distribution and variances. Our results indicated no significant sex-based differences in the R parameter across the populations. However, moderate sexual dimorphism in the ϕ parameter was observed in the Cambodian group. Notably, no geographical differences were found in either R or ϕ parameters, suggesting consistent nasal airflow characteristics across the diverse human groups studied. The study also emphasized the importance of using dimensionless variables to effectively analyze the relationships between form and function in nasal airflow. The observed consistency of R-ϕ parameters across various populations highlights their potential as reliable indicators in both medical practice and further CFD research, particularly in diverse human populations. Our findings suggest the potential applicability of dimensionless CFD parameters in analyzing nasal airflow, highlighting their utility across diverse demographic and geographic contexts. This research advances our understanding of nasal airflow dynamics and underscores the need for additional studies to validate these parameters in broader population cohorts. The approach of employing dimensionless parameters paves the way for future research that eliminates confounding size effects, enabling more accurate comparisons across different populations and sexes. The implications of this study are significant for the advancement of personalized medicine and the development of diagnostic tools that accommodate individual variations in nasal airflow.
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Affiliation(s)
- Manuel A Burgos
- Department of Thermal and Fluid Engineering, Fluid Mechanics and Thermal Engineering Group, Polytechnic University of Cartagena, Cartagena, Spain
| | - Markus Bastir
- Department of Paleobiology, Paleoanthropology Group, National Museum of Natural Sciences - Spanish National Research Council, Madrid, Spain
| | - Alejandro Pérez-Ramos
- Faculty of Science, Department of Ecology and Geology, Paleobiology, Paleoclimatology and Paleogeography Group, University of Málaga, Málaga, Spain
- Faculty of Science, Department of Surgery, Paleobiology, Paleoclimatology and Paleogeography Group, University of Málaga, Málaga, Spain
| | - Daniel Sanz-Prieto
- Department of Thermal and Fluid Engineering, Fluid Mechanics and Thermal Engineering Group, Polytechnic University of Cartagena, Cartagena, Spain
- Faculty of Sciences, Department of Biology, Autonomous University of Madrid, Madrid, Spain
| | - Yann Heuzé
- PACEA UMR 5199, University of Bordeaux, French National Centre for Scientific Research, Ministère de la Culture, Pessac, France
| | - Laura Maréchal
- PACEA UMR 5199, University of Bordeaux, French National Centre for Scientific Research, Ministère de la Culture, Pessac, France
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Xavier R. Peak Nasal Inspiratory Flow (PNIF) for Nasal Breathing Evaluation. Facial Plast Surg 2024; 40:310-313. [PMID: 38158212 DOI: 10.1055/a-2236-4581] [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: 01/03/2024] Open
Abstract
Measuring nasal airflow and nasal breathing has been a major goal of rhinology. Many objective methods for measuring nasal airflow or nasal airway resistance or dimensions provide valuable data but are time-consuming and require expensive equipment and trained technicians, thus making these methods less practical for clinical practice. Peak nasal inspiratory flow (PNIF) measurement is fast, unexpensive, noninvasive, and able to provide an objective evaluation of nasal airflow in real-time. Unilateral PNIF measurements allow separated evaluation of each side of the nasal airway and may prove particularly useful when clinical assessment detects significant asymmetry between both nasal cavities.PNIF measurements are most useful for assessing changes in nasal airflow achieved by any form of therapy, including surgical treatment of the nasal airway. These measurements generally correlate with other objective methods for nasal airway evaluation, but not unequivocally with patient-reported evaluation of nasal breathing. Nevertheless, as low PNIF values prevent the sensation of a suitable nasal breathing, PNIF measurement may also prove useful to optimize the decision of how to best address patients with complaints of nasal airway obstruction.
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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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Fearington FW, Awadallah AS, Hamilton GS, Olson MD, Dey JK. Long-Term Outcomes of Septoplasty With or Without Turbinoplasty: A Systematic Review. Laryngoscope 2024; 134:2525-2537. [PMID: 37991145 DOI: 10.1002/lary.31193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Septoplasty is used to correct nasal obstruction from nasal septum deviation. However, the long-term efficacy of septoplasty is unclear, and no literature reviews have examined long-term outcomes of septoplasty with or without turbinate modification. This systematic review aimed to evaluate the long-term efficacy of septoplasty with or without turbinate modification in improving nasal obstruction. DATA SOURCES PubMed, EMBASE, Cochrane CENTRAL. METHODS A systematic review of the literature was conducted using the aforementioned databases. Studies reporting outcomes 12+ months after functional septoplasty with or without turbinate surgery for nasal obstruction were included. Septorhinoplasties, concurrent sinus surgery, pediatric studies, and studies where septoplasty was performed for indications other than nasal obstruction were excluded. RESULTS After screening, 35 studies with 4,432 patients were included. Mean weighted post-operative follow-up time was 29.1 months (range 12-120 months). All studies reported significant improvement in subjective and objective outcomes at long-term follow-up compared to baseline. When comparing short-term (<12 months) to long-term (≥12 months) outcomes, four studies noticed that subjective outcomes worsened slightly over time, but no study found a significant change in objective outcomes over time. In addition, 23 studies reported patient satisfaction and/or improvement rates, with 75.4% (2,348/3,113) of patients expressing satisfaction/improvement at an average of 27.0 months after surgery. CONCLUSIONS Overall, septoplasty with or without turbinate modification shows significant improvement in obstructive symptoms at long-term follow-up per both objective and subjective measures. Whether outcomes may worsen slightly over time remains indeterminate based on mixed results in the literature. LEVEL OF EVIDENCE N/A Laryngoscope, 134:2525-2537, 2024.
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Affiliation(s)
| | | | - Grant S Hamilton
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
- Division of Facial Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michael D Olson
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
- Division of Facial Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jacob K Dey
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
- Division of Facial Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Xavier R. Overview of Nasal Airway and Nasal Breathing Evaluation. Facial Plast Surg 2024; 40:268-274. [PMID: 38331036 DOI: 10.1055/s-0044-1779043] [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: 02/10/2024] Open
Abstract
Several methods are available for evaluating nasal breathing and nasal airflow, as this evaluation may be made from several different perspectives.Physiologic methods for nasal airway evaluation directly measure nasal airflow or nasal airway resistance, while anatomical methods measure nasal airway dimensions. Subjective methods evaluate nasal breathing through several validated patient-reported scales assessing nasal breathing. Computational fluid dynamics evaluates nasal airflow through the analysis of several physics' variables of the nasal airway.Being familiar to these methods is of utmost importance for the nasal surgeon to be able to understand data provided by the different methods and to be able to choose the combination of evaluation methods that will provide the information most relevant to each clinical situation.
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Blanco M, Ernst G, Rabino A, Salvado A, Borsini EE. Performance of the NOSE Questionnaire in Mask Selection for Home CPAP Titration. Sleep Sci 2023; 16:e425-e429. [PMID: 38197029 PMCID: PMC10773520 DOI: 10.1055/s-0043-1776769] [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: 01/03/2022] [Accepted: 01/31/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction Many patients abandon CPAP treatment because they find the mask uncomfortable. Therefore, specialists may benefit from the predictive value of airway assessment tools. Objective To identify nasal ventilation failure through the Nasal Obstruction Symptom Evaluation (NOSE) scale in patients with obstructive sleep apnea (OSA) who undergo home-based auto-adjusting CPAP titration and to determine whether there is a correlation between NOSE score and the type of mask selected. Materials and Methods In this prospective correlational study, the NOSE scale was used in terms of mask selection and titration indicators. Patients were classified based on their NOSE score: > or < 50. Results We included 303 patients; 226 men (74.5%), BMI: 33.2 ± 6.1 kg/m 2 , neck circumference (cm): 42.8 ± 3.6 and Epworth (ESS) score: 9.2 ± 5.6, mild OSA: 12 (3.9%), moderate OSA: 127 (41.9%), and severe OSA: 164 (54.1%). The mean NOSE score was 24.3 ± 22.8 and 42 patients (13.8%) had NOSE scores > 50. Indicators for both groups were: compliance (5.9 ± 1.3 vs. 5.8 ± 1.4 hours) p: 0.41, therapeutic pressure (9.1 ± 2.0 vs. 8.8 ± 1.6 cm of H 2 O) p: 0.23, residual AHI (2.3 ± 1.8 vs. 2.8 ± 2.6 events/hour) p: 0.25, and leaks (20.5 ± 10.6 vs. 21.3 ± 10.7 liters/minute) p: 0.64. According to adjusted multiple regression, a NOSE of > 50 was not a predictor of mask selection. Conclusions A > 50 NOSE score was not a predictor of mask selection, and it was not correlated to titration performance.
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Affiliation(s)
- Magalí Blanco
- Sleep and Ventilation Unit, Hospital Britanico, Buenos Aires, Buenos Aires City, Argentina
| | - Glenda Ernst
- Sleep and Ventilation Unit, Hospital Britanico, Buenos Aires, Buenos Aires City, Argentina
| | - Alberto Rabino
- Otorhinolaryngology Department, Hospital Britanico, Buenos Aires, Buenos Aires City, Argentina
| | - Alejandro Salvado
- Sleep and Ventilation Unit, Hospital Britanico, Buenos Aires, Buenos Aires City, Argentina
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Cheung RCC, Chen B, Ho CCJ, Tipoe GL, Yang J. "Where is the spleen? Where are the lungs?"-An investigation of the level of anatomical knowledge of the Hong Kong public. ANATOMICAL SCIENCES EDUCATION 2023; 16:1209-1217. [PMID: 37409614 DOI: 10.1002/ase.2318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 06/09/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
This article investigates the level of anatomical knowledge of the Hong Kong public and uses the data to help suggest public engagement activities and health campaigns to raise health literacy in the general population. In the annual public engagement event organized by the University of Hong Kong, 250 attendees took a survey assessing basic anatomical knowledge by putting organs/structures in their correct positions. Description analysis, correlation analysis, independent sample t-test, and one-way ANOVA analysis were conducted by SPSS 27.0. Overall, a mean score of 6.5 out of 20 was achieved. Differences between various demographic parameters were analyzed, and the results showed that better performance on the survey was associated with younger age, higher educational levels, and having healthcare experience. There was also a statistically significant difference in correctly positioning the thyroid between males and females. Interestingly, some misconceptions were thought to arise from the bespoke use of the Chinese language in the survey. The data reflected room for improvement in the level of anatomical knowledge among the public, notably in the older age groups. This was attributed partially to a lack of public outreach initiatives and established anatomy-focused programs, which has restricted public exposure to anatomical knowledge and hindered the development of anatomical sciences in Hong Kong. In conclusion, the knowledge of the public on the human body needs to be improved and possible solutions to improve public awareness of health were raised.
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Affiliation(s)
| | - Bixia Chen
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Faculty of Education, The University of Hong Kong, Hong Kong, Hong Kong
| | - Cheuk Chun Joseph Ho
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - George L Tipoe
- Bau Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Jian Yang
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Merma-Linares C, Martinez MD, Gonzalez M, Alobid I, Figuerola E, Mullol J. Management of Mechanical Nasal Obstruction Isolated or Associated to Upper Airway Inflammatory Diseases in Real Life: Use of both Subjective and Objective Criteria. Curr Allergy Asthma Rep 2023; 23:567-578. [PMID: 37561310 PMCID: PMC10506933 DOI: 10.1007/s11882-023-01104-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE OF REVIEW Mechanical nasal obstruction (MNO) is a prevalent condition with a high impact on patient's quality-of-life (QoL) and socio-economic burden. The aim of this study was to determine the usefulness of both subjective and objective criteria in the appropriate management of MNO, either alone or associated to upper airway inflammatory diseases such as allergic rhinitis (AR) or chronic rhinosinusitis with nasal polyps (CRSwNP). RECENT FINDINGS A long debate persists about the usefulness of subjective and objective methods for making decisions on the management of patients with nasal obstruction. Establishing standards and ranges of symptom scales and questionnaires is essential to measure the success of an intervention and its impact on QoL. To our knowledge this is the first real-life study to describe the management of MNO using both subjective and objective criteria in MNO isolated or associated to upper airway inflammatory diseases (AR or CRSwNP). Medical treatment (intranasal corticosteroids) has a minor but significant improvement in MNO subjective outcomes (NO, NOSE, and CQ7) with no changes in loss of smell and objective outcomes. After surgery, all MNO patients reported a significant improvement in both subjective and objective outcomes, this improvement being higher in CRSwNP. We concluded that in daily clinical practice, the therapeutic recommendation for MNO should be based on both subjective and objective outcomes, nasal corrective surgery being the treatment of choice in MNO, either isolated or associated to upper airway inflammatory diseases, AR or CRSwNP.
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Affiliation(s)
- Carla Merma-Linares
- Department of Otorhinolaryngology- Head and Neck Surgery, Hospital Universitari de Tarragona Joan XXIII, Doctor Mallafre Guasch 4, 43005, Tarragona, Catalonia, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Tarragona, Catalonia, Spain.
- Clinical & Experimental Respiratory Immunoallergy, Institute of Biomedical Research "August Pi i Sunyer" (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain.
- Universitat Rovira i Virgili, Tarragona, Spain.
| | - M Dolores Martinez
- Department of Otorhinolaryngology- Head and Neck Surgery, Hospital Universitari de Tarragona Joan XXIII, Doctor Mallafre Guasch 4, 43005, Tarragona, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Tarragona, Catalonia, Spain
| | - Miriam Gonzalez
- Department of Otorhinolaryngology- Head and Neck Surgery, Hospital Universitari de Tarragona Joan XXIII, Doctor Mallafre Guasch 4, 43005, Tarragona, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Tarragona, Catalonia, Spain
| | - Isam Alobid
- Skull Base Unit, ENT department, Hospital Clinic of Barcelona, Barcelona, Spain
- Clinical & Experimental Respiratory Immunoallergy, Institute of Biomedical Research "August Pi i Sunyer" (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain
| | - Enric Figuerola
- Department of Otorhinolaryngology- Head and Neck Surgery, Hospital Universitari de Tarragona Joan XXIII, Doctor Mallafre Guasch 4, 43005, Tarragona, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Tarragona, Catalonia, Spain
| | - Joaquim Mullol
- Department of Otorhinolaryngology, Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain.
- Clinical & Experimental Respiratory Immunoallergy, Institute of Biomedical Research "August Pi i Sunyer" (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain.
- Universitat de Barcelona, Barcelona, Spain.
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Karataş M, Koparal M, Yılmazer C, Kelles M. Correlations between objective and subjective tests of nasal patency in patients undergoing septoplasty. J Laryngol Otol 2023; 137:413-418. [PMID: 35607263 DOI: 10.1017/s002221512200127x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study assessed correlations between pre- and post-operative objective and subjective nasal patency test results in patients undergoing septoplasty to treat nasal septum deviation. METHOD Eighty nasal septum deviation patients who underwent septoplasty were prospectively enrolled. Nasal Obstruction Symptom Evaluation questionnaire scores, anterior rhinomanometry and acoustic rhinometry data were compared pre-operatively and three months after surgery. The left, right and total volume and left, right and total minimum cross-sectional area acoustic rhinometry values were compared. RESULTS The left volume, total volume, left minimum cross-sectional area and total minimum cross-sectional area differed significantly between the two time-points (all p < 0.05). The total resistance, inspiratory total airflow, expiratory total resistance and expiratory total airflow rhinomanometric data did not differ between the two timepoints (all p > 0.05). CONCLUSION This study suggested that subjective tests such as the Nasal Obstruction Symptom Evaluation questionnaire are optimal to identify complaints and assess post-operative satisfaction.
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Affiliation(s)
- M Karataş
- Department of Otolaryngology, Faculty of Medicine, Adiyaman University, Turkey
| | - M Koparal
- Department of Otolaryngology, Faculty of Medicine, Adiyaman University, Turkey
| | - C Yılmazer
- Department of Otolaryngology, Faculty of Medicine, Adiyaman University, Turkey
| | - M Kelles
- Department of Otolaryngology, Faculty of Medicine, Turgut Özal University, Malatya, Turkey
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García-Chabur MA, Castellanos J, Corredor-Rojas G, Salgar M, Moreno S, Pinzón M, Peñaranda A. Improvement in Nasal Obstruction and Quality of Life after Nasal Septoplasty with Turbinoplasty: A Pre- and Post-study. Int Arch Otorhinolaryngol 2023; 27:e266-e273. [PMID: 37125370 PMCID: PMC10147458 DOI: 10.1055/s-0042-1743462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/16/2021] [Indexed: 02/16/2023] Open
Abstract
Abstract
Introduction Septoplasty and turbinoplasty are common surgical interventions used to relieve nasal obstructive symptoms. Since it is difficult to measure the degree of nasal blockage, current literature wonders about the frequent performance of these procedures.
Objective To evaluate the perceived change in the nasal obstruction and the quality of life (QoL) of patients that underwent a septoplasty along with a turbinoplasty by applying subjective scales, to describe the correlation between those scales, and to study the impact of clinical factors in the postoperative outcomes.
Methods Prospective observational study. The Nasal Obstruction Symptom Evaluation (NOSE), the Visual Analog Scale (VAS), and the Glasgow Benefit Inventory (GBI) were assessed. The paired sample Wilcoxon test was used to evaluate the difference between the pre- and postoperative surveys. The correlation coefficient between the subjective scales was calculated. A quantile regression was performed to evaluate the effect of surgery on the results adjusted for clinical and demographic variables.
Results A total of 115 patients were interviewed. Postoperative NOSE scores were 45 points lower (95% confidence interval [CI]: - 53.53–- 35.46; p < 0.001) in comparison with the NOSE preoperative scores. Obesity was the only statistically significant factor associated with worse outcomes. Additionally, we found a high correlation between the NOSE and VAS scores and a negative correlation between the GBI and postoperative VAS scores.
Conclusion Nasal septoplasty, when paired with a turbinoplasty, decreases nasal obstruction and improves QoL. Obesity was associated with worse results. There was a strong correlation between the NOSE and the VAS results and between the GBI and postoperative VAS results.
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Affiliation(s)
- María A. García-Chabur
- Department of Otorhinolaryngology, Fundación Universitaria de Ciencias de la Salud, Hospital de San José, Bogotá, Colombia
- Otolaryngology Research group, UNIMEQ-ORL, Bogotá, Colombia
| | - Juliana Castellanos
- Department of Otorhinolaryngology, Fundación Universitaria de Ciencias de la Salud, Hospital de San José, Bogotá, Colombia
| | | | - Mariana Salgar
- Department of Otorhinolaryngology, Fundación Universitaria de Ciencias de la Salud, Hospital de San José, Bogotá, Colombia
| | - Sergio Moreno
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Otolaryngology Research group, UNIMEQ-ORL, Bogotá, Colombia
| | - Martín Pinzón
- Department of Otorhinolaryngology, Fundación Universitaria de Ciencias de la Salud, Hospital de San José, Bogotá, Colombia
- Department of Otolaryngology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Otolaryngology Research group, UNIMEQ-ORL, Bogotá, Colombia
| | - Augusto Peñaranda
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Department of Otolaryngology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Otolaryngology Research group, UNIMEQ-ORL, Bogotá, Colombia
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11
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Ottaviano G, Pendolino AL, Scarpa B, Torsello M, Sartori D, Savietto E, Cantone E, Nicolai P. Correlations between Peak Nasal Inspiratory Flow, Acoustic Rhinometry, 4-Phase Rhinomanometry and Reported Nasal Symptoms. J Pers Med 2022; 12:jpm12091513. [PMID: 36143298 PMCID: PMC9502950 DOI: 10.3390/jpm12091513] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Rhinomanometry, acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) are popular methods for nasal patency evaluation. The aim of the present study was to compare these three methods with the reported nasal symptoms to determine the best diagnostic tool to assess nasal obstruction. Methods: 101 subjects were evaluated using PNIF, 4-phase rhinomanometry (4PR), AR, Visual Analogue Scale for nasal obstruction (VAS-NO) and Sino-Nasal Outcome Test (SNOT-22). Correlations among PNIF, 4PR, AR, VAS-NO and SNOT-22 were obtained. Results: VAS-NO and SNOT-22 were moderately correlated with each other (r = 0.54, p < 0.001). 4PR was moderately correlated with PNIF (r = −0.31, p = 0.0016) and AR (r = −0.5, p < 0.001). VAS-NO was mildly correlated with PNIF (r = −0.29, p = 0.0034). SNOT-22 was moderately correlated with PNIF (r = −0.31, p = 0.0017). After dividing the population into symptomatic and asymptomatic subjects, based on their VAS-NO score, the former showed significantly lower PNIF values (p = 0.009) and higher 4PR values (p = 0.013) compared to the latter ones. Conclusion: PNIF and 4PR showed a significant moderate correlation with each other, but PNIF showed a significant correlation (weak-moderate) with the reported nasal symptom scores.
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Affiliation(s)
- Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35121 Padova, Italy
- Correspondence: ; Tel.: +39-(0)49-8214470; Fax: +39-(0)49-8213113
| | - Alfonso Luca Pendolino
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London WC1E 6DG, UK
- Ear Institute, University College London, London WC1X 8EE, UK
| | - Bruno Scarpa
- Department of Statistical Sciences and Department of Mathematics Tullio Levi-Civita, University of Padova, 35128 Padova, Italy
| | - Miriam Torsello
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35121 Padova, Italy
| | - Daniele Sartori
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35121 Padova, Italy
| | - Enrico Savietto
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35121 Padova, Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat, Federico II University, 80131 Naples, Italy
| | - Piero Nicolai
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35121 Padova, Italy
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Xavier R, Azeredo-Lopes S, Menger DJ, Carvalho HCD, Spratley J. Comparative Functional Effect of Alternative Surgical Techniques Used in Rhinoplasty. Ann Otol Rhinol Laryngol 2022; 132:638-647. [PMID: 35794799 DOI: 10.1177/00034894221111096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this investigation is to compare the functional effect of the different surgical techniques used for addressing each section of the nose. METHODS Prospective study of 57 consecutive rhinoplasty patients. Patients were evaluated with peak nasal inspiratory flow (PNIF), Nasal Obstruction Symptom Evaluation (NOSE), and Visual Analog Scale (VAS) for nasal obstruction before and 1 year after rhinoplasty. Additionally, esthetic evaluation of the nose was obtained with Rhinoplasty Outcomes Evaluation (ROE). According to the surgical technique used to address each portion of the nose, groups of patients were created and the functional improvement of these groups was compared. RESULTS Using the TukeyHSD multiple pairwise-comparison test, the estimated difference of the increase of PNIF between using spreader grafts and using spreader flaps was 94.9 (95% CI 24.3, 165.5, P = .004) between spreader grafts and neither grafts or flaps was 79.2 (95% CI 5.8, 152.6, P = .03), between spreader grafts and bilateral spreader flaps plus a unilateral spreader graft was 90.2 (95% CI 22.1, 158.2, P = .005). In all other portions of the nose, no significant difference was found in the functional improvement between different surgical techniques. CONCLUSIONS Spreader grafts increase PNIF more significantly than other surgical techniques used for dorsal mid-vault reconstruction. Spreader grafts should be preferred over other techniques whenever an improvement of nasal airflow is required. No significant differences were found between the functional effect of alternative techniques used in other sections of the nose. Additional cohort studies will be necessary to further confirm data from this investigation.
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Affiliation(s)
| | - Sofia Azeredo-Lopes
- Comprehensive Health Research Centre (CHRC) and EpiDoC Unit, CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | | | - Jorge Spratley
- Faculdade de Medicina da Universidade do Porto, Centro Hospitalar Universitário S.João and Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Porto, Portugal
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13
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Alagoz E, Unver T, Seker ED, Kurt G, Senturk E, Ozdem A, Dolanmaz D. EVALUATING CHANGES IN NASAL AIRWAY VOLUME AND NASAL AIRFLOW AFTER SURGICALLY ASSISTED RAPID MAXILLARY EXPANSION. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:533-542. [DOI: 10.1016/j.oooo.2022.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/10/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
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14
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Yoo SH, Choi JH, Mo JH. Long-term efficacy of turbinoplasty compared with medical treatment in patients with allergic rhinitis. Acta Otolaryngol 2022; 142:431-437. [PMID: 35635012 DOI: 10.1080/00016489.2022.2078879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The effectiveness of turbinate surgery has been proven in patients with allergic rhinitis (AR). OBJECTIVES This study evaluated the long-term efficacy of turbinoplasty in AR and to compare the results with those of medical treatment. METHODS This study included 192 patients diagnosed with AR who underwent surgical or medical treatment. Medical records were reviewed to assess pre-treatment and 2-year post-treatment frequency and severity of AR symptoms, prescription frequency for AR medication, and satisfaction score for treatment. Parameters for 5-year post-treatment efficacy were acquired via a telephone survey. A total of 128 patients who had undergone turbinoplasty were defined as a 'turbinoplasty group,' and 64 patients who were treated only with medications were defined as a 'medication group'. Allergic symptom, medication, and satisfaction scores were compared. RESULTS Patients in the turbinoplasty group demonstrated significant improvements in all allergic symptom scores, while those in the medication group showed significant symptom improvement only in nasal obstruction on long-term follow-up. Patients in the turbinoplasty group also showed a lower prescription frequency after treatment and higher subjective satisfaction scores than those in the medication group. CONCLUSIONS This long-term follow-up study demonstrated that turbinoplasty for AR appears to be an effective treatment option compared with medical therapy alone.
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Affiliation(s)
- Shin Hyuk Yoo
- Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea
| | - Ji Hyeok Choi
- Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea
| | - Ji-Hun Mo
- Department of Otorhinolaryngology, Dankook University College of Medicine, Cheonan, Korea
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15
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Valero A, Ibáñez-Echevarría E, Vidal C, Raducan I, Castelló Carrascosa JV, Sánchez-López J. Efficacy of subcutaneous house dust mite immunotherapy in patients with moderate to severe allergic rhinitis. Immunotherapy 2022; 14:683-694. [PMID: 35465692 DOI: 10.2217/imt-2021-0353] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the efficacy of subcutaneous immunotherapy (SCIT) for the treatment of allergy to house dust mites (HDM) in adults with moderate/severe allergic rhinitis (AR). Methods: Patients sensitized to HDM were randomized to SCIT plus rescue medication (Group A, n = 38) or rescue medication alone (Group B, n = 18), and assessed at baseline and 2, 6 and 12 months. Results: At month 12, Group A presented significant improvement with respect to baseline as evaluated by a visual analogue scale at three concentrations of antigen (0.1, 1 and 10 IR/ml; p < 0.0001). Group A presented significant decreases in symptom scores after 2 months of treatment, which were maintained after 1 year. After 12 months of treatment, Group A showed rescue medication consumption reductions (p < 0.001) and quality of life improvements (p < 0.0001). SCIT elicited a strong immunological response and was well tolerated. Conclusion: SCIT is efficacious for HDM allergy in patients with AR, generating a strong immunological response. Trial Registration Number: EUCTR2009-018155-16-ES (Cochrane Central Register of Controlled Trials).
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Affiliation(s)
- Antonio Valero
- Department of Allergy, Hospital Clínic, Barcelona, Spain
| | | | - Carmen Vidal
- Department of Allergy, University Hospital of Santiago, Santiago de Compostela, Spain
| | - Isabela Raducan
- Department of Allergy, General University Hospital of Castellón, Castellón, Spain
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16
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Portillo-Vásquez AM, Jiménez-Chobillón MA, Santillán-Macías A, Cristerna-Sánchez L, Castorena-Maldonado AR. Validation of the Nasal Obstruction Symptom Evaluation Scale in Mexican Adults. Arch Med Res 2022; 53:329-335. [PMID: 35341602 DOI: 10.1016/j.arcmed.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nasal obstruction is a feeling of impaired airflow through the nose, caused by diverse factors with high prevalence. There are numerous methods to study it, being the most important subjective instrument the Nasal Obstruction Symptom Evaluation score, NOSE, with good structural validity and internal consistency. It has been translated and validated in several languages, including European Spanish, but hasn't been validated in Mexico. AIM Adapt and validate the NOSE scale to the Spanish language for a Mexican adult population. METHODS This study was conducted from May-August 2015. The scale was translated from English to Spanish and assessed by two experts to confirm its acceptability, being retranslated later. Adult subjects with native Mexican Spanish were recruited from the outpatient clinic, with chronic rhinopathy and without evidence of respiratory pathology. Both groups filled the scale, and anthropometric data were collected. A subgroup completed the instrument again after one month. STATA 15.1 was used for analysis. RESULTS The sample were 261 subjects. Cronbach alpha was 0.89, intraclass correlation coefficient 0.84, agreement limits -9.62 to 16.29. There was a statistically significant difference in score between groups. The area under the ROC curve was 0.855, with 83% sensibility and 76% specificity for a 20 total score. Moderate to strong item-total association was found with Spearman. The response model showed moderate item discrimination. In the factorial analysis, one factor was found, with an Eigenvalue of 3.21. CONCLUSION The adaptation of the NOSE scale is reliable and valid for its application in Mexican adult population.
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Affiliation(s)
| | | | - Alejandra Santillán-Macías
- Departamento de Otorrinolaringología, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, Ciudad de México, México
| | - Lisette Cristerna-Sánchez
- Departamento de Otorrinolaringología, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, Ciudad de México, México
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17
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Saxon S, Johnson R, Spiegel JH. Laterality and severity of nasal obstruction does not correlate between physicians and patients, nor among physicians. Am J Otolaryngol 2021; 42:103039. [PMID: 33930682 DOI: 10.1016/j.amjoto.2021.103039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nasal obstruction is a common patient complaint and has a variety of etiologies, and a specific anatomical abnormality can often be found within the nasal cavity on physical examination. In practice, this observed pathology does not always correlate with the laterality, severity, and exact intranasal site of the patients' perceived obstruction. OBJECTIVES We seek to answer the following questions: 1) Does a physician's evaluation of nasal obstruction correlate with subjective patient complaints? 2) Is there reasonable correlation between physicians of similar training in the routine evaluation of nasal obstruction? METHODS First, we asked patients presenting to the otolaryngology clinic with a primary complaint of nasal obstruction to fill out a modified NOSE survey. Nasal endoscopy was performed on all subjects to assess all potential sites of obstruction. We then determined whether there is an association between patient complaints and findings on physical examination. Second, we determined if there is correlation between similarly trained physicians in their interpretation of a basic nasal examination. Otolaryngologists were shown a series of standardized videos of an endoscopic nasal examination that were recorded with a primary complaint of nasal obstruction. Findings were reported in an anonymous online survey focusing on laterality, severity, and specific site of perceived obstruction. RESULTS A total of 38 patients were included in the first part of the study. The Cohen's kappa coefficient was used to determine the interrater agreement between the patient and physician in the degree of nasal obstruction. The kappa coefficient was 0.03 (p value 0.372) for the comparison of the left-sided scores (fair agreement), and 0.16 (p value 0.014) for the right-sided scores (slight agreement). A comparison was also done between the side of the nose the patient felt was most obstructed to the most obstructed side found on physical exam by the otolaryngologist. Thirteen of the 38 patients (34%) had perceived nasal obstruction on the opposite side of that noted to be most obstructed on physical exam. Despite this, the kappa coefficient in this comparison was 0.43 (p value <0.001) revealing moderate agreement between the two groups. Seventeen otolaryngologists participated in the second part of the study. Data extrapolated revealed very little agreement among the physicians in reporting which side of the nose was most obstructed, what anatomical structure contributed to the obstruction the most, and what percentage obstruction was present. DISCUSSION Based on our findings, patients can reasonably determine based on their symptoms which side is most obstructed, but symptoms do not correlate with severity of obstruction when compared to physical exam. There is also very little consistency between otolaryngologists in their assessment of the degree of nasal obstruction on exam. The results of this study may have far-reaching implications for patient management, surgical intervention, and medicolegal documentation as it relates to the current surgical treatment of nasal obstruction.
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Affiliation(s)
- Sarah Saxon
- Facial Plastic Surgery, Austin, TX, United States of America
| | - Romaine Johnson
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern, Dallas, TX, United States of America
| | - Jeffrey H Spiegel
- Boston University School of Medicine, Boston, MA, United States of America.
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18
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Xavier R, Azeredo-Lopes S, Menger DJ, Cyrne de Carvalho H, Spratley J. Which Nasal Airway Dimensions Correlate with Nasal Airflow and with Nasal Breathing Sensation? Facial Plast Surg Aesthet Med 2021. [PMID: 34492200 DOI: 10.1089/fpsam.2021.0148] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Rhinoplasty modifies the nasal pyramid, thereby also modifying the nasal airway. Objectives: To correlate the sensation of nasal breathing, as measured by patient-reported outcome measures, and nasal airflow, as assessed by peak nasal inspiratory flow (PNIF), with nasal airway dimensions, as measured on computed tomography (CT) images. Methods: Fifty Caucasian patients were studied through visual analogue scale (VAS), nasal obstruction symptom evaluation (NOSE) and PNIF. Measurements of the nasal airway were made on CT images: minimal distance between septum and inferior and middle turbinates, nasal valve angle, and nasal valve area. Results: There was a significant association between PNIF and nasal valve area, between VAS and the narrower nasal valve angle and between NOSE and minimal distance between septum and middle turbinate of the narrower side. Conclusions: This study suggests that the dimensions of the nasal valve and of the middle nasal airway have a substantial impact on nasal breathing capacity. It also highlights the importance of unilateral nasal airway obstruction to nasal breathing.
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Affiliation(s)
- Rui Xavier
- Department of Otorhinolaryngology, Hospital Luz Arrabida, Vila Nova de Gaia, Portugal
| | | | - Dirk Jan Menger
- Department of Facial Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jorge Spratley
- Faculdade de Medicina da Universidade do Porto, Centro Hospitalar e Universitário S.João and Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Porto, Portugal
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19
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Kaura A, Pendolino AL, Navaratnam A, Andrews PJ, Leung TS. The Nasal Obstruction Balance Index: A Novel Approach to Improving Correlation Between Unilateral Nasal Airway Measurements and Evaluating Nasal Airway Asymmetry. Laryngoscope 2021; 131:E2833-E2840. [PMID: 33949695 DOI: 10.1002/lary.29597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/29/2021] [Accepted: 04/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Demonstrate that the Nasal Obstruction Balance Index (NOBI) model fulfils the unmet need of improving unilateral correlation between subjective and objective nasal obstruction outcome measures and identifying the more obstructed side. Improve correlation between unilateral objective nasal airway measurements (nasal inspiratory peak flow [NIPF] and acoustic rhinometry [AR]) and subjective Visual Analogue Scale for nasal obstruction (VAS-NO) scores. Improve assessment of nasal airway asymmetry by evaluating unilateral measurements both before and after the application of nasal decongestant; which the patient could better understand. NOBI represents a ratio calculated by taking the difference between left and right nasal airway measurements and divided by the maximum unilateral measurement. It is based on Poiseuille's law and aims to reduce the confounding variables which challenge nasal airway measurement. STUDY DESIGN Prospective cohort study. METHODS Forty-three controls and 34 patients with nasal obstruction underwent both unilateral and bilateral NIPF, AR and VAS-NO measurements; these were repeated after the application of nasal decongestant. The NOBI values for unilateral NIPF, AR, and VAS-NO were calculated both before and after decongestant. RESULTS The correlation between unilateral NIPF and AR measurements was enhanced considerably (r = 0.57, P < .01) when NOBI was applied. The NOBI metric significantly increased the correlation between unilateral NIPF, AR, and VAS-NO scores. Postdecongestant NOBI for NIPF and AR measurements correctly identified the more obstructed side in 82.4% and 94.1% of the deviated nasal septum (DNS) cases, respectively. CONCLUSION The NOBI model provides a better correlation between unilateral subjective and objective measurements and identifies the more obstructed side. LEVEL OF EVIDENCE Prospective cohort study (level III) Laryngoscope, 2021.
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Affiliation(s)
- Anika Kaura
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, United Kingdom.,Ear Institute, University College London, Grays Inn Road, London, United Kingdom, United Kingdom
| | - Alfonso Luca Pendolino
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, United Kingdom.,Ear Institute, University College London, Grays Inn Road, London, United Kingdom, United Kingdom
| | - Annakan Navaratnam
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Peter J Andrews
- Department of Rhinology and Facial Plastic Surgery, Royal National Throat Nose and Ear Hospital, London, United Kingdom.,Ear Institute, University College London, Grays Inn Road, London, United Kingdom, United Kingdom
| | - Terence S Leung
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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20
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Unadkat SN, Pendolino AL, Auer D, Khwaja S, Randhawa PS, Andrews PJ, Saleh HA. The Evidence Base for the Benefits of Functional Septorhinoplasty and its Future Post COVID-19. Facial Plast Surg 2021; 37:625-631. [PMID: 33676375 DOI: 10.1055/s-0041-1725162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Ever since the introduction of the concept of Procedures of Limited Clinical Value (PoLCV), procedures such as functional septorhinoplasty have been subject to additional funding restrictions within the British National Health Service. Recent publications have suggested that 10% of Clinical Commissioning Groups in the United Kingdom no longer fund septorhinoplasty surgery irrespective of the indications, including congenital malformations or post-trauma, and despite the strong evidence available in the literature in treating a range of health conditions. Thus, inequity exists across the country. At present functional septorhinoplasty surgery is frequently but incorrectly grouped together with aesthetic rhinoplasty, both of which are deemed to be cosmetic interventions. Moreover, as we exit the peak of the current coronavirus disease 2019 (COVID-19) pandemic, procedures deemed to be of lower clinical priority will potentially be at risk throughout Europe. The purpose of this review is twofold; the first is to put forward the evidence to commissioners in favor of functional septorhinoplasty surgery on patient well-being and mental health; the second is to demonstrate why functional septorhinoplasty surgery is a distinct procedure from aesthetic rhinoplasty and why it ought not to be classified as a procedure of limited clinical value.
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Affiliation(s)
- Samit N Unadkat
- Department of Rhinology and Facial Plastic Surgery, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom
| | - Alfonso Luca Pendolino
- Department of Rhinology and Facial Plastic Surgery, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom.,Ear Institute, University College London, United Kingdom
| | - Deborah Auer
- Department of Otolaryngology, Charing Cross Hospital, London, United Kingdom
| | - Sadie Khwaja
- Department of Otolaryngology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Premjit S Randhawa
- Department of Rhinology and Facial Plastic Surgery, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom
| | - Peter J Andrews
- Department of Rhinology and Facial Plastic Surgery, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom.,Ear Institute, University College London, United Kingdom
| | - Hesham A Saleh
- Department of Otolaryngology, Charing Cross Hospital, London, United Kingdom
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21
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Thongngarm T, Wongsa C, Phinyo P, Assanasen P, Tantilipikorn P, Sompornrattanaphan M. As-Needed Versus Regular Use of Fluticasone Furoate Nasal Spray in Patients with Moderate to Severe, Persistent, Perennial Allergic Rhinitis: A Randomized Controlled Trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:1365-1373.e6. [DOI: 10.1016/j.jaip.2020.09.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/06/2020] [Accepted: 09/25/2020] [Indexed: 01/20/2023]
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22
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Xavier R, Azeredo-Lopes S, Menger DJ, de Carvalho HC, Spratley J. Objective measurement and patient-reported evaluation of the nasal airway: Is correlation dependent on symptoms or on nasal airflow? Clin Otolaryngol 2021; 46:744-751. [PMID: 33533570 DOI: 10.1111/coa.13726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/29/2020] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence has shown that the sensation of nasal breathing is related to variations in nasal mucosa temperature produced by airflow. An appropriate nasal airflow is necessary for changing mucosal temperature. Therefore, the correlation between objective measurements of nasal airflow and patient-reported evaluation of nasal breathing should be dependent on the level of nasal airflow. OBJECTIVES To find if the correlation between patient-reported assessment of nasal breathing and objective measurement of nasal airflow is dependent on the severity of symptoms of nasal obstruction or on the level of nasal airflow. METHODS The airway of 79 patients was evaluated using NOSE score and peak nasal inspiratory flow (PNIF). Three subgroups were created based on NOSE and three subgroups were created based on PNIF level to find if correlation was dependent on nasal symptoms or airflow. RESULTS The mean value of PNIF for the 79 patients was 92.6 L/min (SD 28.1 L/min). The mean NOSE score was 48.4 (SD 24.4). The correlation between PNIF and NOSE was statistically significant (P = .03), but with a weak association between the two variables (r = -.248). Evaluation of correlation based on symptoms demonstrated a weak or very weak association in each subgroup (r = -.250, r = -.007, r = -.104). Evaluation of correlation based on nasal airflow demonstrated a very weak association for the subgroups with middle-level and high PNIF values (r = -.190, r = -.014), but a moderate association for the subgroup with low PNIF values (r = -.404). CONCLUSIONS This study demonstrated a weak correlation between NOSE scores and PNIF values in patients non-selected according to symptoms of nasal obstruction or to airflow. It demonstrated that patients with symptoms of nasal obstruction have different levels of nasal airflow and that low nasal airflow prevents the sensation of good nasal breathing. Therefore, patients with symptoms of nasal obstruction may require improving nasal airflow to improve nasal breathing sensation.
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Affiliation(s)
| | | | | | | | - Jorge Spratley
- Centro Hospitalar e Universitário S. João and Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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23
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Corredor-Rojas G, García-Chabur MA, Castellanos J, Moreno S, Pinzón M, Peñaranda A. Nasal Obstruction and Quality of Life Assessment After Septoplasty With Turbinoplasty: Correlation Between Subjective Scales. Am J Rhinol Allergy 2020; 35:568-573. [PMID: 33297717 DOI: 10.1177/1945892420978956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Assessment of nasal obstruction is imprecise due to a low correlation between findings on the physical examination and objective measures with the severity of symptoms reported by the patient even after septoplasty with turbinoplasty is performed. The aim of this study is to evaluate the use of subjective scales, and the correlation between them for the evaluation of nasal obstruction after surgery. OBJECTIVE To assess the impact of undergoing septoplasty with turbinoplasty to relieve nasal obstructive symptoms and the quality of life in a mid-term period by using the Visual Analogue Scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE), and Glasgow Benefit Inventory (GBI). METHODS A retrospective study was conducted of patients who underwent a septoplasty with turbinoplasty due to nasal septodeviation and secondary nasal obstructive symptoms at the Hospital Universitario Fundación Santa Fe de Bogotá. Three scales were used to measure the outcomes one year after surgery: VAS (0-10), NOSE (0-100), and GBI (-100 to 100). RESULTS Data from 56 patients (21 females, mean age 37.5 years of age, SD 12.13) was collected. The results showed that 75% of the patients had a post-surgical NOSE score below 50 and a VAS score below 6. Regarding the GBI scale, 75% of the patients improved in their quality of life. An inverse proportional correlation was found between the NOSE and GBI scales (rho = -0.3682) (95% CI -0.579 to -0.111), and there was a directly proportional correlation between the NOSE and VAS scales (rho = 0.7440) (95% CI 0.595 to 0.844). CONCLUSION Subjective measures suggest there was an improvement in nasal obstructive symptoms and quality of life after surgery. Non-anatomical causes such as rhinitis can be confounding factors to consider in subsequent studies. VAS stands out as a possible interchangeable scale with NOSE to measure nasal obstruction in these patients.
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Affiliation(s)
- Gloria Corredor-Rojas
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia.,Department of Otorhinolaryngology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - María A García-Chabur
- Department of Otorhinolaryngology, Fundación Universitaria de Ciencias de la Salud-Hospital de San José, Bogotá, Colombia
| | - Juliana Castellanos
- Department of Otorhinolaryngology, Fundación Universitaria de Ciencias de la Salud-Hospital de San José, Bogotá, Colombia
| | - Sergio Moreno
- Department of Otorhinolaryngology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Martin Pinzón
- Department of Otorhinolaryngology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Department of Otorhinolaryngology, Fundación Universitaria de Ciencias de la Salud-Hospital de San José, Bogotá, Colombia
| | - Augusto Peñaranda
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia.,Department of Otorhinolaryngology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Department of Otorhinolaryngology, Fundación Universitaria de Ciencias de la Salud-Hospital de San José, Bogotá, Colombia
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24
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Seyed Resuli A, Oktem F, Ataus S. The Role of the Depressor Nasi Septi Muscle in Nasal Air Flow. Aesthetic Plast Surg 2020; 44:1766-1775. [PMID: 32246212 PMCID: PMC7508750 DOI: 10.1007/s00266-020-01693-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/16/2020] [Indexed: 11/29/2022]
Abstract
Background Musculus depressor septi nasi and its tendon, the dermocartilaginous ligament, play an important role in external nasal valve and nasal respiration. If the ligament is cut during septorhinoplasty operations, nasal functions of the nose and facial expressions are affected. Therefore, the aim of this study was to investigate the role of M. depressor septi nasi in nasal respiration at open rhinoplasty operations using rhinomanometry and electromyography. Methods The study included 29 patients who had only external nasal deformity (nasal hump deformity). All patients underwent open rhinoplasty. The dermocartilaginous ligament of the patients in the study group (DCL + group) was repaired but not in the control group (DCL − group). Rhinomanometry and electromyography were applied to all patients preoperatively and postoperatively. Results In the DCL − group, right and left nasal airflow values were significantly lower in post-op (562.92 cm3/s and 548.57 cm3/s), whereas right, left, and total nasal resistances were significantly lower in pre-op (0.28 Pa/cm3/s, 0.22 Pa/cm3/s, and 0.11 Pa/cm3/s). Statistically significant differences were not found between rhinomanometric measurements in pre-op and post-op values of the DCL + group. Post-op right, left and mean values of M. depressor septi nasi amplitude in the DCL + group (2.05 mV, 2.0 mV, 2.02 mV) were significantly higher than those in the DCL − group (1.52 mV, 1.61 mV, 1.57 mV). Conclusion Repair of the dermocartilaginous ligament during open rhinoplasty operations enhances nasal respiratory functions by expanding the external nasal valve through M. depressor septi nasi and allows the nose to participate in mimic movements. 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. Electronic supplementary material The online version of this article (10.1007/s00266-020-01693-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ali Seyed Resuli
- Department of ENT, Faculty of Medicine, İstanbul Yeni Yüzyıl University, İstanbul, Turkey.
| | - Fatih Oktem
- Department of ENT, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Sureyya Ataus
- Department of Neurology, Bahat Hospital, Eski Edirne Asfaltı No: 653 Bahat Hastanesi, Sultangazi, İstanbul, Turkey
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Three-Dimensional Computed Tomography Volume and Physiology of Nasal Cavity After Septhorhinoplasty. J Craniofac Surg 2020; 30:2445-2448. [PMID: 31274820 DOI: 10.1097/scs.0000000000005730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE In this study, the authors aimed to compare the nasal physiology and nasal cavity volume with three-dimensional computed tomography (3D-CT) 1 year after the operation with the values before the operation to investigate the possible narrowing and loss of function in the nasal cavity after septorhinoplasty (SRP) operation. METHODS Of 415 patients who had a primary SRP operation, 28 patients who met the criteria were included in the study. Nasal cavity volumes of patients with postoperative CTs were measured three-dimensionally after a mean 13 months, and objective rhinologic measurements (rhinomanometry, acoustic rhinometry, and peak nasal inspiratory flow [PNIF]) and subjective assessment methods (Visual Analog Scale [VAS], Nasal Obstruction Symptom Evaluation [NOSE]) were performed. RESULTS The mean postoperative VAS and PNIF values of the patients were significantly higher than the mean preoperative values. The mean postoperative NOSE value of the patients was significantly lower than the mean preoperative values. Although the mean MCA-1 and MCA-2 levels of the patients increased postoperatively, the increase was not significant. Although the postoperative mean values of VOL-1 and VOL-2 increased compared with the preoperative values, the increase was not significant. In the CT measurements of the patients, the nasal cavity volumes were significantly higher than the preoperative values. CONCLUSION Nasal cavity volumes in patients undergoing SRP were compared with 3D-CT for the first time in the literature, and a significant increase in nasal volume was observed in the postoperative first year. This finding suggests that the correction of intranasal problems leads to an increase in the nasal volume in SRP operations, although nasal osteotomy is performed.
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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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Unilateral and Bilateral PNIF in Quality Control of Nasal Septal Surgery. Int J Otolaryngol 2018; 2018:7846843. [PMID: 30410542 PMCID: PMC6206571 DOI: 10.1155/2018/7846843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/24/2018] [Accepted: 10/02/2018] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to explore the usefulness of unilateral, combined unilateral (left + right), and bilateral peak nasal inspiratory flow (PNIF) measurements in assessing the results of nasal septal surgery. Nasal obstruction was recorded subjectively and objectively before and 4 months after nasal septoplasty using a visual analogue scale (VAS) and a PNIF meter. Nasal septoplasty (58 patients) and septoplasty with turbinoplasty (68 patients) were performed on 126 patients (85 males; 41 females) with a mean age of 32.8 years. The results showed a significant improvement in VAS scores, as well as unilateral, combined unilateral, and bilateral PNIF values after both septoplasty and septoplasty with turbinoplasty. Septoplasty with turbinoplasty showed better improvement in VAS and PNIF scores than septoplasty alone and this was significant for bilateral PNIF scores. The best unilateral pre- and postoperative correlations between VAS and PNIF measurements were found using the lower of the two unilateral PNIF scores, irrespective of side. In the total material, VAS/PNIF correlations were mostly significant, but weak (all r<0.30). We found VAS and PNIF to be useful instruments in reporting results of surgery. The weak correlations between VAS and PNIF measurements suggest that these subjective and objective instruments may target different aspects of nasal obstruction.
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Augé J, Vent J, Agache I, Airaksinen L, Campo Mozo P, Chaker A, Cingi C, Durham S, Fokkens W, Gevaert P, Giotakis A, Hellings P, Herknerova M, Hox V, Klimek L, La Melia C, Mullol J, Muluk NB, Muraro A, Naito K, Pfaar O, Riechelmann H, Rondon C, Rudenko M, Samolinski B, Tasca I, Tomazic P, Vogt K, Wagenmann M, Yeryomenko G, Zhang L, Mösges R. EAACI Position paper on the standardization of nasal allergen challenges. Allergy 2018; 73:1597-1608. [PMID: 29377177 DOI: 10.1111/all.13416] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 12/12/2022]
Abstract
Nasal allergen challenge (NAC) is an important tool to diagnose allergic rhinitis. In daily clinical routine, experimentally, or when measuring therapeutic success clinically, nasal allergen challenge is fundamental. It is further one of the key diagnostic tools when initiating specific allergen immunotherapy. So far, national recommendations offered guidance on its execution; however, international divergence left many questions unanswered. These differences in the literature caused EAACI to initiate a task force to answer unmet needs and find a consensus in executing nasal allergen challenge. On the basis of a systematic review containing nasal allergen challenges of the past years, task force members reviewed evidence, discussed open issues, and studied variations of several subjective and objective assessment parameters to propose a standardized way of a nasal allergen challenge procedure in clinical practice. Besides an update on indications, contraindications, and preparations for the test procedure, main recommendations are a bilaterally challenge with standardized allergens, with a spray device offering 0.1 mL per nostril. A systematic catalogue for positivity criteria is given for the variety of established subjective and objective assessment methods as well as a schedule for the challenge procedure. The task force recommends a unified protocol for NAC for daily clinical practice, aiming at eliminating the previous difficulty of comparing NAC results due to unmet needs.
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Affiliation(s)
- J. Augé
- Department of Otorhinolaryngology, Head and Neck Surgery; University of Cologne Medical Center; Cologne Germany
- Institute of Medical Statistics and Computational Biology; Faculty of Medicine; University of Cologne; Cologne Germany
| | - J. Vent
- Department of Otorhinolaryngology, Head and Neck Surgery; University of Cologne Medical Center; Cologne Germany
- Institute of Medical Statistics and Computational Biology; Faculty of Medicine; University of Cologne; Cologne Germany
- Department of Otorhinolaryngology, Head and Neck Surgery; Universitätsmedizin Mannheim, Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - I. Agache
- Transylvania University Brasov; Faculty of Medicine; Department of Allergy and Clinical Immunology; Brasov Romania
| | - L. Airaksinen
- Health and Work Ability; Finnish Institute of Occupational Health; Helsinki Finland
| | - P. Campo Mozo
- Allergy Unit; IBIMA-Regional University Hospital of Málaga, ARADyAL; Málaga Spain
| | - A. Chaker
- Department of Otolaryngology; Center of Allergy and Environment (ZAUM); Klinikum rechts der Isar; Technical University Munich; Munich Germany
| | - C. Cingi
- ENT Department; Faculty of Medicine; Eskisehir Osmangazi University; Eskisehir Turkey
| | - S. Durham
- Allergy and Clinical Immunology; Imperial College; NHLI; London UK
| | - W. Fokkens
- Otorhinolaryngology; Academic Medical Centre; Amsterdam The Netherlands
| | - P. Gevaert
- Otorhinolaryngology; Ghent University; Ghent Belgium
| | - A. Giotakis
- Department of Otorhinolaryngology - Head and Neck Surgery; Medical University of Innsbruck; Medizinische Universitat Innsbruck; Innsbruck Austria
| | - P. Hellings
- Department of Otorhinolaryngology; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - M. Herknerova
- Alergologie a klinická imunologie; Nemocnice na Homolce; Prague Czech Republic
| | - V. Hox
- Department of Otorhinolaryngology; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - L. Klimek
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - C. La Melia
- Department of ENT; Azienda Ausl di Imola; Imola Italy
| | - J. Mullol
- Clinical and Experimental Immunoallergy; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Department of ORL; Hospital Clínic de Barcelona; Universitat de Barcelona; Barcelona Spain
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES); Barcelona Spain
| | - N. B. Muluk
- Department of Otorhinolaryngology; Medical Faculty; Kirikkale University; Kirikkale Turkey
| | - A. Muraro
- Department of Pediatrics; Referral Centre for Food Allergy; Padua General University Hospital; Padua Italy
| | - K. Naito
- Fujita Health University, Otolaryngology; 1-98 Denngakugakubo, Kutukake-cho; Toyoake city Aichi Prefecture Japan
| | - O. Pfaar
- Center for Rhinology and Allergology; Wiesbaden Germany
- Department of Otorhinolaryngology, Head and Neck Surgery; Universitätsmedizin Mannheim, Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - H. Riechelmann
- Department of Otorhinolaryngology - Head and Neck Surgery; Medical University of Innsbruck; Medizinische Universitat Innsbruck; Innsbruck Austria
| | - C. Rondon
- Allergy Unit; IBIMA-Regional University Hospital of Málaga, ARADyAL; Málaga Spain
| | - M. Rudenko
- London Allergy and Immunology Centre; London UK
| | - B. Samolinski
- Department of Prevention of Envinronmental Hazards and Allergology; Medical University of Warsaw; Poland
| | - I. Tasca
- Department of ENT; Azienda Ausl di Imola; Imola Italy
| | - P. Tomazic
- Department of General Otorhinolaryngology, Head and Neck Surgery; Medical University of Graz; Graz Austria
| | - K. Vogt
- Faculty of Medicine; University of Latvia; Riga Latvia
| | - M. Wagenmann
- Department of Otorhinolaryngology; Düsseldorf University Hospital (UKD); Düsseldorf Germany
| | - G. Yeryomenko
- Kharkiv National Medical University; Kharkiv Ukraine
| | - L. Zhang
- Department of Otolaryngology Head and Neck Surgery; Beijing TongRen Hospital; Capital Medical University; Beijing China
| | - R. Mösges
- Institute of Medical Statistics and Computational Biology; Faculty of Medicine; University of Cologne; Cologne Germany
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Resende L, Carmo CD, Mocellin L, Pasinato R, Mocellin M. Disease-specific quality of life after septoplasty and bilateral inferior turbinate outfracture in patients with nasal obstruction. Braz J Otorhinolaryngol 2017; 84:591-598. [PMID: 28823695 PMCID: PMC9452246 DOI: 10.1016/j.bjorl.2017.07.001] [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: 03/28/2017] [Revised: 07/07/2017] [Accepted: 07/12/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Septal deviations might cause nasal obstruction and negative impact on the quality of life of individuals. The efficacy of septoplasty for treatment of septal deviation and the predictors of satisfactory surgical outcomes remain controversial. Technical variability, heterogeneity of research samples and absence of a solid tool for clinical evaluation are the main hindrances to the establishment of reliable statistical data regarding the procedure. Objective To evaluate the clinical improvements in the disease-specific quality-of-life between patients submitted to septoplasty with bilateral outfracture of the inferior turbinate under sedation and local anesthesia in a tertiary hospital and to assess possible clinical–epidemiological variables associated with functional outcome. Methods Fifty-two patients consecutively submitted to septoplasty with bilateral outfracture of the inferior turbinate for treatment of nasal obstruction filled in forms regarding clinical and epidemiological information during enrollment and had their symptom objectively quantified using the Nose Obstruction Symptom Evaluation (NOSE) scale preoperatively and one and three months after the procedure. Statistical analysis aimed to determine overall and stratified surgical outcomes and to investigate correlations between the clinical–epidemiological variables with the scores obtained. Results Statistically significant improvement in the preoperative NOSE questionnaire compared to the scores obtained three months after surgery was demonstrated (p < 0.001, T-Wilcoxon), with strong correlation between the preoperative score and the postoperative improvement during this period (r = −0.614, p < 0.001, Spearman). After one month, patients reached in average 87.15% of the result obtained at the study termination. Smokers and patients with rhinitis and/or pulmonary comorbidity showed increased average preoperative NOSE scores, although without statistical significance (p > 0.05). Gender, age, history of rhinitis and presence of pulmonary comorbidity did not influence significantly surgical outcomes (p > 0.05). Smokers presented greater reduction in NOSE scores during the study (p = 0.043, U-Mann–Whitney). Conclusion Septoplasty with bilateral outfracture of the inferior turbinate has proven to significantly improve disease-specific quality-of-life and this favorable outcome seems to occur precociously.
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Affiliation(s)
- Lucas Resende
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Serviço de Otorrinolaringologia, Curitiba, PR, Brazil.
| | - Carolina do Carmo
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Serviço de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Leão Mocellin
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Serviço de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Rogério Pasinato
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Serviço de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Marcos Mocellin
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Serviço de Otorrinolaringologia, Curitiba, PR, Brazil
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Assessment of Nasal Obstruction With Rhinomanometry and Subjective Scales and Outcomes of Surgical and Medical Treatment. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.otoeng.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lara-Sánchez H, Álvarez Nuño C, Gil-Carcedo Sañudo E, Mayo Iscar A, Vallejo Valdezate LÁ. Assessment of nasal obstruction with rhinomanometry and subjective scales and outcomes of surgical and medical treatment. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 68:145-150. [PMID: 27780551 DOI: 10.1016/j.otorri.2016.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Prospective study of patients with nasal obstruction (NO) in order to measure therapeutic success by anterior active rhinomanometry (AAR), Nasal Obstruction Symptom Evaluation (NOSE) scale and Visual Analogue Scale (VAS) and to establish the correlation between these tests. METHODS Patients with NO, on whom we performed an AAR, NOSE and VAS scales at baseline and after medical treatment (topical nasal steroid) or surgery (septoplasty, turbinoplasty or septoplasty and turbinoplasty). The nasal flow obtained by the AAR and the score of both subjective scales (NOSE and VAS) were compared and analyzed. RESULTS A total of 102 patients were included in the study. Surgical treatment resulted in statistically significant differences with the AAR and the subjective scales. While in patients with medical treatment there was an increase in the AAR nasal flow but without statistical significance (P=.1363). The correlation between the AAR, the NOSE and VAS scales was measured finding a strong correlation between the NOSE and VAS scales only (r=.83327). CONCLUSIONS The patients with NO treated surgically have better results when these are evaluated by AAR or with subjective scales. There is no significant correlation between AAR, NOSE and VAS scales, this is considered to be because the AAR and subjective scales are complementary and measure different aspects of NO. The AAR and subjective scales are useful tools to be used together for the follow up of patients with NO.
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Affiliation(s)
- Hugo Lara-Sánchez
- Servicio de Otorrinolaringología, Hospital Universitario Río Hortega, Valladolid, España.
| | - Candelas Álvarez Nuño
- Servicio de Otorrinolaringología, Hospital Universitario Río Hortega, Valladolid, España
| | | | - Agustín Mayo Iscar
- Departamento de Estadística e Investigación Operativa, Universidad de Valladolid, Valladolid, España
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Saafan ME, Hegazy HM, Albirmawy OA. Empty nose syndrome: etiopathogenesis and management. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2016. [DOI: 10.4103/1012-5574.186540] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Garcia GJM, Hariri BM, Patel RG, Rhee JS. The relationship between nasal resistance to airflow and the airspace minimal cross-sectional area. J Biomech 2016; 49:1670-1678. [PMID: 27083059 PMCID: PMC4885785 DOI: 10.1016/j.jbiomech.2016.03.051] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 02/29/2016] [Accepted: 03/28/2016] [Indexed: 10/22/2022]
Abstract
The relationship between nasal resistance (R) and airspace minimal cross-sectional area (mCSA) remains unclear. After the introduction of acoustic rhinometry, many otolaryngologists believed that mCSA measurements would correlate with subjective perception of nasal airway obstruction (NAO), and thus could provide an objective measure of nasal patency to guide therapy. However, multiple studies reported a low correlation between mCSA and subjective nasal patency, and between mCSA and R. This apparent lack of correlation between nasal form and function has been a long-standing enigma in the field of rhinology. Here we propose that nasal resistance is described by the Bernoulli Obstruction Theory. This theory predicts two flow regimes. For mCSA>Acrit, the constriction is not too severe and there is not a tight coupling between R and mCSA. In contrast, when mCSA Acrit (estimated to be 0.37cm(2)), this theory suggests that airway constrictions are rarely an exclusive contributor to nasal resistance, which may explain the weak correlation between mCSA and subjective nasal patency.
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Affiliation(s)
- Guilherme J M Garcia
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, United States; Biotechnology and Bioengineering Center, Medical College of Wisconsin, United States.
| | - Benjamin M Hariri
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, United States; Biotechnology and Bioengineering Center, Medical College of Wisconsin, United States
| | - Ruchin G Patel
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, United States; Biotechnology and Bioengineering Center, Medical College of Wisconsin, United States
| | - John S Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, United States
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Effect of acupuncture on house dust mite specific IgE, substance P, and symptoms in persistent allergic rhinitis. Ann Allergy Asthma Immunol 2016; 116:497-505. [PMID: 27156748 DOI: 10.1016/j.anai.2016.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/31/2016] [Accepted: 04/05/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Clinical evidence suggests that acupuncture improves symptoms in persistent allergic rhinitis, but the physiologic basis of these improvements is not well understood. OBJECTIVE A randomized, sham-controlled trial of acupuncture for persistent allergic rhinitis in adults investigated possible modulation of mucosal immune responses. METHODS A total of 151 individuals were randomized into real and sham acupuncture groups (who received twice-weekly treatments for 8 weeks) and a no acupuncture group. Various cytokines, neurotrophins, proinflammatory neuropeptides, and immunoglobulins were measured in saliva or plasma from baseline to 4-week follow-up. RESULTS Statistically significant reduction in allergen specific IgE for house dust mite was seen only in the real acupuncture group, from 18.87 kU/L (95% CI, 10.16-27.58 kU/L) to 17.82 kU/L (95% CI, 9.81-25.83 kU/L) (P = .04). A mean (SE) statistically significant down-regulation was also seen in proinflammatory neuropeptide substance P (SP) 18 to 24 hours after the first treatment from 408.74 (299.12) pg/mL to 90.77 (22.54) pg/mL (P = .04). No significant changes were seen in the other neuropeptides, neurotrophins, or cytokines tested. Nasal obstruction, nasal itch, sneezing, runny nose, eye itch, and unrefreshed sleep improved significantly in the real acupuncture group (postnasal drip and sinus pain did not) and continued to improve up to 4-week follow-up. CONCLUSION Acupuncture modulated mucosal immune response in the upper airway in adults with persistent allergic rhinitis. This modulation appears to be associated with down-regulation of allergen specific IgE for house dust mite, which this study is the first to report. Improvements in nasal itch, eye itch, and sneezing after acupuncture are suggestive of down-regulation of transient receptor potential vanilloid 1. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Identifier: ACTRN 12610001052022.
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Ottaviano G, Fokkens WJ. Measurements of nasal airflow and patency: a critical review with emphasis on the use of peak nasal inspiratory flow in daily practice. Allergy 2016; 71:162-74. [PMID: 26447365 DOI: 10.1111/all.12778] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 12/26/2022]
Abstract
Objective measures can be used to assist the clinician to diagnose and treat nasal obstruction and also to quantify nasal obstruction in research. Objective measurements of nasal obstruction are as important as objective measurements of lung function. peak nasal inspiratory flow (PNIF), acoustic rhinometry (AR) and rhinomanometry (RM), with their specific peculiarity, assess different aspects of nasal obstruction. From the studies available in the literature, it seems that these methods roughly correlate with each other and that all of them can be alternatively utilized very well in research as well as in clinical practice. This review describes the various methods that can be used to measure nasal patency, airflow and resistance, mainly peak nasal inspiratory flow, rhinomanometry and acoustic rhinometry. PNIF has been demonstrated to be reproducible and as good an indication of objective nasal patency as formal rhinomanometry and has the advantage to be cheap, simple and suitable for serial measurements and for home use even in the paediatric population. PNIF normative data are available for children, adults and elderly subjects, and the availability of unilateral PNIF normal values allows evaluation of nasal sides separately. Just as in the lower airways, objective and subjective evaluation gives different information that together optimizes the diagnosis and the treatment of our patients. We argue that PNIF should be used regularly in every outpatient clinic that treats patients with nasal obstruction.
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Affiliation(s)
- G. Ottaviano
- Otolaryngology Section; Department of Neurosciences; University of Padova; Padova Italy
| | - W. J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Centre; Amsterdam The Netherlands
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Abstract
Empty nose syndrome (ENS) is a rare, late complication of turbinate surgery. The most common clinical symptoms are paradoxical nasal obstruction, nasal dryness and crusting, and a persistent feeling of dyspnea. Little is known about the pathogenesis of ENS, though it is speculated that anatomical changes leading to alterations in local environment, disruption of mucosal cooling, and disruption of neurosensory mechanisms are strongly implicated. The diagnosis is clinical, though often difficult to make due to the poor correlation between subjective and objective findings. Medical therapies include mucosal humidification, irrigations, and emollients. Surgical therapy should be reserved for refractory cases and may involve turbinate reconstruction, most commonly using implantable biomaterials. Ultimately, prevention of this feared complication through turbinate-sparing techniques is essential.
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Roopa Manjunatha G, Mahapatra DR, Prakash S, Rajanna K. Validation of polyvinylidene fluoride nasal sensor to assess nasal obstruction in comparison with subjective technique. Am J Otolaryngol 2015; 36:122-9. [PMID: 25447932 DOI: 10.1016/j.amjoto.2014.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/13/2014] [Accepted: 09/26/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study is to validate the applicability of the PolyVinyliDene Fluoride (PVDF) nasal sensor to assess the nasal airflow, in healthy subjects and patients with nasal obstruction and to correlate the results with the score of Visual Analogue Scale (VAS). METHODS PVDF nasal sensor and VAS measurements were carried out in 50 subjects (25-healthy subjects and 25 patients). The VAS score of nasal obstruction and peak-to-peak amplitude (Vp-p) of nasal cycle measured by PVDF nasal sensors were analyzed for right nostril (RN) and left nostril (LN) in both the groups. Spearman's rho correlation was calculated. The relationship between PVDF nasal sensor measurements and severity of nasal obstruction (VAS score) were assessed by ANOVA. RESULTS In healthy group, the measurement of nasal airflow by PVDF nasal sensor for RN and LN were found to be 51.14±5.87% and 48.85±5.87%, respectively. In patient group, PVDF nasal sensor indicated lesser nasal airflow in the blocked nostrils (RN: 23.33±10.54% and LN: 32.24±11.54%). Moderate correlation was observed in healthy group (r=-0.710, p<0.001 for RN and r=-0.651, p<0.001 for LN), and moderate to strong correlation in patient group (r=-0.751, p<0.01 for RN and r=-0.885, p<0.0001 for LN). CONCLUSION PVDF nasal sensor method is a newly developed technique for measuring the nasal airflow. Moderate to strong correlation was observed between PVDF nasal sensor data and VAS scores for nasal obstruction. In our present study, PVDF nasal sensor technique successfully differentiated between healthy subjects and patients with nasal obstruction. Additionally, it can also assess severity of nasal obstruction in comparison with VAS. Thus, we propose that the PVDF nasal sensor technique could be used as a new diagnostic method to evaluate nasal obstruction in routine clinical practice.
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Affiliation(s)
- G Roopa Manjunatha
- Department of Instrumentation and Applied Physics, Indian Institute of Science, Bangalore-560012, India
| | - D Roy Mahapatra
- Department of Aerospace Engineering, Indian Institute of Science, Bangalore-560012, India
| | - Surya Prakash
- Department of Ear, Nose & Throat M.S. Ramaiah Medical College and Hospital, Bangalore-560054, India
| | - K Rajanna
- Department of Instrumentation and Applied Physics, Indian Institute of Science, Bangalore-560012, India.
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Soliman M, North ML, Steacy LM, Thiele J, Adams DE, Ellis AK. Nasal allergen challenge studies of allergic rhinitis: a guide for the practicing clinician. Ann Allergy Asthma Immunol 2014; 113:250-6. [PMID: 25168223 DOI: 10.1016/j.anai.2014.06.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Mena Soliman
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario
| | - Michelle L North
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario
| | - Lisa M Steacy
- Allergy Research Unit, Kingston General Hospital, Kingston, Ontario
| | - Jenny Thiele
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario
| | - Daniel E Adams
- Allergy Research Unit, Kingston General Hospital, Kingston, Ontario
| | - Anne K Ellis
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario; Allergy Research Unit, Kingston General Hospital, Kingston, Ontario; Department of Medicine, Queen's University, Kingston, Ontario.
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Sozansky J, Houser SM. The physiological mechanism for sensing nasal airflow: a literature review. Int Forum Allergy Rhinol 2014; 4:834-8. [PMID: 25079504 DOI: 10.1002/alr.21368] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Nasal obstruction is a common otolaryngologic complaint, yet the mechanism of sensing airflow is not commonly understood. The objective of this work was to review current knowledge on the physiological mechanism for sensing nasal airflow. METHODS Current literature pertaining to nasal sensation to airflow was retrieved using PubMed and Google Scholar searches. RESULTS The primary physiological mechanism that produces the sensation of ample nasal airflow is activation of trigeminal cool thermoreceptors, specifically transient receptor potential melastatin family member 8 (TRPM8), by nasal mucosal cooling. The dynamic change in temperature is ultimately sensed. Nasal mucosal cooling is a result of conductive heat loss, driven by temperature gradient, and evaporative heat loss, driven by humidity gradient. The perception of ample nasal airflow is dependent on the overall nasal surface area stimulated by mucosal cooling, which is mainly governed by air flow patterns. Cool thermoreceptors in the nasal mucosa are connected to the respiratory centers and consequently can alter respiration patterns. Mechanoreceptors do not seem to play a role in sensing nasal airflow. Computational fluid dynamics (CFD) modeling could be a valuable objective tool in evaluating patients with nasal congestion. CONCLUSION Understanding the physiological mechanism of how the nose senses airflow can aid in diagnosing the cause behind patient symptoms, which allows physicians to provide better treatment options for patients.
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Sozansky J, Houser SM. Pathophysiology of empty nose syndrome. Laryngoscope 2014; 125:70-4. [DOI: 10.1002/lary.24813] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 04/26/2014] [Accepted: 06/05/2014] [Indexed: 12/15/2022]
Affiliation(s)
| | - Steven M. Houser
- Department of Otolaryngology, MetroHealth Medical Center; Case Western Reserve University College of Medicine; Cleveland Ohio U.S.A
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Tatar A, Altas E. Effects of radiofrequency thermal ablation on the nasal cycle measured using rhinomanometry. Ann Otol Rhinol Laryngol 2014; 123:771-7. [PMID: 24944272 DOI: 10.1177/0003489414538763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study was designed to research the effects of radiofrequency thermal ablation (RFTA) surgery on the nasal cycle, with anterior rhinomanometry being used for assessment. METHODS Thirty patients with inferior concha hypertrophy and 13 healthy volunteers were included in this study. An anterior rhinomanometry was performed on each of the patients before surgery and at 1 month and 6 months after surgery, and on the volunteers in the control group, simultaneously. RESULTS Nineteen of the 30 patients and 8 of the 13 healthy participants showed a distinct type of nasal cycle at different periods of measurement. The mean of the total nasal airflow of the patients was lower before RFTA surgery but increased at a rate of 71.07%, closer to the value of the control group, after RFTA surgery. After RFTA, the unilateral nasal airflow (fmin and fmax) values increased at ratios of 22.36% and 94.44%, respectively. The amplitude (fmax-fmin) showed a statistically significant decrease in the postoperative period (108.43 ± 54.37), when compared with that of the preoperative period (202.80 ± 81.24) (P < .01). CONCLUSION We conclude that the RFTA is a useful method for treating inferior concha hypertrophy, because it positively affects the nasal physiology, increasing the total nasal airflow without changing the nasal cycle time.
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Affiliation(s)
- Arzu Tatar
- Department of Otorhinolaryngology-Head and Neck Surgery, Regional Training and Research Hospital, Erzurum, Turkey
| | - Enver Altas
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Peak nasal inspiratory flow: a useful and handy tool for the diagnosis of nasal obstruction in the elderly. Eur Arch Otorhinolaryngol 2014; 271:2427-31. [PMID: 24381024 DOI: 10.1007/s00405-013-2875-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
Abstract
The global population is aging, with the over-65 age group expected to double in the USA by 2030. Three subcategories of elderly people have been identified: "young old" (from 65 to 74 years), "older old" (from 75 to 84) and "oldest old" (85 or more). Rhinosinusitis is a common disease that affects more than 31 million people in the USA every year. Nasal obstruction is one of the most common symptoms in patients affected by rhinosinusitis. An accurate nasal obstruction evaluation in the elderly is becoming of increasing interest for medical doctors, especially for geriatricians. Peak nasal inspiratory flow (PNIF) is a cheap and easy method for assessing nasal patency. The purpose of the study was to compare young old normal PNIF values with older old normal PNIF values. Charts relating PNIF normal values in the elderly with various explanatory variables have been provided. PNIF measurements were performed in 113 volunteers aged 65-84 years. One hundred and five of them fulfilled the study criteria and were self-reported healthy elderly. None of them complained of nasal symptoms. Data were statistically analyzed and figures and tables were produced relating PNIF to height, sex and age. PNIF values decreased with age (p = 0.0053) and were significantly lower in the "older old" sub-cohort than in the "young old" group (p = 0.007). Nasal obstruction in the elderly is a common problem and appropriate diagnosis and treatment are important for improving their quality of life. The measurement of PNIF could be useful in evaluating elderly patients who complain of nasal obstruction.
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Koinis-Mitchell D, Esteban C, Kopel SJ, Jandasek B, Dansereau K, Fritz GK, Klein RB. Perceptual accuracy of upper airway compromise in children: Clinical relevance and future directions for research. ALLERGY & RHINOLOGY 2013; 4:e54-62. [PMID: 24124637 PMCID: PMC3793113 DOI: 10.2500/ar.2013.4.0060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Approximately 80% of children with asthma have coexisting allergic rhinitis. The accurate recognition and assessment of asthma and rhinitis symptoms is an integral component of guideline-based treatment for both conditions. This article describes the development and preliminary evaluation of a novel paradigm for testing the accuracy of children's assessment of their upper airway (rhinitis) symptoms. This work is guided by our previous research showing the clinical efficacy of tools to evaluate children's perceptual accuracy of asthma symptoms and linking accurate asthma symptom perception to decreased asthma morbidity (Fritz G, et al., Ethnic differences in perception of lung function: A factor in pediatric asthma disparities? Am J Respir Crit Care Med 182:12-18, 2010; Klein RB, et al., The Asthma Risk Grid: Clinical interpretation of symptom perception, Allergy Asthma Proc 251-256, 2004). The pilot study tests a paradigm that allows for the examination of the correspondence of children's assessment of their upper airway functioning with actual values of upper airway flow through the use of a portable, handheld nasal peak flowmeter. Nine children with persistent asthma were evaluated over a 4-week period. The article describes the rhinitis perceptual accuracy paradigm and reviews the results of a pilot study, showing a large proportion of inaccurate rhinitis symptoms "guesses" by the sample of children with persistent asthma. Patterns of inaccuracy, rhinitis control, and asthma morbidity are also described. Directions for future work are reviewed. The development of clinical tools to evaluate children's accuracy of rhinitis symptoms are needed, given the central role of the self-assessment of symptoms in guideline-based care. Accurate perception of the severity of rhinitis symptoms may enhance rhinitis control, lessen the burden of asthma, and prevent unnecessary emergency use among this high-risk group of children.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Dietz de Loos DAE, Segboer CL, Gevorgyan A, Fokkens WJ. Disease-specific quality-of-life questionnaires in rhinitis and rhinosinusitis: review and evaluation. Curr Allergy Asthma Rep 2013; 13:162-70. [PMID: 23299562 DOI: 10.1007/s11882-012-0334-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Quality of life (QoL) measurements are the best approximation of the burden of disease for the patient. Patient-reported outcome measurements (PROMs) estimate health-related quality of life (HRQoL). PROMs can be generic or disease-specific. Generic PROMs allow comparisons between different diseases but can be relatively insensitive for measuring changes within a disease. Recommended QoL questionnaires in allergic rhinitis and rhinoconjunctivitis are the RQLQ (or adapted versions), in chronic rhinosinusitis, the SNOT-22 or RSOM-31, and in acute rhinosinusitis, the modified SNOT-16. PROMs can be used both for daily clinical work and for research. In daily practice, a quick evaluation of the questionnaire directly indicates how the patient is doing. It makes sure that symptoms important for the patient are not overlooked and, during the consultation, the physician can elaborate on specific aspects of the symptomatology. It is important, especially in research, to realize that disease-specific questionnaires are only validated for specific diseases and are not automatically valid for other diseases.
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Affiliation(s)
- Dirk A E Dietz de Loos
- Department of Otorhinolaryngology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
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