Acoustic rhinometry in mouth breathing patients: a systematic review

Towards a better diagnosis of mouth breathing: validity and reliability of a protocol for assessing the awake breathing pattern in preschool children

PURPOSE

The Awake Breathing Pattern Assessment (ABPA) is a prototypical clinical grid recently designed through an international consensus of Speech and Language Pathologists (SLPs) to categorize the awake and habitual breathing pattern during the orofacial myofunctional assessment. This cross-sectional study aims to explore the psychometric properties of the ABPA in a preschool population.

METHODS

133 children from 2;11 to 6 years old were assessed with the ABPA. The percentage of time spent breathing through the mouth was objectively measured by a CO2 sensor and used as a baseline measurement. We first performed a multivariate Latent Profile Analysis based on the CO2 measurement and a parental questionnaire to define the number of categories that best characterize the breathing pattern. Subsequently, we assessed the intra- and inter-rater reliability, internal consistency criterion validity, construct validity and sensitivity and specificity.

RESULTS

The awake breathing pattern can best be described by two groups: nasal and mouth breathing. The ABPA, initially designed in three groups, was adjusted accordingly. This final version showed excellent intra-rater and inter-rater reliability. There was a significant correlation between the ABPA and the CO2 measurement. The ABPA showed a fair sensitivity and a good specificity.

CONCLUSION

The reference tool based on CO2 data was used in children for the first time and was found to be reliable. The ABPA is a suitable tool for SLPs to confirm the diagnosis of mouth breathing in preschool children if more sensitive screening tools, like parental questionnaires, are used beforehand.

Variation in Practice Patterns of Current Rhinoplasty Surgeons for Nasal Valve Compromise

Background: To compare practice patterns of rhinoplasty surgeons with the 2010 clinical consensus statements (CCSs) on nasal valve compromise (NVC) and delineate what variables may affect such practice patterns and consensus. Methods: An online questionnaire pertaining to the 2010 CCS was administered at the Advances in Rhinoplasty meeting with responses based on a 9-point Likert scale. Results: Of 580 participants, 113 completed the survey with the majority of statements in accordance between panelists and surveyors. Less than 10% of responses met discordance criteria. Significant differences in practice patterns exist when stratified by specialty, years-in-practice, geographic location, type of practice, and annual number of rhinoplasties performed. Conclusion: There is a general concordance between practice patterns of active rhinoplasty surgeons and the 2010 CCS on NVC despite a decade of new studies in the interim. Significant differences, however, exist regarding the utility of diagnostic imaging, rhinoscopy, nasal endoscopy, and acoustic rhinomanometry in the evaluation of NVC. Furthermore, variables such as specialty, years in practice, annual number of rhinoplasties performed, practice setting, and geographic location significantly affect these perspectives and overall consensus.

Evaluation of Velopharyngeal Closure Ratio by a New Semi-Automatic Detection Method Based on Nasopharyngoscopy With Image Processing Method

ABSTRACT

The goal of this study is to develop and validate a novel semi-automatic detection method (SADM) under nasopharyngoscopy based on the image processing technique, which can assist the evaluation of the velar closure ratio (VCR). After the development of the SADM, 72 patients were enrolled. The reliability of SADM was evaluated by repeated measurements. Velar closure ratio are given by conventional nasopharyngoscopy method and SADM were compared. Velar closure ratios given by SADM were further translated into a trichotomous classification for velopharyngeal function diagnosis, that is, velopharyngeal closure (VPC), marginal VPC (MVPC), and velopharyngeal incomplete. The 2 VCR-thresholds used for the translation were explored and validated. As results shown, SADM was proved to be reliable with an intraclass correlation coefficient of 0.996 (95% confidence interval: 0.993-0.997, P < 0.001). Intraclass correlation coefficient between conventional nasopharyngoscopy method and SADM was 0.954 (95% confidence interval: 0.927- 0.971, P < 0.001). Velar closure ratio-thresholds were set at 0.82 and 0.92 according to the ROC curve. Diagnostic sensitivity and specificity for velopharyngeal incomplete were 1.00 and 1.00. MVPC had 0.58 sensitivity and 0.96 specificities while VPC had 0.92 and 0.79, respectively. No statistically significant difference was found between the diagnosis of SADM and speech pathologists (P > 0.1). In conclusion, this study successfully developed an accurate and reliable semi-automatic method to evaluate VCR, which could help improve the efficacy of VCR evaluation and velopharyngeal function diagnosis.

Predictors of nasal bacterial culture rates in patients with chronic rhinosinusitis

All nontechnical factors were analyzed to predict nasal bacterial culture results in patients with chronic rhinosinusitis (CRS). Four hundred and ninety-six CRS patients, who underwent functional endoscopic sinus surgery (FESS), were enrolled. Prior to FESS, the severity of each patient's CRS was evaluated using a questionnaire, endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and CT scan. Nasal bacterial cultures were collected from both middle meati using a cotton-tipped stick. Our results showed that the symptom severity complained of by patients and their loss of smell function did not influence the bacterial culture rate. We discovered that the bacterial culture rate was significantly higher in nostrils with nasal polyps than those without polyps, along with nostrils experiencing thick, purulent discharge as opposed to those without discharge. Additionally, this result also occurred in nostrils with a saccharin transit time of more than 30 min than it did in those with a saccharin transit time of less than or equal to 30 min. Both the total endoscopic score and anterior group CT score were significantly higher in nostrils with positive culture than those with negative culture, while the second minimal cross-sectional area (MCA₂) of the nasal cavity was significantly lower in nostrils with positive culture than those with negative culture. Multiple logistic regression analysis showed that both nasal polyps and MCA₂ were the predictors for positive nasal bacterial culture results. It was concluded that nasal polyps and MCA₂ were the predictors for positive nasal bacterial culture results in CRS patients.

The effects of heated humidification to nasopharynx on nasal resistance and breathing pattern

Background

Mouth breathing could induce not only dry throat and eventually upper respiratory tract infection, but also snoring and obstructive sleep apnea, while nasal breathing is protective against those problems. Thus, one may want to explore an approach to modify habitual mouth breathing as preferable to nasal breathing. The aim of this study was to investigate the physiological effects of our newly developed mask on facilitation of nasal breathing.

Methods

Thirty seven healthy male volunteers were enrolled in a double blind, randomized, placebo-controlled crossover trial. Participants wore a newly developed heated humidification mask or non-heated-humidification mask (placebo) for 10-min each. Subjective feelings including dry nose, dry throat, nasal obstruction, ease to breathe, relaxation, calmness, and good feeling were asked before and after wearing each mask. In addition, the effects of masks on nasal resistance, breathing pattern, and heart rate variability were assessed.

Results

Compared with the placebo mask, the heated humidification mask improved all components of subjective feelings except for ease to breathe; moreover, decreased nasal resistance and respiratory frequency accompanied a simultaneous increase in a surrogate maker for tidal volume. However, use of the heated humidification mask did not affect heart rate variability

Conclusion

Adding heated humidification to the nasopharynx could modulate breathing patterns with improvement of subjective experience and objective nasal resistance.

Aeração nasal e força muscular respiratória em crianças respiradoras orais

Resumo: OBJETIVO: observar se existe relação entre força muscular respiratória e área da aeração nasal em crianças respiradoras orais. MÉTODOS: trata-se de um estudo do tipo observacional, transversal comparativo entre dois grupos. Participaram 32 crianças com Respiração Oral secundária à rinite alérgica (21 meninos e 11 meninas) e 30 respiradoras nasais sem rinite alérgica (09 meninos e 21 meninas), 7 a 12 anos, submetidas à avaliação da aeração nasal com o espelho de Altmann e à avaliação da força muscular respiratória com o manovacuômetro digital (MVD(r)30). RESULTADOS: não houve correlação entre aeração nasal e força muscular respiratória em cada subgrupo. Houve diferença comparando-se valores das pressões expiratórias máximas entre meninos e meninas respiradores orais (p=0,0064) e entre meninos e meninas respiradores nasais (p=0,0030). Também houve diferença das pressões inspiratórias máximas entre meninos e meninas respiradores orais (p=0,0324) e entre meninos e meninas respiradores nasais (p=0,0210). CONCLUSÃO: não foi possível confirmar a relação entre a área de aeração nasal e a força muscular respiratória nos respiradores orais.