Acoustic rhinometry and its uses in rhinology and diagnosis of nasal obstruction

Effects of Mucosal Decongestion on Nasal Aerodynamics: A Pilot Study

OBJECTIVE

Mucosal decongestion with nasal sprays is a common treatment for nasal airway obstruction. However, the impact of mucosal decongestion on nasal aerodynamics and the physiological mechanism of nasal airflow sensation are incompletely understood. The objective of this study is to compare nasal airflow patterns in nasal airway obstruction (NAO) patients with and without mucosal decongestion and nondecongested healthy subjects.

STUDY DESIGN

Cross-sectional study of a convenience sample.

SETTING

Academic tertiary medical center.

METHODS

Forty-five subjects were studied (15 nondecongested healthy subjects, 15 nondecongested NAO patients, and 15 decongested NAO patients). Three-dimensional models of the nasal anatomy were created from computed tomography scans. Steady-state simulations of airflow and heat transfer were conducted at 15 L/min inhalation rate using computational fluid dynamics.

RESULTS

In the narrow side of the nose, unilateral nasal resistance was similar in decongested NAO patients and nondecongested healthy subjects, but substantially higher in nondecongested NAO patients. The vertical airflow distribution within the nasal cavity (inferior vs middle vs superior) was also similar in decongested NAO patients and nondecongested healthy subjects, but nondecongested NAO patients had substantially less middle airflow. Mucosal cooling, quantified by the surface area where heat flux exceeds 50 W/m2, was significantly higher in decongested NAO patients than in nondecongested NAO patients.

CONCLUSION

This pilot study suggests that mucosal decongestion improves objective measures of nasal airflow, which is consistent with improved subjective sensation of nasal patency after decongestion.

Effectiveness of out-fracture of the inferior turbinate with reduction nasal bone fracture

BACKGROUND

The nasal bone, being the most protruding bone in the center of the facial bones, is particularly susceptible to damage. Nasal bone fractures can often result in secondary deformation and dysfunction of the nose, including septal fractures. Studies on functional or intra-nasal complications have been rarely reported after nasal bone fracture reduction.

AIM

To evaluate the severity of nasal obstruction and its improvement following nasal bone fracture reduction using inferior turbinoplasty.

METHODS

We conducted a retrospective review of data from 50 patients with symptomatic nasal obstruction between January to December 2010. All patients underwent preoperative Computed tomography evaluation, and symptom changes and nasal cavity volume were analyzed using a visual analog scale and acoustic rhinometry before and after surgery. Closed reduction and out-fracture of both inferior turbinates performed by the same surgeon. Treatment outcomes were assessed by comparing changes in the nasal airway volume measured using acoustic rhinometry before and after surgery. The minimal cross-sectional area (MCA) was also analyzed based on the Stranc classification.

RESULTS

Before reduction, the mean MCA for all cases was 0.59 ± 0.06 cm2, which represented an 11% decrease compared to the average size of a Korean adult (0.65 ± 0.03 cm2). The MCA for frontal impact was 0.60 ± 0.02 cm2 and for lateral impact, it was 0.58 ± 0.03 cm2. After reduction via inferior turbinoplasty, the MCA improved to 0.64 ± 0.04 cm2.

CONCLUSION

This study suggests that turbinoplasty is helpful in addressing nasal obstruction. Out-fracture of the inferior turbinate is an effective and durable technique that can be easily performed to enlarge the nasal airway with minimal morbidity.

Efficacy and safety of self-administered acupressure on symptoms, quality of life and nasal mucosal function in patients with perennial allergic rhinitis: study protocol for a randomized controlled exploratory trial

INTRODUCTION

Allergic rhinitis is a global health problem that can potentially be managed through acupressure. Our clinical observations have identified Allergic Rhinitis Acupressure Therapeutic (ARAT) as a novel acupressure treatment acting on specific acupoints, which may enhance the effectiveness of acupressure. Therefore, we propose a three-arm randomized controlled trial will be conducted to investigate the efficacy and safety of ARAT for perennial allergic rhinitis (PAR).

METHODS/DESIGN

In this trial, eligible 111 participants diagnosed with PAR will be randomly assigned to one of three groups: the ARAT group, the non-specific acupoints group, or the blank control group. The primary outcome will be the change in the total nasal symptom score, and the secondary outcomes will include: 1) changes in the scores of the standard version of Rhinoconjunctivitis Quality of Life Questionnaire (RQLQs); 2) acoustic rhinometry and anterior rhinomanometry; 3) changes in the scores of relief medication usage; 4) incidence of adverse events. Additionally, we will measure and compare the changes in cytokine levels (IL-5, IL-13, IFN-γ, and TSLP) in nasal secretions. The RQLQs and primary outcomes will be assessed at the beginning, middle, and end stages of the treatment period, with monthly follow-ups conducted over a total of three months. The secondary outcomes and biomarkers in nasal secretions will be measured at the beginning and end of the treatment period. Any adverse events or need for rescue medication will be carefully noted and recorded.

DISCUSSION

This study may produce a new acupressure treatment prescription that is easy to learn, more targeted, and adaptable. This trial represents the first clinical investigation comparing ARAT treatment for PAR with the non-specific acupoints group and blank control group. Our data is expected to provide evidence demonstrating the safety and efficacy of ARAT for PAR patients, while also exploring the functional mechanism underlying ARAT treatment, moreover, the results offer valuable insights for healthcare professionals in managing PAR symptoms.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR2300072292. Registered on June 08, 2023.

Validation of the Nasal Obstruction Symptom Evaluation Scale in Mexican Adults

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.

The nasal cycle before and after nasal septoplasty

PURPOSE

Septoplasty is one of the most frequently performed operations in patients with septal deviation of the nose. The aim of this surgical intervention is to reduce nasal obstruction and to achieve a physiological nasal breathing. The nasal cycle plays a crucial role in this. The aim of this study was to investigate nasal breathing and the nasal cycle after septoplasty over a long period of time and under everyday conditions.

METHODS

We examined 22 healthy subjects and 19 patients with nasal septal deviation. They participated in two sessions separated by an interval of three months. Shortly after the first session patients received nasal septoplasty. Testing included multiple questionnaires regarding nasal breathing and olfactory function, anterior rhinoscopy, rhinomanometry, acoustic rhinometry, and long-term rhinoflowmetry over 24 h.

RESULTS

Nasal septoplasty was associated with subjectively improved nasal breathing and nasal patency comparable to that in healthy subjects. The severity of nasal obstruction was reduced. Nasal airflow and the hydraulic diameter increased on the deviated side of the nose while the inspiratory resistance did not significantly change. In addition, the number of phases of the nasal cycle decreased on the nondeviated side. Hence, the surgery was associated with a more even distribution of phases on both sides of the nose.

CONCLUSION

Nasal septoplasty leads to a subjectively satisfactory result in patients with pathological septal deviation of the nose. In particular, septoplasty appears to be accompanied by a more even distribution of the nasal cycle across the two nasal cavities.

Evaluation of Nasal Patency Among Patients With Unilateral Cleft Lip and Palate: Cleft Versus Non-Cleft Side

OBJECTIVE

To evaluate the nasal patency using acoustic rhinometry (AR) in patients with unilateral cleft lip and palate (UCLP) and to ascertain the rhinological importance of the same.

METHODS

Eccovision Acoustic Rhinometer system was used for assessment of nasal cross-sectional area (CSA) and volume in 15 patients with UCLP. The CSA1, CSA2, and CSA3, which represent the CSA at the nasal valve area and anterior end of the inferior turbinate, the anterior half of the inferior turbinate and the anterior end of the middle turbinate, and the region of middle portion of middle turbinate, respectively, were compared on the cleft and non-cleft side.

RESULTS

The mean ± SD of CSA1, CSA2, and CSA3 as well as the overall nasal CSA were significantly higher on non-cleft side compared to cleft side (P value < .001). The mean ± SD of nasal volume was also significantly higher in non-cleft side compared to cleft side (P value < .001).

CONCLUSIONS

The nasal patency among patients with UCLP demonstrates a range of impairments that can be objectively measured using acoustic rhinometry. The orthodontic, orthopedic, or orthosurgical management of maxillary deficiency in these patients can affect the nasal area and volume and can have an impact on breathing, speech, and sleep. The pretreatment assessment may be useful to identify patients who are at potential risk of deterioration of nasal patency and airway post-intervention. Taking into consideration the multiple diagnostic procedures in the course of long-term multidisciplinary treatment of patients with cleft lip and palate, a noninvasive investigation technique such as AR may be the preferred mode of investigation to ascertain nasal patency.

Maxillary sinus recovery after LeFort I osteotomy: a prospective clinical and radiographic evaluation

Introduction: The purpose of this study was to obtain insight into the perioperative condition of the maxillary sinus in the LeFort I osteotomy by evaluating clinically and radiographically. Materials and methods: 25 patients who required conventional LeFort I procedures for orthognathic correction were included in the study. Damage to the maxillary sinus during the procedure and its recovery were prospectively analysed using validated questionnaires for sino-nasal complaints using RSOM-31 (RSOM − rhinosinusitis outcome measure), VAS score (VAS − visual analogue scale) and CT scan to compare and analyse changes in maxillary sinus prior to surgery and postoperatively 2 months after the surgery. The scores obtained from RSOM-31 questionnaire was analysed using Chi-square test, VAS questionnaire was interpreted using Wilcoxon sign rank test and CT scan findings were analysed using Fischer's exact test. Results: Mucosal thickening assessed using CT scan was the only consistent finding that was evident for all the patients who underwent LeFort I osteotomy which showed a statistically significant results of P < 0.05, whereas clinical correlation showed insignificant results of P > 0.05. Conclusion: In our attempt on extensive patient analysis we found that mucosal thickening was the prime alteration that was observed radiographically and no clinical changes were evident.

Two-dimensional assessment of the nasal valve area cannot predict minimum cross-sectional area or airflow resistance

BACKGROUND

Clinicians who manage nasal obstruction often comment on the shape and size of the nasal valve (NV) area. However, correlation of the symptoms of obstruction, nasal airflow dynamics, and the endoscopic appearance of the anatomic cross-sectional area of the NV is poorly understood. Endoscopic imaging and calculation of the NV area is investigated as a tool for either clinical or research use.

OBJECTIVE

To describe and evaluate a two-dimensional measurement of the minimum cross-sectional area (MCA) of the NV by using endoscopic imaging.

METHODS

A cross-sectional study of patients with symptoms of nasal obstruction who were undergoing nasal assessment was performed. The NV was measured with digital imaging taken from the endoscopy. Adobe Photoshop was used to calculate the digital MCA of the NV based on pixel count and a reference marker placed in the image field. Airway parameters were assessed by using a nasal obstruction visual analog scale, nasal airway resistance via rhinomanometry, and acoustic rhinometry derived MCA (acoustic MCA). Correlation of the digital MCA and airway parameters was made and interobserver correlation of the MCA measures was calculated.

RESULTS

Thirty-three nasal airways were assessed: mean (standard deviation) digital MCA (0.28 ± 0.13 cm(2)) and mean (standard deviation) acoustic MCA (0.51 ± 0.15 cm(2)). Correlation of the digital MCA with visual analog scale was poor (Pearson r = 0.10, p = 0.56). Similar finding between digital and acoustic MCA was poor (Pearson r = 0.50, p = 0.56, respectively) despite a moderately strong interobserver correlation for the digital MCA (Pearson r = 0.79, p < 0.001).

CONCLUSION

Qualitative endoscopic assessment of the NV may help clinicians predict NV dysfunction but simple two-dimensional measures seemed to be of limited value in accurately assessing the three-dimensional NV quantitatively.

Acoustic rhinometry in mouth breathing patients: a systematic review

INTRODUCTION

When there is a change in the physiological pattern of nasal breathing, mouth breathing may already be present. The diagnosis of mouth breathing is related to nasal patency. One way to access nasal patency is by acoustic rhinometry.

OBJECTIVE

To systematically review the effectiveness of acoustic rhinometry for the diagnosis of patients with mouth breathing.

METHODS

Electronic databases LILACS, MEDLINE via PubMed and Bireme, SciELO, Web of Science, Scopus, PsycInfo, CINAHL, and Science Direct, from August to December 2013, were consulted. 11,439 articles were found: 30 from LILACS, 54 from MEDLINE via Bireme, 5558 from MEDLINE via PubMed, 11 from SciELO, 2056 from Web of Science, 1734 from Scopus, 13 from PsycInfo, 1108 from CINAHL, and 875 from Science Direct. Of these, two articles were selected.

RESULTS

The heterogeneity in the use of equipment and materials for the assessment of respiratory mode in these studies reveals that there is not yet consensus in the assessment and diagnosis of patients with mouth breathing.

CONCLUSION

According to the articles, acoustic rhinometry has been used for almost twenty years, but controlled studies attesting to the efficacy of measuring the geometry of nasal cavities for complementary diagnosis of respiratory mode are warranted.

Nasal Airway Dimensions of Children With Repaired Unilateral Cleft Lip and Palate

OBJECTIVE

To measure cross-sectional areas of the main nasal constrictions as a function of the distance into the nose in children with repaired unilateral cleft lip and palate, as compared with children without cleft, by acoustic rhinometry.

DESIGN

Prospective analysis.

SETTING

Craniofacial anomalies hospital.

PARTICIPANTS

A total of 39 children with repaired unilateral cleft lip and palate and 34 healthy controls without cleft, of both genders, aged 6 to 9 years. Interventions/Variables : Nasal cross-sectional areas measured at the three main deflections of the rhinogram (CSA1, CSA2, CSA3) and distances from the nares (dCSA1, dCSA2, dCSA3) were assessed by means of an Eccovision Acoustic Rhinometer, before and after nasal decongestion. Differences were analyzed at a significance level of 5%.

RESULTS

At the cleft side, mean CSA1, CSA2, and CSA3 values ± standard deviation obtained before nasal decongestion were 0.17 ± 0.12, 0.29 ± 0.20, and 0.40 ± 0.28 cm(2), respectively, and dCSA1, dCSA2, and dCSA3 values ± standard deviation were 2.02 ± 0.40, 3.74 ± 0.51, and 5.50 ± 0.44 cm, respectively. At the noncleft side, these were 0.33 ± 0.11, 0.65 ± 0.28, and 0.90 ± 0.43 cm(2), respectively, and 1.69 ± 0.48, 3.67 ± 0.53, and 5.60 ± 0.70 cm, respectively. Increased cross-sectional area means were seen after nasal decongestion in the control and cleft groups. Mean cross-sectional area values at the cleft side were significantly smaller than noncleft side and control values, and the mean dCSA1 value was smaller at the noncleft side before and after decongestion.

CONCLUSIONS

Objective assessment of internal nasal dimensions has shown that children with unilateral cleft lip and palate have a significant impairment of nasal patency due to the reduced cross-sectional areas seen at the cleft side.

Surgical treatment of nasal obstruction in rhinoplasty

Often, rhinoplasty patients present not just for aesthetic correction, but for improvement of their nasal breathing due to functional abnormalities or problems. Because the aesthetic and functional problems must be addressed together, an understanding of both the internal and external anatomy is essential. In this article, the authors review the differential diagnosis of nasal obstruction and the important components of a thorough examination. In this article, medical treatment options are not discussed, but just as an exacting aesthetic analysis leads to an appropriate cosmetic rhinoplasty plan, a thorough functional analysis will dictate the appropriate medical or surgical treatment.

Validation of a cadaveric model for comprehensive physiologic and anatomic evaluation of rhinoplastic techniques

BACKGROUND

The physiologic effects of specific rhinoplasty maneuvers are incompletely understood, largely because of a limited ability to objectively examine such interventions. The purpose of this study was to develop and validate a cadaveric model for rhinoplasty testing.

METHODS

Ten cadaver heads were methodically prepared to simulate ventilatory conditions. Airway dimensions were measured with three-dimensional computed tomography and acoustic rhinometry. Airflow, pressure, and resistance were measured under conditions of both inhalation and exhalation. Resistance was determined using active anterior rhinomanometry and a continuously variable pressure gradient. Anatomic and physiologic properties were first compared against normative data. Measurements were then taken after application of an adhesive external midvault dilator (BreatheRight; GlaxoSmithKline).

RESULTS

The average minimal cross-sectional areas by acoustic rhinometry and by computed tomography were 0.87 cm2 and 0.84 cm2 per nostril, respectively (n = 20). The average distance from the nostril to the internal nasal valve was 1.7 cm by acoustic rhinometry and 1.5 cm by computed tomography, consistent with published in vivo normative data at the internal nasal valve. The average resistance with simulated exhalation closely approximated known normative values. With the application of the adhesive nasal dilator, the average area (acoustic rhinometry) increased by 50 percent at the internal nasal valve. During inhalation, the resistance decreased by 21 percent following application of the adhesive dilator.

CONCLUSIONS

The model provides an accurate representation of nasal anatomy and physiology suitable for objective analysis of rhinoplasty maneuvers. The objective modalities used herein may be applied to rhinoplasty study using this model with accuracy and reproducibility. The external dilator increased area at the internal valve (minimal cross-sectional area) and decreased resistance.

Value of nasal mucosa congestion index in choosing treatment strategies for chronic rhinosinusitis

CONCLUSION

The mucosa compliance in lesions is determined by the congestion index, enabling us to determine whether the patient is sensitive to pharmacotherapy and to choose surgical management rationally.

OBJECTIVE

To explore the correlation between the nasal mucosa congestion index and tissue remodeling in chronic rhinosinusitis (CRS) and to provide objective evidence for clinical choice of therapeutic methods.

PATIENTS AND METHODS

Forty-four patients with CRS who underwent nasal endoscopic surgery were enrolled in the study. The congestion indexes of the nasal mucosa were measured using an acoustic rhinometer and specimens were taken from the uncinate process mucosa to evaluate vascular density and degree of fibrosis. The correlations were statistically analyzed.

RESULTS

There was an inverse correlation between the congestion index and degree of fibrosis (r=- 0.522, p=0.00) and a direct correlation between the congestion index and vascular density (r=0.838, p=0.00) in nasal mucosa. There was a significant correlation between the congestion index and the combination of degree of fibrosis and vascular density with a determination coefficient (R(2)) of 0.778.

Influence of nasal bone fracture and its reduction on the airway

Studies regarding nasal bone fractures have mainly focused on esthetic aspects, but the nose also plays an important role as an airway. The purpose of this study was to evaluate the influence of nasal bone fractures and the treatment of nasal bone fractures on nasal obstruction. Nasal bone fractures were classified by fracture site and septal displacement. Nasal airways were investigated at 3 time points: before reduction (n = 84), 6 days postreduction (n = 84), and 1-year postreduction (n = 27). Airway changes were based on minimal cross-sectional area measurements. The severity of airway obstruction following fracture differed according to the fracture site and the presence of septal displacement. Bilateral fractures caused more profound airway obstruction than unilateral or tip fractures and septal displacement was the most important parameter in nasal obstruction. Airway obstruction improved immediately after reduction by 21% and deteriorated by 4% 1-year postreduction.

Effect of an intra-oral nasal dilation appliance on 3-D nasal airway morphology in adults

To determine the effects of a nasal dilation appliance on 3-D nasopharyngeal airway patency. The sample comprised 187 adults (98 males, 89 females) with a history of sleep-disordered breathing. Acoustic rhinometry readings were taken from all patients before and after the intra-oral placement of a nasal dilation appliance (OASYS). The mean left and right nasopharyngeal airways were reconstructed in 3-D, and the data from the right and left nostrils were subjected to principal components analysis (PCA) and finite-element scaling analysis (FESA). Comparing the pre- and post-treatment 3-D mean, left nasopharyngeal airways using PCA, the first two eigenvalues accounted for 96% of the total shape change, and statistical differences were found (p < 0.01). Similarly, for the right side, significant differences were detected between the mean pre- and post-treatment 3-D nasopharyngeal airways (p < 0.01) using PCA. Using FESA to quantify and localize changes after the placement of the nasal dilation appliance, the 3-D mean, normalized, left nasopharyngeal airway was found to be 14% wider in the anterior nasal valve region and 28% wider in the distal regions, while the 3-D mean, normalized, right nasopharyngeal airway was 13% wider in the anterior nasal valve region and 27% wider further distally. The use of an intra-oral nasal dilation appliance may be useful in the management of nasopharyngeal conditions, such as snoring, upper airway resistance syndrome, sleep-disordered breathing, and obstructive sleep apnea, especially in cases where nasal obstruction is demonstrable.

Revision septoplasty

This article addresses the challenge of persistent nasal airway obstruction following septoplasty, specifically as it relates to revision septoplasty. Emphasis is on the importance of and the steps to be taken in making a complete and correct diagnosis of the problem before any surgery is performed. The authors present two categories of revision surgery: surgery involving the cartilaginous septum and surgery involving the bony septum, because they believe the evaluation and management of these areas are distinct. This article presents a discussion of airflow dynamics, options to objectively assess nasal volume and patency, examination of the septum, and surgical approaches and techniques.

Diagnosis of nasal airway obstruction

Nasal airway obstruction is the source of significant patient discomfort and financial burden; hence, otolaryngologists encounter this symptom on an almost daily basis. This article provides a thorough yet concise summary of common and more specialized techniques that are instrumental in diagnosing nasal obstruction. The article begins with a brief overview of significant nasal anatomy and physiology. Ultimately, the main focus is on exploring the role of nasal endoscopy, radiographic imaging, acoustic rhinomanometry and other diagnostic tests that assist in the diagnosis of nasal airway obstruction.

Nasal sound analysis: a new method for evaluating nasal obstruction in allergic rhinitis

OBJECTIVE

Current measurements of nasal obstruction are unreliable and may be improved with the development of new techniques. The effectiveness of odiosoft-rhino (OR) in the evaluation of nasal obstruction was investigated in a blind comparison at a referral center, institutional practice.

PATIENTS

Forty-eight patients with perennial allergic rhinitis and 52 healthy subjects were studied. Nasal endoscopic examination, acoustic rhinometry (AR), and OR were performed and symptom scores compared.

MAIN OUTCOME MEASURE

Assessment of nasal blockage with OR method was the main outcome measure.

RESULTS

Using the OR technique, significant differences were observed between the patient and control groups. OR data correlated with symptom scores and endoscopic examination. However, this was not observed with AR. A 15.5-dB cutoff point for the left side and 14.5 dB cutoff point for the right side at the 2,000 to 4,000 Hz frequency interval resulted in 93.8% sensitivity and 92.3% specificity and 72.9% sensitivity and 80.8% specificity, respectively. A 8.5-dB cutoff point for the left and right sides at the 4,000 to 6,000 Hz frequency interval resulted in 87.5% sensitivity and 80.8% specificity and 70.8% sensitivity and 78.8% specificity, respectively.

CONCLUSION

OR is a simple, noninvasive test for assessing nasal obstruction. The OR technique can detect nasal obstruction with high sensitivity and specificity, and these findings correlate with symptoms and physical examination.

Bibliography. Current world literature. Nose and paranasal sinuses

PURPOSE OF REVIEW

Patients with advanced head and neck cancer are being treated with chemo-radiotherapy, and life is being prolonged, with or without persistent disease, for longer than was previously. Hypercalcaemia may present in patients with advanced or disseminated head and neck cancer, and, as such, these patients may present to a larger variety of clinicians for advice concerning their symptoms and illness. Modes of presentation of hypercalcaemia and treatment strategies are reviewed.

RECENT FINDINGS

There were previously few large series of head and neck cancer patients diagnosed with hypercalcaemia, which may or may not have been related to their cancer being treated. Investigations, by way of blood/serum calcium level, may identify such patients. Patients with cancer-related hypercalcaemia have a poor prognosis, but many may respond temporarily to treatment when offered, with an improvement of their quality of life and death.

SUMMARY

Hypercalcaemia should and must be considered in all patients who have or possibly have a diagnosis of a head and neck cancer and who present unwell with symptoms of fatigue, lethargy and somnolence. Investigation must include serum calcium (corrected for serum albumin binding) and parathyroid hormone level. Patients may be treated by a combination of rehydration and bisulphonate therapy until the serum calcium is reduced to a level below 3 mmol/l. The majority of patients diagnosed with hypercalcaemia due to head and neck malignancy die of their diseases in the short term, but some may enjoy a prolongation of life with reasonable quality if diagnosed and treated aggressively.

Acoustic rhinometry: should we be using it?

PURPOSE OF THE REVIEW

The purpose of this review is to examine the role of acoustic rhinometry in clinical practice. Although acoustic rhinometry was first described for clinical use in 1989, it is not in common use today. Should we be using it? Yes. I think we should be using it more often. This review provides an update of the new standard for interpretation and expanded clinical uses.

RECENT FINDINGS

The most significant advances in the past year in this area have been the publication of standards for its clinical use. In addition, the repertoire of clinical problems that can be analyzed objectively with acoustic rhinometry has expanded to include turbinoplasty, sleep disorders, more types of cosmetic/reconstructive procedures, sinus surgery, vasomotor rhinitis, maxillofacial expansion procedures, and aspirin and methacholine challenge. (Its ability for pediatric disorders, such as adenoidectomy, has been reaffirmed.) Some case examples are included to demonstrate the utility of acoustic rhinometry for 'mixed' pathology.

SUMMARY

Acoustic rhinometry is a rapid, objective, painless, noninvasive technique for assessing nasal airway obstruction. Recently, standards have been developed that aid its expansion for clinical use. Expanded clinical applications include sleep disorders, cosmetic/reconstructive and maxillofacial disorders, sinus and turbinate procedures, and pediatrics. Acoustic rhinometry should be utilized to improve our ability to practice evidence-based medicine in rhinology.

Nasal wall compliance in vasomotor rhinitis

Nasal compliance is a measure related to the blood volume in the nasal mucosa. The objective of this study was to better understand the vascular response in vasomotor rhinitis by measuring nasal cross-sectional area and nasal compliance before and after mucosal decongestion in 10 patients with vasomotor rhinitis compared with 10 healthy subjects. Nasal compliance was inferred by measuring nasal area by acoustic rhinometry at pressures ranging from atmospheric pressure to a negative pressure of -10 cmH2O. Mucosal decongestion was obtained with one puff per nostril of 0.05% oxymetazoline. At atmospheric pressure, nasal cross-sectional areas were similar in the vasomotor rhinitis group and the healthy subject group. Mucosal decongestion did not induce any decrease of nasal compliance in patients with vasomotor rhinitis in contrast with healthy subjects. Our results support the hypothesis, already proposed, of an autonomic dysfunction based on a paradoxical response of the nasal mucosa in vasomotor rhinitis. Moreover, the clearly different behavior between healthy subjects and vasomotor rhinitis subjects suggests that nasal compliance measurement may therefore represent a potential line of research to develop a diagnostic tool for vasomotor rhinitis, which remains a diagnosis of exclusion.