Endonasal measurements by acoustic rhinometry in children: A preliminary study

Nasal Patency Measurement: State of the Art of Acoustic Rhinometry

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.

Effect of Age and Head Position on Total and Regional Aerosol Deposition in Three-Dimensional Models of Human Intranasal Airways Using a Mucosal Atomization Device

Background: This study examined the effect of age and head position on total and regional deposition of aerosol delivered by a mucosal atomization device (MAD™) in three-dimensional (3D) models of the intranasal airways of an 18-, 5-, and 2-year-old human. Models consisted of four pieces: anterior nose and nasal cavity that was divided horizontally into upper, middle, and lower thirds. Methods: Models were tested six times at supine, supine with head backward at 45° (supine45), and sitting with head backward at 45° (sitting45). The MAD delivered saline/fluorescein aerosol into model nostrils, during static airflow. Model pieces were tested for fluorescence using a fluorometer, and deposition calculated as percent fluorescence per piece relative to its reference. Total deposition (four pieces combined) and regional deposition (four pieces separately) were calculated. Results: Age and head position had little effect on total deposition. In contrast, deposition in the upper and middle third supine45 and in the lower third sitting45 was significantly different in the 2-year-old model, compared with the two older models. In addition, some head positions significantly increased deposition in the upper, middle, and lower thirds within each model, compared with other positions. Upper deposition was significantly greater at supine45, compared with sitting45 (18-year-old) and supine45, compared with supine and sitting45 (5-year-old). Middle deposition was significantly greater at supine and supine45, compared with sitting45 (2-year-old). Lower deposition was significantly greater at sitting45, compared with supine45 (18-year-old); supine and sitting45, compared with supine45 (5-year-old); and sitting45, compared with supine45 and supine (2-year-old). Conclusions: Age and head position significantly affected regional deposition of aerosol delivered by the MAD in these 3D models. Such models might be used to study other methods for targeting intranasal regions with aerosolized medications in children and adults.

Evaluation of nasal obstruction in children by acoustic rhinometry: A prospective study

INTRODUCTION

acoustic rhinometry (AR) is a non-invasive method measuring the nasal volume (NV) and the nasal minimal cross-sectional area (MCA), reflecting nasal obstruction. The first objective of this study was to measure and compare NV and MCA between 3 groups of children: "achondroplasia", "Down syndrome" and "control". The control group corresponded to children with suspicion of sleep disorder disease and without cranio-facial malformation. The second objective was to correlate AR measurements with the obstructive apnea-hypopnea index (OAHI).

METHODS

prospective study between February and July 2017, in a tertiary care center. The following data were collected: demographic characteristics, medical and surgical history, NV, MCA, and OAHI.

RESULTS

83 children were included. The mean NV was lower in achondroplasia group compared to control group: 2.75 cm3 vs 3.60 cm3 (p = 0.02, 95% CI [0.0694, 0.7456]). Negative correlation was found between the NV and the OAHI for children with achondroplasia (T = -0.37; p = 0.02).

CONCLUSIONS

AR is an effective tool for assessing nasal obstruction in children. Nasal obstruction was correlated to OAHI in achondroplasia. AR could become a routine tool in the management of nasal obstruction of children with cranio-facial malformations.