Detection of particles within the nasal airways before and after nasal decongestion

[Nasal turbinate surgery]

The nose forms the first 8 cm of the upper respiratory tract and is responsible for cleansing, humidification, and temperature control of the supplied air. This is also referred to as conditioning. The nasal valve region, formed by the head of the lower nasal concha, portions of the cartilaginous septum, and the upper lateral cartilage, is responsible for diffusing and accelerating the respiratory airflow. Prerequisite are regular mucociliary clearance and sufficient air passage. Hypertrophy of the lower nasal turbinate is one of the most common causes of symptomatic nasal congestion. In unclear cases, rhinometric procedures are available. In addition to conservative therapy of allergic or vasomotor rhinitis by specific immunotherapy or topical corticoids, numerous interventional procedures are available to reduce conchal tissue. All modern methods have a high degree of protection of the respiratory mucosa in common.

Impact of resection of the turbinates and the lateral nasal wall on particle deposition

OBJECTIVES/HYPOTHESIS

The aim of the investigation was to determine the influence of complete resection of the turbinates and the lateral nasal wall on nasal deposition of particulate matter with an aerodynamic diameter of 10 microm or less (pm10) and its relation to nasal patency and geometry.

STUDY DESIGN

Retrospective study.

METHODS

Eight patients were enrolled in the study after unilateral sinus surgery for a unilateral inverted papilloma of the sinuses. Particle deposition from the inhaled and exhaled air was measured by means of a laser particle counter in the nasal valve area and the nasopharynx during nose-only breathing and nose-in, mouth-out breathing. The data on deposited fraction for the operated side were compared with the data for the untreated, healthy side. Rhinomanometry and acoustic rhinometry were performed.

RESULTS

Particle deposition did not differ significantly between the operated and untreated sides of the nose at both detection sites. No correlation between the deposited fraction and rhinomanometric and rhinometric values was found.

CONCLUSION

Radical resection of the turbinates does not seem to disturb particle deposition (pm10) measured in the nose to a significant degree. Factors other than impaction and sedimentation onto the mucosal surface of the turbinates seem to be sufficient for effective particle deposition after radical removal of the turbinates.

The impact of expiration on particle deposition within the nasal cavity

One of the most important functions of the nose is cleansing the inspired air. The aim of this study was to compare the intranasal deposition of particles during inspiration and expiration, applying different breathing manoeuvres. In nine subjects, the non-deposited particles during inhalation of an aerosol of starch particles were laser-optically detected by placing a suction probe transnasally in the anterior nasal segment. The particle deposition was measured during cyclical nose-in/nose-out (nose-only) and nose-in/mouth-out breathing. The deposited fraction was calculated in percentages. Active anterior rhinomanometry and acoustic rhinometry were performed. The mean deposited fraction in the anterior nasal segment was statistically significantly higher (P < 0.02) during nose-only breathing (46.0%) compared with nose-in/mouth-out breathing (33.0%). Our results suggest that intranasal particle deposition takes place during inspiration as well as during expiration. The period of expiration does not only seem to be important for water and heat recovery, but also for cleansing of the respiratory air.

Decontaminating the nasal passages

Nasal decontamination may be indicated when the anterior nasal passages are contaminated with highly radioactive material or radioactive material with either irritating or toxic properties. Nasal irrigation (wash, rinse, douche, lavage) is an established technique used for other conditions and can be applied in these cases. This paper discusses the rationale and use of nasal irrigation and how to perform the technique.