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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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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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Yan X, Menzel S, Zhao K, Kim K, Hummel T. Intranasal trigeminal sensitivity to mechanical stimuli is associated with the perception of nasal patency. Eur Arch Otorhinolaryngol 2023; 280:5391-5399. [PMID: 37561188 DOI: 10.1007/s00405-023-08126-2] [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: 04/15/2023] [Accepted: 07/12/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE The aim of this prospective study was to examine the characteristics of a clinical test for the assessment of nasal trigeminal sensitivity to mechanical stimuli and its association with the perception of nasal patency. METHODS Thirty-two normosmic healthy subjects participated (17 women and 15 men; age = 26 ± 3 years). Precisely defined air puffs were used with a flow rate of 2L/min for mechanical stimulation. They were presented to the nasal vestibule, nasal septum, and inferior turbinate with various stimulus durations. Thresholds were measured by single-staircase stimuli with changes in stimulus duration in steps of 10 ms. Trigeminal suprathreshold intensity was rated by subjects for stimulus durations of 200, 300, 400, and 500 ms. Test-retest reliability was examined by intraclass correlations (ICCs) and Bland-Altman plot with limits of agreement. Pearson's correlations were calculated between self-rated nasal patency and nasal trigeminal sensitivity. RESULTS As indicated by trigeminal threshold and suprathreshold intensities, the nasal vestibule is the most sensitive area among the three locations, followed by the nasal septum and the inferior turbinate (p < 0.001). Coefficients of correlations between test and retest were 0.76 for thresholds, and 0.56 suprathreshold intensities (p < 0.001). The Bland-Altman analysis showed a good agreement between test-retest values. In addition, significant positive associations between trigeminal suprathreshold intensities and self-rated nasal obstruction were found at the inferior turbinate (r = 0.4, p < 0.05). CONCLUSION Reliable assessment of nasal trigeminal sensitivity for air puffs appears to be possible. Nasal trigeminal suprathreshold sensitivity to mechanical stimuli is associated with the perception of nasal patency at the inferior turbinate. This opens a window into the assessment of the perception of nasal airflow in various clinical purposes, especially for patients with sinonasal diseases. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Xiaoguang Yan
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Susanne Menzel
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Kai Zhao
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Kanghyun Kim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Thomas Hummel
- Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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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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de Oliveira GMM, Correia Júnior MADV, Costa EC, Lira GVDAG, Rizzo JÂ, Hunter S, Gaua N, Sarinho ESC. Accuracy of peak nasal flow to determine nasal obstruction in patients with allergic rhinitis. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:155-161. [PMID: 35612507 PMCID: PMC9131999 DOI: 10.14639/0392-100x-n1617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022]
Abstract
Objective Methods Results Conclusions
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Kamburoglu HO, Bitik O, Vargel İ. Airflow Considerations and the Effect of Webster's Triangle in Reduction Rhinoplasty. Aesthetic Plast Surg 2021; 45:2244-2254. [PMID: 33598741 DOI: 10.1007/s00266-021-02168-9] [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: 11/30/2020] [Accepted: 01/31/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Reduction rhinoplasties, regardless of the methods used (structural or preservation), can cause a reduction in the internal nasal volume, which may lead to breathing problems. In 1977, Webster proposed preserving a little triangle in the beginning of the lower lateral osteotomy line to prevent breathing problem. However, its importance is still controversial. OBJECTIVES and methods: This prospective randomized controlled study (level of evidence 1) included 46 patients without nasal breathing problem. High-to-low (Webster's triangle preservation) osteotomy (control group, n = 23) and low-to-low osteotomy (study group, n = 23) were performed. All operations were performed according to the proposed volumetric rhinoplasty steps (examination/measurement, prevention and treatment). Nasal obstruction symptom evaluation (NOSE) test, visual analog scale, acoustic rhinometry, rhinomanometry, peak nasal inspiratory flow (PNIF), and three-dimensional measurements were performed in all patients. Breathing tests were repeated before and 6 months after surgery with and without xylometazoline administration. RESULTS No statistically significant difference in NOSE and visual analog scale scores was found between the two groups. Acoustic rhinometry, PNIF, and rhinomanometry findings showed no statistically significant breathing difference between the two groups. CONCLUSIONS In reduction rhinoplasties, a decrease in the internal volume may be expected as directly proportional with the reduction amount. The decrease in the internal volume may create nasal breathing problems. To prevent it, nasal airflow should be adjusted according to new anatomy. In this study, we discussed "volumetric rhinoplasty" steps to prevent breathing problems in reduction rhinoplasty. Following these steps, not preserving Webster's triangle (low-to-low osteotomy) has no effect on the nasal airway. LEVEL OF EVIDENCE II 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Haldun O Kamburoglu
- Private Practice, Koc Ikiz Kuleleri A Blok No 57 Sogutozu, Cankaya, 06520, Ankara, Turkey.
| | | | - İbrahim Vargel
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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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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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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Open, prospective, multicenter study on postoperative intranasal phototherapy in nasal polyposis. Ir J Med Sci 2021; 191:375-383. [PMID: 33547613 DOI: 10.1007/s11845-021-02518-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The therapeutic effect of ultraviolet (UV) light is generally attributed to its immunosuppressive and immunomodulatory effects. Since chronic inflammation is the major factor in the development of nasal polyposis, we have previously used mixed ultraviolet-visible light (mUV-VIS, Rhinolight®) phototherapy for the treatment of nasal polyps. AIMS In the present open, multicenter study, our aim was to delineate whether mUV-VIS applied postoperatively in vivo together with intranasal steroid treatment could reduce the recurrence of nasal polyps. METHODS After functional endoscopic sinus surgery, one group of patients received mUV-VIS light together with standard intranasal steroid (mometason furoate 2 × 200 μg) application for a 12-week treatment period, whereas the other patient group obtained only intranasal steroid for the same duration. We recorded nasal endoscopy images and obtained demographical and clinical data, total nasal score (TNS), and nasal obstruction symptom evaluation (NOSE). We performed acoustic rhinometry and measured nasal inspiratory peak flow. Follow-up was 12 months. RESULTS We found that the recurrence of nasal polyps was significantly diminished, and based on video-endoscopic measurements, the size and grade of recurrent polyps were significantly smaller in the phototherapy-receiving group. Nasal obstruction values and NOSE were significantly better throughout the follow-up period in the mUV-VIS light-treated group than in the intranasal steroid monotreatment group. CONCLUSIONS Rhinophototherapy together with standard nasal steroid application may have a supportive role in the treatment of recurrent bilateral nasal polyps.
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Objectification of the nasal patency assessment techniques used in nasal allergen provocation testing. Postepy Dermatol Alergol 2020; 37:635-640. [PMID: 33240000 PMCID: PMC7675096 DOI: 10.5114/ada.2019.81404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/24/2018] [Indexed: 11/17/2022] Open
Abstract
Topical allergen application in nasal provocation testing (NPT) is associated with remarkably rapid changes in nasal patency. Thus, selecting the techniques of assessing the extent of nasal obstruction (as one of the responses to topical allergen application) is an important component of NPT. The study attempted to systematize and evaluate the techniques selected for assessing nasal patency during NPT based on a review of relevant literature. We reviewed the literature on the attempts to standardize the objective techniques for assessing nasal patency and their use in NPT. The best known, well-established technique for assessing nasal patency as part of NPT was rhinomanometry, followed by peak nasal inspiratory flow (PNIF) testing and acoustic rhinometry.
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Hsu YB, Liu SYC, Lan MY, Huang YC, Tzeng IS, Lan MC. Role of rhinomanometry in the prediction of therapeutic positive airway pressure for obstructive sleep apnea. Respir Res 2020; 21:115. [PMID: 32404107 PMCID: PMC7222300 DOI: 10.1186/s12931-020-01382-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/03/2020] [Indexed: 12/26/2022] Open
Abstract
Background This study was conducted to evaluate the relationship between nasal resistance in different posture and optimal positive airway pressure (PAP) level. Other potential factors were also assessed for possible influence on PAP pressure. Methods Forty- three patients diagnosed with obstructive sleep apnea (OSA) were prospectively recruited in this study. Nasal resistance was assessed by active anterior rhinomanometry in a seated position and then in a supine position at pressures of 75, 150, and 300 pascal. The factors correlating with PAP pressure were analyzed, including nasal resistance and patients’ clinical data. Results Univariate analysis revealed that PAP pressure was correlated to nasal resistance in the supine position at 75 and 150 pascal (SupineNR75 and SupineNR150) (P = 0.019 and P = 0.004 in Spearman’s correlation coefficient analysis), but not correlated to nasal resistance in the seated position at different pressures or in the supine position at 300 pascal. The multiple linear regression analysis revealed that both SupineNR150 and body mass index (BMI) significantly predicted PAP pressure (β = 0.308, p = 0.044; β = 0.727, p = 0.006). The final PAP pressure predictive model was: PAP pressure = 0.29 BMI + 2.65 SupineNR150 + 2.11. Conclusions Nasal resistance in the supine position measured at 150 pascal may provide valuable information regarding optimal PAP pressure. Rhinomanometry should be included in the treatment algorithm of OSA patients when PAP therapy is considered.
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Affiliation(s)
- Yen-Bin Hsu
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ming-Ying Lan
- Department of Otolaryngology-Head & Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Chen Huang
- Department of Otolaryngology-Head & Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ming-Chin Lan
- Department of Otolaryngology-Head & Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan. .,School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Alexandrino AS, Santos R, Melo C, Tomé D, Bastos JM, Postiaux G. Immediate effects of a rhino-pharyngeal clearance protocol in nasal obstruction and middle ear condition of children under 3 years of age with upper respiratory infections: A randomized controlled trial. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 70:192-199. [PMID: 29891397 DOI: 10.1016/j.otorri.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/15/2018] [Accepted: 03/18/2018] [Indexed: 01/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Children up to 2 years old are at high risk of respiratory infections and nasal irrigation is often prescribed. Yet, to date there is no sufficient knowledge about its immediate effects on the nasopharynx and middle ear. Therefore, this study aimed to analyze the effect of a rhino-pharyngeal clearance intervention protocol on nasal obstruction and middle ear condition in children under 3 years of age with URTI. MATERIALS AND METHODS Randomized controlled trial in a day-care centre of Porto, including 44 children randomized to Intervention Group (IG) and Control Group (CG). Nasal auscultation and tympanometry were performed at baseline (M0) as well as after the intervention (M1), which consisted of nasal irrigation (NaCl .9%) followed by a forced nasal inspiration in the IG, and after 30min of normal activities, in the CG. RESULTS In M1 there was a lower frequency of children classified as having an obstructed nasal sound in the IG when compared to the CG (IG=33.3%; CG=68.4%; p=0.042). We also observed an improvement of mean peak pressure (PP) in the IG (Left ear: M0=-124daPa; M1=-92daPa; p=0.022. Right ear: M0=-102daPa; M1=-77daPa; p=0.021), which was not observed in the CG (Left ear: M0=-105daPa; M1=-115daPa; p=0.485. Right ear: M0=-105daPa; M1=-131daPa; p=0.105). There were no significant results concerning the compliance of the tympanic membrane. CONCLUSIONS The rhino-pharyngeal clearance improved the nasal obstruction and PP of the middle ear of children under 3 years of age with URTI.
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Affiliation(s)
- Ana Silva Alexandrino
- Department of Physiotherapy, School of Health - P.Porto, Portugal; Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal.
| | - Rita Santos
- Department of Physiotherapy, School of Health - P.Porto, Portugal; Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - Cristina Melo
- Department of Physiotherapy, School of Health - P.Porto, Portugal; Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal
| | - David Tomé
- Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal; Department of Audiology, School of Health - P.Porto, Portugal
| | | | - Guy Postiaux
- Department of Intensive Care and Pediatric Service, Grand Hôpital de Charleroi - GHDC, Charleroi, Belgium
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Alexandrino AS, Santos R, Melo C, Tomé D, Bastos JM, Postiaux G. Immediate effects of a rhino-pharyngeal clearance protocol in nasal obstruction and middle ear condition of children under 3 years of age with upper respiratory infections: A randomized controlled trial. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Computed Tomography Evaluation of Nasal Bone and Nasal Pyramid in the Turkish Population. J Craniofac Surg 2018; 28:1063-1067. [PMID: 28230603 DOI: 10.1097/scs.0000000000003622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To classify shapes of the nasal bones in the Turkish population and comparatively evaluate the sizes of nasal bone and piriform apertures. METHODS Two- and three-dimensional paranasal sinus computed tomography images of 363 patients were evaluated. Upper, intermediate, and inferior thickness of bilateral nasal bones and thickness of medial and lateral osteotomy line were measured. The shapes of the nasal bones were classified. RESULTS The mean thickness of nasal bone in the study participants was 1.99 ± 0.40 mm, the mean thickness at the level of medial osteotomy line was 1.99 ± 0.40 mm, the mean thickness at the level of lateral osteotomy line was 1.75 ± 0.30 mm, the mean length of nasal bone was 1.75 ± 0.30 mm, maximum width and height of piriform aperture were 23.41 ± 2.68 and 36.76 ± 7.06 mm, respectively. When the patients were classified according to the type of nasal bone, 26.7% had type A, 10.5% had type B, 19.6% had type D, and 15.4% had type E nasal bone. CONCLUSION The results of the current study provide information about morphological characteristics of nasal bone and piriform aperture in the Turkish population and would therefore reduce postoperative complications after reconstructive surgery and contribute otolaryngology and anthropology.
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Kiricsi Á, Tiszlavicz L, Rázga Z, Krasznai M, Vóna I, Hirschberg A, Szabó Z, Kemény L, Rovó L, Kadocsa E, Bella Z. Prospective, multicenter, randomized clinical study to evaluate the clinical efficacy and tolerability of long term mixed ultraviolet and visible light phototherapy in eosinophil nasal polyps. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2017; 176:118-123. [DOI: 10.1016/j.jphotobiol.2017.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 09/21/2017] [Accepted: 09/28/2017] [Indexed: 01/18/2023]
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Sen I, Dutta M, Haldar D, Sinha R. Estimation of partitioning of airflow in septal surgery: A prospective study with reference to the NOSE scale. EAR, NOSE & THROAT JOURNAL 2017; 96:E6-E12. [PMID: 28231369 DOI: 10.1177/014556131709600212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Improper patient selection for septal surgery often has been found to result in therapeutic failure, and there needs to be an objective assessment of nasal obstruction before the surgery and for postoperative follow-up that can be applied in the routine otolaryngology practice. The purpose of this study is to assess the usefulness of a cost-effective device for objective measurement of the nasal airway partitioning in selecting patients for septal surgery and for postoperative outcome evaluation. A hospital-based, prospective, observational study was carried out in a tertiary-care teaching institution involving 74 patients waiting for septal surgery. Each patient was exposed to subjective assessment of nasal obstruction by the Nasal Obstruction Symptom Evaluation (NOSE) scale and objective measurement by Nasal Partitioning Ratio (NPR) using a new device, Nasal Airway Partition Meter (NAPM), once before and twice after surgery. Overall, average NOSE score and NPR values were 66.42 ± 9.42 and 0.57 ± 0.18, respectively, at preoperative assessment (correlation coefficient 0.441). Sixty of the 74 patients had high values for both NPR and NOSE scores (Group 1), but in the remaining 14, NPR values were found to be lower despite high NOSE scores (Group 2). Postsurgery, the NOSE score and NPR values were significantly reduced in Group 1. In contrast, participants in Group 2 showed no alteration in the values of both the parameters after the same operative maneuver. However, 2 patients in Group 1 had NOSE score and NPR values unaltered, while 1 patient in Group 2 had a reduced NOSE score after surgery. Therefore, the validity of the new equipment was calculated to be 96.7% sensitive and 92.9% specific to identify patients who needed to undergo septal surgery for their nasal obstruction. It can be deduced from the present study that NAPM can be a cost-effective device for clinicians to objectively measure nasal airway obstruction and screen patients for septal surgery.
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Affiliation(s)
- Indranil Sen
- Department of Otorhinolaryngology and Head-Neck Surgery, Midnapore Medical College and Hospital, Midnapore, India
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Zhu Z, Xie Y, Guan W, Gao Y, Xia S, Shi X, Zheng J. Correlations of nasal responses to leukotriene D4 and histamine nasal provocation with quality of life in allergic rhinitis. Asia Pac Allergy 2016; 6:245-252. [PMID: 27803885 PMCID: PMC5088261 DOI: 10.5415/apallergy.2016.6.4.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 10/02/2016] [Indexed: 12/20/2022] Open
Abstract
Background The symptoms of allergic rhinitis (AR) greatly affect the quality of life (QoL) in the patients with AR. The correlations of nasal response to leukotriene D4 (LTD4) and histamine nasal provocation with health related QoL in AR are not clear. Objective To evaluate the correlations of nasal response to LTD4 and histamine nasal challenge with QoL in AR. Methods Patients randomly underwent LTD4 and histamine nasal challenge tests, completed the rhinoconjunctivitis quality of life questionnaire (RQoLQ), and rating the symptom severity score (total symptom score 4, TSS4) in the previous week. The correlations between nasal challenge tests induced nasal responses and QoL in RQoLQ were analyzed. Results A total of 25 eligible AR patients enrolled and finished both LTD4 and histamine nasal challenge and completed the questionnaire of RQoLQ. Histamine nasal challenge induced sneezing, increased nasal resistant were correlated with most of the dimensions (general, practical, nasal, eye problems, and quality of sleep, p < 0.05), while LTD4 nasal challenge induced sneeze, increased nasal resistant only correlated with nasal and ocular problems. On the contrary, the severity of the sneeze assessed by TSS4, was not correlated with QoL, while the severity of rhinorrhea, congestion, and nasal pruritus were correlated with nasal and practical problems, and nasal congestion was also correlated with ocular problems (r = 0.60, p = 0.01). Conclusion LTD4 and histamine nasal challenge induced nasal responses were correlated with different clinical symptoms severity and QoL, which can be used as a good diagnosis and evaluation methods for the management of AR.
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Affiliation(s)
- Zheng Zhu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yanqing Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Weijie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yi Gao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Shu Xia
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xu Shi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jinping Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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Kowalski ML, Ansotegui I, Aberer W, Al-Ahmad M, Akdis M, Ballmer-Weber BK, Beyer K, Blanca M, Brown S, Bunnag C, Hulett AC, Castells M, Chng HH, De Blay F, Ebisawa M, Fineman S, Golden DBK, Haahtela T, Kaliner M, Katelaris C, Lee BW, Makowska J, Muller U, Mullol J, Oppenheimer J, Park HS, Parkerson J, Passalacqua G, Pawankar R, Renz H, Rueff F, Sanchez-Borges M, Sastre J, Scadding G, Sicherer S, Tantilipikorn P, Tracy J, van Kempen V, Bohle B, Canonica GW, Caraballo L, Gomez M, Ito K, Jensen-Jarolim E, Larche M, Melioli G, Poulsen LK, Valenta R, Zuberbier T. Risk and safety requirements for diagnostic and therapeutic procedures in allergology: World Allergy Organization Statement. World Allergy Organ J 2016; 9:33. [PMID: 27777642 PMCID: PMC5062928 DOI: 10.1186/s40413-016-0122-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 08/19/2016] [Indexed: 01/14/2023] Open
Abstract
One of the major concerns in the practice of allergy is related to the safety of procedures for the diagnosis and treatment of allergic disease. Management (diagnosis and treatment) of hypersensitivity disorders involves often intentional exposure to potentially allergenic substances (during skin testing), deliberate induction in the office of allergic symptoms to offending compounds (provocation tests) or intentional application of potentially dangerous substances (allergy vaccine) to sensitized patients. These situations may be associated with a significant risk of unwanted, excessive or even dangerous reactions, which in many instances cannot be completely avoided. However, adverse reactions can be minimized or even avoided if a physician is fully aware of potential risk and is prepared to appropriately handle the situation. Information on the risk of diagnostic and therapeutic procedures in allergic diseases has been accumulated in the medical literature for decades; however, except for allergen specific immunotherapy, it has never been presented in a systematic fashion. Up to now no single document addressed the risk of the most commonly used medical procedures in the allergy office nor attempted to present general requirements necessary to assure the safety of these procedures. Following review of available literature a group of allergy experts within the World Allergy Organization (WAO), representing various continents and areas of allergy expertise, presents this report on risk associated with diagnostic and therapeutic procedures in allergology and proposes a consensus on safety requirements for performing procedures in allergy offices. Optimal safety measures including appropriate location, type and required time of supervision, availability of safety equipment, access to specialized emergency services, etc. for various procedures have been recommended. This document should be useful for allergists with already established practices and experience as well as to other specialists taking care of patients with allergies.
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Affiliation(s)
- Marek L. Kowalski
- Department of Immunology, Rheumatology & Allergy, Medical University of Lodz, 251 Pomorska Str, 92-213 Lodz, Poland
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quiron Bizkaia, Bilbao, Spain
| | - Werner Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Mubeccel Akdis
- Swiss institute of Allergy & Asthma research, Davos, Switzerland
| | - Barbara K. Ballmer-Weber
- Allergy Unit, Dermatology Clinic, University Hospital Zürich, University Zürich, Zürich, Switzerland
| | - Kirsten Beyer
- Kirsten Beyer, Charité Universitätsmedizin Berlin, Klinik für Pädiatrie m.S. Pneumologie und Immunologie, Berlin, Germany
| | - Miguel Blanca
- Hospital Reg. Univ. Carlos Haya, Allergy Serv, Malaga, Spain
| | - Simon Brown
- Royal Perth Hospital, Department of Emergency Medicine, Perth, WA Australia
| | - Chaweewan Bunnag
- Department of Otolaryngology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Mariana Castells
- Brigham & Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Hiok Hee Chng
- Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Frederic De Blay
- Hôpitaux Universitaires de Strasbourg, Chest Diseases Department, Strasbourg, France
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa Japan
| | - Stanley Fineman
- Emory University School of Medicine, Atlanta Allergy & Asthma, Atlanta, Georgia
| | | | - Tari Haahtela
- Helsinki University Central Hospital, Helsinki, Finland
| | | | | | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joanna Makowska
- CSK, Department of Allergy & Clinical Immunology, Lodz, Poland
| | | | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, and CIBERES, Barcelona, Spain
| | - John Oppenheimer
- UMDNJ – Rutgers Medical School, c/o Pulmonary and Allergy Associates, Summit, New Jersey, USA
| | - Hae-Sim Park
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, South Korea
| | | | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino Hospital IST, University of Genoa, Genoa, Italy
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Harald Renz
- Universitatsklinikum GI & MR GmbH, Institut fur Laboratoriumsmedizin & Path, Standort Marburg, Marburg, Germany
| | - Franziska Rueff
- Klinikum der Ludwig-Maximilians-Universitat, Klinik & Poliklinik fur Dermatologie & Allergologie, Munchen, Germany
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidadad, Caracas, Venezuela
| | - Joaquin Sastre
- Allergy Department, Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, CIBER de Enfermedades Respiratorias (CIBERES), Institute Carlos III, Madrid, Spain
| | | | - Scott Sicherer
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | | | | | - Vera van Kempen
- Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum, Germany
| | - Barbara Bohle
- Division of Experimental Allergology, Department of Pathophysiology, Allergy Research Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria
| | - G Walter Canonica
- Allergy & Respiratory Disease Clinic, DIMI – Department Int Med, University of Genoa, IRCCS AOU, San Martino – IST, Genoa, Italy
| | - Luis Caraballo
- Immunology Department, Universidad De Cartagena, Cartagena, Colombia
| | | | - Komei Ito
- Department of Allergy, Aichi Children’s Health and Medical Center, Aichi, Japan
| | - Erika Jensen-Jarolim
- Messerli Research Institute, Medical University Vienna, University Vienna, Vienna, Austria
| | - Mark Larche
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
| | | | - Lars K. Poulsen
- Gentofte University Hospital, Lab for Allergology, Allergy Clinic, Hellerup, Denmark
| | | | - Torsten Zuberbier
- Campus Charite Mitte, Klinik fur Dermatologie & Allergologie, Berlin, Germany
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Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth-breathing adults: A cross-sectional study. J Electromyogr Kinesiol 2015; 25:463-8. [DOI: 10.1016/j.jelekin.2015.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 11/17/2022] Open
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Evaluation of a nasal surgical questionnaire designed for monitoring surgical outcomes and comparing different techniques. The Journal of Laryngology & Otology 2015; 129:656-61. [PMID: 26004145 DOI: 10.1017/s0022215115001188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study evaluated a nasal surgical questionnaire designed for monitoring surgical outcomes and comparing different techniques. METHODS Eighty-three healthy volunteers answered the same questionnaire twice with a minimum interval of five weeks. Three visual analogue scale items were used to assess nasal obstruction during the day, at night and during exercise. Respondents rated nasal obstruction severity by marking on a 10 cm line, with scores ranging from 0 to 100 (measured in millimetres). Other nasal symptoms, considered secondary outcomes, were graded using four-point Likert scales. RESULTS Mean visual analogue scale scores for nasal obstruction severity experienced during the day, at night and during exercise at initial assessment were 9.99, 12.95 and 11.67, respectively. Thirty-eight per cent of scores indicated no obstruction (scores of 0), 47 per cent indicated mild obstruction (scores 1-30), 13 per cent indicated moderate obstruction (scores 31-70) and 2 per cent indicated severe obstruction (scores 71-100). Males had higher scores than females. The scores for the first and second assessment did not differ, except at night for obstruction in allergic individuals which was considered clinically unimportant. CONCLUSION The questionnaire reliably assesses nasal symptoms and may be useful for prospective studies of nasal surgery.
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Wei W, Liu H, Kang D, Wang H, East CE. Non-surgical interventions for nasal congestion during pregnancy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Menger DJ, Richard W, Swart KMA, Grolman W. Does Functional Septorhinoplasty Provide Improvement of the Nasal Passage in Validated Patient-Reported Outcome Measures? ORL J Otorhinolaryngol Relat Spec 2015; 77:123-31. [PMID: 25926049 DOI: 10.1159/000381025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/16/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether functional septorhinoplasty provides improvement of the nasal passage in validated patient-reported outcome measures (PROMs) for adults with an anatomical obstruction of the nasal valve. All patients with an anatomical obstruction of the nasal valve area due to nasal valve pathology and/or septal deviations in this area were included. METHODS A systematic PubMed, Embase and Cochrane Library search was performed to identify relevant articles. The articles were critically appraised and ranked according to validity and relevance. RESULTS Sixteen articles met our inclusion criteria, and after critical appraisal, 10 were eligible for further analysis. In 9 studies, the Nose Obstruction Symptom Evaluation (NOSE) score improved from 35 to 60 points. In 1 study, the Sino-Nasal Outcome Test (SNOT-22) improved 3.5 points. CONCLUSION The results suggest that there is a significant improvement of the validated PROMs after functional septorhinoplasty in the first postoperative year. We recommend that adults with nasal breathing problems due to an anatomical problem of the nasal valve area should consider undergoing functional septorhinoplasty.
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Affiliation(s)
- Dirk Jan Menger
- Department of Otorhinolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, University Medical Center, Utrecht, The Netherlands
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Menger DJ, Swart KMA, Nolst Trenité GJ, Georgalas C, Grolman W. Surgery of the external nasal valve: the correlation between subjective and objective measurements. Clin Otolaryngol 2015; 39:150-5. [PMID: 24725912 DOI: 10.1111/coa.12243] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS Minimum cross-sectional area of the nasal passage on CT (CT-MCA) is an objective computerised determination of the minimum cross-sectional area of the nasal passage on CT. CT-MCA was evaluated before and after surgery on the external nasal valve using the 'lateral crus pull-up' procedure (LCPU). The outcomes of CT-MCA were compared with other currently available objective tests for nasal valve patency. STUDY DESIGN Prospective cohort study. METHODS This study included 34 patients undergoing surgery on the external nasal valve with the use of the LCPU technique. CT-MCA was performed before and after surgery and compared with the subjective perception of nasal passage using the Nasal Obstruction Symptom Evaluation (NOSE) scale and with objective tests such as acoustic rhinometry (A-MCA), rhinomanometry (NAR) and peak nasal inspiratory flow (PNIF). RESULTS This study showed a significant correlation between CT-MCA and the NOSE scale, PNIF and NAR. Paired-samples t-tests showed significant improvement after surgery on CT-MCA, PNIF and the NOSE scale. Multiple linear regression analysis showed that PNIF, CT-MCA and NAR were significantly associated with the NOSE scale. CONCLUSION CT-MCA and PNIF were both significantly correlated and associated with the patient's subjective perception of nasal passage. The surgical procedure, the 'lateral crus pull-up', showed a significant improvement in the postoperative result both subjectively and objectively.
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Affiliation(s)
- D J Menger
- Department of Otorhinolaryngology - FPS, University Medical Center, Utrecht, The Netherlands; O.L.V.G., Amsterdam, The Netherlands
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Allergic Rhinitis in Children: A Randomized Clinical Trial Targeted at Symptoms. Indian J Otolaryngol Head Neck Surg 2014; 66:386-93. [PMID: 26396949 DOI: 10.1007/s12070-014-0708-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/28/2014] [Indexed: 12/13/2022] Open
Abstract
Allergic rhinitis (AR) underlies many symptoms and complications which severely affect children's quality of life. This two-arm study aimed at evaluate the efficacy and safety of the medical device Narivent(®) versus topical corticosteroids in the symptomatic management of allergic rhinitis in paediatric patients. A randomized study was conducted. Forty subjects with a diagnosis of allergic rhinitis were randomized to receive one puff of Narivent(®) into each nostril twice daily for 30 days (n = 20) or to receive one puff of topical intranasal corticosteroid into each nostril twice daily for 30 days (n = 20). In both treatment arms, severity of major symptoms related to AR, including nasal congestion, rhinorrhoea, sneezing and nasal itching, was assessed subjectively on a 0-100 mm visual analogue scale. Nasal congestion, rhinorrhoea and sneezing improved significantly after 30 days of treatment with Narivent(®). Similarly, in topical steroids group severity of all subjective symptoms decreased significantly. Narivent(®) appears to be efficacious in treating nasal congestion and other major symptoms in children with AR over a 30-day period, showing comparable results to intranasal corticosteroids therapy but with a better safety profile.
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Yepes-Nuñez J, Bartra J, Muñoz-Cano R, Sánchez-López J, Serrano C, Mullol J, Alobid I, Sastre J, Picado C, Valero A. Assessment of nasal obstruction: correlation between subjective and objective techniques. Allergol Immunopathol (Madr) 2013; 41:397-401. [PMID: 23140913 DOI: 10.1016/j.aller.2012.05.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 05/12/2012] [Accepted: 05/17/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nasal sensation of airflow describes the perception of the passage of air through the nose. Nasal obstruction can be assessed using subjective techniques (symptom scores and visual analogue scales [VAS]) and objective techniques (anterior rhinomanometry [RMN], acoustic rhinometry [AR], and peak nasal inspiratory flow [PNIF]). Few studies have evaluated the correlation between these techniques. OBJECTIVE The primary objective of our study was to determine the degree of correlation between subjective and objective techniques to assess nasal obstruction. MATERIALS AND METHODS Nasal obstruction was assessed using a symptom score, VAS, RMN, AR (minimal cross-sectional area [MCSA] and volume), and PNIF in 184 volunteer physicians. Spearman's rho was recorded. Correlations were considered weak if r ≤ 0.4, moderate if 0.4 < r < 0.8, and strong if r > 0.8. RESULTS Mean (SD) age was 37.1 (6.9) years (range, 25-56 years); 61% were women. We found a strong correlation (r > 0.8; p = 0.001) between the different parameters of RMN and a moderate correlation between symptom score and VAS (r = 0.686; p = 0.001) and between MCSA and RMN (resistance) (r = 0.496; p = 0.001) and PNIF (r = 0.459; p = 0.001). The correlations were weak or non-significant for the remaining comparisons. CONCLUSION Nasal obstruction can be assessed using subjective and objective approaches. The correlations between objective techniques were moderate to strong. In addition, between subjective techniques we reported a moderate correlation. Finally, the correlations between the subjective and objective techniques were weak and absent. These findings suggest that each of the techniques assesses different aspects of nasal obstruction, thus making them complementary.
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Damiani V, Camaioni A, Viti C, Scirè AS, Morpurgo G, Gregori D. A single-centre, before-after study of the short- and long-term efficacy of Narivent(®) in the treatment of nasal congestion. J Int Med Res 2013. [PMID: 23206477 DOI: 10.1177/030006051204000534] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Nasal congestion is a common symptom in allergic and nonallergic rhinitis, rhinosinusitis and nasal polyposis. The present study evaluated the clinical effectiveness of Narivent(®), an osmotically-acting medical device with anti oedematous and anti-inflammatory effects, in nasal congestion. METHODS A single-centre, prospective study with a pre- post design and consecutive patient enrolment was conducted in an Italian otolaryngology department. Patients with persistent nasal congestion were allocated to treatment groups as follows: group 1 (n = 36) treated for 7 days; group 2 (n = 56) treated for 30 days. In each group, patients received two puffs of Narivent(®) into each nostril twice daily. Symptom severity was assessed subjectively on a 0-10 visual analogue scale, and objectively by the presence/absence of signs and symptoms. Differences in subjective and objective severity measures before and after treatment were compared using Wilcoxon's signed rank test. RESULTS All symptoms and objective scores improved after treatment with Narivent(®) for 7 or 30 days and no adverse effects were reported by the patients in either group. CONCLUSION Narivent(®) appears to be efficacious in treating nasal congestion over a 7- or a 30-day period.
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Affiliation(s)
- V Damiani
- Ear, Nose and Throat Department, San Giovanni Addolorata Hospital, Rome, Italy
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Guastella AJ, Hickie IB, McGuinness MM, Otis M, Woods EA, Disinger HM, Chan HK, Chen TF, Banati RB. Recommendations for the standardisation of oxytocin nasal administration and guidelines for its reporting in human research. Psychoneuroendocrinology 2013; 38:612-25. [PMID: 23265311 DOI: 10.1016/j.psyneuen.2012.11.019] [Citation(s) in RCA: 270] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 11/25/2012] [Accepted: 11/26/2012] [Indexed: 12/20/2022]
Abstract
A series of studies have reported on the salubrious effects of oxytocin nasal spray on social cognition and behavior in humans, across physiology (e.g., eye gaze, heart rate variability), social cognition (e.g., attention, memory, and appraisal), and behavior (e.g., trust, generosity). Findings suggest the potential of oxytocin nasal spray as a treatment for various psychopathologies, including autism and schizophrenia. There are, however, increasing reports of variability of response to oxytocin nasal spray between experiments and individuals. In this review, we provide a summary of factors that influence transmucosal nasal drug delivery, deposition, and their impact on bioavailability. These include variations in anatomy and resultant airflow dynamic, vascularisation, status of blood vessels, mode of spray application, gallenic formulation (including presence of uptake enhancers, control release formulation), and amount and method of administration. These key variables are generally poorly described and controlled in scientific reports, in spite of their potential to alter the course of treatment outcome studies. Based on this review, it should be of no surprise that differences emerge across individuals and experiments when nasal drug delivery methods are employed. We present recommendations for researchers to use when developing and administering the spray, and guidelines for reporting on peptide nasal spray studies in humans. We hope that these recommendations assist in establishing a scientific standard that can improve the rigor and subsequent reliability of reported effects of oxytocin nasal spray in humans.
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Affiliation(s)
- Adam J Guastella
- Brain & Mind Research Institute, University of Sydney, Sydney 2006, Australia.
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Thorstensen WM, Bugten V, Sue-Chu M, Fossland NPW, Romundstad PR, Steinsvåg SK. Sino-nasal characteristics in asthmatic patients. Otolaryngol Head Neck Surg 2012; 147:950-7. [PMID: 22714421 DOI: 10.1177/0194599812451408] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The Unified Airways Hypothesis suggests an involvement of the upper airways in asthma. We aimed to evaluate the association between subjective sino-nasal complaints, nasal air flow, and sino-nasal quality of life (QOL) in patients with asthma compared with nonasthmatic subjects. STUDY DESIGN Case-control study. SETTING A tertiary referral center. SUBJECTS AND METHODS Symptoms, quality of life, and nasal airflow were assessed in 91 asthmatics and 95 nonasthmatic controls with Visual Analog Scale (VAS, 0-100), Sino-Nasal Outcome Test (SNOT-20), and Peak Nasal Inspiratory Flow (PNIF), respectively. Asthma and allergy status were assessed by Asthma Control Questionnaire (ACQ) and skin prick test or specific IgE. RESULTS Asthmatic patients (men/women, 37/54; mean age, 43.7 years; range, 19-64 years) reported significantly more nasal obstruction (mean VAS, 37 mm; SD = 26, 95% CI, 32-43 vs 9 mm, SD = 11, 95% CI, 7-11, P < .001) and lower sino-nasal quality of life (mean SNOT-20, 1.3; SD = 0.8, 95% CI, 1.1-1.5 vs 0.4, SD = 0.5, 95% CI, 0.3-0.5, P < .001) than controls (men/women, 42/53; mean age, 43.8 years; range, 20-65 years). PNIF was significantly lower in asthmatic patients than controls (mean PNIF, 84 l/min; SD = 24, 95% CI, 79-89 vs 100 l/min SD = 24, 95% CI, 95-105, P < .001). CONCLUSION Both allergic and nonallergic asthma were associated with increased sino-nasal symptoms, reduced sino-nasal QOL, and reduced inspiratory nasal air flow compared to controls. This provides further evidence of the clinical importance of the upper airway in the diagnostic and therapeutic management of asthma patients beyond the scope of allergy.
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Affiliation(s)
- Wenche Moe Thorstensen
- Department of Otolaryngology, Head and Neck Surgery, St Olavs Hospital, University Hospital of Trondheim, Norway.
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Abstract
How well do subjective descriptions of the sensation of nasal closure or absence of nasal patency agree with objective measures of nasal geometry and airflow? Problems with this concept begin with terminology. "Congestion" has been applied to both the subjective and objective measures. Therefore, the term "fullness" will be used to describe perceptions of nasal mucosal heaviness or blockage that subjects with allergic rhinitis articulate. "Congestion" will refer to the objective measures used to assess patency. Sensations attributed to the nasal mucosa are highly integrated interpretations summed from multiple subsets of nociceptive and other neurons. Activation of sensor systems is required to depolarize afferent neurons. These sensors and other receptor proteins can be modulated by inflammation as part of the neural plasticity that leads to increased sensitivity to nasal stimuli. This plasticity and hyperalgesia may extend from the afferent neuron to spinal cord dorsal horn synapses, and regulatory and analytical regions of the brainstem and cerebrum. Although glandular hypersecretion can deliver obstructing material into the nasal cavities, the dilation of deep venous sinusoids is the strongest factor regulating nasal airspace volumes. There is a long history of attempts to correlate subjective sensations to objective measurements such as airflow resistance (rhinomanometry), nasal wall geometry (acoustic rhinometry), and peak nasal inspiratory flow. The medical evidence supporting each method has been analyzed on the basis of the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system. These results provide a starting point for linking the outcomes of pathophysiological processes with a patient's psychometrically calibrated sensation of airflow.
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Intranasal steroids or radiofrequency turbinoplasty in persistent allergic rhinitis: effects on quality of life and objective parameters. Eur Arch Otorhinolaryngol 2010; 268:845-50. [DOI: 10.1007/s00405-010-1462-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 12/06/2010] [Indexed: 12/16/2022]
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Kjaergaard T, Cvancarova M, Steinsvaag SK. Smoker's nose: structural and functional characteristics. Laryngoscope 2010; 120:1475-80. [PMID: 20564717 DOI: 10.1002/lary.20967] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS The effects of smoking on endonasal geometry and airflow remain largely unknown. Our study examined the relationship between smoking status and objective measures of nasal cavity dimensions, nasal congestion, and nasal airflow, using acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF). STUDY DESIGN Cross-sectional study. METHODS Included in the study were 2,523 consecutive patients referred for evaluation of chronic nasal or sleep-related complaints. Smoking history was recorded, and AR and PNIF were measured at baseline and after decongestion of the nasal mucosa. Minimal cross-sectional areas (MCA), nasal cavity volumes (NCV), and PNIF, as well as quantified reversible mucosal congestion based on nasal congestion indexes (NCI) were analyzed to reveal possible associations with smoking status. Linear and logistic regressions were applied adjusting for possible confounders. RESULTS Smokers exhibited lower values of MCA, NCV, and PNIF than nonsmokers, both at baseline and after decongestion. Further, smokers had a lower decongestive capacity of the nasal mucosa, reflected by lower NCI for AR measures. Cigarette consumption, expressed as either pack-years or cigarettes smoked per day, showed a similar inverse relationship with the rhinometric measures even though a linear dose-response relationship could not be established. CONCLUSIONS We have clearly demonstrated that smokers exhibit lower MCA and NCV, achieve lower PNIF values, and have a less-compliant nasal mucosa than nonsmokers. Our results are unique, and provide evidence that smoking has adverse effects on the nasal airway, possibly due to mucosal inflammation. This might have further implications because altered nasal function could compromise the lower airways.
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Affiliation(s)
- Thomas Kjaergaard
- Department of Otolaryngology-Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.
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Wandalsen GF, Mendes AI, Solé D. Objective improvement in nasal congestion and nasal hyperreactivity with use of nasal steroids in persistent allergic rhinitis. Am J Rhinol Allergy 2010; 24:e32-6. [PMID: 20109319 DOI: 10.2500/ajra.2010.24.3427] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Our objective was to evaluate the action of topical nasal steroid in nasal congestion and nasal hyper-reactivity in children and adolescents with persistent allergic rhinitis. METHODS Twenty atopic children and adolescents (6 to 18 years) with moderate-to-severe persistent allergic rhinitis (PAR) were treated with mometasone furoate (100 microg once a day) for 21 days. At the beginning and end of treatment, the following were recorded: a) nasal symptoms score; b) several parameters of nasal congestion measured by acoustic rhinometry (SRE 2000 Rhinometrics); c) degree of nasal hyper-reactivity to histamine (concentration of histamine necessary to induce at least 100% increase in total nasal resistance during nasal provocation test). Data were compared with those from 20 controls. RESULTS Compared to controls, PAR patients had significantly higher score of symptoms, as well as higher degree of nasal hyper-reactivity and lower nasal volumes. After treatment, there was a significant decrease in the mean nasal symptoms score (8.0 versus 3.8; p < 0.001) and in the nasal hyper-reactivity (histamine concentration: 0.72 mg/ml versus 2.60 mg/ml; p < 0.001). Congestion improvement was observed by the increase in all acoustic rhinometry parameters. Among all studied volumes, the volume in the segment between 2 and 5 cm showed the highest mean increase (19.8%). CONCLUSION Treatment with topical nasal steroid objectively reduced nasal congestion and nasal histamine hyper-reactivity in children and adolescents with PAR.
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Affiliation(s)
- Gustavo F Wandalsen
- Department of Allergy and Clinical Immunology, Federal University of São Paulo, Brazil.
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Kjærgaard T, Cvancarova M, Steinsvåg SK. Cigarette smoking and self-assessed upper airway health. Eur Arch Otorhinolaryngol 2010; 268:219-26. [PMID: 20512499 DOI: 10.1007/s00405-010-1287-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 05/11/2010] [Indexed: 11/24/2022]
Abstract
Habitual smoking represents a chronic insult to the airway. However, the effects of smoking on upper airway health remains poorly described. Our objective was to examine the relationship between cigarette smoking and self-assessed upper airway health and evaluate dose-response relationships between exposure and complaints in a sample of 2,523 patients. Eligible subjects were adults referred to ENT specialist for evaluation of chronic nasal or sleep-related complaints. Thirteen specific symptoms and conditions, mainly related to the upper airway, were graded based on visual analog scales (VAS). Smokers, representing 33% of the sample, were more likely to report severe upper airway complaints compared to non-smokers (odds ratio 1.31-2.08) and exhibited significantly higher visual analog scale scores than non-smokers for 9 out of 13 outcome variables (p < 0.001-0.007). Further, significant associations were found between cigarette consumption and severity of complaints (p < 0.001-0.01), heavy smokers generally being more likely to exhibit high VAS scores than light smokers. In several cases smoking status and self-reported asthma/allergy had similar impact on subjective outcomes. Cigarette smoking was clearly associated with impaired upper airway health and seemed to be an important determinant in subjects seeking medical attention due to chronic nasal or sleep-related complaints. Both threshold and dose-response like relationships were evident between cigarette consumption and the outcome measures.
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Affiliation(s)
- Thomas Kjærgaard
- Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.
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Krouse J, Lund V, Fokkens W, Meltzer EO. Diagnostic strategies in nasal congestion. Int J Gen Med 2010; 3:59-67. [PMID: 20463824 PMCID: PMC2866556 DOI: 10.2147/ijgm.s8084] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Indexed: 11/23/2022] Open
Abstract
Nasal congestion is a major symptom of upper respiratory tract disorders, and its characterization an important part of the diagnosis of these illnesses. Patient history and assessment of nasal symptoms are essential components of diagnosis, providing an initial evaluation that may be adequate to rule out serious conditions. However, current congestion medications are not always fully effective. Thus, if symptoms do not respond adequately to therapy, or symptoms suggestive of more serious conditions are present, specialized assessments may be needed. Various techniques are available for diagnosing patients, including those used chiefly by primary care clinicians and those requiring the expertise of otolaryngologists, allergists, and other specialists. Endoscopy remains a mainstay for evaluating nasal blockage and its causes, while modalities such as peak nasal inspiratory flow and acoustic rhinometry are evolving to provide easy-to-use, noninvasive procedures that are sensitive enough to measure small but clinically important abnormalities and therapeutic changes. Several imaging modalities are available to the specialist for severe or unusual cases, as are specialized diagnostic procedures that measure adjunctive features of congestion, such as impaired mucociliary function.
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Affiliation(s)
- John Krouse
- Temple University School of Medicine, Philadelphia, PA, USA
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Bousquet J, Bieber T, Fokkens W, Kowalski ML, Humbert M, Niggemann B, Simon HU. Rhinitis and asthma represent hot topics for allergy. Allergy 2009; 64:1-4. [PMID: 19132972 DOI: 10.1111/j.1398-9995.2008.01954.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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