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Li CH, Kaura A, Tan C, Whitcroft KL, Leung TS, Andrews P. Diagnosing nasal obstruction and its common causes using the nasal acoustic device: A pilot study. Laryngoscope Investig Otolaryngol 2020; 5:796-806. [PMID: 32904889 PMCID: PMC7461538 DOI: 10.1002/lio2.445] [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: 04/23/2020] [Revised: 07/06/2020] [Accepted: 07/25/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives There is a need to develop a medical device which can accurately measure normal and abnormal nasal breathing which the patient can better understand in addition to being able to diagnose the cause for their nasal obstruction. The aim is to evaluate the accuracy of the nasal acoustic device (NAD) in diagnosing the common causes for nasal obstruction and diagnosing normal and abnormal (nasal obstruction) nasal breathing. Methods This pilot study recruited 27 patients with allergic rhinitis (AR), chronic rhinosinusitis (CRS), and a deviated nasal septum (DNS) which represents the common causes for NO and 26 controls (with normal nasal breathing). Nasal breathing sounds were recorded by the NAD akin to two small stethoscopes placed over the left and right nasal ala. The novel outcome metrics for the NAD include inspiratory nasal acoustic score (INA) score, expiratory nasal acoustic (ENA) score and the inspiratory nasal obstruction balance index (NOBI). The change in acoustic score following decongestant is key in this diagnostic process. Results Pre‐decongestant ENA score was used to detect the presence of nasal obstruction in patients compared to controls, with a sensitivity of 0.81 (95% CI: 0.66‐0.96) and a specificity of 0.77 (0.54‐1.00). Post‐decongestant percentage change in INA score was used to identify the presence of AR or CRS, with a sensitivity of 0.87 (0.69‐1.00) and specificity of 0.72 (0.55‐0.89) for AR; and a sensitivity of 0.92 (0.75‐1.00) and specificity of 0.69 (0.52‐0.86) for CRS. Post‐decongestant inspiratory NOBI was used to identify DNS, with a sensitivity of 0.77 (0.59‐0.95) and specificity of 0.94 (0.82‐1.00). Conclusion We have demonstrated that the NAD can help distinguish between normal and abnormal nasal breathing and help diagnose AR, CRS, and DNS. Such a device has not been invented and could revolutionize COVID‐19 recovery telemedicine. Level of Evidence Diagnostic accuracy study—Level III.
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Affiliation(s)
- Chia-Hung Li
- Department of Medical Physics and Biomedical Engineering University College London London UK
| | - Anika Kaura
- Department of Rhinology and Facial Plastic Surgery Royal National Throat, Nose and Ear Hospital London UK.,UCL Ear Institute, University College London London UK
| | - Calvin Tan
- Department of Medical Physics and Biomedical Engineering University College London London UK.,UCL Medical School, Faculty of Medical Sciences University College London London UK
| | - Katherine L Whitcroft
- Department of Rhinology and Facial Plastic Surgery Royal National Throat, Nose and Ear Hospital London UK.,UCL Ear Institute, University College London London UK
| | - Terence S Leung
- Department of Medical Physics and Biomedical Engineering University College London London UK
| | - Peter Andrews
- Department of Rhinology and Facial Plastic Surgery Royal National Throat, Nose and Ear Hospital London UK.,UCL Ear Institute, University College London London UK
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Mo S, Gupta SS, Stroud A, Strazdins E, Hamizan AW, Rimmer J, Alvarado R, Kalish L, Harvey RJ. Nasal Peak Inspiratory Flow in Healthy and Obstructed Patients: Systematic Review and Meta-Analysis. Laryngoscope 2020; 131:260-267. [PMID: 32386248 DOI: 10.1002/lary.28682] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/07/2020] [Accepted: 03/13/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Nasal peak inspiratory flow (NPIF) is a practical and affordable tool that measures maximum inspiratory flow rate through both nostrils. Although NPIF values for healthy controls and patients appear to differ considerably, a generally expected value for populations with and without nasal obstruction has yet to be established. The aim of this systematic review and meta-analysis was to determine the mean NPIF value in populations with and without nasal obstruction. METHODS Medline (1946-) and Embase (1947-) were searched until July 1, 2017. A search strategy was used to identify studies that reported NPIF values for defined healthy or disease states. All studies providing original data were included. The study population was defined as having either normal nasal breathing or nasal obstruction. A meta-analysis of the mean data was presented in forest plots, and data were presented as mean (95% confidence interval [CI]). RESULTS The search yielded 1,526 studies, of which 29 were included. The included studies involved 1,634 subjects with normal nasal breathing and 817 subjects with nasal obstruction. The mean NPIF value for populations with normal nasal breathing was 138.4 (95% CI: 127.9-148.8) L/min. The mean value for populations with nasal obstruction was 97.5 (95% CI: 86.1-108.8) L/min. CONCLUSIONS Current evidence confirms a difference between mean NPIF values of populations with and without nasal obstruction. The mean value of subjects with no nasal obstruction is 138.4 L/min, and the mean value of nasally obstructed populations is 97.5 L/min. Prospective studies adopting a standardized procedure are required to further assess normative NPIF values. Laryngoscope, 131:260-267, 2021.
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Affiliation(s)
- Shirley Mo
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Sai S Gupta
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna Stroud
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Erika Strazdins
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Aneeza W Hamizan
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,Department of Otolaryngology-Head and Neck Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Janet Rimmer
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,St. Vincent's Clinic, St. Vincent's Hospital, Sydney, New South Wales, Australia.,The Woolcock Institute, Sydney University, Sydney, New South Wales, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Larry Kalish
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology-Head and Neck Surgery, Concord General Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Tsounis M, Swart KMA, Georgalas C, Markou K, Menger DJ. The clinical value of peak nasal inspiratory flow, peak oral inspiratory flow, and the nasal patency index. Laryngoscope 2014; 124:2665-9. [PMID: 25073629 DOI: 10.1002/lary.24810] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/19/2014] [Accepted: 06/04/2014] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to ascertain the most reliable objective measurement for the assessment of nasal patency by investigating the relationship between peak nasal inspiratory flow, peak oral inspiratory flow, and the nasal patency index in relation to the patient's subjective perception regarding nasal obstruction. STUDY DESIGN Prospective cohort study. METHODS This study included 131 volunteers of both genders, aged 18 years or older, with or without nasal symptoms, who were able to give informed consent, completed the study protocol, and could speak and write Dutch fluently. Peak nasal inspiratory flow and peak oral inspiratory flow were performed and nasal patency index was computed. The results were evaluated and compared with the subjective perception of nasal passage, using the validated Nasal Obstruction Symptom Evaluation scale and visual analog scale for nasal passage. RESULTS Our study showed that peak nasal inspiratory flow, nasal patency index and nasal patency visual analog scale correlate with the Nasal Obstruction Symptom Evaluation scale in contrast to peak oral inspiratory flow. Peak nasal inspiratory flow and nasal patency index also showed significant association with the Nasal Obstruction Symptom Evaluation scale after adjustment for confounders. CONCLUSIONS Peak nasal inspiratory flow is the most reliable method for the assessment of nasal patency. It is quick, inexpensive, and easy to perform, and correlates significantly with the subjective feeling of nasal obstruction. There is no clinical need to measure peak oral inspiratory flow or to calculate the nasal patency index in the evaluation of nasal patency. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Michael Tsounis
- Department of Otorhinolaryngology/Head and Neck Surgery, Queen's Medical Centre, Nottingham, United Kingdom
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