Guideline Values for Minimum Nasal Cross-Sectional Area in Children

Pediatric Inferior Turbinate Hypertrophy: Diagnosis and Management. A YO-IFOS Consensus Statement

OBJECTIVE

Pediatric inferior turbinate hypertrophy (PedTH) is a frequent and often overlooked cause or associated cause of nasal breathing difficulties. This clinical consensus statement (CCS) aims to provide a diagnosis and management framework covering the lack of specific guidelines for this condition and addressing the existing controversies.

METHODS

A clinical consensus statement (CCS) was developed by a panel of 20 contributors from 7 different European and North American countries using the modified Delphi method. The aim of the CCS was to offer a multidisciplinary reference framework for the management of PedTH on the basis of shared clinical experience and analysis of the strongest evidence currently available.

RESULTS

A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria was performed. From the initial 96 items identified, 7 articles were selected based on higher-evidence items such as randomized-controlled trials, guidelines, and systematic reviews. A 34-statement survey was developed, and after three rounds of voting, 2 items reached strong consensus, 17 reached consensus or near consensus, and 15 had no consensus.

CONCLUSIONS

Until further prospective data are available, our CCS should provide a useful reference for PedTH management. PedTH should be considered a nasal obstructive disease not necessarily related to an adult condition but frequently associated with other nasal or craniofacial disorders. Diagnosis requires clinical examination and endoscopy, whereas rhinomanometry, nasal cytology, and questionnaires have little clinical role. Treatment choice should consider the specific indications and features of the available options, with a preference for less invasive procedures.

LEVEL OF EVIDENCE

5 Laryngoscope, 134:1437-1444, 2024.

The relation of velopharyngeal coupling area and vocal tract scaling to identification of stop-nasal cognates

The purpose of this study was to determine whether the threshold of velopharyngeal (VP) coupling area at which listeners switch from identifying a consonant as a stop to a nasal in North American English was different for speech produced by a model based on an adult male, an adult female, and a 4-year-old child. V1CV2 stimuli were generated with a speech production model that encodes phonetic segments as relative acoustic targets imposed on an underlying vocal tract and laryngeal structure that can be scaled according to sex and age. Each V1CV2 was synthesized with a set of VP coupling functions whose maximum area ranged from 0 to 0.1 cm2. Results showed that scaling the vocal tract and vocal folds had essentially no effect on the VP coupling area at which listener identification shifted from stop to nasal. The range of coupling areas at which the crossover occurred was 0.037-0.049 cm2 for the male model, 0.040-0.055 cm2 for the female model, and 0.039-0.052 cm2 for the 4-year-old child model, and overall mean was 0.044 cm2. Calculations of band limited peak nasalance indicated that 85% peak nasalance during the consonant was well aligned with listener responses.

Clinical parameters influencing the results of anterior rhinomanometry in children

BACKGROUND

Nasal obstruction is a frequent symptom in both adults and children and it is a common reason to see an otorhinolaryngologist. Endoscopy of the nasal cavity and the epipharyngeal space along with anterior rhinomanometry is regarded the gold standard since many years to estimate the severity of nasal obstruction in the particular patient. Endoscopy shows anatomical reasons for an obstruction, whereas the nasal flow volume and nasal resistance can be determined using anterior rhinomanometry. Currently, there are only few data available for rhinomanometry results in children. The purpose of the present study was to evaluate the application of this technique in the pediatric population for objective evaluation of nasal flow. Whether it achieves reproducible results and which clinical parameters have some influence on the results were studied.

PATIENTS AND METHODS

427 children (average age of 8.5 years, range 7 months through 17 years) who were admitted to evaluate nasal patency or for allergy testing were examined. After clinical examination and endoscopy of the nasal cavity and epipharyngeal space, anterior rhinomanometry was performed before and after application of decongestant nose drops separately for each nose side in 334 children. The nasal flow with a pressure of 150 Pasc was measured and served for statistical evaluation. Flow values were correlated to clinical and endoscopic parameters along with results of allergy tests (prick tests).

RESULTS

Reproducible rhinomanometric measurements were possible in children age 3 years and older. However, the standard deviation and variation of measurements were significant in this cohort of patients. Statistically highest significant correlations were found between flow measurements and body height along with the age of the children (p < 0.01) and status following adenoidectomy (p < 0.05). No statistically significant correlations were found between rhinomanometry and results of prick tests.

CONCLUSIONS

The study demonstrates that rhinomanometry can be applied in the pediatric population for objective evaluation of nasal obstruction and for determining the effects of decongestant nose drops. The highest correlation was found between nasal flow and children's body height, children's age and status following adenoidectomy. The correlation between nasal flow and clinically/endoscopically determined degree of nasal obstruction was lower. However, definition of normal flow values for particular age groups is challenging since the results showed high variation and standard deviation. Yet with regard to individual patient, the technique achieves reliable results in nasal provocation tests, which are widely used for allergy testing in children. When performed in children it should always be considered that there are age-specific requirements for the examination and interpretation of results in this patient cohort.