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Harvey RJ, Roland LT, Schlosser RJ, Pfaar O. Chief Complaint: Nasal Congestion. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1462-1471. [PMID: 38677589 DOI: 10.1016/j.jaip.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
Nasal obstruction is the subjective perception and objective state of insufficient airflow through the nose. Nasal congestion, conversely, describes a state of not just inadequate airflow or obstructive phenomena but also pressure- and mucus-related states to the patient. Nasal receptors belonging to the transient receptor potential (TRP) protein family mediate the sense of nasal patency via the trigeminal nerve. The transient receptor potential melastatin-8 (TRPM8) responds to temperatures around 8°C to 22°C, and is stimulated by menthol and other cooling agents. The radiant effects of airflow create heat loss to activate these receptors and humans perceive this as nasal patency rather than the direct detection of airflow. The thermovascular state of the mucosa, in conditions such as rhinitis, influence TRPM8 activation. Nasal endoscopy can show signs of rhinitis and should be considered an essential part of the workup of nasal congestion. Efforts to relieve nasal congestion need to manage the mucosal state and surgery needs to ensures that the nasal cavity mucosa is exposed to the cooling effects of airflow rather than simply creating a passage to the nasopharynx.
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Affiliation(s)
- Richard John Harvey
- Rhinology & Skull Base, University of New South Wales and Macquarie University, Sydney, Australia.
| | - Lauren T Roland
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Mo
| | - Rodney J Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
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2
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Hung WT, Lee TJ, Wu PW, Huang CC, Chang PH, Huang CC. Functional Exercise Capacity and Perceived Exertion in Patients with Empty Nose Syndrome. Diagnostics (Basel) 2024; 14:885. [PMID: 38732300 PMCID: PMC11083273 DOI: 10.3390/diagnostics14090885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Empty nose syndrome (ENS) is a complex condition characterized by symptoms such as dyspnea, nasal discomfort, and emotional challenges. This study aimed to evaluate functional exercise capacity and perceived exertion in patients with ENS. Patients with ENS who presented with a range of severe symptoms were prospectively enrolled. Pulmonary function was evaluated using spirometry, and functional exercise capacity was measured via the 6 min walk test (6-MWT). Perceived exertion was quantified using the Borg scale, and cardiopulmonary function was evaluated by monitoring peripheral oxygen saturation (SpO2). These parameters were assessed before and after nasal reconstruction surgery. A total of 44 patients with ENS were enrolled and classified into mild-to-moderate (n = 20) and severe (n = 24) symptom groups. Spirometry results showed no significant differences before and after surgery in the entire cohort. Perceived exertion showed significant postoperative improvement (p = 0.006). The severe ENS symptom group experienced significant improvement in SpO2 (p = 0.013) and perceived exertion (p = 0.002) at the end of the 6-MWT after surgery. Surgical intervention significantly enhanced functional exercise capacity (p = 0.038) in patients with mild-to-moderate ENS symptoms. Surgical reconstruction positively affected perceived exertion and SpO2 at the end of the 6-MWT in patients with ENS. The severity of ENS symptoms, as assessed by SNOT-25 scores, influenced these outcomes. These findings underscore the potential benefits of surgical intervention for enhancing exercise tolerance and respiratory efficiency.
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Affiliation(s)
- Wei-Te Hung
- Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan;
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou 33305, Taiwan; (T.-J.L.); (P.-W.W.); (C.-C.H.); (P.-H.C.)
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen 361028, China
| | - Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou 33305, Taiwan; (T.-J.L.); (P.-W.W.); (C.-C.H.); (P.-H.C.)
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chi-Che Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou 33305, Taiwan; (T.-J.L.); (P.-W.W.); (C.-C.H.); (P.-H.C.)
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Po-Hung Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou 33305, Taiwan; (T.-J.L.); (P.-W.W.); (C.-C.H.); (P.-H.C.)
| | - Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou 33305, Taiwan; (T.-J.L.); (P.-W.W.); (C.-C.H.); (P.-H.C.)
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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Johnsen SG. Computational Rhinology: Unraveling Discrepancies between In Silico and In Vivo Nasal Airflow Assessments for Enhanced Clinical Decision Support. Bioengineering (Basel) 2024; 11:239. [PMID: 38534513 DOI: 10.3390/bioengineering11030239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/09/2024] [Accepted: 02/17/2024] [Indexed: 03/28/2024] Open
Abstract
Computational rhinology is a specialized branch of biomechanics leveraging engineering techniques for mathematical modelling and simulation to complement the medical field of rhinology. Computational rhinology has already contributed significantly to advancing our understanding of the nasal function, including airflow patterns, mucosal cooling, particle deposition, and drug delivery, and is foreseen as a crucial element in, e.g., the development of virtual surgery as a clinical, patient-specific decision support tool. The current paper delves into the field of computational rhinology from a nasal airflow perspective, highlighting the use of computational fluid dynamics to enhance diagnostics and treatment of breathing disorders. This paper consists of three distinct parts-an introduction to and review of the field of computational rhinology, a review of the published literature on in vitro and in silico studies of nasal airflow, and the presentation and analysis of previously unpublished high-fidelity CFD simulation data of in silico rhinomanometry. While the two first parts of this paper summarize the current status and challenges in the application of computational tools in rhinology, the last part addresses the gross disagreement commonly observed when comparing in silico and in vivo rhinomanometry results. It is concluded that this discrepancy cannot readily be explained by CFD model deficiencies caused by poor choice of turbulence model, insufficient spatial or temporal resolution, or neglecting transient effects. Hence, alternative explanations such as nasal cavity compliance or drag effects due to nasal hair should be investigated.
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Seifelnasr A, Si X, Xi J. Assessing Nasal Epithelial Dynamics: Impact of the Natural Nasal Cycle on Intranasal Spray Deposition. Pharmaceuticals (Basel) 2024; 17:73. [PMID: 38256906 PMCID: PMC10819912 DOI: 10.3390/ph17010073] [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: 12/15/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
This study investigated the intricate dynamics of intranasal spray deposition within nasal models, considering variations in head orientation and stages of the nasal cycle. Employing controlled delivery conditions, we compared the deposition patterns of saline nasal sprays in models representing congestion (N1), normal (N0), and decongestion (P1, P2) during one nasal cycle. The results highlighted the impact of the nasal cycle on spray distribution, with congestion leading to confined deposition and decongestion allowing for broader dispersion of spray droplets and increased sedimentation towards the posterior turbinate. In particular, the progressive nasal dilation from N1 to P2 decreased the spray deposition in the middle turbinate. The head angle, in conjunction with the nasal cycle, significantly influenced the nasal spray deposition distribution, affecting targeted drug delivery within the nasal cavity. Despite controlled parameters, a notable variance in deposition was observed, emphasizing the complex interplay of gravity, flow shear, nasal cycle, and nasal morphology. The magnitude of variance increased as the head tilt angle increased backward from upright to 22.5° to 45° due to increasing gravity and liquid film destabilization, especially under decongestion conditions (P1, P2). This study's findings underscore the importance of considering both natural physiological variations and head orientation in optimizing intranasal drug delivery.
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Affiliation(s)
- Amr Seifelnasr
- Department of Biomedical Engineering, University of Massachusetts, Lowell, MA 01854, USA;
| | - Xiuhua Si
- Department of Mechanical Engineering, California Baptist University, Riverside, CA 92504, USA;
| | - Jinxiang Xi
- Department of Biomedical Engineering, University of Massachusetts, Lowell, MA 01854, USA;
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Kumar A, Joshi D. Effect of ambient temperature and respiration rate on nasal dominance: preliminary findings from a nostril-specific wearable. J Breath Res 2023; 17:046011. [PMID: 37611568 DOI: 10.1088/1752-7163/acf339] [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: 03/29/2023] [Accepted: 08/23/2023] [Indexed: 08/25/2023]
Abstract
The nasal dominance (ND) determination is crucial for nasal synchronized ventilator, optimum nasal drug delivery, identifying brain hemispheric dominance, nasal airway obstruction surgery, mindfulness breathing, and for possible markers of a conscious state. Given these wider applications of ND, it is interesting to understand the patterns of ND with varying temperature and respiration rates. In this paper, we propose a method which measures peak-to-peak temperature oscillations (difference between end-expiratory and end-inspiratory temperature) for the left and right nostrils during nasal breathing. These nostril-specific temperature oscillations are further used to calculate the nasal dominance index (NDI), nasal laterality ratio (NLR), inter-nostril correlation, and mean of peak-to-peak temperature oscillation for inspiratory and expiratory phase at (1) different ambient temperatures of 18 °C, 28 °C, and 38 °C and (2) at three different respiration rate of 6 bpm, 12 bpm, and 18 bpm. The peak-to-peak temperature (Tpp) oscillation range (averaged across participants;n= 8) for the left and right nostril were 3.80 ± 0.57 °C and 2.34 ± 0.61 °C, 2.03 ± 0.20 °C and 1.40 ± 0.26 °C, and 0.20 ± 0.02 °C and 0.29 ± 0.03 °C at the ambient temperature of 18 °C, 28 °C, and 38 °C respectively (averaged across participants and respiration rates). The NDI and NLR averaged across participants and three different respiration rates were 35.67 ± 5.53 and 2.03 ± 1.12; 8.36 ± 10.61 and 2.49 ± 3.69; and -25.04 ± 14.50 and 0.82 ± 0.54 at the ambient temperature of 18 °C, 28 °C, and 38 °C respectively. The Shapiro-Wilk test, and non-parametric Friedman test showed a significant effect of ambient temperature conditions on both NDI and NLR. No significant effect of respiration rate condition was observed on both NDI and NLR. The findings of the proposed study indicate the importance of ambient temperature while determining ND during the diagnosis of breathing disorders such as septum deviation, nasal polyps, nosebleeds, rhinitis, and nasal fractions, and in the intensive care unit for nasal synchronized ventilator.
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Affiliation(s)
- Amit Kumar
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Deepak Joshi
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
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Letzel J, Darbinjan A, Hummel T. The nasal cycle before and after nasal septoplasty. Eur Arch Otorhinolaryngol 2022; 279:4961-4968. [PMID: 35286439 DOI: 10.1007/s00405-022-07322-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Septoplasty is one of the most frequently performed operations in patients with septal deviation of the nose. The aim of this surgical intervention is to reduce nasal obstruction and to achieve a physiological nasal breathing. The nasal cycle plays a crucial role in this. The aim of this study was to investigate nasal breathing and the nasal cycle after septoplasty over a long period of time and under everyday conditions. METHODS We examined 22 healthy subjects and 19 patients with nasal septal deviation. They participated in two sessions separated by an interval of three months. Shortly after the first session patients received nasal septoplasty. Testing included multiple questionnaires regarding nasal breathing and olfactory function, anterior rhinoscopy, rhinomanometry, acoustic rhinometry, and long-term rhinoflowmetry over 24 h. RESULTS Nasal septoplasty was associated with subjectively improved nasal breathing and nasal patency comparable to that in healthy subjects. The severity of nasal obstruction was reduced. Nasal airflow and the hydraulic diameter increased on the deviated side of the nose while the inspiratory resistance did not significantly change. In addition, the number of phases of the nasal cycle decreased on the nondeviated side. Hence, the surgery was associated with a more even distribution of phases on both sides of the nose. CONCLUSION Nasal septoplasty leads to a subjectively satisfactory result in patients with pathological septal deviation of the nose. In particular, septoplasty appears to be accompanied by a more even distribution of the nasal cycle across the two nasal cavities.
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Affiliation(s)
- Justus Letzel
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Alexander Darbinjan
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Thomas Hummel
- Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Shah R, Frank-Ito DO. The role of normal nasal morphological variations from race and gender differences on respiratory physiology. Respir Physiol Neurobiol 2022; 297:103823. [PMID: 34883314 PMCID: PMC9258636 DOI: 10.1016/j.resp.2021.103823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 11/19/2022]
Abstract
This study identifies anatomical and airflow-induced relationships based on nasal morphological variations due to inter- and intra-racial differences and gender. Subject-specific nasal airway reconstruction was created from computed tomography images in 16 subjects: 4 subjects from each ethnic group (Black, East Asian, Caucasian, and Latino) comprising of 2 males and 2 females. Volume, surface area and nasal index were calculated, as well as airflow rate and nasal resistance after computational fluid dynamics simulations in the nasal airway. Results showed that nasal airspace surface area (p = 0.0499) and volume (p = 0.0281) were significantly greater in males than in females. Nasal volume was greatest in East Asians (Median = 20.38cm3, Interquartile Range [IQR] = 4.58 cm3), Latinos had the greatest surface area (Median = 219.70cm2, IQR = 29.56cm2). On average, East Asian and Black females had larger nasal index than their male counterparts. Caucasians had the highest median nasal resistance (0.050 Pa.s/mL, IQR = 0.025 Pa.s/mL). Results indicate that there exist anatomical variabilities based on race and gender. However, these variabilities may not significantly influence nasal function.
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Affiliation(s)
- Reanna Shah
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Dennis Onyeka Frank-Ito
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA; Computational Biology & Bioinformatics PhD Program, Duke University, Durham, NC, USA.
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8
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Xiao Q, Bates AJ, Cetto R, Doorly DJ. The effect of decongestion on nasal airway patency and airflow. Sci Rep 2021; 11:14410. [PMID: 34257360 PMCID: PMC8277849 DOI: 10.1038/s41598-021-93769-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Nasal decongestant reduces blood flow to the nasal turbinates, reducing tissue volume and increasing nasal airway patency. This study maps the changes in nasal anatomy and measures how these changes affect nasal resistance, flow partitioning between superior and inferior cavity, flow patterns and wall shear stress. High-resolution MRI was applied to capture nasal anatomy in 10 healthy subjects before and after application of a topical decongestant. Computational fluid dynamics simulated nasal airflow at steady inspiratory flow rates of 15 L.min[Formula: see text] and 30 L.min[Formula: see text]. The results show decongestion mainly increases the cross-sectional area in the turbinate region and SAVR is reduced (median approximately 40[Formula: see text] reduction) in middle and lower parts of the cavity. Decongestion reduces nasal resistance by 50[Formula: see text] on average, while in the posterior cavity, nasal resistance decreases by a median factor of approximately 3 after decongestion. We also find decongestant regularises nasal airflow and alters the partitioning of flow, significantly decreasing flow through the superior portions of the nasal cavity. By comparing nasal anatomies and airflow in their normal state with that when pharmacologically decongested, this study provides data for a broad range of anatomy and airflow conditions, which may help characterize the extent of nasal variability.
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Affiliation(s)
- Qiwei Xiao
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alister J Bates
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Raul Cetto
- Department of Aeronautics, Imperial College London, South Kensington Campus, London, SW7 1AZ, UK
| | - Denis J Doorly
- Department of Aeronautics, Imperial College London, South Kensington Campus, London, SW7 1AZ, UK.
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9
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Lan MC, Lan MY, Kuan EC, Huang YC, Huang TT, Hsu YB. Nasal Obstruction as a Potential Factor Contributing to Hypoxemia in Obstructive Sleep Apnea. Nat Sci Sleep 2021; 13:55-62. [PMID: 33469400 PMCID: PMC7811484 DOI: 10.2147/nss.s288618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/14/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study aimed to evaluate the correlation between nasal resistance and oxygen desaturation to better elucidate the role of nasal obstruction in the pathophysiology of obstructive sleep apnea (OSA). PATIENTS AND METHODS Eighty-eight OSA patients aged between 22 and 77 years were enrolled in this study. Nasal resistance was measured at pressures of 75, 150, and 300 Pa, with the patients first in the seated position than in the supine position. Relationships between the oximetric variables and nasal resistance in the seated and supine positions were analyzed. RESULTS From seated to supine position, a statistically significant increase in nasal resistance was observed at pressures of 75 and 150 Pa (p=0.001 and p=0.006, respectively). Significant positive correlations were noted between nasal resistance in the supine position at 75 Pa (SupineNR75) and oximetry variables, including oxygen desaturation index (ODI, p=0.015) and the percentage of total time with oxygen saturation level lower than 90% (T < 90%, p=0.012). However, significant positive correlations existed only in moderate to severe OSA when the study group was further divided into two subgroups (mild vs moderate to severe OSA). Body mass index (β = 0.476, p<0.001) and SupineNR75 (β = 0.303, p=0.004) were identified as independent predictors for increased ODI. CONCLUSION Nasal resistance in the supine position measured at 75 Pa significantly correlated with the severity of oxygen desaturation. Therefore, nasal obstruction may play an important role in the pathophysiology of hypoxemia in OSA patients, especially in patients with moderate to severe OSA.
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Affiliation(s)
- Ming-Chin Lan
- Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ming-Ying Lan
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Yun-Chen Huang
- Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Tung-Tsun Huang
- Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yen-Bin Hsu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Virtual septoplasty: a method to predict surgical outcomes for patients with nasal airway obstruction. Int J Comput Assist Radiol Surg 2020; 15:725-735. [PMID: 32078099 DOI: 10.1007/s11548-020-02124-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE A deviated nasal septum is the most common etiology for nasal airway obstruction (NAO), and septoplasty is the most common surgical procedure performed by ear-nose-throat surgeons in adults. However, quantitative criteria are rarely adopted to select patients for surgery, which may explain why up to 50% of patients report persistent or recurrent symptoms of nasal obstruction postoperatively. This study reports a systematic virtual surgery method to identify patients who may benefit from septoplasty. METHODS One patient with symptoms of NAO due to a septal deviation was selected to illustrate the virtual surgery concept. Virtual septoplasty was implemented in three steps: (1) determining if septal geometry is abnormal preoperatively, (2) virtually correcting the deviation while preserving the anatomical shape of the septum, and (3) estimating the post-surgical improvement in airflow using computational fluid dynamics. Anatomical and functional changes predicted by the virtual surgery method were compared to a standard septoplasty performed independently from the computational analysis. RESULTS A benchmark healthy nasal septum geometry was obtained by averaging the septum dimensions of 47 healthy individuals. A comparison of the nasal septum geometry in the NAO patient with the benchmark geometry identified the precise locations where septal deviation and thickness exceeded the healthy range. Good agreement was found between the virtual surgery predictions and the actual surgical outcomes for both airspace minimal cross-sectional area (0.05 cm2 pre-surgery, 0.54 cm2 virtual surgery, 0.50 cm2 actual surgery) and nasal resistance (0.91 Pa.s/ml pre-surgery, 0.08 Pa.s/ml virtual surgery, 0.08 Pa.s/ml actual surgery). CONCLUSIONS Previous virtual surgery methods for NAO were based on manual edits and subjective criteria. The virtual septoplasty method proposed in this study is objective and has the potential to be fully automated. Future implementation of this method in virtual surgery planning software has the potential to improve septoplasty outcomes.
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11
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Malik J, Thamboo A, Dholakia S, Borchard NA, McGhee S, Li C, Zhao K, Nayak JV. The cotton test redistributes nasal airflow in patients with empty nose syndrome. Int Forum Allergy Rhinol 2020; 10:539-545. [PMID: 31951101 DOI: 10.1002/alr.22489] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Empty nose syndrome (ENS) remains a controversial disease primarily associated with inferior turbinate tissue loss. Cotton placement into the inferior meatus often alleviates ENS symptoms within minutes, but the physiologic explanation for this phenomenon is unknown. Computational fluid dynamics (CFD) was employed to evaluate the mechanisms of altered nasal airflow conferred by cotton testing. METHODS Six ENS patients (12 sides) with pre-existing sinus computed tomography (CT) imaging were enrolled after marked symptomatic improvement (decrease in score on the Empty Nose Syndrome 6-Item Questionnaire [ENS6Q] of >7 points) with office-based cotton testing. The fashioned cotton plug was labeled in situ with iohexol contrast spray, and sinus CT was immediately obtained to detect cotton contouring in the inferior meatus. CT imaging from pre- and post-cotton placement was analyzed using comparative CFD techniques. RESULTS After cotton placement, significant symptomatic improvement and reduced ENS6Q scores (16.8 ± 4.1 to 3.1 ± 2.4; p < 0.001) were recorded. Using CFD, cotton placement produced an expected 21% increase in upper airway resistance (p < 0.05). However, a significant shift in the nasal airflow distribution was also detected, with a transition of airflow vectors away from a middle meatus jetstream (-41%; p < 0.002). CONCLUSION Objective CFD assessment confirmed that the cotton test not only increases nasal resistance, but also restores airflow distribution to the inferior meatus in symptomatic ENS patients. These results highlight the potential efficacy of cotton test in ENS patients and further bolster the utility of this tool in identifying appropriate candidates for the inferior meatus augmentation procedure.
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Affiliation(s)
- Jennifer Malik
- Department of Otolaryngology, Head & Neck Surgery, The Ohio State University, Columbus, OH
| | - Andrew Thamboo
- Department of Otolaryngology, Head & Neck Surgery, University of British Columbia, Vancouver, Canada
| | - Sachi Dholakia
- Department of Otolaryngology, Head & Neck Surgery, Stanford University, Stanford, CA
| | - Nicole A Borchard
- Department of Otolaryngology, Head & Neck Surgery, Stanford University, Stanford, CA
| | - Sam McGhee
- Department of Otolaryngology, Head & Neck Surgery, The Ohio State University, Columbus, OH
| | - Chengyu Li
- Department of Mechanical Engineering, Villanova University, Villanova, PA
| | - Kai Zhao
- Department of Otolaryngology, Head & Neck Surgery, The Ohio State University, Columbus, OH
| | - Jayakar V Nayak
- Department of Otolaryngology, Head & Neck Surgery, Stanford University, Stanford, CA
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12
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Borojeni AAT, Garcia GJM, Moghaddam MG, Frank-Ito DO, Kimbell JS, Laud PW, Koenig LJ, Rhee JS. Normative ranges of nasal airflow variables in healthy adults. Int J Comput Assist Radiol Surg 2019; 15:87-98. [PMID: 31267334 DOI: 10.1007/s11548-019-02023-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Virtual surgery planning based on computational fluid dynamics (CFD) simulations of nasal airflow has the potential to improve surgical outcomes for patients with nasal airway obstruction (NAO). Virtual surgery planning requires normative ranges of airflow variables, but few studies to date have quantified inter-individual variability of nasal airflow among healthy subjects. This study reports CFD simulations of nasal airflow in 47 healthy adults. METHODS Anatomically accurate three-dimensional nasal models were reconstructed from cone beam computed tomography scans and used for steady-state inspiratory airflow simulations with a bilateral flowrate of 250 ml/s. Normal subjective sensation of nasal patency was confirmed using the nasal obstruction symptom evaluation and visual analog scale. Healthy ranges for several CFD variables known to correlate with subjective nasal patency were computed, including unilateral airflow, nasal resistance, airspace minimal cross-sectional area (mCSA), heat flux (HF), and surface area stimulated by mucosal cooling (defined as the area where HF > 50 W/m2). The normative ranges were targeted to contain 95% of the healthy population and computed using a nonparametric method based on order statistics. RESULTS A wide range of inter-individual variability in nasal airflow was observed among healthy subjects. Unilateral airflow varied from 60 to 191 ml/s, airflow partitioning ranged from 23.8 to 76.2%, and unilateral mCSA varied from 0.24 to 1.21 cm2. These ranges are in good agreement with rhinomanometry and acoustic rhinometry data from the literature. A key innovation of this study are the normative ranges of flow variables associated with mucosal cooling, which recent research suggests is the primary physiological mechanism of nasal airflow sensation. Unilateral HF ranged from 94 to 281 W/m2, while the surface area stimulated by cooling ranged from 27.4 to 64.3 cm2. CONCLUSIONS These normative ranges may serve as targets in future virtual surgery planning for patients with NAO.
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Affiliation(s)
- Azadeh A T Borojeni
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.,Department of Biomedical Engineering, Marquette University & The Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Guilherme J M Garcia
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA. .,Department of Biomedical Engineering, Marquette University & The Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Masoud Gh Moghaddam
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.,Department of Biomedical Engineering, Marquette University & The Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Dennis O Frank-Ito
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA.,Computational Biology and Bioinformatics Program, Duke University, Durham, NC, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
| | - Julia S Kimbell
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Purushottam W Laud
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lisa J Koenig
- Department of Oral Medicine and Oral Radiology, Marquette University School of Dentistry, Milwaukee, WI, USA
| | - John S Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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13
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Air-conditioning characteristics in nasal cavity models exhibiting nasal cycle states. J Therm Biol 2019; 83:60-68. [PMID: 31331526 DOI: 10.1016/j.jtherbio.2019.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/06/2019] [Accepted: 05/10/2019] [Indexed: 11/23/2022]
Abstract
The air-conditioning characteristics in nasal cavity models obtained from two subjects exhibiting different degrees of the nasal cycle states in terms of the airflow partition were investigated using computational fluid dynamics. A constant inspiratory flow rate of approximately 250 mL/s was considered, and the air temperature and relative humidity at the inlet were assumed to be 25 °C and 35%, respectively. The air-conditioning capacities of the congested and decongested sides were assessed by the amounts of epithelial heat and water vapor transferred to the inhaled air through the airway from the nostrils to the end of the septum. The results revealed that the air temperature and relative humidity near the end of the septum, respectively, reached approximately 31.4-32.5 °C and 81.4-88.0% in the decongested sides and 34.0-35.9 °C and 95.3-100% in the congested sides. The differences seen in the air temperatures and relative humidity between the congested and decongested sides were found to be larger in the cavity model that showed a larger degree of reciprocal change in the airflow rate. From a fluid mechanics perspective, while the congested side is in a rest period during the nasal cycle such that a lower amount of airflow is transported through it, this side, in effect, works to provide assistive air-conditioning capacity to the nasal cavity and aids when insufficiently conditioned airflow passes through the decongested side so that the inhaled air merging after the septum can approach the alveolar condition favorably through the nasopharynx.
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14
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Scadding GK, Kariyawasam HH, Scadding G, Mirakian R, Buckley RJ, Dixon T, Durham SR, Farooque S, Jones N, Leech S, Nasser SM, Powell R, Roberts G, Rotiroti G, Simpson A, Smith H, Clark AT. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2019; 47:856-889. [PMID: 30239057 DOI: 10.1111/cea.12953] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.
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Affiliation(s)
- G K Scadding
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - H H Kariyawasam
- The Royal National Throat Nose and Ear Hospital, London, UK.,UCLH NHS Foundation Trust, London, UK
| | - G Scadding
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - R Mirakian
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - R J Buckley
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - T Dixon
- Royal Liverpool and Broad green University Hospital NHS Trust, Liverpool, UK
| | - S R Durham
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - S Farooque
- Chest and Allergy Department, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - N Jones
- The Park Hospital, Nottingham, UK
| | - S Leech
- Department of Child Health, King's College Hospital, London, UK
| | - S M Nasser
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - R Powell
- Department of Clinical Immunology and Allergy, Nottingham University, Nottingham UK
| | - G Roberts
- Department of Child Health, University of Southampton Hospital, Southampton, UK
| | - G Rotiroti
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - A Simpson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, UK
| | - H Smith
- Division of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - A T Clark
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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15
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Kumaran EM. Alteration in Nasal Cycle Rhythm as an Index of the Diseased Condition. PATHOPHYSIOLOGY - ALTERED PHYSIOLOGICAL STATES 2018. [DOI: 10.5772/intechopen.70599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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16
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Numminen J, Ahtinen M, Huhtala H, Laranne J, Rautiainen M. Correlation between Rhinometric Measurement Methods in Healthy Young Adults. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240201600405] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The most common rhinometric measurement methods used in modern rhinology are acoustic rhinometry, rhinomanometry, and nasal peak expiratory flow (PEF) rate. In this prospective study, we wanted to clarify whether the parameters given by these three methods in the same subject support each other and can be used simultaneously in clinical practice. We also wanted to define the dimensions of normal nasal geometry and function based on these three methods. The rhinometric measurements were done in 249 healthy white subjects consisting of 171 women and 78 men. The geometry was analyzed with regard to body mass index (BMI) and smoking habits. The result could be used as some kind of reference value for the same kind of patient cohort as when rhinological pathology is investigated. The measurements obtained by acoustic rhinometry showed only statistically significant correlations between the measured volume and minimal cross-sectional area in the nasal cavities (r = 0.959). Rhinomanometry showed only a statistically significant correlation between the measured resistance in expiration and inspiration (r = 0.977). Acoustic rhinometry, rhinomanometry, and nasal PEF did not show any correlations and the BMI did not have any effect on the results. Although the smoking group was relatively small in this cohort, the rhinometric methods showed smaller nasal cavity volume, higher resistance, and lower nasal PEF values. Based on these results, we recommend the use of these three rhinometric methods as independent instruments in rhinological examinations. However, in the pathological nose, e.g., smokers, the methods show equal changes in measurements. It is important to measure at least acoustic rhinometry and rhinomanometry at the same time in clinical practice to achieve good quality of examinations.
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Affiliation(s)
- Jura Numminen
- Department of Otorhinolaryngology, Head, and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Mikko Ahtinen
- Department of Medical Faculty, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Department of School of Public Health, University of Tampere, Tampere, Finland
| | - Jussi Laranne
- Department of Otorhinolaryngology, Head, and Neck Surgery, Tampere University Hospital, Tampere, Finland
| | - Markus Rautiainen
- Department of Otorhinolaryngology, Head, and Neck Surgery, Tampere University Hospital, Tampere, Finland
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17
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Bremner FD, Nordström JG. A Case of Synchronised Pupillary and Nasal Cycling: Evidence for a Central Autonomic Pendulum? Neuroophthalmology 2018; 41:241-246. [PMID: 29339957 DOI: 10.1080/01658107.2017.1315144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022] Open
Abstract
We previously reported that some healthy individuals show alternating anisocoria. We now describe one such individual who also exhibits a classic nasal cycle (alternating periods of nasal congestion and decongestion). We made measurements of his pupil asymmetry and nasal asymmetry at 21 different time points and found that these variables were always synchronised such that greater nasal airflow was invariably found on the same side as the larger pupil. We hypothesise that a common central oscillator may be responsible for co-modulating the sympathetic outflow to both nasal vessels and iris dilator muscles in some healthy individuals.
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Affiliation(s)
- Fion D Bremner
- National Hospital for Neurology & Neurosurgery, London, UK
| | - Jonas Gälldin Nordström
- Husie Health Centre, Department of General Practice, Skane University Hospital, Malmö, Sweden
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18
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Balakin BV, Farbu E, Kosinski P. Aerodynamic evaluation of the empty nose syndrome by means of computational fluid dynamics. Comput Methods Biomech Biomed Engin 2017; 20:1554-1561. [PMID: 29064287 DOI: 10.1080/10255842.2017.1385779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The potential outcome of a surgical enlargement of internal nasal channels may be a complication of nasal breathing termed the Empty Nose Syndrome (ENS). ENS pathophysiology is not entirely understood because the expansion of air pathways would in theory ease inhalation. The present contribution is aimed at defining the biophysical markers responsible for ENS. Our study, conducted in silico, compares nasal aerodynamics in pre- and post-operative geometries acquired by means of computer tomography from the same individual. In this article, we elucidate and analyse the deviation of airflow patterns and nasal microclimate from the healthy benchmarks. The analysis reveals 53% reduction in flow resistance, radical re-distribution of nasal airflow, as well as dryer and colder nasal microclimate for the post-operative case.
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Affiliation(s)
- Boris V Balakin
- a Department of Mechanical and Marine Engineering , Western Norway University of Applied Sciences , Bergen , Norway.,b Department of Thermal Physics , National Nuclear Research University MEPhI , Moscow , Russia
| | - Erlend Farbu
- a Department of Mechanical and Marine Engineering , Western Norway University of Applied Sciences , Bergen , Norway
| | - Pawel Kosinski
- c Department of Physics and Technology , University of Bergen , Bergen , Norway
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19
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Gaberino C, Rhee JS, Garcia GJM. Estimates of nasal airflow at the nasal cycle mid-point improve the correlation between objective and subjective measures of nasal patency. Respir Physiol Neurobiol 2017; 238:23-32. [PMID: 28089607 PMCID: PMC5316304 DOI: 10.1016/j.resp.2017.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/06/2017] [Accepted: 01/06/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The nasal cycle represents a significant challenge when comparing pre- and post-surgery objective measures of nasal airflow. METHODS Computational fluid dynamics (CFD) simulations of nasal airflow were conducted in 12 nasal airway obstruction patients showing significant nasal cycling between pre- and post-surgery computed tomography scans. To correct for the nasal cycle, mid-cycle models were created virtually. Subjective scores of nasal patency were obtained via the Nasal Obstruction Symptom Evaluation (NOSE) and unilateral visual analog scale (VAS). RESULTS The correlation between objective and subjective measures of nasal patency increased after correcting for the nasal cycle. In contrast to biophysical variables in individual patients, cohort averages were not significantly affected by the nasal cycle correction. CONCLUSIONS The ability to correct for the confounding effect of the nasal cycle is a key element that future virtual surgery planning software for nasal airway obstruction will need to account for when using anatomic models based on single instantaneous imaging.
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Affiliation(s)
- Courtney Gaberino
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, United States; Department of Biomedical Engineering, Marquette University & the Medical College of Wisconsin, United States.
| | - John S Rhee
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, United States.
| | - Guilherme J M Garcia
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, United States; Department of Biomedical Engineering, Marquette University & the Medical College of Wisconsin, United States.
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20
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Kahana-Zweig R, Geva-Sagiv M, Weissbrod A, Secundo L, Soroker N, Sobel N. Measuring and Characterizing the Human Nasal Cycle. PLoS One 2016; 11:e0162918. [PMID: 27711189 PMCID: PMC5053491 DOI: 10.1371/journal.pone.0162918] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/30/2016] [Indexed: 11/18/2022] Open
Abstract
Nasal airflow is greater in one nostril than in the other because of transient asymmetric nasal passage obstruction by erectile tissue. The extent of obstruction alternates across nostrils with periodicity referred to as the nasal cycle. The nasal cycle is related to autonomic arousal and is indicative of asymmetry in brain function. Moreover, alterations in nasal cycle periodicity have been linked to various diseases. There is therefore need for a tool allowing continuous accurate measurement and recording of airflow in each nostril separately. Here we provide detailed instructions for constructing such a tool at minimal cost and effort. We demonstrate application of the tool in 33 right-handed healthy subjects, and derive several statistical measures for nasal cycle characterization. Using these measures applied to 24-hour recordings we observed that: 1: subjects spent slightly longer in left over right nostril dominance (left = 2.63 ± 0.89 hours, right = 2.17 ± 0.89 hours, t(32) = 2.07, p < 0.05), 2: cycle duration was shorter in wake than in sleep (wake = 2.02 ± 1.7 hours, sleep = 4.5 ± 1.7 hours, (t(30) = 5.73, p < 0.0001). 3: slower breathing was associated with a more powerful cycle (the extent of difference across nostrils) (r = 0.4, p < 0.0001), and 4: the cycle was influenced by body posture such that lying on one side was associated with greater flow in the contralateral nostril (p < 0.002). Finally, we provide evidence for an airflow cycle in each nostril alone. These results provide characterization of an easily obtained measure that may have diagnostic implications for neurological disease and cognitive state.
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Affiliation(s)
- Roni Kahana-Zweig
- Department of Neurobiology, The Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Maya Geva-Sagiv
- Department of Neurobiology, The Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Aharon Weissbrod
- Department of Neurobiology, The Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Lavi Secundo
- Department of Neurobiology, The Weizmann Institute of Science, Rehovot, 76100, Israel
| | - Nachum Soroker
- Loewenstein Rehabilitation Hospital, Ra’anana, 43100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 69978, Israel
| | - Noam Sobel
- Department of Neurobiology, The Weizmann Institute of Science, Rehovot, 76100, Israel
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21
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Abstract
BACKGROUND Over the past few decades, evidence has emerged suggesting that nasal airflow asymmetry and brain asymmetry are linked. The nose exhibits asymmetrical airflow, with the dominant airflow alternating from one nasal passage to the other over a period of hours. Some authors have suggested a correlation between cerebral hemisphere dominance and nostril dominance. Others have proposed an association between rhythmic fluctuations in nasal airflow and corresponding fluctuations in cerebral hemisphere activity. Based on ancient yoga breathing techniques, newer evidence suggests that altering nasal airflow can influence brain activity, with reports of improved cognitive function caused by unilateral forced nostril breathing. It seems that a nasal airflow stimulus may have an activating effect on the brain, as it has also been shown to trigger seizure activity in epileptic patients. OBJECTIVES This article explores these theories in detail, reviews the evidence, and presents new models linking nasal airflow and brain activity.
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22
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Abstract
Allergic rhinitis (AR) is the most common immunologic disease in industrialized societies and has a significant impact on quality of life. Most asthmatics also have rhinitis. AR may present with comorbidities, including chronic otitis media with effusion, cough, and pollen-food cross-reactivity. AR may occur in isolation or be part of a mixed rhinitis.
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Affiliation(s)
- Glenis K Scadding
- Department of Allergy and Rhinology, Royal National Throat, Nose and Ear Hospital, 330 Gray's Inn Road, London WC1X 8DA, UK.
| | - Guy W Scadding
- Allergy, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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23
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A model for the central control of airflow patterns within the human nasal cycle. The Journal of Laryngology & Otology 2015; 130:82-8. [PMID: 26482243 DOI: 10.1017/s0022215115002881] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The nasal cycle exhibits mainly reciprocal changes in nasal airflow that may be controlled from centres in the hypothalamus and brainstem. This study aims to gather new knowledge about the nasal cycle to help develop a control model. METHOD Right and left nasal airflow was measured in healthy human subjects by rhinomanometry. This was performed over 7-hour periods on 2 study days separated by approximately 1 week. The correlation coefficient for nasal airflow was calculated for day 1 and day 2. RESULTS Thirty subjects (mean age, 22.7 years) completed the study. The correlation coefficient for nasal airflow varied between r = 0.97 with in-phase changes in airflow and r = -0.89 with reciprocal changes in airflow. The majority of r values were negative, indicating reciprocal changes in airflow (50 out of 60). There was a tendency for r values to become more negative between day 1 and day 2 (p < 0.001). CONCLUSION A control model involving a hypothalamic centre and two brainstem half centres is proposed to explain both the in-phase and reciprocal changes in airflow associated with the nasal cycle.
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24
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Abstract
CONCLUSION The reciprocal nature of the nasal cycle declined with age in keeping with other published data, suggesting that studies of the nasal cycle may be a useful measure of central nervous system (CNS) disease and aging. OBJECTIVES The aim of this study was to investigate changes in the nasal cycle with age. METHODS In one male subject changes in nasal airflow were measured by anterior rhinomanometry to determine the reciprocal nature of the 'nasal cycle' at age 28 and again at age 66 years. RESULTS Significant reciprocity was demonstrated in the historical study (age 28 years) with correlation coefficients for the 3 study days of -0.81, -0.83 and -0.79. compared with the current study (age 66 years) where non-significant correlation coefficients of 0.02 and -0.43 were obtained.
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Affiliation(s)
- Mark R Williams
- Common Cold Centre, Cardiff School of Biosciences, Cardiff University , Cardiff, Wales , UK
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25
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Lasters F, Mallegho C, Boudewyns A, Vanderveken O, Cox T, Ketelslagers K, Verbraecken J. Nasal symptoms in patients with obstructive sleep apnea and their impact on therapeutic compliance with continuous positive airway pressure. Acta Clin Belg 2014; 69:87-91. [PMID: 24724746 DOI: 10.1179/0001551214z.00000000028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Continuous positive airway pressure (CPAP) is the first line treatment for moderate to severe obstructive sleep apnea syndrome. Despite the high effectiveness of this treatment, its use is often limited by suboptimal compliance and/or intolerance. Nasal side effects are considered a major cause of low therapeutic compliance. At present, there are no data to predict which patients will develop CPAP intolerance caused by nasal symptoms and only few studies looked at the effect of treatment of nasal symptoms on CPAP compliance. The first section of this review focuses on the impact of nasal symptoms (pre-existing or as a side effect of CPAP) on CPAP compliance/intolerance. The second section deals with the effect of nasal symptom treatment on CPAP compliance.
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Telles S, Joshi M, Somvanshi P. Yoga breathing through a particular nostril is associated with contralateral event-related potential changes. Int J Yoga 2012; 5:102-7. [PMID: 22869992 PMCID: PMC3410187 DOI: 10.4103/0973-6131.98220] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In earlier studies uninostril yoga breathing was shown to influence the activity of the cerebral hemispheres differently, based on (i) auditory evoked potentials recorded from bilateral scalp sites, and (ii) performance in hemisphere-specific tasks. But change in P300 (event-related potential generated when subjects attend to and discriminate between stimuli) from bilateral scalp sites when subjects were practicing uni- and alternate-nostril breathing are yet to be explored. AIM The present study was designed to determine whether or not immediately after uninostril or alternate nostril yoga breathing there would be a change in the ability to pay attention to a given stimulus. MATERIALS AND METHODS Twenty-nine healthy male volunteers, with ages between 20 and 45 years were randomly allocated to five sessions, viz., (i) right-, (ii) left-, (iii) alternate-nostril yoga breathing, (iv) breath awareness and (v) no intervention, each for 45 min on separate days. The P300 event related potential was recorded using an auditory oddball paradigm from sites on the left (C3) and right (C4), referenced to linked earlobes, before and after each session. RESULTS Post-hoc analysis with Bonferroni adjustment showed that the P300 peak latency was significantly lower at C3 compared to that at C4, following right nostril yoga breathing (P<0.05). CONCLUSION These results suggest that right nostril yoga breathing facilitates the activity of contralateral (left) hemisphere, in the performance of the P300 task.
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Affiliation(s)
- Shirley Telles
- Department of Yoga Research and Development, Patanjali Research Foundation, Haridwar, India
| | - Meesha Joshi
- Department of Yoga Research and Development, Patanjali Research Foundation, Haridwar, India
| | - Prasoon Somvanshi
- Department of Yoga Research and Development, Patanjali Research Foundation, Haridwar, India
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28
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Normal nasal patency: problems in obtaining standard reference values for the surgeon. The Journal of Laryngology & Otology 2012; 126:563-9. [PMID: 22494413 DOI: 10.1017/s002221511200045x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This review examines why there is no normal range of nasal patency available to the surgeon when assessing nasal obstruction, and discusses the factors that influence nasal patency. Current normal ranges are examined and criticised because of the variability of normal values and the poor sampling methods used. Instability of physiological nasal patency is related to factors such as the nasal cycle and the nose's direct exposure to the external environment. Decongestion of the nose is proposed as a way of stabilising anatomical nasal patency, and measurements of patency in this state may be more useful to the surgeon. Population studies are needed to establish a normal range, but these studies must control for factors such as age, height, sex, and nasal shape and size related to climatic adaptation. Rather than classify populations according to unscientific categories such as race, anthropometric measures such as the nasal index are proposed.
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29
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Scheithauer MO. Surgery of the turbinates and "empty nose" syndrome. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2011; 9:Doc03. [PMID: 22073107 PMCID: PMC3199827 DOI: 10.3205/cto000067] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Surgical therapy of the inferior and/or middle turbinate is indicated when conservative treatment options have failed. The desired goal is a reduction of the soft tissue volume of the turbinates regarding the individual anatomic findings, whilst simultaneously conserving as much mucosa as possible. As the turbinates serve as a functional entity within the nose, they ensure climatisation, humidification and cleaning of the inhaled air. Thus free nasal breathing means a decent quality of life, as well.Regarding the multitude of different surgical techniques, we confirm that no ideal standard technique for turbinate reduction has been developed so far. Moreover, there is a lack of prospective and comparable long-term studies, which makes it difficult to recommend evidence-based surgical techniques. However, the anterior turbinoplasty seems to fulfil the preconditions of limited tissue reduction and mucosa-preservation, and therefore it is the method of choice today.Radical resection of the turbinates may lead to severe functional disturbances developing a secondary atrophic rhinitis. The "empty nose" syndrome is a specific entity within the secondary atrophic rhinitis where intranasal changes in airflow result in disturbed climatisation and also interfere with pulmonary function. Results deriving from an actual in vivo study of climatisation and airflow in "empty nose" patients are presented.
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30
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Raghuraj P, Telles S. Immediate effect of specific nostril manipulating yoga breathing practices on autonomic and respiratory variables. Appl Psychophysiol Biofeedback 2008; 33:65-75. [PMID: 18347974 DOI: 10.1007/s10484-008-9055-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 03/03/2008] [Indexed: 10/22/2022]
Abstract
The effect of right, left, and alternate nostril yoga breathing (i.e., RNYB, LNYB, and ANYB, respectively) were compared with breath awareness (BAW) and normal breathing (CTL). Autonomic and respiratory variables were studied in 21 male volunteers with ages between 18 and 45 years and experience in the yoga breathing practices between 3 and 48 months. Subjects were assessed in five experimental sessions on five separate days. The sessions were in fixed possible sequences and subjects were assigned to a sequence randomly. Each session was for 40 min; 30 min for the breathing practice, preceded and followed by 5 min of quiet sitting. Assessments included heart rate variability, skin conductance, finger plethysmogram amplitude, breath rate, and blood pressure. Following RNYB there was a significant increase in systolic, diastolic and mean pressure. In contrast, the systolic and diastolic pressure decreased after ANYB and the systolic and mean pressure were lower after LNYB. Hence, unilateral nostril yoga breathing practices appear to influence the blood pressure in different ways. These effects suggest possible therapeutic applications.
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Affiliation(s)
- P Raghuraj
- Swami Vivekananda Yoga Research Foundation, Bangalore, India
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31
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Scadding GK, Durham SR, Mirakian R, Jones NS, Leech SC, Farooque S, Ryan D, Walker SM, Clark AT, Dixon TA, Jolles SRA, Siddique N, Cullinan P, Howarth PH, Nasser SM. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clin Exp Allergy 2008; 38:19-42. [PMID: 18081563 PMCID: PMC7162111 DOI: 10.1111/j.1365-2222.2007.02888.x] [Citation(s) in RCA: 245] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This guidance for the management of patients with allergic and non-allergic rhinitis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practicing in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are clinical classification of rhinitis, aetiology, diagnosis, investigations and management including subcutaneous and sublingual immunotherapy. There are also special sections for children, co-morbid associations and pregnancy. Finally, we have made recommendations for potential areas of future research.
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Affiliation(s)
- G. K. Scadding
- The Royal National Throat Nose & Ear Hospital, Gray's Inn Road, London, UK
| | - S. R. Durham
- Department of Upper Respiratory Medicine, Imperial College NHLI, Guy Scadding Building, Royal Brompton Campus, London, UK
| | - R. Mirakian
- Cambridge University NHS Foundation Trust, Allergy Clinic, Cambridge, UK
| | - N. S. Jones
- Department of Otorhinolaryngology‐Head & Neck Surgery, Queens Medical Centre, Nottingham, UK
| | - S. C. Leech
- Department of Child Health, Kings College Hospital, Denmark Hill, London, UK
| | - S. Farooque
- Department of Asthma, Allergy & Respiratory Medicine, Guy's Hospital, London, UK
| | - D. Ryan
- Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, UK
| | - S. M. Walker
- Education For Health, The Athenaeum, Warwick, UK
| | - A. T. Clark
- Cambridge University NHS Foundation Trust, Allergy Clinic, Cambridge, UK
| | - T. A. Dixon
- Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK
| | - S. R. A. Jolles
- Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK
| | - N. Siddique
- Department of respiratory medicine, Southampton General Hospital, Southampton, UK
| | - P. Cullinan
- Department of Occupational and Environmental Medicine, Imperial College, London, UK and
| | | | - S. M. Nasser
- Cambridge University NHS Foundation Trust, Allergy Clinic, Cambridge, UK
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Scadding GK, Durham SR, Mirakian R, Jones NS, Drake-Lee AB, Ryan D, Dixon TA, Huber PAJ, Nasser SM. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy 2007; 38:260-75. [PMID: 18167126 DOI: 10.1111/j.1365-2222.2007.02889.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This guidance for the management of patients with rhinosinusitis and nasal polyposis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The recommendations are based on evidence and expert opinion and are evidence graded. These guidelines are for the benefit of both adult physicians and paediatricians treating allergic conditions. Rhinosinusitis implies inflammation of the nose and sinuses which may or may not have an infective component and includes nasal polyposis. Acute rhinosinusitis lasts up to 12 weeks and resolves completely. Chronic rhinosinusitis persists over 12 weeks and may involve acute exacerbations. Rhinosinusitis is common, affecting around 15% of the population and causes significant reduction in quality of life. The diagnosis is based largely on symptoms with confirmation by nasendoscopy. Computerized tomography scans and magnetic resonance imaging are abnormal in approximately one third of the population so are not recommended for routine diagnosis but should be reserved for those with acute complications, diagnostic uncertainty or failed medical therapy. Underlying conditions such as immune deficiency, Wegener's granulomatosis, Churg-Strauss syndrome, aspirin hypersensitivity and allergic fungal sinusitis may present as rhinosinusitis. There are few good quality trials in this area but the available evidence suggests that treatment is primarily medical, involving douching, corticosteroids, antibiotics, anti-leukotrienes, and anti-histamines. Endoscopic sinus surgery should be considered for complications, anatomical variations causing local obstruction, allergic fungal disease or patients who remain very symptomatic despite medical treatment. Further well conducted trials in clearly defined patient groups are needed to improve management.
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Affiliation(s)
- G K Scadding
- The Royal National Throat Nose & Ear Hospital, Gray's Inn Road, London, UK
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Nathan RA, Eccles R, Howarth PH, Steinsvåg SK, Togias A. Objective monitoring of nasal patency and nasal physiology in rhinitis. J Allergy Clin Immunol 2007; 115:S442-59. [PMID: 15746882 PMCID: PMC7112320 DOI: 10.1016/j.jaci.2004.12.015] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
Nasal obstruction can be monitored objectively by measurement of nasal airflow, as evaluated by nasal peak flow, or as airways resistance/conductance as evaluated by rhinomanometry. Peak flow can be measured during inspiration or expiration. Of these measurements, nasal inspiratory peak flow is the best validated technique for home monitoring in clinical trials. The equipment is portable, relatively inexpensive, and simple to use. One disadvantage, however, is that nasal inspiratory peak flow is influenced by lower airway as well as upper airway function. Rhinomanometry is a more sensitive technique that is specific for nasal measurements. The equipment, however, requires an operator, is more expensive, and is not portable. Thus, it is applicable only for clinic visit measures in clinical trials. Measurements require patient cooperation and coordination, and not all can achieve repeatable results. Thus, this objective measure is best suited to laboratory challenge studies involving smaller numbers of selected volunteers. A nonphysiological measure of nasal patency is acoustic rhinometry. This sonic echo technique measures internal nasal luminal volume and the minimum cross-sectional area. The derivation of these measures from the reflected sound waves requires complex mathematical transformation and makes several theoretical assumptions. Despite this, however, such measures correlate well with the nasal physiological measures, and the nasal volume measures have been shown to relate well to results obtained by imaging techniques such as computed tomography scanning or magnetic resonance imaging. Like rhinomanometry, acoustic rhinometry is not suitable for home monitoring and can be applied only to clinic visit measures or for laboratory nasal challenge monitoring. It has advantages in being easy to use, in requiring little patient cooperation, and in providing repeatable results. In addition to nasal obstruction, allergic rhinitis is recognized to be associated with impaired mucociliary clearance and altered nasal responsiveness. Measures exist for the monitoring of these aspects of nasal dysfunction. Although measures of mucociliary clearance are simple to perform, they have a poor record of reproducibility. Their incorporation into clinical trials is thus questionable, although positive outcomes from therapeutic intervention have been reported. Measures of nasal responsiveness are at present largely confined to research studies investigating disease mechanisms in allergic and nonallergic rhinitis. The techniques are insufficiently standardized to be applied to multicenter clinical trials but could be used in limited-center studies to gain insight into the regulatory effects of different therapeutic modalities.
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MESH Headings
- Humans
- Monitoring, Immunologic/methods
- Nasal Mucosa/immunology
- Nasal Mucosa/pathology
- Nasal Obstruction/immunology
- Nasal Obstruction/pathology
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/pathology
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/pathology
- Rhinomanometry
- Rhinometry, Acoustic
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Affiliation(s)
- Robert A Nathan
- Asthma and Allergy Associates, 2709 North Tejon, Colorado Springs, CO 80907, USA.
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Boyce J, Eccles R. Do chronic changes in nasal airflow have any physiological or pathological effect on the nose and paranasal sinuses? A systematic review. Clin Otolaryngol 2007; 31:15-9. [PMID: 16441795 DOI: 10.1111/j.1749-4486.2006.01125.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
.A reduction in nasal airflow associated with anatomical defects of the nose such as nasal septal deviation has been proposed to cause nasal pathology. . The majority of animal experiments where one nasal passage is surgically closed over several months report only minor changes in the histology of the nasal epithelium and no rhinitis or sinusitis. .Complete abolition of nasal airflow associated with laryngectomy or the treatment of atrophic rhinitis is not associated with the development of rhinitis or sinusitis. . Radiological studies have shown a lack of association between the degree of nasal septal deviation and evidence of rhinosinusitis. .Such studies provide evidence that reduced nasal airflow causes no significant nasal disease. . There is no convincing evidence that a reduction in nasal airflow is a causative factor for rhinitis or sinusitis.
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Affiliation(s)
- J Boyce
- Common Cold Centre, Cardiff School of Biosciences, Cardiff University, Cardiff, UK
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Neeley WW, Edgin WA, Gonzales DA. A Review of the Effects of Expansion of the Nasal Base on Nasal Airflow and Resistance. J Oral Maxillofac Surg 2007; 65:1174-9. [PMID: 17517302 DOI: 10.1016/j.joms.2006.06.295] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 06/01/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this article is to inform the reader of the current literature regarding nasal airflow resistance. The anatomy and physiology of nasal airflow resistance will be examined and the known effects of widening of the nasal airway upon airflow will be described. MATERIALS AND METHODS This article is a review of the current literature regarding nasal airflow and resistance and the effects of widening of the nasal base. No patient data were collected. RESULTS The literature shows that nasal airflow resistance can be changed by surgical manipulation and by rapid palatal expansion, but that the effects on airflow resistance and future growth and development are unpredictable. CONCLUSION Patients with a maxilla that is constricted in the transverse dimension and nasal airflow problems may benefit from expansion of the nasal base. The resultant effects upon nasal airflow resistance and subsequent growth and development are unpredictable and therefore airflow issues alone may not be a primary reason to increase the transverse dimension of the nasal base.
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Affiliation(s)
- Wendell W Neeley
- University of Texas Health Science Center School of Dentistry, San Antonio, TX 78258, USA.
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Carey SA, Minard KR, Trease LL, Wagner JG, Garcia GJM, Ballinger CA, Kimbell JS, Plopper CG, Corley RA, Postlethwait EM, Harkema JR, Einstein DR. Three-dimensional mapping of ozone-induced injury in the nasal airways of monkeys using magnetic resonance imaging and morphometric techniques. Toxicol Pathol 2007; 35:27-40. [PMID: 17325970 DOI: 10.1080/01926230601072343] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Age-related changes in gross and microscopic structure of the nasal cavity may alter local tissue susceptibility as well as the dose of inhaled toxicant delivered to susceptible sites. This article describes a novel method for the use of magnetic resonance imaging, 3-dimensional airway modeling, and morphometric techniques to characterize the distribution and magnitude of ozone-induced nasal injury in infant monkeys. Using this method, we generated age-specific, 3-dimensional, epithelial maps of the nasal airways of infant Rhesus macaques. The principal nasal lesions observed in this primate model of ozone-induced nasal toxicology were neutrophilic rhinitis, along with necrosis and exfoliation of the epithelium lining the anterior maxilloturbinate. These lesions, induced by acute or cyclic (episodic) exposures, were examined by light microscopy, quantified by morphometric techniques, and mapped on 3-dimensional models of the nasal airways. Here, we describe the histopathologic, imaging, and computational biology methods developed to precisely characterize, localize, quantify, and map these nasal lesions. By combining these techniques, the location and severity of the nasal epithelial injury were correlated with epithelial type, nasal airway geometry, and local biochemical and molecular changes on an individual animal basis. These correlations are critical for accurate predictive modeling of exposure-dose-response relationships in the nasal airways, and subsequent extrapolation of nasal findings in animals to humans for determining risk.
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Affiliation(s)
- Stephan A Carey
- Comparative Medicine and Integrative Biology, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824-1224, USA
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37
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Wiestner TS, Koch DA, Nad N, Balli A, Roos M, Weilenmann R, Michel E, Arnold S. Evaluation of the repeatability of rhinomanometry and its use in assessing transnasal resistance and pressure in dogs. Am J Vet Res 2007; 68:178-84. [PMID: 17269884 DOI: 10.2460/ajvr.68.2.178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate a modified posterior rhinomanometric method for clinical application in dogs. ANIMALS 15 healthy Beagles and 8 Bulldogs (4 healthy and 4 with respiratory problems). PROCEDURES Rhinomanometry was performed 3 times within a 15-minute period in anesthetized dogs. Transnasal pressure (P(NA)) and nasal resistance (R(NA)) were determined by use of artificial airflow (adjusted for body weight) for inspiration (P(NAin) and R(NAin), respectively) and expiration (P(NAout) and R(NAout)). Procedures were repeated for the Beagles 7 days later. RESULTS For the Beagles, mean +/- SD of P(NAin) for both days (0.162 +/- 0.042 kPa) was significantly lower than P(NAout) (0.183 +/- 0.053 kPa). Similarly, R(NAin) (1.47 +/- 0.41 kPa/[L/s]) was significantly lower than R(NAout) (1.64 +/- 0.46 kPa/[L/s]). Pairwise comparison of values for P(NA) and R(NA) for the 2 days revealed no significant difference. Repeatability of the method (estimated as within-day variation) for R(NA) was +/- 0.19 kPa/(L/s), whereas variation between the days was +/- 0.36 kPa/(L/s) for R(NAin) and +/- 0.44 kPa/(L/s) for R(NAout). The 4 clinically normal Bulldogs had R(NA) values ranging from 1.69 to 3.48 kPa/(L/s), whereas in the 4 Bulldogs with respiratory problems, R(NA) ranged from 9.83 to 20.27 kPa/(L/s). CONCLUSIONS AND CLINICAL RELEVANCE R(NA) is inversely dependent on body size and nonlinearly associated with airflow. We propose that R(NA) in dogs should be determined for airflows standardized on the basis of body size. The P(NA) and R(NA) in Beagles can be measured with sufficient repeatability for clinical use and nasal obstructions are detectable.
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Affiliation(s)
- Thomas S Wiestner
- Equine Hospital, Vetsuisse Faculty, University of Zurich, Zurich CH-8057, Switzerland
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38
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Ernstgård L, Iregren A, Sjögren B, Johanson G. Acute effects of exposure to vapours of acetic acid in humans. Toxicol Lett 2006; 165:22-30. [PMID: 16490326 DOI: 10.1016/j.toxlet.2006.01.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 01/17/2006] [Accepted: 01/18/2006] [Indexed: 11/18/2022]
Abstract
Acetic acid is used in plastics, chemical and pharmaceutical industries. Despite a widespread use, information of possible health effects is sparse. The aim of this study was to evaluate acute irritation during controlled exposure to vapours of acetic acid. Six female and six male healthy volunteers were exposed to 0 ppm (control exposure), 5 and 10 ppm acetic acid vapour for 2 h at rest in a balanced order. Subjective ratings of nasal irritation and smell increased significantly with exposure level. Except for smell, all average ratings at 10 ppm were at the lower end of the 0-100mm visual analogue scale, and did not exceed the verbal expression "somewhat" (26 mm). No effects on pulmonary function, nasal swelling, nasal airway resistance or plasma inflammatory markers (C-reactive protein, and interleukin-6), measured before and after exposure, were seen. There was a non-significant tendency to increased blinking frequency, as measured continuously during exposure, after exposure to 10 ppm acetic acid. In conclusion, our study suggests a mild irritative effect at 10 ppm acetic acid.
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Affiliation(s)
- Lena Ernstgård
- Work Environment Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden.
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Kohler M, Thurnheer R, Bloch KE. Side-selective, unobtrusive monitoring of nasal airflow and conductance. J Appl Physiol (1985) 2006; 101:1760-5. [PMID: 16840575 DOI: 10.1152/japplphysiol.00517.2006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Whether nasal obstruction disturbs sleep and nocturnal breathing is controversial because convenient techniques for measuring nasal resistance during sleep are lacking. Therefore, we developed a technique for unobtrusive, side-selective nasal conductance monitoring. The technique measures left and right nasal airflow and transnasal pressure using nasal cannulas, thin catheters inserted through the cannulas into the nasopharynx, and three pressure transducers. Their processed signals provide conductance as airflow-to-resistive pressure ratio for the left and right side and the sum, total nasal conductance. For validation, total nasal conductance was also determined by a flowmeter attached to a nasal mask and nasopharyngeal pressure that served as reference standard. Methods were compared in five normal subjects during pharmacological interventions and in 12 snorers during sleep. The novel technique accurately tracked total nasal conductance by the reference method at baseline, after nasal application of histamine and xylomethazoline in normal subjects; mean difference (bias) was 1%, and limits of agreement (+/-2 SD of bias) were +/- 22% (75 comparisons). Corresponding values during overnight sleep studies in snorers were 0 +/- 19% (192 comparisons); bias and limits of agreement of changes in nasal conductance were 1 +/- 19% (180 comparisons). Conductance measured once at the beginning of sleep studies differed from subsequent measurements during the night by a mean +/- SD of 26 +/- 20%, P < 0.0001. The novel technique accurately measures side-selective conductance. It is suitable to investigate interactions among nasal obstruction, sleep and nocturnal breathing, and drug effects. One-time measurements at the beginning of sleep studies do not appropriately reflect the highly variable nasal conductance during an entire night.
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Affiliation(s)
- Malcolm Kohler
- Department of Internal Medicine, Pulmonary Division, University Hospital of Zürich, Switzerland
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40
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Virkkula P, Bachour A, Hytönen M, Salmi T, Malmberg H, Hurmerinta K, Maasilta P. Snoring is not relieved by nasal surgery despite improvement in nasal resistance. Chest 2006; 129:81-7. [PMID: 16424416 DOI: 10.1378/chest.129.1.81] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES In the present study, we evaluated the effect of nasal surgery on snoring time, snoring intensity, and sleep-disordered breathing. The role of abnormal cephalometry in treatment outcome was assessed. DESIGN A cross-sectional prospective study. SETTING University teaching hospital. PATIENTS Forty consecutive snoring men who were referred to ENT Hospital because of a snoring problem or suspicion of sleep apnea. INTERVENTIONS The patients underwent anterior rhinomanometry and polysomnography (PSG) with recording of snoring before and after operative treatment of nasal obstruction. Cephalometric radiographs were obtained before surgery. RESULTS Nasal resistance decreased significantly in the overall patient group. Snoring time, snoring intensity, nocturnal breathing, and sleep architecture did not change after nasal surgery. Cephalometry did not predict operative outcome in these patients. Snoring intensity was found to be significantly higher during non-rapid eye movement (NREM) sleep than during rapid eye movement sleep. CONCLUSIONS Operative treatment of mainly structural nasal obstruction did not seem to decrease snoring intensity, snoring time, or sleep-disordered breathing in an objective assessment by PSG performed after surgery. The effect of treating inflammatory nasal changes during nocturnal breathing, as well as the role of cephalometry in the prediction of treatment outcome will need further evaluation. Higher snoring intensity related to NREM sleep may add to the sleep disturbance of a bed partner in the evening.
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Affiliation(s)
- Paula Virkkula
- ENT Hospital, Department of Plastic Surgery, Helsinki University Central Hospital, Haartmaninkatu 4.E., PO Box 220, FIN-00029 HUS, Helsinki, Finland.
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Abstract
During sleep there is a discrete fall in minute ventilation and an associated increase in upper airway resistance. In normal subjects, the nasal part of the upper airway contributes only little to the elevation of the total resistance, which is mainly the consequence of pharyngeal narrowing. Yet, swelling of the nasal mucosa due to congestion of the submucosal capacitance vessels may significantly affect nasal airflow. In many healthy subjects an alternating pattern of congestion and decongestion of the nasal passages is observed. Some individuals demonstrate congestion of the ipsilateral half of the nasal cavity when lying down on the side. Nasal diseases, including structural anomalies and various forms of rhinitis, tend to increase nasal resistance, which typically impairs breathing via the nasal route in recumbency and during sleep. A role of nasal obstruction in the pathogenesis of sleep-disordered breathing has been implicated by many authors. While it proves difficult to show a relationship between the degree of nasal obstruction and the number of disturbed breathing events, the presence of nasal obstruction will most likely have an impact on the severity of sleep-disordered breathing. Identification of nasal obstruction is important in the diagnostic work-up of patients suffering from snoring and sleep apnea.
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Affiliation(s)
- Dirk A Pevernagie
- Department of Respiratory Diseases, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
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42
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Searleman A, Hornung DE, Stein E, Brzuszkiewicz L. Nostril dominance: differences in nasal airflow and preferred handedness. Laterality 2005; 10:111-20. [PMID: 15849027 DOI: 10.1080/13576500342000329] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Because there appears to be a general propensity among many people to have a consistency in the sidedness of their lateral preferences, the purpose of the present study was to determine if this consistency extends to the airflow through the individual nostrils as well. To test for this, hot wire anemometers measured the airflow in each nostril at 15-minute intervals for 6 continuous hours in 11 right-handed and 9 left-handed adult males. Participants also provided self-reports of which nostril appeared to have the greater airflow. The airflow measurements supported the hypothesis of a handedness by nostril interaction, in that left-handers more often experienced greater airflow in their left nostrils whereas right-handers showed the opposite pattern. Self-reports were not an especially reliable measure of nasal patency. In most subjects the same nostril was not always the more open one. This left/right shifting of the more patent nostril is termed the nasal cycle. This study also provides the first data comparing the nasal cycle patterns of left-handers and right-handers.
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Affiliation(s)
- Alan Searleman
- Department of Psychology, St. Lawrence University, Canton, New York 13617-1475, USA.
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Davis SS, Eccles R. Nasal congestion: mechanisms, measurement and medications. Core information for the clinician. ACTA ACUST UNITED AC 2005; 29:659-66. [PMID: 15533155 DOI: 10.1111/j.1365-2273.2004.00885.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The article provides the clinician with core information about the aetiology and treatment of nasal congestion and discusses nasal blood vessels, autonomic nerves, nasal cycle, effects of posture, subjective sensation of congestion, objective assessments of congestion and medical and surgical treatments.
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Affiliation(s)
- S S Davis
- Common Cold Centre, Cardiff School of Biosciences, Cardiff University, Cardiff, UK
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44
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Rice DH, Daneshrad P, Chin GY. The Authors Respond. EAR, NOSE & THROAT JOURNAL 2003. [DOI: 10.1177/014556130308200707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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45
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Abstract
In recent years increasing evidence has been provided on frequent simultaneous coexistence of inflammatory diseases and allergies in upper and lower airways. To achieve a good standard of measurement of upper airways, an objective method should be used. A total of 48 nasal cavities with nasal stuffiness associated with chronic sinusitis were measured with acoustic rhinometry (AR) and High-resolution computer tomography volumetry (HRCTV). Comparison of volumes and minimum cross-sectional areas measured with these methods was performed. The volumes measured from the nostril with both methods were the anterior (0-10 mm), middle (11-40 mm) and posterior (41-70 mm) volumes. The AR cross-sectional area curve was analysed based on two minimal notches corresponding to local minimal areas. A series of 1-mm coronal CT images without intervening gaps were made and analysed based on two minimal voxel values, which were later converted to cross-sectional areas corresponding to local, minimum cross-sectional areas (MCA). Furthermore, the distances of these 2 MCAs from the nostril were also measured. Strong statistically significant (P < 0.05) correlations were found between AR and computer tomography volumetry (CTV) volumes in the anterior (r = 0.83) and middle (r = 0.77) parts of the nasal cavity. In the posterior part of the nasal cavity a statistically significant (P < 0.05) correlation was also found (r = 0.62). Good agreements between the AR and CTV volumes in the anterior and middle parts of the nasal cavities were confirmed with Bland-Altman plots. Correlations among the MCAs were weaker (r = 0.59 and r = 0.55). Our results suggest that the reliability of AR appears sufficient for clinical and scientific use in the nasal cavities. Reliability is very good in the anterior and middle parts of the nasal cavities, while strong conclusions based on evaluation of the posterior part should be avoided due to decreasing accuracy.
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Affiliation(s)
- J Numminen
- Department of Otorhinolaryngology, Head and Neck Surgery, Tampere University Hospital and Tampere University Finland, Finland.
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46
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Huang ZL, Ong KL, Goh SY, Liew HL, Yeoh KH, Wang DY. Assessment of Nasal Cycle by Acoustic Rhinometry and Rhinomanometry. Otolaryngol Head Neck Surg 2003; 128:510-6. [PMID: 12707653 DOI: 10.1016/s0194-59980300123-2] [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: 10/14/2022]
Abstract
OBJECTIVE: We sought to investigate the pattern, duration, and amplitude of nasal cycle and its response to nasal decongestant.
STUDY DESIGN AND SETTING: Ten adult volunteers attended 2 sessions (with and without nasal spray of 0.1% xylometazoline) for consecutive examinations by rhinomanometry and acoustic rhinometry every 10 minutes over 6 hours.
RESULTS: A spontaneous fluctuation in nasal minimum cross-sectional area, volume, and nasal resistances (inspiration and expiration) could be observed in every consecutive measurement. A significant negative correlation ( r = −0.33 to −0.70, P < 0.05) between both nasal passages was shown in 5 subjects by rhinomanometry and in 2 subjects by acoustic rhinometry but was not detectable after nasal spray with 0.1% xylometazoline.
CONCLUSION: A spontaneous fluctuation in nasal patency can be documented every 10 minutes with irregular pattern, frequency, and amplitude. Classic nasal cycle is not a universal phenomenon, which can be abolished by the application of decongestant.
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Affiliation(s)
- Zhi Li Huang
- Department of Otolaryngology, Faculty of Medicine, the National University of Singapore, Singapore
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47
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Carney AS, Powe DG, Huskisson RS, Jones NS. Atypical nasal challenges in patients with idiopathic rhinitis: more evidence for the existence of allergy in the absence of atopy? Clin Exp Allergy 2002; 32:1436-40. [PMID: 12372122 DOI: 10.1046/j.1365-2745.2002.01465.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The pathophysiology of idiopathic rhinitis is unknown although evidence is accumulating to suggest that many patients may have a localized form of allergic rhinitis in the absence of other atopic symptoms and markers. This study compares detailed nasal challenge results obtained from patients with idiopathic rhinitis to those of atopic and normal controls. METHODS Patients with idiopathic rhinitis (n = 23), perennial allergic rhinitis (n = 8) and normal controls (n = 8) underwent a normal saline challenge to exclude hyper-reactivity and then bilateral nasal allergen challenges. Nasal patency was assessed by anterior active rhinomanometry. RESULTS All of the patients with atopic rhinitis demonstrated positive bilateral allergen challenges. All normal control subjects had bilateral negative challenges. Two patients in the idiopathic group tested positively to saline and were excluded from further study with 62% of the remainder testing positive to allergens. Of the idiopathic patients testing positive, 85% were sensitive to house dust mite. CONCLUSION A significant proportion of patients with idiopathic rhinitis have positive nasal challenges, the vast majority to house dust mite allergen. These findings add to the weight of evidence that suggests 'localized allergy' may exist in the absence of systemic atopic markers.
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Affiliation(s)
- A S Carney
- Department of Otolaryngology - Head and Neck Surgery, Flinder's Medical Centre, Bedford Park, Adelaide, SA, Australia.
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48
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Chambers DC, Carpenter DA, Ayres JG. Exchange dynamics of nitric oxide in the human nose. J Appl Physiol (1985) 2001; 91:1924-30. [PMID: 11641326 DOI: 10.1152/jappl.2001.91.5.1924] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Nasal nitric oxide (NO) exchange dynamics are poorly understood but potentially are of importance, inasmuch as they may provide insight into the NO-related physiology of the bronchial tree. In healthy human volunteers, NO output was assessed by isolating the nasal cavity through elevation of the soft palate and application of tight-fitting nasal olives. Mean NO output was 334 nl/min and was a positive function of gas flow. With the use of a mathematical model and the introduction of nonzero concentrations of NO, the diffusing capacity for NO in the nose (DNO) and the mucosal NO concentration (Cw) were determined. DNO ranged from 0.52 to 2.98 x 10(-3) nl x s(-1) x ppb(-1) and Cw from 1,236 to 8,947 ppb. Cw declined with increasing gas flow, while DNO was constant. NO output declined with luminal hypoxia, particularly at oxygen tensions <10%. Measurement of nasal DNO and Cw is easy using this method, and the range of intersubject values of Cw raises the possibility of interindividual differences in NO-dependent nasal physiology.
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Affiliation(s)
- D C Chambers
- Department of Respiratory Medicine, Birmingham Heartlands Hospital, Birmingham B9 5SS, United Kingdom
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49
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Anselmo-Lima WT, Lund VJ. The effects of endoscopic sinus surgery on the nasal cycle as assessed by acoustic rhinometry. AMERICAN JOURNAL OF RHINOLOGY 2001; 15:165-8. [PMID: 11453502 DOI: 10.2500/105065801779954139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Previous studies have demonstrated that acoustic rhinometry (AR) has a considerable utility in measuring nasal patency and in detecting the nasal cycle. This study was performed in 10 patients with chronic rhinosinusitis who were submitted to endoscopic sinus surgery. AR was used to determine minimum nasal cross-sectional area and volume as the indices of the nasal patency in all patients on the day before the surgery and 3 months postoperatively. We did not find any significant alteration when comparing the pattern of fluctuation, the periodicity, and the amplitude of the nasal cycle demonstrated by patients in the pre and postoperative periods, confirming that this surgery does not have any adverse effect on this physiologic cycle.
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Affiliation(s)
- W T Anselmo-Lima
- Faculty of Medicine of Ribeirão Preto-University of São Paulo, Brazil
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50
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Hanif J, Jawad SS, Eccles R. The nasal cycle in health and disease. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 2000; 25:461-7. [PMID: 11122280 DOI: 10.1046/j.1365-2273.2000.00432.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J Hanif
- Common Cold Centre, Cardiff University, Cardiff, UK
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