Change in minimal cross sectional area using the new nasal dilator, "Airplus"

A Comparison of Over-the-Counter Mechanical Nasal Dilators: A Systematic Review

IMPORTANCE

The internal nasal valve is the narrowest part of the nasal airway and a common site of inspiratory collapse and obstruction of nasal airflow. Over-the-counter mechanical nasal dilators are an alternative to surgical intervention that attempts to improve airflow through the internal nasal valve.

OBJECTIVE

To determine the efficacy of over-the-counter mechanical nasal dilators and classify these products by mechanism.

EVIDENCE REVIEW

A database of 33 available over-the-counter mechanical nasal dilators was generated via a PubMed search as well as an internet search via Amazon.com and Google, conducted from April 1, 2013, through December 31, 2015. Products determined to be unavailable or discontinued were excluded from the database. Of the devices examined in published literature, efficacy was based on objective measures, such as measured airflow, the cross-sectional area of the nasal valve, and changes in resistance. Measures of reported sleep quality or patient perception were excluded.

FINDINGS

An analysis of each product's mechanism revealed 4 broad classes: external nasal dilator strips, nasal stents, nasal clips, and septal stimulators. A review demonstrated 5 studies supporting the use of external nasal dilator strips, 4 studies supporting the use of nasal clips, 1 study supporting the use of nasal stents, and no studies supporting the use of septal stimulators.

CONCLUSIONS AND RELEVANCE

Our findings suggest that external nasal dilator strips and nasal clips effectively relieve obstruction of the internal nasal valve and may be an alternative to surgical intervention in some patients.

Dichotomous physiological effects of nocturnal external nasal dilation in heavy snorers: the answer to a rhinologic controversy?

The purpose of this article was to study the impact of external dilation on nasal airway dimensions, sleep architecture, and snoring. Eighteen heavy snorers without severe obstructive sleep apnea syndrome (mean apnea-hypopnea index (AHI) 9.3) reporting nocturnal nasal obstruction were enrolled in a randomized (controlled) cross-over study, evaluating subjective and objective effects of external nasal dilation (Breathe Right, 3M). The active dilator was also worn during a one-week pretrial run-in period. Polysomnography, recording of snoring sounds, and repeated acoustic rhinometry were performed on two consecutive nights, one with the active dilator and one with a placebo strip. The significant subjective improvement reported during the run-in period compared to the preceding period without dilator (p < 0.01), remained only for nasal patency (p < 0.05) when comparing the two nights in the sleep laboratory. The nasal dimensions increased significantly (p < 0.001) with the active dilator compared to placebo, both in the evening and the next morning. In a subgroup (n = 6) of habitual snorers (AHI < 10) with severe morning obstruction (combined minimal cross-sectional area < 0.6 cm2), external dilation significantly improved the mean sleep PaSO2 (92.4 --> 96.7) and the percentage of sleep with a PaSO2 < 95% (49.9% --> 4.9%) (p < 0.05). In this subgroup there was a trend toward reduction in (7.4 --> 5.4) (p = 0.06), whereas the AHI increased significantly in the group of 12 with larger nocturnal nasal dimensions (p < 0.05). Duration and intensity of snoring remained unchanged regardless of the subgrouping. Objective beneficial effects were restricted to nocturnal oxygen saturation and AHI in a subgroup of habitual heavy snorers identified by repeated acoustic rhinometry, in whom external dilation objectively relieved marked nocturnal nasal obstruction. This finding may provide a logical explanation for the conflicting results of medical, surgical, and mechanical expansion of the nasal dimensions on snoring and sleep disturbances. (American