From nasal respiration to brain dynamic

While breathing is a vital, involuntary physiological function, the mode of respiration, particularly nasal breathing, exerts a profound influence on brain activity and cognitive processes. This review synthesizes existing research on the interactions between nasal respiration and the entrainment of oscillations across brain regions involved in cognition. The rhythmic activation of olfactory sensory neurons during nasal respiration is linked to oscillations in widespread brain regions, including the prefrontal cortex, entorhinal cortex, hippocampus, amygdala, and parietal cortex, as well as the piriform cortex. The phase-locking of neural oscillations to the respiratory cycle, through nasal breathing, enhances brain inter-regional communication and is associated with cognitive abilities like memory. Understanding the nasal breathing impact on brain networks offers opportunities to explore novel methods for targeting the olfactory pathway as a means to enhance emotional and cognitive functions.

Improvement in Quality of Life after Septoplasty in Children: a Systematic Review

KEY POINTS

Septoplasty for nasal obstruction in the pediatric population shows positive outcomes in objective and subjective post-operative measurements. Septoplasty in children results in disease-related improvement in quality of life. Higher level studies are needed to confirm these results.

[The current status and expectation of pediatric total facial management]

The pediatric total facial management refers to a series of diagnosis and treatment processes to achieve the healthy development of the face through reasonable medical intervention. The main reason for the poor treatment effect is that the first contact doctor is limited to his own disciplinary analysis and treatment. The importance of multidisciplinary cooperation in the diagnosis and treatment of facial dysplasia in children has become increasingly prominent. it is necessary to comprehensively analyze and find the pathogenic factors of patients and formulate a comprehensive treatment plan to restore normal upper airway structure and nasal breathing, and then reshape the healthy craniomaxillofacial tissue structure, and the monitoring of the results of medical intervention should accompany the whole process of children's growth and development. This paper summarizes the current situation of the treatment of children with facial dysplasia and puts forward the concept of orderly individualized multi-disciplinary diagnosis and treatment of pediatric oral maxillofacial management.

Electromyographic activities of the jaw and facial muscles in subjects with different vertical skeletal patterns and breathing modes

BACKGROUND

Mouth breathing (MB) can affect morphological changes in the craniofacial structures, electromyography is widely used for quantitative analysis of muscle function.

OBJECTIVE

The aim was to evaluate the electromyographic (EMG) activities of the anterior temporalis (TA), masseter muscle (MM), orbicularis oris superior (OOS) and mentalis muscle (MT) in children with different vertical skeletal patterns and breathing modes during rest and various functional mandibular movements.

METHODS

BioEMG III was used to measure the variations in EMG activities of TA, MM, OOS, and MT in 185 subjects aged 6-12 years during continuous clenching, rest, maximal intercuspation, lips closed lightly and swallowing.

RESULTS

The results of logistic regression analysis showed that the model with vertical skeletal patterns as the dependent variable was ineffective (p = .106), while the model with breathing modes as the dependent variable was effective (p = .000). When considering both vertical skeletal patterns and breathing modes, the following significant differences were found. (1) In the normal-angle group, the EMG ratio in OOS with lips closed lightly of MB was significantly higher than NB (p = .005). (2) In the low-angle group, EMG ratios in TA and MM during the swallowing of MB were significantly lower than NB (p = .020, p = .040, respectively). (3) In the high-angle group, EMG ratios of MB were significantly higher in MT during continuous clenching, rest, lips closed lightly and swallowing (p = .038, p = .036, p = .005, p = .028, respectively), and OOS with lips closed lightly compared to NB (p = .005).

CONCLUSION

Breathing modes and vertical skeletal patterns interacted to alter maxillofacial EMG activities, with breathing modes having a greater effect.

Paper-Based Humidity Sensor for Respiratory Monitoring

Flexible respiratory monitoring devices have become available for outside-hospital application scenarios attributable to their improved system wearability. However, the complex fabrication process of such flexible devices results in high prices, limiting their applications in real-life scenarios. This study proposes a flexible, low-cost, and easy-processing paper-based humidity sensor for sleep respiratory monitoring. A paper humidity sensing model was established and sensors under different design parameters were processed and tested, achieving high sensitivity of 5.45 kΩ/%RH and good repeatability with a matching rate of over 85.7%. Furthermore, the sensor patch with a dual-channel 3D structure was designed to distinguish between oral and nasal breathing from origin signals proved in the simulated breathing signal monitoring test. The sensor patch was applied in the sleep respiratory monitoring of a healthy volunteer and an obstruct sleep apnea patient, demonstrating its ability to distinguish between different respiratory patterns as well as various breathing modes.

[Subjective assessment of the effect of septoplasty on respiratory and voice functions]

OBJECTIVE

To assess the impact of septoplasty on quality of life by measuring changes in nasal breathing and voice function using subjective assessment questionnaires.

MATERIAL AND METHODS

The study included 98 patients who underwent septoplasty for the nasal septum deviation. The effect of the operation on nasal breathing was assessed subjectively using the Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire, and the effect on voice function was assessed using the Voice Handicap Index-30 (VHI-30) questionnaire.

RESULTS

There was a statistically significant difference between the preoperative and postoperative (after 1 and 3 months) NOSE data (in both cases, p<0.001) and and between the indicators 1 and 3 months after surgery (p<0.001). There was a statistically significant difference (p<0.001 in both cases) between the preoperative VHI-30 and 1 and 3 months postoperatively. There was also a statistically significant difference (p<0.001) between 1 and 3 months after surgery for this test.

CONCLUSION

In this study, the effect of septoplasty on respiratory and voice function was demonstrated using subjective tests. In the postoperative period, patients subjectively positively assessed changes in both nasal breathing and voice.

[Comprehensive assessment of the respiratory function of nasal packs with airway tubes]

Intranasal packs with breathing tubes are one of the possible methods of postoperative management of patients after endonasal surgery. The role of these devices is to provide the possibility of nasal breathing of patients to facilitate the course of the postoperative period. However, the possibility of providing proper nasal breathing with these devices has not been studied. The aim of the work is to study the calculated and clinical possibilities of nasal breathing when using intranasal packs with breathing tubes after endonasal surgical interventions.

MATERIAL AND METHODS

We studied packs with air tubes from two manufacturers: Medtronic and Spiggle & Theis. During the experimental part, measurements of the air tubes and their study using acoustic rhinometry were carried out. In the clinical part, there were two groups of patients with different types of tampons and control group of volunteers with normal nasal breathing, the total number of participants was 45 people. All patients of groups 1 and 2 underwent septoplasty, bilateral lower partial conchotomy. In the postoperative period, rhinomanometry, rhinoflowmetry, a study of the duration of nasal breathing, and a subjective assessment of nasal breathing were performed.

RESULTS

According to measurements and acoustic rhinometry, the airway tubes of the tampons have a cross-sectional area that is more than 4 times smaller than the narrowest part of the nasal cavity in healthy volunteers. According to the results of a clinical study, the tampons in question are not able to provide a level of nasal breathing comparable to normal, even after clearing the lumen by a doctor. Medtronic packs provide somewhat better airway function due to the larger internal diameter of the tubes, but also do not create conditions for satisfactory nasal breathing.

CONCLUSION

Improving the respiratory function of tampons in the future can be achieved by increasing the internal lumen of the breathing tubes while maintaining comfort of use.

Effect of Sensory Deprivation of Nasal Respiratory on Behavior of C57BL/6J Mice

Nasal breathing is a dynamic cortical organizer involved in various behaviors and states, such as locomotion, exploration, memory, emotion, introspection. However, the effect of sensory deprivation of nasal respiratory breath (NRD) on behavior remain poorly understood. Herein, general locomotor activity, emotion, learning and memory, social interaction, and mechanical pain were evaluated using a zinc sulfate nasal irrigation induced nasal respiratory sensory deprivation animal model (ZnSO₄-induced mouse model). In the open field test, the elevated O-maze test, and forced swim test, NRD mice exhibited depressive and anxiety-like behaviors. In memory-associated tests, NRD mice showed cognitive impairments in the hippocampal-dependent memory (Y maze, object recognition task, and contextual fear conditioning (CFC)) and amygdala-dependent memory (the tone-cued fear conditioning test (TFC)). Surprisingly, NRD mice did not display deficits in the acquisition of conditional fear in both CFC and TFC tests. Still, they showed significant memory retrieval impairment in TFC and enhanced memory retrieval in CFC. At the same time, in the social novelty test using a three-chamber setting, NRD mice showed impaired social and social novelty behavior. Lastly, in the von Frey filaments test, we found that the pain sensitivity of NRD mice was reduced. In conclusion, this NRD mouse model showed a variety of behavioral phenotypic changes, which could offer an important insight into the behavioral impacts of patients with anosmia or those with an impaired olfactory bulb (OB) (e.g., in COVID-19, Alzheimer’s disease, Parkinson’s disease, etc.).

Randomized Trials of Nasal Patency and Dermal Tolerability With External Nasal Dilators in Healthy Volunteers

Background

External nasal dilator strips are used as nonpharmacological therapy to reduce snoring and daytime sleepiness. In a product improvement initiative, a marketed strip (BRNS) and 2 prototype nasal strips were evaluated.

Objective

To compare the nasal patency and multiple-use dermal tolerability of the BRNS and prototype nasal strips using both objective and subject-reported outcome measures.

Methods

Two studies were conducted separately in healthy volunteers ≥18 years of age. A single-day nasal patency randomized crossover study assessed minimal cross-sectional area (MCA; second restriction) and nasal volume (using acoustic rhinometry); nasal inspiratory flow and resistance (using posterior rhinomanometry); and subject-reported evaluations of the BRNS compared with the butterfly strip and teardrop strip prototypes. A single-center, randomized, controlled, parallel-group, evaluator-blinded study assessed dermal tolerability of the BRNS and the butterfly strip over 7 consecutive nights of use, using the Dermal Response Scale (DRS) and subject-reported comfort and ease of removal.

Results

In the Patency study (N = 50), all 3 strips demonstrated significant improvement from baseline in MCA, nasal volume, and nasal flow parameters (resistance and peak flow). The prototype strips demonstrated significantly more improvement in nasal volume than the BRNS, and the butterfly strip showed significantly more improvement in MCA than the BRNS; all strips were similar with respect to nasal flow and subject-reported nasal breathing outcomes. In the Dermal Tolerability study (N = 82), all subjects scored 0 (no evidence of irritation) on the DRS at all 7 morning assessments; the BRNS was numerically, but not significantly, superior to the butterfly strip on subject-reported outcomes.

Conclusion

The Patency study demonstrated significant improvement from baseline in nasal dimensions and flow for all 3 evaluated strips; between-strip differences were confined to nasal dimensions. Both the BRNS and butterfly strip were generally well tolerated, with no evidence of dermal response over 7 consecutive nights of use.

ClinicalTrials.gov identifiers: NCT01105949 and NCT01495494

Association of breathing patterns and quality of life in patients with nasal obstruction

INTRODUCTION

In the general population, nasal obstruction is a common complaint. However, an objective evaluation of nasal obstruction is difficult. Nose examination, computed tomography (CT), acoustic rhinometry, and anterior rhinomanometry do not accurately reflect the discomfort reported by patients with nasal obstruction. In patients with nasal obstruction, this study evaluated nasal breathing with a unique device for continuous nasal-oral spirometry - a nasal-oral flow analyzer (NOFA); moreover, quality of life was compared between patients with normal nasal breathing on NOFA and of those with impaired nasal breathing on NOFA.

METHODS

Of 181 adult patients admitted to an ENT department due to nasal obstruction that were enrolled in the study, 97 (53.6%) completed all per-protocol assessments, including the SF-36 questionnaire and 3-hour, continuous nasal-oral spirometry with NOFA. Based on the presence of normal nasal breathing defined as ≥95% of nasal flow, the 97 patients were divided into those with normal nasal breathing (n=31) and impaired nasal breathing (n=66).

RESULTS

Patients with normal nasal breathing differed from those with impaired nasal breathing with respect to all SF-36 subscales (physical functioning, p=0.004; role-physical, p=0.009; bodily pain, p&lt;0.001; general health, p=0.007; vitality, p=0.002; social functioning, p=0.008; mental health, p=0.009; physical component summary, p&lt;0.001; mental component summary, p=0.02), except for the role-emotional subscale (p=0.1).

CONCLUSIONS

Among patients with symptoms of nasal obstruction, compared to patients with normal nasal breathing, those with impaired nasal breathing had significantly lower quality of life in the physical and mental domains. Further research needs to determine whether NOFA can be used to diagnose nasal obstruction.

[The state of the serotonin system in the patients presenting with chronic polypous rhinosinusitis]

This article presents the results of the study designed to determine the concentration of the neuromediator serotonin in the blood serum and tissue homogenates prepared from the polypous tissue harvested in the patients presenting with chronic polypous rhinosinusitis (CPR). The study included 51 patients with this pathology while 11 patients with chronic maxillary rhinosinusitis (CMR) and deflection of the nasal septum (DNS) made up the group of comparison. The serum serotonin levels were measured and compared in the patients of the main and both control groups. The results obtained give evidence of the significant inverse correlation between serotonin levels in the sera and tissue homogenates on the one hand and the history of allergic diseases in individual patients on the other hand.

Pressure drop of filtering facepiece respirators: How low should we go?

INTRODUCTION

This study was undertaken to determine the mean peak filter resistance to airflow (Rfilter) encountered by subjects while wearing prototype filtering facepiece respirators (PRs) with low Rfilter during nasal and oral breathing at sedentary and low-moderate work rates.

MATERIAL AND METHODS

In-line pressure transducer measurements of mean Rfilteracross PRs with nominal Rfilter of 29.4 Pa, 58.8 Pa and 88.2 Pa (measured at 85 l/min constant airflow) were obtained during nasal and oral breathing at sedentary and low-moderate work rates for 10 subjects.

RESULTS

The mean Rfilter for the 29.4 PR was significantly lower than the other 2 PRs (p < 0.000), but there were no significant differences in mean Rfilter between the PRs with 58.8 and 88.2 Pa filter resistance (p > 0.05). The mean Rfilter was greater for oral versus nasal breathing and for exercise compared to sedentary activity (p < 0.001).

CONCLUSIONS

Mean oral and nasal Rfilter for all 3 PRs was at, or below, the minimal threshold level for detection of inspiratory resistance (the 58.8-74.5 Pa/l×s-1), which may account for the previously-reported lack of significant subjective or physiological differences when wearing PRs with these low Rfilter. Lowering filtering facepiece respirator Rfilter below 88.2 Pa (measured at 85 l/min constant airflow) may not result in additional subjective or physiological benefit to the wearer.