The potential role of peak nasal inspiratory flow to evaluate active sinonasal inflammation and disease severity

José Araújo-Martins,Nuno Neuparth,Carlos Brás-Geraldes

doi:10.1038/s41598-020-69693-6

Abstract

Although the pathophysiology of nasal polyposis is incompletely understood, rhinologists have seldom studied it with rhinomanometry or peak nasal inspiratory flow (PNIF) due to technical limitations and the perception that polyp size might impair reproducibility and the usefulness of recordings. The objective of this study is to assess how measures of rhinomanometry and PNIF relate to disease activity. Nineteen patients with polyps, 15 patients with chronic sinusitis without polyps and 11 negative controls were evaluated with active anterior rhinomanometry and PNIF. Sinusitis and polyp patients were re-evaluated after medical treatment. Polyp patients had the highest median Lund-Mackay score (14) and a median Johansen score of 1. PNIF and its variation after treatment were also lowest in this group (median 90 L/min before and after treatment; median variation of 0 L/min). Nasal resistance was similar between groups, and only correlated with Johansen score (Spearman = 0.517, p = 0.048) after treatment. Our study suggests that evaluating polyp patients using rhinomanometry and PNIF may provide useful and reproducible data. Several findings considered together suggest that polyp size is not the main determinant of nasal functional changes in these patients, warranting further studies to verify whether PNIF changes reflect sinus inflammation or merely airway obstruction.

Highlights

The pathophysiology of nasal polyposis is incompletely understood, rhinologists have seldom studied it with rhinomanometry or peak nasal inspiratory flow (PNIF) due to technical limitations and the perception that polyp size might impair reproducibility and the usefulness of recordings
Lund-Mackay scores are significantly different between groups, despite the observed trend for higher values in the Nasal polyposis (NP) group, statistical significance could not be reached when comparing chronic rhinosinusitis (CRS) to NP patients (p values between 0.07 and 0.17)
Findings from our study suggest that PNIF and rhinomanometry can provide objective measures of nasal ventilation in almost all sinusitis and polyp

Summary

Introduction

The pathophysiology of nasal polyposis is incompletely understood, rhinologists have seldom studied it with rhinomanometry or peak nasal inspiratory flow (PNIF) due to technical limitations and the perception that polyp size might impair reproducibility and the usefulness of recordings. Our study suggests that evaluating polyp patients using rhinomanometry and PNIF may provide useful and reproducible data. Several findings considered together suggest that polyp size is not the main determinant of nasal functional changes in these patients, warranting further studies to verify whether PNIF changes reflect sinus inflammation or merely airway obstruction. Rhinologists agree that research to determine the most effective treatment plan is a priority[12] and should be encouraged by proper authorities[13], with emphasis on the principles of precision medicine and patient centered care[3]. These explicitly recommend the use of relevant clinical biomarkers to elaborate personalized treatment plans. Several studies suggest that nasal ventilation may influence the behaviour of NP

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Conclusion