Active Anterior Rhinomanometry Research Articles

Normal aging does not deteriorate nose-related quality of life: Assessment with “NOSE” and “SNOT-20” questionnaires

Objective Aging causes changes in nasal morphology and function. This study assesses if the age-related nasal changes are detectable with objective measurements and reflected in two validated quality of life outcome tools: the Nasal Obstruction Symptom Evaluation Scale (NOSE) and the Sino-Nasal Outcome Test (SNOT-20) questionnaires. Methods Two study groups were included: the “young” group A ( n = 40) with a mean age of 27 years and the “elder” group B ( n = 40) with a mean age of 70 years. The subjective nasal complaints and quality of life status were recorded by means of the NOSE and SNOT-20 questionnaires. Objective assessment of intranasal dimensions and nasal airflow in all subjects were performed with the use of acoustic rhinometry and active anterior rhinomanometry respectively. Results The values obtained from acoustic rhinometry were significantly higher in the older group compared to the younger, presenting wider nasal airway passages for the elderly. However this was not the case with rhinomanometry values as no significant differences between groups were found. In addition no statistically significant difference was demonstrated in both questionnaires scoring between younger and older subjects. Conclusion The outcome of the NOSE and SNOT questionnaires show no deterioration of quality of life in elderly related with changes in nasal function. Acoustic rhinometry confirmed that nasal cavities are becoming larger across the lifespan.

The Effect of Myrtol Standardized on Human Nasal Ciliary Beat Frequency and Mucociliary Transport Time

This study was designed to observe the effects of myrtol standardized (Gelomyrtol forte), a secretomucolytic phytomedicine, on both ciliary beat frequency (CBF) in vitro and mucociliary transport time (MTT) in vivo. Changes in cultured human nasal CBF in response to immediate treatment with 75, 150, or 300 ng/mL of myrtol standardized and prolonged treatment (12 or 24 hours) with 300 ng/mL of myrtol standardized were quantified by using high-speed digital microscopy. In addition, MTT before and after oral application of myrtol standardized (three times a day, 900 mg/day, 10 days) was determined using the saccharine test, and the effects of this treatment regime on nasal patency was measured by acoustic rhinometry and active anterior rhinomanometry in 22 patients with nonallergic chronic rhinitis. Another 10 patients without medication, who had the same examinations twice with a 10-day interval, were involved as controls. Neither immediate nor prolonged treatment with myrtol standardized produced a distinguishable change in CBF. Meanwhile, only in patients with treatment, MTT, as well as a unilateral minimum cross-sectional area, the volume of 0-5 cm inside the nasal cavity, the unilateral nasal resistance at 75 Pa and total symptom visual analog score were significantly improved after treatment. Based on these results we propose that a 10-day treatment with an herbal medicine, myrtol standardized, improves nasal mucociliary clearance as well as nasal patency in patients with chronic rhinitis. However, it has no impact on ex vivo CBF.

Acupuncture for Nasal Congestion: A Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Pilot Study

Nasal congestion is one of the most common complaints dealt with in otorhinolaryngology. Side effects of decongestants are frequently seen in patients with chronic nasal congestion. This leads to an increasing demand of alternative treatments such as acupuncture. Future studies on acupuncture should aim at objectifying effects by both physical measuring and double blinding. Therefore, we were interested in whether these effects can potentially be measured as increase in nasal airflow (NAF) in ventus ("wind") disease of traditional Chinese medicine (TCM). Twenty-four patients with a history of nasal congestion due to hypertrophic inferior turbinates or chronic sinusitis without polyposis were additionally diagnosed according to the Heidelberg model of TCM. They were asked to score the severity of their nasal congestion on a visual analog scale (VAS). The acupuncturist was blinded according to the Heidelberg blinding assay. NAF was measured by using active anterior rhinomanometry (ARM). Specific verum acupoints according to the Chinese medical diagnosis were tested against nonspecific control acupoints. VAS and NAF were scored and measured before and 15 and 30 minutes after acupuncture. Control acupuncture showed a significant improvement in VAS and a deterioration of NAF. Verum acupuncture showed highly significant improvements in VAS and NAF. In addition, verum acupuncture improved NAF and VAS significantly over time. Our control and verum acupoints fulfill the condition of a control and verum treatment, respectively. Measuring NAF by RRM and scoring VAS are possible and reflect acupuncture effects in vivo.

The Effect of Maxillary Multidirectional Movement on Nasal Respiration

Deformities of the maxilla may exist on all planes, and we treat these problems by mobilizing and repositioning the maxilla on all planes. Some authors have examined the effects of maxillary movement on the nasal airway. In clinical, practice, active anterior rhinomanometry is the most reliable and frequently used method to assess nasal respiratory function. The purpose of this study was to evaluate changes in nasal airflow and nasal airway resistance after maxillary movement performed by active anterior rhinomanometry. We studied 25 patients (18 female patients and 7 male patients; aged 16-30 years) in this clinical trial. Three days before surgery and 6 months after surgery, after a rest period of 30 minutes, active anterior rhinomanometry with a tube was performed at a fixed transnasal pressure of 150 Pa. The surgical treatment plan included bimaxillary surgery consisting of a 1-piece Le Fort I osteotomy combined with a bilateral sagittal split osteotomy. Mean and median total nasal airflow and nasal resistance rate were calculated before surgery and after surgery and compared by use of SPSS software (version 11.5; SPSS, Chicago, IL) and paired t test. An increase in nasal airflow (P = .009) and a decrease in nasal resistance (P = .022) were observed in the maxillary impaction and advancement group. In the maxillary impaction and setback group, there was a significant difference in nasal resistance changes (P = .027); however, postsurgical nasal airflow compared with presurgical values showed no statistically significant difference (P = .244). Impaction and advancement of the maxilla can improve nasal respiratory function, but maxillary impaction and setback reduce nasal respiratory function. Hence candidates for maxillary impaction and setback must be informed about decreased nasal respiratory function.

Results of a Prospective Anthropometric and Functional Study About Aesthetics and Nasal Respiration After Secondary Rhinoplasty in Cleft Lip and Palate Patients

In contrast to the multitude of investigations regarding aesthetic changes in nasal surgery, few data are available concerning nasal function. This is especially important for cleft patients with a compromised nasal respiration.In this prospective study, 68 cleft patients, who underwent nasal surgery, were evaluated concerning aesthetic and respiratory outcome. To assess nasal respiration, active anterior rhinomanometry, rhinoresistometry, and acoustic rhinometry were performed preoperatively and 6 months postoperatively (without and with nasal decongestion, according to international standards). For analyzing the changes in aesthetic parameters, photographs from 3 directions, which were taken preoperatively and at least 6 months postoperatively, were compared. Thus, 57 angles and relations of lines were created out of 54 anthropometric points. The Wilcoxon test was used to compare preoperative and postoperative data (P < 0.05). Regarding aesthetic outcome, a significant improvement in many parameters was seen. The noses postoperatively proved to be significantly narrower and more symmetric and showed a better projection.Although analysis of functional respiratory data showed a significant increase in nasal volume, no change in nasal airflow and hydraulic diameter could be found.Whereas aesthetic improvement of the cleft nose is a goal, which can be achieved regularly, nasal respiration still seems to be a challenge in cleft patients. This study highlights the necessity of taking functional data to learn more about the effects of surgery. Objective methods to assess nasal respiratory function are important for planning and performing nasal surgery and are a means of quality control.

Olfactory dysfunction in Wegener's granulomatosis

Necrotizing granulomatous inflammation of the upper respiratory tract is one of the hallmarks of Wegener's granulomatosis (WG), which may explain the reason for olfactory dysfunction in WG. However, a systematic analysis using modem olfactory testing tools has not been performed and potential causes of dysfunction at different levels of olfactory information processing remain obscure so far. In this study a group of 76 WG-patients was examined with sniffin'sticks screening 12, odour threshold (T)/discrimination (D)/identification (I) TDI-score, active anterior rhinomanometry and a standardized questionnaire for olfactory function. WG-patients were aware of their olfactory dysfunction, as proven by psychophysiological test results. An altered olfactory function was significantly correlated to local administration of mupirocin and to the time interval between first diagnosis and study entry. None of the other variables had a statistical significant effect on the olfactory dysfunction.

Rapid palatal expansion effect on breathing

Background and Objectives: This presentation focuses on showing the clinical results of rapid palatal expansion (RPE) on the nasal cavity measured by computed tomography (CT) and active anterior rhinomanometry, as it improves the patient's breathing.

Nasal Patency by Rhinomanometry in Patients with Sensation of Nasal Obstruction

The objective assessment of nasal patency is a common challenge in clinical practice. This study was designed to show and compare the values of active anterior rhinomanometry (RMM) in patients with sensation of nasal obstruction. According to the physical examination, 7283 individuals with sensation of nasal obstruction were divided into the nasal septal deviation (NSD) group and normal nasal anatomy group. The NSD group and normal nasal anatomy group were further divided into subgroups according to skin-prick test positivity or negativity, respectively. Nasal airway resistances (NARs) of the subgroups were evaluated and compared. The mean value of total inspiratory NAR was 0.51 and 0.34 Pa/cm3 per second at 150-Pa pressure point in allergic rhinitis subjects with and without NSD, respectively; 0.48 and 0.32 Pa/cm3 per second were the mean values of total inspiratory NAR in nonallergic rhinitis subjects with and without NSD, respectively. The total inspiratory resistances in groups with NSD were significantly higher than the others. We believe that the results of so large a number of participants in this test will make an obvious contribution to the medical literature.

The lateralization percentage as a measure of nasal flow asymmetry in active anterior rhinomanometry

The lateralization percentage as a measure of nasal flow asymmetry in active anterior rhinomanometry

Rapid Maxillary Expansion for the Treatment of Nasal Obstruction in Children Younger Than 12 Years

To assess short- and long-term effects of rapid maxillary expansion (RME) on nasal flow in young children. Since RME has been reported to positively influence nasal obstruction in subjects with respiratory problems by reducing nasal resistance, a similar efficacy of RME could be expected in children with deciduous and/or mixed dentition who are affected by maxillary constriction and nasal obstruction from a different cause. Prospective study of children younger than 12 years, with different grades of malocclusion and oral breathing. Data included active anterior rhinomanometry in both the supine and orthostatic positions, as well as radiographic cephalometric measurements. Tertiary care university hospital. Data were prospectively collected from 2005 to 2007. Nasal flow and resistance were measured in 65 children younger than 12 years, with mixed or deciduous dentition and different grades of malocclusion and oral breathing. Efficacy of RME for resolution of maxillary constriction. After RME, an improvement of nasal flow and resistance has been recorded in patients, in the supine position, who presented both anterior and posterior obstruction. Less notable changes were shown in isolated forms of obstruction and in the orthostatic position. In cases of maxillary constriction and nasal airway obstruction, RME has proved to be efficient for the improvement of nasal respiration in children via a widening effect on the nasopharyngeal cavity.

Computerized rhinomanometry: A study of total nasal resistance normal values

Computerized rhinomanometry with the practical software programmes is used widely as a research tool to evaluate objectively nasal air flow and resistance parameters, while the increase of its clinical application may be facilitated by further standardization of the method. The aim of the study was to determine the total nasal resistance normal values in healthy adult population using a method of computerized rhinomanometry. A randomized sample of 108 white healthy adults (216 nasal cavities), both sexs with a mean age of 32 (20-45) years comprised the test group. Nasal patency was measured by active anterior rhinomanometry in non-decongested mucosa ("at rest") during 10 repetitive measurements at inspiratory and expiratory reference pressure of 150 Pa. Nasal resistance was measured and calculated according to the recommendations of the Committee on objective assessment of the nasal airway, International Rhinologic Society. The mean total nasal resistance in the sample was found to be 0.179 Pa/cm3/s with the confidant interval from 0,167 to 0,191 Pa/cm3/s at the probability level of 95%. Total nasal resistance was very significantly influenced by sex (t = -4.614), height (F=11.625) and weight (F=11.529) of the examinees. This paper provides additional information on total nasal resistance normal values in healthy adult population important for computirezed rhinomanometry normative parameters standardization.

Morphological examination of upper airway in obstructive sleep apnea

Objectives An aim of this study was to assess the predictive power of an otorhinolaryngological examination of the upper airway to identify risk factors of obstructive sleep apnea syndrome (OSAS) in the patients. Methods We examined 141 consecutive patients with OSAS. The morphological features were assessed by the designated otorhinolaryngologist while the subjects were sitting relaxedly with tidal breathing. The bilateral nasal resistance was measured using the active anterior rhinomanometry during daytime wakefulness. Results The body mass index (BMI), fauces's narrowness, neck circumference, lowest oxygen saturation, tonsil size and modified Mallampati grade (MMP) showed the statistically significant correlations with the apnea–hypopnea index (AHI) of an index of apnoeseverity, however, the age, Epworth sleepiness scale (ESS), nasal resistance and retroglossal space were not significantly associated with the AHI. Conclusions The upper airway morphology significantly associated with AHI are fauces's narrowness, tonsil size, and MMP, but not nasal resistance and retroglossal space.

Nasal-Air Conditioning in Patients With Chronic Rhinosinusitis and Nasal Polyposis

To compare nasal-air conditioning in patients with chronic rhinosinusitis with nasal polyposis with healthy control subjects without nasal pathologic conditions, to investigate nasal-air conditioning after endoscopic sinus surgery with and without septoplasty and turbinoplasty 4 to 6 weeks after surgery, to examine the parameters of nasal patency and nasal geometry that possibly influence nasal-air conditioning before and after endonasal surgery, and to determine their relationship to nasal-air conditioning parameters. Prospective cohort study. Tertiary referral center. Twenty-five patients (median age, 51 years; age range, 20-74 years) having a diagnosis of chronic rhinosinusitis with nasal polyposis refractory to medical treatment and 22 healthy control subjects (median age, 25 years; age range, 18-52 years). Patients underwent endoscopic sinus surgery with or without septoplasty and turbinoplasty during 6 months and were followed up 4 to 6 weeks after surgery. Nasal-air conditioning was measured and acoustic rhinometry and active anterior rhinomanometry were performed before and after nasal surgery. Nasal airflow and nasal volume were significantly higher postoperatively than preoperatively. The preoperative heat increase and water gradient were lower in the patients compared with the controls. The postoperative heat increase was significantly higher than the preoperative values. The water gradient did not change after endonasal surgery. Nasal patency and volume were positively correlated with nasal heating, whereas nasal humidification showed a significant negative correlation with nasal volume. Patients with chronic rhinosinusitis with nasal polyposis seem to benefit from endoscopic sinus surgery with or without septoplasty and turbinoplasty because nasal heating is improved postoperatively. Four to 6 weeks after endonasal surgery, nasal humidification is neither improved nor worsened compared with preoperative values.

Impact of External Nasal Strips on Nasal Geometry and Intranasal Air-conditioning

The anterior nasal segment is the most effective part of the nasal airways when it comes to warming and humidification of the inhaled air. Any changes in nasal geometry in this segment modifying the airflow could therefore affect nasal air conditioning. The goal of this study was to examine if external nasal strips have an influence on intranasal geometry and air-conditioning. Twenty healthy volunteers (mean age, 36 years) were enrolled in the study. All volunteers received active anterior rhinomanometry and acoustic rhinometry before and while wearing commercially available external nasal strips. In addition, in vivo air temperature and humidity were measured with and without nasal strips at the defined intranasal sites. No statistically significant changes in temperature, humidity, and rhinomanometric values were detected during the use of nasal strips (p > 0.05). The statistical analysis of the acoustic rhinometric results showed a significant increase (p < 0.05) in the minimal cross-sectional areas (MCA) 1 (0-2 cm) and MCA2 (2-5 cm) and the nasal volume (Vol) 1 (0-2 cm). On the other hand, the nasal strips did not significantly alter the nasal Vol2 (2-5 cm; p > 0.05). Changes in the nasal geometry of the anterior part of the nose by wearing nasal strips did not relevantly alter intranasal air-conditioning. The application of nasal strips entails an increase in MCAs but not in nasal airflow Vol.

Age‐Related Changes in Intranasal Air Conditioning in the Elderly

Elderly patients frequently complain about the feeling of a dry nose and recurrent crusting probably due to age-related degenerative effects of the nasal mucosa. Data on intranasal air conditioning in elderly patients are missing. The aim of the study was to compare intranasal heating and humidification of respiratory air in elderly subjects and a younger control group. Additionally, rhinomanometrical and rhinometrical data were examined. The study was conceived as randomized, prospective study. Forty study subjects (median age, 70 years; range, 61-84) and 40 control subjects (median age, 27 years; range, 20-40) were included in the study. In vivo air temperature and humidity values were simultaneously measured at defined intranasal sites. Active anterior rhinomanometry and acoustic rhinometry also were performed in every subject. In the study group, the median end-inspiratory air temperature (degrees C)/absolute humidity (g/m3) values were 24.0 degrees C/13.8 g/m3 within the nasal valve region and 24.3 degrees C/14.7 g/m3 anterior to the head of the middle turbinate. In the control group, the corresponding values were 27.0 degrees C/15.5 g/m3 and 26.7 degrees C/17.0 g/m3. Temperature and humidity values were significantly lower in the study group (P < .05). The minimal cross-sectional areas and volumes were significantly higher in the study group (P < .05). Nasal complaints in elderly patients are a consequence of lower intranasal air temperature and humidity values combined with relatively enlarged nasal cavities due to involution atrophy of the nasal mucosa.

S275 – Nasal Morphology and Nasal Patency in Leprosy Patients

Objectives 1) To assess the impact of multi-drug leprosy therapy on the development of nasal deformities and nasal airway patency. 2) Evaluate the nasal morphology and nasal patency in leprosy patients treated with the multidrug therapy in comparison with patients treated with 1 drug therapy and a group of healthy volunteers. Methods In an overall group of 84 patients studied, 38 were treated with a therapy based on a single drug, and 22 were treated with multi-drug therapy, while 24 subjects formed a control group. We used anterior rhinoscopy to analised the morphology of the nose. We meassured the nasal inspiratory and expiratory resistance of the right and left nostrils and total nasal inspiratory and expiratory resistance at a transnasal pressure of 150 Pa. by using active anterior rhinomanometry. The statistical analysis was carried out using the Varianza analisys. Results The nasal structures in the 1-drug therapy group underwent bone and cartilaginous resorption with an increase in nasal resistances. We found significant statistical differences between the resistance values obtained in this group and the control group (p&lt;0,05). In the multidrug therapy group, the morphology of the nose remains as in healthy patients. No significant statistical differences were found between the resistance values obtained in the multidrug therapy patients and the control group (P&gt;0,05). Conclusions The multidrug therapy prevents developing nasal deformities and maintains a normal nasal airflow.

Impact of Menthol Inhalation on Nasal Mucosal Temperature and Nasal Patency

Menthol is a natural herbal compound. Its isomer l-menthol presents the characteristic peppermint scent and is also responsible for the cooling sensation when applied to nasal mucosal surfaces because of stimulation of trigeminal cold receptors. The aim of this study was to assess the effect of menthol inhalation on end-inspiratory nasal mucosa temperature and nasal patency. Eighteen healthy volunteers with a mean age of 30 years were enrolled in this study. Objective measurements included the septal mucosal temperature within the nasal valve area by using a miniaturized thermocouple as well as active anterior rhinomanometry before and after inhalation of l-menthol vapor. All subjects completed a visual analog scale (VAS; range, 1-10) evaluating nasal patency before and after menthol. The mean end-inspiratory mucosal temperature ranged from 27.7 degrees C (+/-4.0) before menthol inhalation to 28.5 degrees C (+/-3.5) after menthol inhalation. There were no statistically significant differences between the temperature values before and after menthol inhalation (p > 0.05). In addition, no statistically significant differences between the rhinomanometric values before and after menthol inhalation were observed. Sixteen of the 18 subjects reported an improvement of nasal breathing after menthol inhalation by means of the VAS. Menthol inhalation does not have an effect on nasal mucosal temperature and nasal airflow. The subjective impression of an improved nasal airflow supports the fact that menthol leads to a direct stimulation of cold receptors modulating the cool sensation, entailing the subjective feeling of a clear and wide nose.

Diagnostic Accuracy of Peak Nasal Inspiratory Flow and Rhinomanometry in Functional Rhinosurgery

Sensitivity and specificity of active anterior rhinomanometry (RMM) and peak nasal inspiratory flow (PNIF) in the diagnosis of functionally relevant structural nasal deformities should be assessed. The reference standard was clinical judgment based on all clinical data available. Prospective study of diagnostic accuracy at a tertiary rhinologic referral center. RMM and PNIF were performed on 53 patients with symptomatic nasal stenosis and 40 healthy volunteers. Cut-offs for RMM and PNIF were defined by receiver operating characteristic analysis. A cut-off between normal and pathological of 700 mL/second for RMM at a transnasal pressure difference of 150 Pa, and of 2,000 mL/second (120 l per minute) for PNIF was calculated. No significant differences in terms of sensitivity of RMM and PNIF (0.77 vs. 0.66), specificity (0.8 vs. 0.8) and diagnostic accuracy (0,79 vs. 0.72) were found. RMM and PNIF provide valuable information to support clinical decision making. However, with both methods, approximately 25% of symptomatic patients with functionally relevant nasal structural deformity were not detected. A negative test outcome of RMM or PNIF does not exclude a functionally relevant nasal stenosis.

Exposure study on chemosensory effects of ε-caprolactam in the low concentration range

Aim of the study was to examine possible chemosensory effects of epsilon-caprolactam in the low concentration range relevant to indoor environmental conditions. Twenty healthy subjects (10 male, 10 female) aged from 21 to 38 years were exposed for 6 h, respectively, to 0, 0.15, 0.5 and 5 mg/m3 epsilon-caprolactam vapours in a randomized and double-blind method. As a measure of trigeminal stimulation of the eye, blink frequency was video-recorded four times per day and evaluated by using a new semi-automatic, computer-assisted method compared to baseline recording and manual counting. Digital slit lamp photographs were taken at the same time to examine conjunctival hyperaemia. A standardized ophthalmologic grading scale was used to measure redness of the eyes objectively. Active anterior rhinomanometry compared nasal resistance before and after exposure. Subjective ratings of discomfort and mental orientation were assessed using the German version of the Swedish Performance Evaluation system (SPES). As a measure of personality traits, positive and negative affectivity was determined (PANAS). Six hour exposures to epsilon-caprolactam revealed no significant dose-response relationship concerning blink frequency, nasal resistance and redness of the bulbar conjunctiva. Subjective ratings of discomfort (sum scores) significantly increased only at the highest concentration of 5 mg/m3. However, the increase in discomfort was only moderate, ranging between "not at all" and "somewhat". Significant increases of the subjective detection of malodour (subscore) already occurred at 0.15 mg/m3, showing no adaptation over time. Irritation of the eyes or upper airways was not reported. Exposure to epsilon-caprolactam vapour did not elicit any acute health effects in a concentration range up to 0.5 mg/m3. Even at the highest concentration of 5 mg/m3, we could only find a slight increase in subjective symptoms, mainly due to an unincisive increase of perception of malodour.

Monopolar and bipolar radiofrequency thermal ablation of inferior turbinates: 20-month follow-up

We prospectively evaluated the efficacy and morbidity of monopolar and bipolar radiofrequency volumetric tissue reduction (RFVTR) of inferior turbinates during a 20-month follow-up. The study was conducted on 150 patients randomly assigned into two groups of 75 each. In group A, we used the bipolar device "Coblator II ENT" (Arthrocare Corp, Sunnyvale, CA) and in group B the monopolar device Somnoplasty (Somnus Medical Technologies, Inc, Sunnyvale, CA). Nasal endoscopy, visual analog scale, anterior active rhinomanometry, acoustic rhinometry, and saccharin tests were used to assess the outcomes of the treatments. Turbinate edema and nasal obstruction decreased significantly (P < 0.0001) in group A seven days after surgery and in group B from month 1. The nasal symptoms were significantly reduced in both groups from the first month (P < 0.0001). A significant increase (P < 0.0001) in nasal volume and decrease in nasal resistance were detected in the first month. No difference was found from three to 20 months after surgery (P > 0.5). We have shown that both methods of RFVTR can produce a long-term improvement on symptoms and on maintenance of nasal function.