Decongestion Test Research Articles

The value of objective methods for assessing nasal breathing function in the diagnostic algorithm for allergic rhinitis

The visual analogue score (VAS) is recommended to assess the severity of symptoms of allergic rhinitis (AR), but despite its advantages, it is a tool for subjective assessment of symptoms and often does not correlate with the true state of nasal patency. Anterior active rhinomanometry (AAR) is the method to objectify obstructive changes in the nasal cavity in patients with AR and is the most accurate method to assess nasal breathing function from a physiological and aerodynamic point of view. In addition, AAR with a decongestant test allows a differential diagnosis of the causes of nasal obstruction. Our study showed that there was no correlation between VAS and AAR scores. In addition, we found the importance of performing AAR with a decongestant test and subsequent assessment of unilateral flow and resistance parameters, which allowed us to suspect the presence of structural changes in the nasal cavity in patients with AR, as recorded as a result of anterior rhinoscopy and/or endoscopic examination. Thus, in addition to the use of VAS, it is necessary to include AAR in the diagnostic algorithm for AR, which allows not only to confirm the presence or absence of nasal breathing impairment, but also to differentiate the causes of its occurrence for the subsequent selection of the optimal management of patients with AR.

Oxymetazoline as a predictor of turbinate reduction surgery outcomes: Objective support from a prospective, single-blinded, computational fluid dynamics study.

A patient's subjective response to topical nasal decongestant is often used to screen for turbinate reduction surgery suitability. However, this anecdotal strategy has not been objectively and quantitatively evaluated. Prospective, longitudinal, and single-blinded cohort study employing computational fluid dynamic modeling based on computed tomography scans at baseline, 30min postoxymetazoline, and 2 months postsurgery on 11 patients with chronic turbinate hypertrophy. Nasal obstruction symptom evaluation (NOSE) and visual analogue scale (VAS) obstruction scores significantly improved from baseline to postoxymetazoline and again to postsurgery (NOSE: 71.82±14.19 to 42.27±25.26 to 22.27±21.04; VAS: 6.09±2.41 to 4.14±2.20 to 2.08±1.56; each interaction p<0.05), with significant correlation between the latter two states (r∼0.37-0.69, p<0.05). Oxymetazoline had a broader anatomical impact throughout inferior and middle turbinates than surgery (many p<0.05); however, the improvement in regional airflow is similar (most p>0.05) and predominantly surrounding the inferior turbinate. Strong postoxymetazoline to postsurgery correlations were observed in decreased nasal resistance (r=0.79, p<0.05), increased regional airflow rates (r=-0.47 to -0.55, p<0.05) and regional air/mucosa shear force and heat flux (r=0.43 to 0.58, p<0.05); however, only increasing peak heat flux significantly correlated to symptom score improvement (NOSE: r=0.48, p<0.05). We present the first objective evidence that the "topical decongestant test" can help predict turbinate reduction surgery outcomes. The predictive effect is driven by similar improvementin regional airflow that leading to improved air/mucosa stimulations (peak heat flux) rather than through reduced nasal resistance.

Rhinomanometry with and without decongestant used to select children for adenoidectomy: a cohort study.

Adenoid hypertrophy may coexist, and often does, with rhinitis. Therefore, in some cases, adenoidectomy alone, despite the fact that it reduces nasal resistance, may be insufficient to restore nasal breathing. Juliusson et al. suggested using rhinomanometry with and without nasal decongestant as a method for selecting patients for adenoidectomy. In this study, we aim to assess whether the decongestant test, when using normative data, is useful to select children for adenoidectomy. Children between 4 and 15years old undergoing adenoidectomy were selected from two tertiary referral university hospitals. Participants underwent anterior active rhinomanometry with and without nasal decongestant before and after surgery. Parents fill in the sinus and nasal quality-of-life survey (SN5). 47 participants were included, and mean age 6.5 ± 2.15. 2 cohorts were defined according to the result of the nasal decongestant test (> 40% improvement in nasal resistance or not). There is a statistically significant difference between groups, with a higher improvement in nasal resistance and airflow after adenoidectomy in the group with less than 40% improvement in nasal resistance. In conclusion, this study supports the use of the decongestant test with rhinomanometry to select children for adenoidectomy; especially as it has proven to be a simple technique, harmless, fast, and easily performed on collaborative children.

Looking for a cutoff value for the decongestant test in children suffering with turbinate hypertrophy.

The main causes for objectively confirmed chronic impaired nasal breathing in children are adenoid and turbinate hypertrophy. Turbinate hypertrophy may be addressed by turbinate surgery. However, specialized guidelines include no specific indications for pediatric patients. The decongestant test consists of simulating the effect of turbinate surgery by means of a nasal decongestant. This project, developed by the YO-IFOS rhinology group, aims to establish a cutoff value for the nasal decongestant test with rhinomanometry to select children for turbinate surgery. Children between 4 and 15years of age were included. Cases were consecutively selected from children affected by turbinate hypertrophy undergoing turbinate radiofrequency ablation with or without adenoidectomy. Controls were consecutively selected from a sample of healthy children. All the subjects were examined with anterior active rhinomanometry with and without nasal decongestant. Sample included 72 cases and 24 healthy controls. There was a statistically significant difference in the improvement with the decongestant between cases (57.91%) and controls (15.67%). The ROC curve revealed an area under the curve of 0.97. The highest amount of correctly classified individuals (93.44%) corresponded to the cutoff value of 31.66%. However, the value with the highest specificity and highest Youden's index was the 38.88% improvement in nasal resistance with nasal decongestant. In conclusion, a preliminary cutoff value for the decongestant test used with rhinomanometry in children has been established. This test could help identify children for turbinate surgery.

Performance and work of nasal breathing

AbstractOBJECTIVE.To evaluate performance (Q) and work (W) of nasal breathing as potential parameters in functional diagnostic of nasal obstruction.MATERIAL AND METHODS.We included in our study 250 patients and we measured by 4-phase-rhinomanometry with decongestion test. We calculated performance Q of the “representative breath” in inspiration and expiration and in total breath, maximal performance Q (Qmax), Work W of nasal breathing in mJ and in mJ/litre and Q in J/min.RESULTS.The interquartile range of Win for representative breath before decongestion is 356 mJ/l, Wex 308 mJ/l, while after decongestion Win is 264 mJ/l and Wex 220 mJ/l. There is no significant difference between work before and after decongestion (p&lt;0.001). Interquartile range for nasal breathing Q before decongestion is 19.2 J/min and after – 14.3 J/min. A significant correlation exists between logarithmic vertex resistance for inspiration and expiration and Qmax for inspiration and expiration (p&lt;0.001). That means that the performance required by breathing depends in the first line on nasal resistance.CONCLUSION.Inspiratory work is 1.2 times higher than expiration work. Increase in nasal airway resistance is followed by increase in maximal nasal performance.

Rhinosinusitis with nasal polyps: main aspects of anti-relapse therapy and recovery of nasal breathing

Objective. This study was conducted to increase effectiveness of anti-relapse therapy of chronic rhinosinusitis with polyps to create a stable long-term remission in the long-term postoperative period.Patients and research methods. 60 patients with total spread of polyposis process in the nasal cavity and paranasal sinuses were examined. All patients underwent endoscopic polysinusotomy and 3 weeks after surgery, basic anti-relapse therapy of PRS in the form Of nasonex intranasal spray of 400 mcg/day for 6 months in combination with irrigation with isotonic salt solutions was prescribed. At the same time, 30 patients 1.5 months after polysinusotomy were additionally given a short course of systemic corticosteroid therapy with Methylprednisolone, starting at 20 mg/day in combination with Omeprazole at 20 mg /day for 14 days. Subjective assessment of the patients ‘condition was carried out by questionnaire, for objective diagnosis acoustic rhinometry and CT of the paranasal sinuses were used.Results. Simultaneous administration of a short course of corticosteroid therapy in combination with prolonged intranasal use of Nasonex spray in patients with nasal polyps in the postoperative period contributed to the most rapid subjective improvement of nasal breathing. The combined scheme in 27 (90%) subjects showed a statistically significant improvement in intra-nasal aerodynamics (p&lt;0.05) 2 months after polysinusotomy according to the results of acoustic rhinometry, the average MPPS1 was 0.67 ± 0,04 cm2 before and after the decongestant test. In 13 patients (44,3%) who received only intranasal corticosteroids reactive edema from the nasal mucosa were more pronounced, which contributed to the formation of zones of pathological narrowing of the nasal flow and a decrease in МППС1 to 0.43 ± 0,04см2 to test with decongestant. 2 years after surgical treatment in patients undergoing a combined course of corticosteroid therapy in relation to patients receiving only monotherapy with intranasal corticosteroids, there was no recurrence of polyposis in 86.7% of cases (26 patients), against 66.7% (20 patients), receiving only intranasal corticosteroids.

Evaluation of nasal and paranasal findings in cases of migraine

Objective The objective of this study was to evaluate nasal and paranasal findings in cases of migraine. Background Migraine triggers are abundant, and anatomical nasal variations like septal spur, concha bullosa, and hypertrophied inferior turbinate may be considered as important trigger factors for migrainous headache by mucosal contact according to the trigeminovascular theory as a proposed mechanism for migraine. Patients and methods This was an observational cross-sectional study comparing 60 patients with migraine versus 40 normal participants with neither migraine nor nasal presentations. History was taken to define the type of migraine and its severity according to Migraine Disability Assessment Score. Computed nasal and paranasal tomography scan, diagnostic nasal endoscopy, and nasal decongestant test were done for all of them to diagnose nasal and paranasal findings in both groups and to confirm mucosal contact points in migraineurs. Results There was a significant increase in overall septal, turbinate, and mucosal findings in case group compared with control group. There was a statistically significant difference between the two groups regarding septal spur, concha bullosa, and abnormal nasal mucosa, being more prevalent in the case group. The most common contact point was between the septum and middle turbinate, with a nonsignificant correlation between the type of contact point and severity of migraine. Conclusion The presence of nasal findings in migraineurs was significantly associated with triggering of migraine through contact point mechanism. The significant findings were septal spur, concha bullosa, and abnormal nasal mucosa, with the most common contact point being between the septum and middle turbinate.

Impact of Corrective Rhinologic Surgery on Rhinogenic Headache

In this study, the localization of the headache, mucosal contact points, sinonasal anatomic variations and the incidence of mucosal abnormalities were determined in patients with rhinogenic headache, and the efficacy of the corrective surgery on the severity of the headache and the rate of improvement on that localization were investigated. Conducted in a prospective manner. Level 2b. Sixty-five patients who were admitted with sinonasal symptoms and headache and had septoplasty, endoscopic sinus surgery, or surgical procedures involving the nasal turbinates were included in this study. The quality and the severity of the headache were investigated preoperatively as well as in the 3rd and 12th postoperative months. Headache was most frequently localized the frontal region. The mucosal contact points were most frequently localized between the nasal septum and the middle or inferior turbinates. Differences between preoperative headache and headache in postoperative 3rd month and postoperative 12th month were statistically significant (P < 0.05). Improvement in headache after surgery was statistically significant in cases with Haller cell and paradoxical middle turbinate and in patients with contact points between the nasal septum and the middle or inferior turbinates (P < 0.05). We have shown the importance of surgery in the treatment of rhinogenic headache. We have also shown the reliability of the decongestion test for determining the indication for surgery. We suggest that the rhinologic surgery may have a great contribution to the treatment of headache.

Can reversibility of nasal obstruction predict the grade of bronchial hyperreactivity?

Aim of the study was to reveal the connection between significance of nasal obstruction and bronchial hyperreactivity. Allergic rhinitis is the most common IgE-mediated disease with progressively increasing prevalence in population. Chronic inflammation and remodelation of mucosa of the upper airways can be a part of generalized affection of respiratory system including lower airways. Severe inflammatory damage of nasal mucosa is connected with irreversibility of nasal obstruction, which is possible to verify by nasal decongestion test. Bronchoprovocation test and rhinomanometry examination with decongestion test were performed in 57 patients. We analysed the grade of bronchial hyperreactivity and response of nasal mucosa to decongestion agent. Number of positive and negative decongestion tests were compared in a group of patients with mild bronchial hyperreactivity with the group of moderate and severe hyperreactivity. Comparing the results of decongestion tests there has been a significant difference found between the group with mild hyperreactivity and the group with moderate and severe hyperreactivity. The study points out to narrow relationship between bronchial asthma and allergic rhinitis, where patients with negative decongestion test showed significantly increased grade of bronchial hyperreactivity. Due to this patients with insufficient response of nasal mucosa to decongestive agent probably require more intensive antiinflammatory therapy compared to patients with positive response. Nasal decongestion tests can be used for examination of the effect of allergic inflammation of nasal mucosa on the lower airways and vice versa (Tab. 4, Ref. 27).

The role of rhinomanometry after nasal decongestant test in the assessment of adenoid hypertrophy in children

IntroductionNasal respiratory obstruction is a very common otolaryngologic problem, often caused by adenoid hypertrophy (AH). Nasal fiberoptic endoscopy (NFE) represents the gold standard method to diagnose AH. Rhinomanometry represents a valid diagnostic support. ObjectiveThe aim of our study was to analyze the diagnostic value of rhinomanometry after nasal decongestant (ND) test for the evaluation of adenoid hypertrophy in children. Materials and methodsSeventy-one of 97 collaborative children, aged 6–12 years, affected by upper airways obstructive symptoms and diagnosed as ‘chronic oral breathers’ by a standardized questionnaire were included in the study. The first evaluation included a complete physical examination, anterior rhinoscopy and anterior active rhinomanometry. Patients with a positive rhinomanometry underwent a second rhinomanometry after the administration of the nasal decongestant (ND) xylometazoline. All children were evaluated using nasal fiberoptic endoscopy (NFE). ResultsAt rhinomanometry a normal nasal airflow was found in 19 (26.8%) of children while nasal obstruction was underlined in 52 (73.2%). These patients were tested also with rhinomanometry after ND which confirmed the presence of nasal obstruction in 29 (55.7%) of patients. All patients included in the study underwent a NFE: 34 (47.8%) of them presented severe AH with an occlusion >75% of the choanal opening (grade≥3) and 37 (52.2%) presented no or a mild form of AH (grade<3). When compared to NFE, rhinomanometry test after ND had 82.7% sensitivity and 82.6% specificity. Positive predictive value and negative predictive value were 85.7% and 79.2%, respectively. Two receiver operating characteristic (ROC) curves were derived using data related to rhinomanometry vs NFE, and to rhinomanometry after ND vs NFE. ConclusionsRhinomanometry after ND, compared to rhinomanometry, is more specific and useful to evaluate nasal obstruction due to AH in children, and it may be helpful to avoid unnecessary surgical procedures in children with temporary nasal obstruction.

Comparison of Nasal Sound Spectral Analysis and Peak Nasal Inspiratory Flow before and after Decongestion in Patients with Nasal Obstruction

We compared the results of nasal sound spectral analysis (NSSA) with the results of peak nasal inspiratory flow (PNIF) testing and use of a visual analog scale in patients with allergic rhinitis with nasal obstruction. We performed NSSA and PNIF testing on 38 patients with allergic rhinitis and 35 healthy subjects. A diagnostic decongestion test was performed on the patients (not on the control subjects). Twenty minutes after decongestant was sprayed into the nostrils, NSSA and PNIF testing were performed again. There was a significant difference in the PNIF values and the nasal inspiratory sound intensities before and after decongestion (p < 0.001). There was a correlation between the NSSA results at the frequency range of 2 to 4 kHz and the PNIF results. The calculated cutoffs between normal and pathological values were 14.8 dB (2 to 4 kHz) for NSSA and 116 +/- 14.1 L/min for PNIF testing. No significant differences were computed between NSSA and PNIF testing in terms of sensitivity (0.71 versus 0.76) or specificity (0.74 versus 0.80). Use of NSSA and PNIF testing together for assessment of nasal obstruction in allergic rhinitis provides clinical relevance in that it allows a fair degree of reliability. Such testing can be performed as a surrogate for rhinomanometry.

The role of rhinomanometry after nasal decongestant test in the assessment of adenoid hypertrophy in children

The role of rhinomanometry after nasal decongestant test in the assessment of adenoid hypertrophy in children

Recruitment factors which affect the outcome of a seasonal allergic rhinitis trial

Although intranasal corticosteroids (INSs) are the first-line treatment for seasonal allergic rhinitis (SAR), some patients do not respond adequately, reflecting biological heterogeneity or confounding conditions. The objective of this study was to determine what recruitment factors identify SAR subjects who will be unresponsive to mometasone furoate (MF). We performed a 2-week, double-blind, placebo-controlled, parallel study on 40 subjects with SAR. Each subject underwent a decongestant test using oxymetazoline. Baseline nasal symptoms, nasal peak inspiratory flow (NPIF) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores were recorded. Next, subjects were randomized to either 200 μg of MF or placebo. Symptom diaries and NPIF measurements were completed twice daily. After 2 weeks, subjects repeated the RQLQ and the global assessment of symptoms. There was a significant reduction in symptoms in the MF group compared with placebo (p ≤ 0.05) in patients with baseline total symptom scores of ≥6. Multivariate analysis showed that treatment (MF versus placebo; p = 0.049) and amount of decongestion (percent change in NPIF after oxymetazoline; p = 0.008) predicted the improvement in total nasal symptoms. In clinical trials, SAR subjects must report multiple symptoms to be responsive to treatment with INSs. Our results also support the use of the decongestant test for choice of appropriate study volunteers, both to ensure participation of potentially responsive subjects and to eliminate those with confounding issues.

Recruitment Factors Which Affect the Outcome of a Seasonal Allergic Rhinitis Trial

RATIONALE: Though intranasal corticosteroids (INS) are first line treatment for seasonal allergic rhinitis (SAR), some patients do not respond adequately reflecting biological heterogeneity or confounding conditions. We sought to determine if failure of the nasal mucosa to decongest adequately with topical oxymetazoline identifies subjects with SAR who are less responsive to mometasone furoate (MF).METHODS: We performed a 2-week, double-blind, placebo-controlled, parallel study in 40 subjects with SAR who underwent a decongestant test which involved objective assessment of decongestion with NPIF before/after topical oxymetazoline. Baseline nasal symptoms, Nasal Peak Inspiratory Flow (NPIF) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores were recorded. Next, subjects were randomized to either 200μg MF or placebo. Symptom diaries and NPIF measurements were completed twice daily. RQLQ was repeated after 2 weeks.RESULTS: There was a significant reduction in symptoms in the MF group compared to placebo (p≤0.05) in subjects with baseline symptom score ≥6, but not with those with <6. MF was associated with a trend toward improvement in RQLQ sleep scores (p=0.08). Multivariate analysis showed that treatment (MF vs. placebo) (p=0.049) and amount of decongestion (% change in NPIF after oxymetazoline) (p=0.005) predicted the magnitude of the change in total nasal symptoms.CONCLUSIONS: To minimize heterogeneity in SAR clinical trials, entry criteria must ensure that subjects report multiple baseline symptoms (above a threshold) to be potentially responsive to INS therapy. Our results support the use of the decongestant test to choose appropriate study volunteers to ensure participation of potentially responsive subjects and eliminate those with confounding issues. RATIONALE: Though intranasal corticosteroids (INS) are first line treatment for seasonal allergic rhinitis (SAR), some patients do not respond adequately reflecting biological heterogeneity or confounding conditions. We sought to determine if failure of the nasal mucosa to decongest adequately with topical oxymetazoline identifies subjects with SAR who are less responsive to mometasone furoate (MF). METHODS: We performed a 2-week, double-blind, placebo-controlled, parallel study in 40 subjects with SAR who underwent a decongestant test which involved objective assessment of decongestion with NPIF before/after topical oxymetazoline. Baseline nasal symptoms, Nasal Peak Inspiratory Flow (NPIF) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores were recorded. Next, subjects were randomized to either 200μg MF or placebo. Symptom diaries and NPIF measurements were completed twice daily. RQLQ was repeated after 2 weeks. RESULTS: There was a significant reduction in symptoms in the MF group compared to placebo (p≤0.05) in subjects with baseline symptom score ≥6, but not with those with <6. MF was associated with a trend toward improvement in RQLQ sleep scores (p=0.08). Multivariate analysis showed that treatment (MF vs. placebo) (p=0.049) and amount of decongestion (% change in NPIF after oxymetazoline) (p=0.005) predicted the magnitude of the change in total nasal symptoms. CONCLUSIONS: To minimize heterogeneity in SAR clinical trials, entry criteria must ensure that subjects report multiple baseline symptoms (above a threshold) to be potentially responsive to INS therapy. Our results support the use of the decongestant test to choose appropriate study volunteers to ensure participation of potentially responsive subjects and eliminate those with confounding issues.

Inferior turbinate surgery and nasal airflow: evidence-based management

This review will discuss the evidence-based management of enlarged inferior turbinate by considering methods of assessing nasal airflow, controversies surrounding patient selection and surgical outcomes. There is currently no consensus on patient selection for turbinate surgery. Patients are empirically offered surgery on the basis of subjective complaint of nasal obstruction and surgeon's clinical examination. Few authors have utilized objective measurements of nasal airflow such as rhinomanometry to select suitable patients for surgery. There is a small body of evidence suggesting that more robust criteria of selecting patients, using a nasal decongestant test and rhinomanometry, may have some influence on the surgical outcome. Although most surgical techniques demonstrate improvement in postoperative nasal airflow and subjective scores, it is impossible to draw conclusions as to which technique is best suited for treating inferior turbinate enlargement. The heterogeneous study cohorts, differing patient selection criteria and outcome measures used do not allow meta-analysis of outcomes and comparison between surgical techniques. Inferior turbinate surgery is an evolving operative concept and the evidence supporting the efficacy of the various techniques remains undecided. More prospective controlled studies are needed with both objective and subjective outcome measures.

Relationship between Responses to Bronchodilation Testing and to Nasal Decongestion Testing in Patients with Allergic Rhinitis Alone

A remarkable relationship exists between upper and lower airways. Bronchial obstruction is a paramount feature of asthma as well as nasal obstruction of allergic rhinitis (AR). This study aims to evaluate the response to both bronchodilation and decongestion testing and their relationships in a large group of patients with moderate-severe persistent AR alone. Two hundred eleven patients with moderate-severe persistent AR were prospectively and consecutively evaluated. Clinical examination, skin prick test, spirometry, bronchodilation test, rhinomanometry, and decongestion test were performed on all patients. Seventeen subjects (8%) did not respond to any of the tests, 55 subjects (26.1%) were responders only to the decongestion test, 31 (14.7%) only to the bronchodilation test, and 108 subjects (51.2%) responded to both these tests. Longer AR duration was significantly associated with positive response to both tests (p&lt;0.01). In conclusion, this study provides the first evidence that patients with moderate-severe persistent AR may frequently show reversibility to both bronchodilation and decongestion tests.

Clinical assessment of nasal decongestion test by VAS in adolescents

Nasal airflow, as measured by rhinomanometry, is frequently impaired in allergic rhinitis (AR). The decongestion test evaluates whether the application of an intranasal vasoconstrictor drug increases nasal airflow. The aim of this study was to verify the suitability of the use of the visual analogue scales (VAS) as a surrogate for rhinomanometry in the decongestion test assessment in adolescents with atopic rhinitis. Forty adolescents [16 males and 24 females, mean age 15 (s.d. 2) yr] with AR were studied. Nasal symptoms, VAS, rhinomanometry, and nasal decongestion test were assessed in all patients. A significant association was observed between VAS and nasal airflow after performing the decongestion test (Spearman's r is -51.7%, p < 0.001). The associated sensitivity and specificity were 84.8 (95% confidence interval, CI 68.1-94.8) and 85.7 (95% CI 42.2-97.6), respectively. The corresponding area under the receiver operating characteristic (ROC) curve of 0.83 (95% CI 0.67-0.93) indicated a good discriminating ability for the decongestion measured on the VAS scale. In conclusion, the use of VAS appears as clinically relevant, in that it allows, with a fair reliability, to perform the decongestion test in the absence of rhinomanometry.

Clinical Assessment of a Nasal Decongestion Test by Visual Analog Scale in Allergic Rhinitis

Nasal airflow, as measured by rhinomanometry, is frequently impaired in allergic rhinitis (AR). The decongestion test evaluates whether the application of an intranasal vasoconstrictor drug increases nasal airflow. That allergy is characterized by inflammation and that the response to the decongestion test correlates with the grade of inflammatory reaction has previously been shown. The aim of this study was to verify the suitability of the use of the visual analog scales (VASs) as a surrogate for rhinomanometry in the decongestion test assessment in patients with persistent allergic rhinitis. One hundred three patients (mean age, 23 years [2.24 SD]) were studied. Nasal symptoms, VAS, rhinomanometry, and nasal decongestion test were assessed in all patients. A significant association was observed between VAS and nasal airflow after the decongestion test (Spearman R = -33.3%; p < 0.001). Moreover, a significant inverse association between changes in decongestion measures was detected, with a Spearman R = -64.7% (p < 0.001). The associated sensitivity was of 92.5%, and the specificity for this test was 60.0%. The corresponding area under the receiver operating characteristic curve was 0.81. The use of VAS for assessing the decongestion test appears clinically relevant in that it allows, with a fair degree of reliability, such a test to be performed in the absence of rhinomanometry.

Relationship Between Rhinitis Duration and Response to Nasal Decongestion Test

Nasal obstruction depends on allergic inflammation. Decongestion tests evaluate the reversibility of nasal airflow limitation. It has been previously reported that duration of persistent allergic rhinitis (PER) may involve important functional consequences. The purpose of the study was to evaluate the impact of the duration of rhinitis on the response to nasal decongestion test in a cohort of patients with PER. A total of 312 patients with moderate-severe PER were prospectively and consecutively evaluated: 234 males and 78 females, mean age 23.6 years. A detailed clinical history was taken and complete physical examination, nasal endoscopy, skin prick test, rhinomanometry, and nasal decongestion test were performed for all patients. A strong inverse correlation was observed (Pearson's r = -0.81) between rhinitis duration (years) and posttest percentage change of nasal airflow values. The duration of PER may induce a progressive impairment of the response to nasal decongestion test.

Persistent Allergic Rhinitis Includes Different Pathophysiologic Types

Allergy rhinitis is typically classified as seasonal allergy rhinitis (SAR) and perennial allergy rhinitis (PAR). More recently, the Allergic Rhinitis and its Impact on Asthma document proposed the intermittent (ITR) and persistent forms (PER). However, it has been previously reported that each single allergen may induce different clinical and pathophysiologic features. The aim of the study was to test the hypothesis that the type of causal allergen might characterize pathophysiologic differences in a cohort of patients with PER. Three hundred nineteen patients, sailors of the Italian Navy, with moderate-severe PER were prospectively and consecutively evaluated with clinical evaluation, skin prick test, rhinomanometry, and nasal decongestion test. Patients with pollen allergy showed significantly more severe symptoms, lower nasal airflow, and higher response to decongestion test than patients with allergy to perennial allergens (P < .0001). This study provides evidence that patients with PER may show different pathophysiologic patterns depending on the type of causal allergen.