Diagnosis Of Nasal Obstruction Research Articles

Obstructive sleep apnea due to nasal obstruction: a review of the literature

Ksenija Kuzborskaja-Riaukė1 1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lietuva Abstract Background. Obstructive sleep apnea (OSA) is a sleep disorder associated with episodic collapses of the upper airway during sleep. Risk factors include conditions leading to reduced pharyngeal radius and increased airway laxity. OSA can have a negative impact on a person’s quality of life, so timely diagnosis is essential. Aim: to identify and summarize the principles of diagnosis and treatment of obstructive sleep apnea due to nasal obstruction. Methods. The Google Scholar and PubMed databases were used for the literature review, with keywords and their combinations: “nasal obstruction”, “obstructive sleep apnea”, “allergic rhinitis”, “nasal surgery” in the regular and advanced search fields. Articles written in English were selected, with priority given to publications not older than 5 years. For this review, 45 articles were analysed and 34 were selected for the further analysis. Results. Endoscopic, rhinomanometric and polysomnographic examinations are used to diagnose nasal obstruction and obstructive sleep apnea. Endoscopy and rhinomanometry are used to differentiate the cause and severity of nasal obstruction, while polysomnography is used to diagnose and differentiate obstructive sleep apnea. Depending on the etiology of nasal obstruction, conservative and surgical methods are indicated. Conclusions. The diagnosis of nasal obstruction and OSA is based on risk factors, clinical symptoms and instrumental tests, the most common being endoscopic examination for nasal obstruction and polysomnography for obstructive sleep apnea. Conservative treatment isn‘t always effective and, depending on the etiology of nasal obstruction and OSA, surgical treatment is indicated. Keywords: nasal obstruction, obstructive sleep apnea, allergic rhinitis, nasal surgery. Full article https://doi.org/10.53453/ms.2023.2.5

A pilot study to determine the effects of nasal co-phenylcaine on drug-induced sleep endoscopy

PurposeThe use of nasal decongestant and nasal anaesthesia is currently not recommended during drug-induced sleep endoscopy (DISE) according to the European position paper. The evaluation of the effects of nasal decongestant/anaesthesia on DISE has not been performed before and our aim is to perform a pilot study to determine whether nasal decongestants/anaesthesia affects DISE outcomes.Methods27 patients undergoing DISE for OSA or for simple snoring were included. On each patient, DISE was performed twice, before and approximately 10 min after the administration of two puffs of co-phenylcaine nasal spray (lidocaine hydrochloride 5%, phenylephrine 0.5%, and benzalkonium chloride 0.01%) into each nostril. A nasal peak inspiratory flow was used for the objective assessment of nasal airway obstruction. During the first and the second DISE the loudness of the snoring was also recorded.ResultsChange in DISE total grading after nasal spray administration was not statistically significant. For the same grading, changes in percentage of contribution to collapse were not statistically significant. Sex, AHI, BMI, tonsils grade, presence of rhinitis, turbinate hypertrophy, nasal septal deviation, or nasal peak inspiratory flow limitation had no influence on the effect of nasal spray. Co-phenylcaine did not significantly influence the loudness of snoring.ConclusionsOur pilot study supports the use of co-phenylcaine nasal spray during DISE and the positive effects of the nasal spray do not influence the grading outcome. Importantly, the decongestant enhances the nasal assessment during DISE and potentially aids in the diagnosis of nasal obstruction while the nasal anaesthetic component may be beneficial by reducing nasal discomfort during DISE and thereby helping to reduce the total dose of intravenous anaesthetic administered. However, further studies on a larger population are needed to confirm our results.

Maxillary Hypoplasia: Differential Diagnosis of Nasal Obstruction in Infants.

Maxillary hypoplasia (MH) is a rare cause of respiratory dysfunction in infants and may occur in association with genetic abnormalities or as an isolated condition. It is included in the differential diagnosis of congenital nasal obstruction. This paper seeks to report a case series of infants with MH, discuss methods for its diagnosis, and compare computed tomography (CT) measurements of nasal cavities of infants with MH and without craniomaxillofacial abnormalities. The therapeutic approach in each patient is also described. All infants with MH admitted to a tertiary hospital between 2012 and 2015 were included. Baseline nasal endoscopy was performed at bedside. The width of the infants' nasal cavities was measured by a radiologist with experience in CT scanning of facial bones. Control patients were infants of matched sex and similar age who underwent head CT scanning for various reasons. Overall, 8 infants with MH and 8 controls were assessed. All nasal cavity dimensions of infants with MH were significantly smaller than those of control subjects. The authors conclude that the diagnosis of MH should be considered in infants with nasal obstruction and nasal cavity narrowing at nasal endoscopy.

Practical Use of Acoustic Rhinometry for Quantitative Assessment of Nasal Obstruction in an Allergic Model Using Macaque Monkeys

Nasal obstruction, a primary symptom of allergic rhinitis, results in breathing difficulties and decreases quality of life in patients. Quantitative methods are required for diagnosis of nasal obstruction to accurately assess drug efficacy, not only in patients but also in animal models. Acoustic rhinometry is a non-invasive technique to measure nasal airway patency using acoustic reflections. To date, little information on its application in non-human primates (NHP) has been accumulated. Macaque monkeys are a practical NHP model because of their high similarity with humans in their biomedical nature, including genomic and immunologic events and morphology. We established an allergic rhinitis model of cynomolgusmacaque (Macaca fascicularis) sensitized with Japanese cedar pollen and applied acoustic rhinometry to measure nasal congestion. The extent of nasal congestion followed by allergen challenge was successfully quantified as the minimal cross-sectional area (MCA) of the nasal passage for the first time in an NHP allergic model. We also applied this acoustic technique to evaluate the efficacy of an antihistamine drug, fexofenadine. The acoustic assessment achieved quantitative evaluation of the efficacy of fexofenadine on nasal congestion in a macaque allergic model.

Peak nasal inspiratory flow: a useful and handy tool for the diagnosis of nasal obstruction in the elderly

The global population is aging, with the over-65 age group expected to double in the USA by 2030. Three subcategories of elderly people have been identified: "young old" (from 65 to 74 years), "older old" (from 75 to 84) and "oldest old" (85 or more). Rhinosinusitis is a common disease that affects more than 31 million people in the USA every year. Nasal obstruction is one of the most common symptoms in patients affected by rhinosinusitis. An accurate nasal obstruction evaluation in the elderly is becoming of increasing interest for medical doctors, especially for geriatricians. Peak nasal inspiratory flow (PNIF) is a cheap and easy method for assessing nasal patency. The purpose of the study was to compare young old normal PNIF values with older old normal PNIF values. Charts relating PNIF normal values in the elderly with various explanatory variables have been provided. PNIF measurements were performed in 113 volunteers aged 65-84 years. One hundred and five of them fulfilled the study criteria and were self-reported healthy elderly. None of them complained of nasal symptoms. Data were statistically analyzed and figures and tables were produced relating PNIF to height, sex and age. PNIF values decreased with age (p = 0.0053) and were significantly lower in the "older old" sub-cohort than in the "young old" group (p = 0.007). Nasal obstruction in the elderly is a common problem and appropriate diagnosis and treatment are important for improving their quality of life. The measurement of PNIF could be useful in evaluating elderly patients who complain of nasal obstruction.

Congenital Inferior Turbinate Hypertrophy: An Unusual Cause of Neonatal Nasal Obstruction

To identify etiologies of congenital nasal obstruction and describe clinical practice patterns in the evaluation, diagnosis, and treatment of symptomatic infants.An electronic chart review from 1/1/2006–10/1/2016 for all patients with a diagnosis of nasal obstruction within the first six months of life using ICD-9 and 10 codes 478.19 and J34.89.A total of 34 patients were evaluated by the Division of Otolaryngology for this chief complaint. 38% of neonates were born premature and 32% were admitted to the NICU at birth, with a female-to-male ratio of 1:1.4. Presenting signs and symptoms included: stertor (44%), cyanosis (24%), stridor (24%), retractions (21%), rhinorrhea (21%), apnea (12%), and epistaxis (8%). 47% of patients received ancillary radiographic imaging (CT or MRI). Diagnoses observed include: midnasal stenosis (38%), pyriform aperture stenosis (21%), choanal stenosis (12%), dacryocystocele (6%), microrhinia (6%), septal deviation (6%), nasopharyngeal reflux (3%), nasopharyngeal teratoma (3%), neonatal rhinitis (3%), and pharyngeal wall collapse (3%). 71% of patients were noted to have bilateral nasal obstruction. 41% of infants were found to have an associated ear, nose, and throat anomaly. 15% of patients required surgical intervention. The mean time-to-resolution was 240 days.Congenital nasal obstruction has a broad differential diagnosis: the timing, onset, and laterality of symptoms can provide insights into the source of upper airway compromise. Most infants improve through conservative management (i.e. suctioning, humidification) and medical therapies (i.e. intranasal drops, nasal sprays).

Endoscopia nasossinusal associada à tomografia computadorizada dos seios paranasais no diagnóstico de obstrução nasal crônica

A obstrução nasal crônica é uma queixa comum na prática ambulatorial nos consultórios de otorrinolaringologia. O diagnóstico de obstrução nasal é fundamentado na história clínica, exame físico e exames complementares. Dentre estes, já é firmada na literatura atual a importância da endoscopia nasossinusal e da tomografia computadorizada. OBJETIVO: O objetivo desse trabalho se baseia em um estudo comparativo entre achados da endoscopia nasossinusal e da TC dos seios paranasais, dentro da propedêutica da investigação etiológica da obstrução nasal crônica, individualizando a importância de cada exame para conclusão diagnóstica. FORMA DE ESTUDO: Coorte histórica. MATERIAL E MÉTODO: Foram estudados 20 pacientes com queixa de obstrução nasal crônica, de idades entre 14 e 51 anos, do Serviço Ambulatorial de Otorrinolaringologia do Hospital Nossa Senhora de Lourdes, São Paulo, capital, em um estudo clínico retrospectivo, realizado através de revisão de prontuários de pacientes atendidos de 2002 a 2004. Todos os pacientes apresentavam queixa de obstrução nasal crônica. RESULTADO: Dos 20 pacientes, 10 (50%) apresentavam queixas alérgicas associadas. Em 16 dos 20 pacientes (80%) foi encontrada hipertrofia de cornetos evidenciada pela nasofibroscopia; em apenas 9 dos 20 pacientes (45%) foi encontrada a mesma alteração à TC. Com base nos resultados apresentados, o achado de hipertrofia de cornetos foi mais evidenciado à nasofibroscopia que à TC (80% X 45%). Dois casos de polipose nasal foram evidenciados à nasofibroscopia não sendo à TC, além de dois outros casos onde não foram observadas alterações à TC, sendo estas verificadas à nasofibroscopia, ou seja, TC normal com alterações à nasofibroscopia. CONCLUSÃO: Assim, diante do estudo apresentado e dos resultados obtidos pôde-se observar que, em âmbito das fossas nasais, os achados obtidos pela endoscopia nasossinusal foram mais conclusivos na elucidação diagnóstica do que os obtidos através da tomografia computadorizada dos seios paranasais.

Nasal endoscopy associated with paranasal sinus computerized tomography scan in the diagnosis of chronic nasal obstruction

SummaryChronic nasal obstruction is a common complaint in Otolaryngology outpatients. The diagnosis of nasal obstruction is based on the clinical history, physical examination and diagnostic procedures. Among these, it is already established in the current literature the importance of nasal endoscopy and computer tomography scan. Aim: The objective of this research study was based on a comparative study among findings of nasal endoscopy and CT scan of the paranasal sinuses, within the examinations for etiological investigation in chronic nasal obstruction, individualizing the importance of each exam for a conclusive diagnosis. Study design: Historic cohort. Material and Method: Twenty patients with chronic nasal obstruction complaints were studied, aged between 14 and 51 years old in the Otolaryngology outpatient unit at Nossa Senhora de Lourdes Hospital, Sao Paulo. It is a retrospective clinical study, carried out by revision of medical charts of assisted patients from 2002 to 2004. Results: All the patients presented complaints of chronic nasal obstruction. In the 20 patients, 10 (50%) presented associated allergic complaints. In 16 out of 20 (80%), patients presented hypertrophic concha evidenced by nasal endoscopy; in only 9 out of 20 (45%) patients we found the same affection as in the CT scan. Based on the presented results, the finding of hypertrophic concha was more evidenced in nasal endoscopy compared to CT (80% X 45%). Two cases of nasal polyposis were evidenced in nasal endoscopy but not in CT, besides two other cases without detection in the CT, but detected by nasal endoscopy, in other words, normal CT with abnormal nasal endoscopy. Conclusion: Thus, the presented study and the results of nasal fossa findings obtained by nasal endoscopy were more conclusive in the elucidation of diagnosis than those obtained by computer tomography of the paranasal sinus.

鼻腔通気度検査についてのアンケート調査結果

Information on rhinomanometry was obtained through questionnaires send to 2, 191 otorhinolaryngologist in the Japan Rhinologic Society June 1, 2000 with answers from 1, 236 within 1 month -a 56.4% response. About half have rhinomanometers in their hospital or clinic. Though many use the rhinomanometer as a clinical test, 17.0% of them did not. They mainly conducted rhinomanometry in patients with allergic rhinitis, chronic sinusitis, hypertrophic rhinitis, septal deviation, nasal polyposis, and sleep apnea. They also used it to assess nasal airway resistance in patients who reporting nasal obstruction but whose rhinoscopic findings were almost normal. Rhinomanometry was used for clinical evaluation of nasal obstruction both in surgical and in conservative treatment of nasal disease. The period between the diagnosis of nasal disease and surgical treatment was over 1 month for 81.6% of doctors. Moreover 93.5% answered that rhinomanometry must be done over 1 month after the surgery. Eighty three per cent of the doctors considered that rhinomanometry was useful in the diagnosis of nasal obstruction. These results strongly suggest that rhinomanometry is essential for otorhinolaryngologist in clinical evaluation of nasal obstruction associated with many nasal diseases.

Nasal fossa dimensions in normal and nasally obstructed neonates and infants: preliminary study

Computed tomography (CT) is a valuable imaging tool in the examination of neonates and infants with nasal obstruction. At present, however, it is difficult to quantitatively evaluate the nasal fossa with CT as normative data and the relative significance of individual nasal fossa dimensions have not been established. A standardized CT image was proposed, and performed on a prospective cohort of 56 infants up to 1 year of age. A parental questionnaire was used to identify infants with nasal obstruction. Normative data for four nasal fossa dimensions are presented and analyzed. The statistical validity of these dimensions in the diagnosis of nasal obstruction was examined; only the maximal posterior bony diameter showed a significant difference between normal and nasally obstructed infants ( t-test, P = 0.05). Examples of CT findings in the above-mentioned cases as well as past cases of ‘choanal stenosis’ are demonstrated.

Rhinomanometry and Diagnosis of Nasal Obstruction

Rhinomanometry and Diagnosis of Nasal Obstruction

RHINITIS: A NASOGRAPHIC STUDY: PRELIMINARY REPORT

A simple accurate method for quantitative study of nasal patency has long been desired by clinicians and rhinologic research workers. The idea of breathing through nasal passages directly onto a previously cooled mirror or metal surface was introduced in 1889 by Zwaardemaker. 1 He later reported use of his metal mirror as an aid in diagnosis of nasal obstruction. In 1895 Kayser, 2 after using same technic, published his work on the exact measurement of nasal air passages. These measurements were derived from size and shape taken by moisture deposited on metal mirror. In 1904 Glatzel 3 modified mirror by adding two curved lines to aid in determining degree of nasal patency. In 1915 Cocks 4 added some straight lines to this modified mirror and attempted to measure more accurately nasal conditions before and after operations by conformity of moisture deposits