External Nasal Dilator Research Articles

Mandibular Advancement vs Combined Airway and Positional Therapy for Snoring

Approximately 150 million individuals in the US snore in the absence of obstructive sleep apnea (primary snoring), but few studies have examined the efficacy of treatments for snoring or evaluated the effect of snoring in sleeping partners. To evaluate the efficacy of 2 treatments for primary snoring. This pilot randomized clinical trial that included a convenience sample of people who snore without sleep apnea and their sleeping partner who underwent 4 weeks of snoring treatment was conducted at an academic medical center between October 3, 2022, and July 3, 2023. Fifty couples were randomized to either use a mandibular advancement device (MAD) or receive combined airway and positional therapy (CAPT; external nasal dilator, nasal saline lavage with mometasone, mouth taping, and lateral positional therapy). Percentage of sleeping partners who reported that their partner's snoring was either very much improved or much improved (responder) on the Clinical Global Impression of Improvement scale. A total of 42 dyads completed the study; 23 (55%) were randomized to MAD and 19 (45%) to CAPT. Among people who snore, 26 (62%) were female, and the mean (SD) age was 48 (14) years. Of 23 dyads randomized to MAD, 21 people who snore (91%) were rated by the sleeping partner as a responder, while 11 of the 19 dyads (58%) randomized to CAPT were rated by the sleeping partner as responder, resulting in a difference of 33 percentage points (95% CI, 8-58) and a number needed to treat of 3. Of the 10 participants who were withdrawn, 4 were withdrawn due to adverse effects of the treatment that were evenly distributed between the MAD (n = 2) and CAPT (n = 2) groups. The results of this randomized clinical trial showed that the MAD may be more effective than CAPT for treating primary snoring, while both treatment options were found to reduce primary snoring. Physicians should have a patient-centered discussion to determine which treatment is best for individual patients with primary snoring, weighing convenience, adverse effects, and cost as factors. ClinicalTrials.gov Identifier: NCT05756647.

External nasal dilator decreases N95 respirator-related respiratory effort and symptoms in gastrointestinal endoscopy unit staff.

Background and study aims N95-filtering facepiece respirators (FFR) use is associated with physiological changes and symptoms due to impaired nasal airflow and increased breathing resistance. We prospectively studied the effect of using an external nasal dilator (END) in gastroenterology laboratory (gastrointestinal lab) staff using N95FFR. Patients and methods N95FFR qualitative saccharine fit testing was performed on study participants with and without an END. Prospective data collection and comparisons included: 1) survey of perceived symptoms and difficulty of performing one day of gastrointestinal procedures with N95FFR and 1 day of gastrointestinal procedures with END plus N95FFR in random sequence; and 2) vitals and respiratory belt plethysmography in ten gastroenterologists performing simulated colonoscopy while wearing a surgical mask (SM), N95FFR plus SM, END plus N95FFR plus SM for 20 minutes each in random sequence and rapid succession. Results Twenty-nine of 31 participants passed the N95FFR and the END plus N95FFR fit test. Twenty-two participants (12 physicians; 11 males; mean age 44.1 years, range 31–61) performed 1 day of gastrointestinal procedures with an N95FFR and 1 day of gastrointestinal procedures with an END plus N95FFR. Significantly less difficulty with nasal breathing and severity of symptoms including breathing difficulty, headache, fatigue and frustration, occurred while using an END plus N95FFR. Respiratory plethysmography peak-to-trough measurement showed an increase during the N95FFR stage compared to the END plus N95FFR stage and the SM stage. Conclusions N95FFR related respiratory changes and symptom development may be mitigated by END use.

PREVALENCE OF EXTERNAL AND/OR INTERNAL NASAL VALVE INSUFFICIENCY IN PATIENTS WITH PRIMARY SNORING AND OBSTRUCTIVE SLEEP APNEA

Introduction: Nasal valve insufficiency is a distinct cause of symptomatic nasal obstruction. The nasal valve has been described as the cross-sectional area with greater resistance to the respiratory-inspiratory flow of the entire respiratory system. This subject is of scientific and academic importance, because it is an original contribution to the aid in the treatment of snoring, considering that nasal valve insufficiency is one of the causes of symptomatic nasal obstruction. This nasal alteration has gained special attention from specialists in the evaluation of the symptomatology of patients with snoring and Obstructive Sleep Apnea Syndrome. Objective: This was a prospective, quantitative, observational, and interventionist study, with the objectives of evaluating the frequency of this alteration and confirming the momentary improvement of this signal with the use of an external nasal dilator device. Methods: Thirty-one patients who sought care at the IPO Hospital (Curitiba/PR, Brazil) participated in this study to evaluate the symptoms of snoring. Patients with snoring symptoms, with no predilection for ethnicity and sex, age 18 years or older, were included. The study was conducted from October to November 2019, by means of detailed anamnesis. Results: A high prevalence of nasal valve insufficiency was identified in the analyzed patients.

Safety and Efficacy of External Nasal Dilator Strips with N95 Respirator Masks by Emergency Department Personnel.

INTRODUCTIONThe coronavirus disease 2019 (COVID-19) pandemic has prompted increased use of personal protective equipment (PPE) to maintain the health and safety of caregivers. This study was conducted in 2020 to evaluate the safety and efficacy of external nasal dilator strips (ENDS) coupled with N95 respirators in a sample of community hospital emergency department personnel.METHODSAfter obtaining written consent, the authors tested participants’ response to exercise (i.e., walking up 10 flights of stairs) while wearing an N95 respirator, both with and without an ENDS. The authors measured participants’ heart rate and respiratory effort responses over four minutes following their exercise trial. A convenience sample of these personnel also repeated their respirator fit testing while wearing an ENDS with the N95 style they had previously been fitted for.RESULTSA total of N = 50 participants were enrolled. Peak heart rate while wearing an ENDS was 125 beats per minute (BPM) with the ENDS versus 130 BPM without (p = 0.21). The Borg Exertion Score while wearing an ENDS peaked at 13 with the ENDS versus 14 without (p = 0.08). However, when subjects were surveyed before and after the trial upon whether they would consider using an ENDS beneath their N95 using a scale of 1-5, their interest in this significantly increased (p = 0.004). Four of the 13 (31%) participants who completed repeated fit testing while wearing the ENDS beneath their N95 respirator failed the repeat testing.CONCLUSIONSThese results first suggest that a sizable proportion of ED personnel may fail N95 fit testing while wearing an ENDS beneath the N95 mask for which they had been previously fitted. Although providers’ subjective interest in use of ENDS increased, these results also demonstrate that use of an ENDS beneath an N95 respirator may not significantly increase exercise tolerance.

Nasal function and cardio-respiratory capacity of adolescent with external nasal dilator

Backgroundthe external nasal dilator (END) has been employed for the purpose of aiding sporting performance. The objective of this study was to evaluate nasal function and cardio-respiratory capacity in healthy adolescent athletes using the END. Methodsdouble-blind, crossover clinical trial in which adolescents were evaluated while using the experimental and placebo END during physical exercise. Values for peak nasal inspiratory flow (PNIF), nasal resistance (NR) and maximal oxygen uptake (VO2max) were obtained in randomized order. Additionally, the rating of perceived exertion (RPE) after the cardio-respiratory test was assessed. Resultsfor the 71 adolescents evaluated, the use of the experimental END, compared to the placebo, produced a significant improvement in values of PNIF (177.4 ± 20.9 L/min and 172.8 ± 20.2 L/min) (p = 0.020), NR (0.24 ± 0.16 and 0.27 ± 0.16) (p = 0.007), VO2max. (39.5 ± 5.2 mL/kg. min-1 and 37.5 ± 5.2 mL/kg. min-1) (p < 0.001) and RPE (6.0 ± 2.2 and 5.5 ± 2.4) (p < 0.001), respectively. Conclusionthe END reduced NR, increased PNIF and improved VO2max. In addition, it improved RPE after the maximal cardio-respiratory test. The use of the END can significantly improve nasal function, increase cardio-respiratory capacity and reduce rating of perceived exertion during a maximal test involving adolescent athletes.

Does the external nasal dilator strip help in sports activity? A systematic review and meta-analysis.

Numerous studies have shown that the external nasal dilator (END) increases the cross sectional area of the nasal valve, thereby reducing nasal resistance, transnasal inspiratory pressure, stabilizing the lateral nasal vestibule, and preventing its collapse during final inhalation. Our objective was to carry out a systematic review of the literature and meta-analysis on the effects of the END during physical exercise. After selecting articles in the PubMed, Cochrane Library and EMBASE databases, 624 studies were identified. However, after applying the inclusion and exclusion criteria, 19 articles were considered eligible for review. Those studies included in the meta-analysis, the maximal oxygen uptake (VO2max.) outcome was assessed in 168 participants in which no statistically significant difference was found, MD (95% CI) = 0.86 [- 0.43, 2.15], p = 0.19, and I2 = 0%. The heart rate (HR) outcome was assessed in 138 participants in which no statistically significant difference was found, MD (95% CI) = 0.02 [- 3.19, 3.22], p = 0.99, and I2 = 0%. The rating of perceived exertion (RPE) outcome was assessed in 92 participants in which no statistically significant difference was found, MD (95% CI) = - 0.12 [- 0.52, 0.28], p = 0.56, and I2 = 27%. The external nasal dilator strip showed no improvement in VO2max., HR and RPE outcomes in healthy individuals during exercise.

외비확장구(ENDS) 부착 전후 비강 모델에 대한 전산유동해석

외비확장구(ENDS)는 코호흡 시 코막힘을 개선하기 위해 고안된 의료기기이다. ENDS를 착용하면 비강의 최소 단면적 부위를 확장시켜 비저항을 감소시킨다고 알려져 있고, 코골이나 수면무호흡증에도 효과가 있다는 보고도 있다. 비강의 해부학적 형상 변화는 비강 내 공기 유동에 변화를 가져오며, 이는 비강의 생리학적 기능들에 영향을 미치게 될 것이다. 본 논문에서는 ENDS부착 전후에 촬영된 환자의 CT데이터로부터 컴퓨터 비강모델을 제작하고, 이 모델들에 대한 전산수치해석을 수행하여 ENDS의 효과를 객관적으로 증명하는 방법론을 확립하려 한다. 이 방법론을 최초로 한국인 코막힘 환자에게 적용한 결과, 비저항의 감소와 좌우 비강 유동의 배분이 개선되었음을 알 수 있었다. 이전의 예측결과들과 달리 보다 넓은 범위의 비강 내 단면적 증가를 확인할 수 있었다.

The role of an internal nasal dilator in athletes.

The nasal valve area has the minimal cross-sectional area of the upper airways. Nasal dilators have been found able to improve sport performance in athletes. The aim of this study was to investigate whether the use an internal nasal dilator may be able to affect respiratory pattern in a group of athletes. The use of internal nasal dilator induced a significant reduction of fatigue perception (p=0.000) and was optimally accepted. In conclusion, the present study demonstrates that Nas-air® is an internal nasal dilator able to reduce the fatigue perception and is preferred to external nasal dilator. (www.actabiomedica.it)

Effect of the external nasal dilator on adolescent athleteswith and without allergic rhinitis

ObjectivesThe ability to effectively breathe through the nose is an important component of physical exercise. The goal of this study is to evaluate the effect of the external nasal dilator (END) on healthy adolescent athletes and those with allergic rhinitis. MethodsClinical trial, double-blind, crossover, in which we evaluated healthy adolescent athletes with allergic rhinitis, using experimental and placebo ENDs, submitted to a maximum cardio-respiratory test in randomized order. Predicted values for peak nasal inspiratory flow (PNIF%) and nasal resistance (NR) were obtained, and the rating of perceived exertion (RPE) was also assessed after the race test. Results65 adolescents participated in the study, 30 of whom had allergic rhinitis. The use of experimental ENDs demonstrated a statistically significant improvement in peak nasal inspiratory flow values (predicted %), nasal resistance, maximal oxygen uptake value (VO2Max.) and rating of perceived exertion, both in the healthy group and the one with allergic rhinitis. ConclusionResults suggested that END reduces nasal resistance, improves maximal oxygen uptake and rating of perceived exertion after a maximum cardio-respiratory test on healthy adolescents and those with allergic rhinitis.

Breathing parameters associated to two different external nasal dilator strips in endurance athletes

ObjectiveThe aim of the study was to investigate and compare the effects of two different external nasal dilator strips (ENDS) on nasal respiratory flow, maximal oxygen uptake (VO2max), nasal VO2max, time to exhaustion and subjective nasal obstruction in adult triathletes participating in exhaustive, controlled physical exercise tests. MethodsThirteen healthy triathletes without nasal symptoms were recruited and randomly tested in three different conditions: without ENDS, wearing the Breathe Right® dilator strip and wearing the Master-aid Roll-flex® strip. We investigated the variations in the peak nasal inspiratory flow (PNIF) and the Nasal Obstruction Symptom Evaluation questionnaire before and after an exhaustive treadmill test. VO2max, nasal VO2max, time to exhaustion, total time of nasal respiration values were also registered and compared. ResultsPost-exercise PNIF was higher than the pre-exercise PNIF. Pre-exercise PNIF was higher in athletes wearing the Master-aid Roll-Flex® than in those wearing the Breathe Right® strips; no differences in post-exercise PNIF values were found in the three different conditions. Nasal VO2max value was higher when both types of ENDS were worn. Nasal respiration time to exhaustion was longer when the athletes were wearing either type of ENDS. Both ENDS gave a better sensation of nasal airflow passage after physical exercise. ConclusionENDS had similar effects, improving the subjective sensation of nasal patency, the nasal respiration time, and the nasal VO2max, anyway Master-aid Roll-flex® is more economic than the Breathe Right® and it can be cut to fit the nasal anatomy.As ENDS affect the cross-sectional area, especially at the level of the nasal valve, in future studies should be conducted also by means of acoustic rhinometry in order to evaluate if any difference could be find at this level when wearing either one of the two ENDS.

Neither internal nor external nasal dilation improves cycling 20-km time trial performance.

Research is equivocal regarding endurance performance benefits of external nasal dilators, and currently research focusing on internal nasal dilators is non-existent. Both devices are used within competitive cycling. This study examined the influence of external and internal nasal dilation on cycling economy of motion and 20-km time trial performance. The study utilized a randomized, counterbalanced cross-over design. Fifteen trained cyclists completed three exercise sessions consisting of a 15min standardized warm up and 20-km cycling time trial while wearing either a Breathe Right® external nasal dilator, Turbine® internal nasal dilator or no device (control). During the warm up, heart rate, ratings of perceived exertion and dyspnea and expired gases were collected. During the time trial, heart rate, perceived exertion, and dyspnea were collected at 4-km intervals and mean 20-km power output was recorded. No differences were observed for mean 20-km power output between the internal (270±45W) or external dilator (271±44W) and control (272±44W). No differences in the economy of motion were observed throughout the 15-min warm up between conditions. The Turbine® and Breathe Right® nasal dilators are ineffective at enhancing 20-km cycling time trial performance.

A phase IV, single-center, crossover evaluation of the efficacy of an external nasal dilator strip in children with nasal congestion

In the United States and other countries, external nasal dilator strips have been marketed for use by adults and by children ages 5-12 years to improve nasal airflow and provide temporary relief from nasal congestion and stuffiness. The objectives of this exploratory analysis were to assess and correlate objective and subjective measures of efficacy of two nasal strips variants, Kids and adult small/medium (Regular), in children with nasal congestion. The correlation of efficacy for each variant to nose dimensions and age was also explored. In a single-center, crossover study, peak nasal inspiratory flow (PNIF) was measured in 40 children with nasal congestion ages 5-12 years before and after application of the nasal strips. Spearman correlations were calculated between objective and subjective measures of efficacy and between efficacy measures, nose dimensions, and age. In the 40 patients who completed the study, both the Kids and the Regular nasal strips worked well and improved the PNIF by 15% (supine position) to 22% (seated position) over baseline. No statistically significant differences in efficacy were found between the two variants of nasal dilator strips. Use of both the Kids and Regular nasal strips significantly improved the PNIF from baseline in children with nasal congestion, and no new safety signals were observed. There was a slight subjective preference for the Kids nasal strips by the younger children, which indicated that children with smaller noses preferred the Kids nasal strips instead of the larger Regular nasal strips. Clinical trial NCT02113449, www.clinicaltrials.gov.

Efficiency of external nasal dilators in pediatric nasal septal deviation

InroductionNasal septal deviation results from irregular development of the nasomaxillary complex and trauma. Treatment of nasal septal deviation in pediatric patients is one of the biggest challenges in rhinology. Surgery may alter craniofacial growth patterns, and so it may be indicated only in the selected cases. The use of external nasal dilators is a relatively new treatment modality in nasal obstruction. ObjectiveThis study was performed to assess the efficacy of external nasal dilator in pediatric nasal septal deviation patients. MethodsSeventy-six children who were diagnosed with nasal septal deviation at our outpatient clinic were included in the study. The patients were divided into 2 groups: the external nasal dilator group was composed of 48 children that had used an external nasal dilator for at least 1 month and still been using, while the control group was comprised of 28 children that had not received any treatment and had not used an external nasal dilator. The parents of the children were asked to complete the obstructive sleep apnea 18 questionnaire. In addition, the external nasal dilator group was asked to complete the questionnaire after stopping external nasal dilator use for 2 weeks and the control group also repeated the obstructive sleep apnea 18 questionnaire. ResultsThe obstructive sleep apnea 18 questionnaire results were significantly different between the external nasal dilator group and the control group at the beginning of the study (i.e., when patients in the external nasal dilator group were still using their dilators, P=0.000). On the other hand, there was no difference between the 2 groups after the patients in the external nasal dilator group had stopped using their external nasal dilator (P=0.670). ConclusionExternal nasal dilator use relieved nasal septal deviation, which narrows the nasal valve. The results of this study suggest that external nasal dilator could be used in patients that are not candidates for septoplasty.

Evaluation of the effectiveness of the external nasal dilator strip in adolescent athletes: A randomized trial

ObjectivesEvaluate the cardio-respiratory capacity (VO2max.) and peak nasal inspiratory flow (PNIF) of healthy adolescent athletes with experimental and placebo external nasal dilator strips (ENDS). Methods48 healthy adolescent athletes between the ages of 11 and 15 were evaluated and submitted to a cardio-respiratory 1000m race in randomized order. The participants had peak nasal inspiratory flow (PNIF) values measured using the In-check-inspiratory flow meter. Dyspnea intensity was evaluated after a 1000m test race using a labeled visual analog scale for dyspnea. ResultsIn relation to VO2max., when the participants used the experimental ENDS, significantly higher means were noted than when the placebo was used (53.0±4.2mL/kgmin−1 and 51.2±5.5mL/kgmin−1, respectively) (p<0.05). In relation to PNIF, there was a statistically significant difference between the experimental and placebo ENDS result, that being, 123±38L/min and 116±38L/min, respectively (p<0.05). The dyspnea perceived by the participants was representatively lesser in the experimental ENDS condition compared to the placebo after the cardio-respiratory test (p<0.05). ConclusionsThe results suggest that the ENDS improve maximal oxygen uptake, nasal patency and respiratory effort in healthy adolescent athletes after submaximal exercise.

Use of the Breathe Right External Nasal Dilator Strip as Temporary Eyelid Splint

Department of Ophthalmology, Methodist Eye Associates, The Methodist Hospital, Houston, TX Financial disclosures/conflicts of interest: None reported.

Relationship between Nasal Valve Changes and Nasalance of the Voice

It is well known that the nasal cavity and paranasal sinuses affect the acoustic characteristics of the voice as resonators. Any expansion in nasal valve area, the narrowest segment of the nasal cavity, affects the nasal resistance and therefore has the potential to alter the nasalance. The aim of this study was to investigate the effect of nasal valve changes on nasalance of the voice by using an external nasal dilator strip that widens the nasal valve area. Before-and-after study. Tertiary university hospital. Healthy volunteer subjects who had no nasal or voice-related complaints were enrolled in the study. All subjects underwent acoustic rhinometry and nasometry before and while wearing a commercially available external nasal dilator strip. The data with and without the nasal strip were compared. Twenty-five subjects were enrolled in the study. After the application of nasal strips, statistically significant increases were observed in the minimal cross-sectional area of the nasal valve. However, there were no significant changes in the nasalance measurements. Despite increasing the nasal valve area, application of the nasal strips did not cause any significant change in nasalance scores in healthy subjects, showing no relationship between the nasal valve and nasalance of the voice.

Acoustic Rhinometry: Impact of External Nasal Dilator on the Two First Notches of the Rhinogram

Acoustic rhinometry is more accurate in the anterior portion of the nasal cavities, from the nostril to the nasal valve (NV), the most important site of nasal obstruction. Literature presents different opinions regarding the anatomical correlation of the two notches at the beginning of the rhinogram curve in normal adult white individuals. The aim of this study was to present new data for a better understanding of the anatomic correlation of these two notches. This prospective study included 32 nasal cavities under the following conditions: (1) basal condition, (2) with external nasal dilator strip (ENDS), (3) after decongestion (0.05% oxymetazoline chloride applied as an aerosol spray), and (4) after decongestion with ENDS. No statistically significant variation was observed in the cross-sectional area of the first notch (CSA1) after decongestion. However, there was a statistically significant increase in the CSA2 after ENDS. Analysis of the results suggested that the first notch of the rhinogram refers to the nostril and the second notch refers to the NV as a whole. This study was part of the clinical trial NCT01411969 registered at http://www.clinicaltrials.gov.

Relationship between Nasal Valve Changes and Nasalance of the Voice

Objective: Investigate the effect of nasal valve changes on nasalance of the voice by using an external nasal dilator strip that widens the nasal valve area. Method: Healthy volunteers who had normal nasal and laryngeal findings were enrolled into the study. All volunteers received acoustic rhinometry and nasometry before and while wearing a commercially available external nasal dilator strip. The data with and without nasal strip were compared. Results: Twenty-five subjects were enrolled into the study. After application of the nasal strips, statistically significant increases were observed in the minimal cross-sectional area of the nasal valve. However, there were no significant changes in nasalance measurements. Conclusion: Despite increasing the nasal valve area, application of nasal strips did not cause a significant change in nasalance scores, showing no relationship between the nasal valve changes and nasalance of the voice.

The Effect of an Adhesive External Nasal Dilator Strip on the Inspiratory Nasal Airflow

We studied the affect of an adhesive external nasal dilator strip (ENDS) on the inspiratory nasal airflow. A prospective study was performed. Twenty-two healthy volunteers were enrolled in the study. All volunteers analyzed the inspiratory nasal sound samples before and while wearing a commercially available ENDS. This nasal sound analysis includes the spectral analysis and average sound intensities in low frequency (Lf), medium frequency (Mf), and high frequency (Hf). In the sound analyses, an increase was found in sound intensity at Hf when the nasal strips were not worn whereas a decrease was found in sound intensity at Hf when the nasal strips were on. Changes in the nasal geometry of the anterior part of the nose by wearing nasal strips affects the pattern of nasal airflow and transforms it into a laminar pattern.

Breathe Right® External Nasal Dilator Strips As An Ergogenic Aid To Exercise

PURPOSE: Having the ability to breathe easily through the nose is an important part of exercising. The nose effectively warms and humidifies incoming air to better suit the bodies needs. It is known that having difficulty breathing through the nose can negatively affect exercise performance. METHODS: The purpose of this study is to investigate the effects of the Breath Right® external nasal dilator strip on exercise performance at 80% of an individual's VO2 max. Eighteen people participated in the study. Subjects signed an informed consent, PAR-Q, additional questionnaire, and rated their ease of breathing through their nose on a 1 to 10 scale prior to testing. Testing was performed in the Human Performance Laboratory at the University of Louisiana at Monroe. Subjects VO2 max was measured using open spirometry on a treadmill ergometer. On two separate occasions participants returned to the laboratory for a treadmill run at 80% of the subjects predetermined VO2 max; once with the nasal dilator strip and once with a placebo. Heart rate (HR), Borg‘s Rate of Perceived Exertion (RPE), and time to exhaustion were measured. Statistical analysis was conducted using SPSS 14.0. Significance level was preset at p<.05. RESULTS: A significant difference was found in the time to exhaustion between runs with the Breathe Right® strip vs. runs with the placebo strip. No significant difference in HR or RPE was found between runs with the Breathe Right® strip vs. runs with the placebo strip. CONCLUSIONS: Prior data shows mixed results when testing at a high percentage of VO2 max. This study provides further support that Breath Right® strips may have an ergogenic effect on aerobic exercise performance.