Mean Minimal Cross-sectional Area Research Articles

Impact of different fracture types in the pyriform buttress area on nasal airway function

IntroductionFractures in the pyriform buttress area adversely affect facial appearance and nasal airway patency. Nasal airway function has received less attention than aesthetic problems in the literature. This retrospective study classified the different fracture types in this area and determined their impact on nasal airway function.MathodsThree-dimensional computed tomography images of patients with fractures in the pyriform buttress area were analyzed to identify the exact fracture pattern. The nasal airway functions were evaluated and compared between patients with different fracture patterns using acoustic rhinometry, rhinomanometry, and the nasal obstruction symptom evaluation scale.Results Overall, 47 patients, including 16 with type I fractures (high fracture line; group I), 16 with type II fractures (intermediate fracture line; group II), and 15 with type III fractures (low fracture line; group III), were included in the study. The mean minimal cross-sectional area (MCA), total nasal inspiratory resistance (Tri) and total nasal expiratory resistance (Tre) of group I were 0.51 ± 0.06 cm2, 1.67 ± 0.11 kPa L−1 s−1, and 1.66 ± 0.12 kPa L−1 s−1, respectively; those of group II were 0.48 ± 0.07 cm2, 1.89 ± 0.15 kPa L−1 s−1, and 1.88 ± 0.14 kPa L−1 s−1, respectively; and those of group III were 0.36 ± 0.04 cm2, 1.94 ± 0.21 kPa L−1 s−1, and 2.01 ± 0.34 kPa L−1 s−1, respectively. The nasal obstruction symptom evaluation (NOSE) scale scores for groups I, II, and III were 7.188, 9.813, and 13.27, respectively.Conclusion Therefore, the severity of the nasal airway obstruction depends on the displacement of the fractured bones in patients with fractures in the pyriform buttress area. The most profound nasal obstruction occurs in patients with the lowest fracture line.

Effectiveness of out-fracture of the inferior turbinate with reduction nasal bone fracture.

The nasal bone, being the most protruding bone in the center of the facial bones, is particularly susceptible to damage. Nasal bone fractures can often result in secondary deformation and dysfunction of the nose, including septal fractures. Studies on functional or intra-nasal complications have been rarely reported after nasal bone fracture reduction. To evaluate the severity of nasal obstruction and its improvement following nasal bone fracture reduction using inferior turbinoplasty. We conducted a retrospective review of data from 50 patients with symptomatic nasal obstruction between January to December 2010. All patients underwent preoperative Computed tomography evaluation, and symptom changes and nasal cavity volume were analyzed using a visual analog scale and acoustic rhinometry before and after surgery. Closed reduction and out-fracture of both inferior turbinates performed by the same surgeon. Treatment outcomes were assessed by comparing changes in the nasal airway volume measured using acoustic rhinometry before and after surgery. The minimal cross-sectional area (MCA) was also analyzed based on the Stranc classification. Before reduction, the mean MCA for all cases was 0.59 ± 0.06 cm2, which represented an 11% decrease compared to the average size of a Korean adult (0.65 ± 0.03 cm2). The MCA for frontal impact was 0.60 ± 0.02 cm2 and for lateral impact, it was 0.58 ± 0.03 cm2. After reduction via inferior turbinoplasty, the MCA improved to 0.64 ± 0.04 cm2. This study suggests that turbinoplasty is helpful in addressing nasal obstruction. Out-fracture of the inferior turbinate is an effective and durable technique that can be easily performed to enlarge the nasal airway with minimal morbidity.

The effect of steam inhalation on nasal obstruction in patients with allergic rhinitis.

Nasal obstruction is often impact on quality of life in allergic rhinitis (AR). The steam inhalation is one of widely used home remedies to soothe and open the nasal passages. Furthermore, steam inhalation may provide change in objective nasal airway assessment. To compare the effect of steam inhalation on nasal obstruction between patients with AR and normal individuals, as well as the change in the cross-sectional area of the nasal cavity and in nasal airway resistance (NAR) between 2 groups. A prospective comparative, parallel group study was conducted in AR and normal individuals. Steam with the temperature of 42-44°C was inhaled. Variables obtained before and after steam inhalation were compared. After steam inhalation, nasal symptom score, combined global symptoms, and Visual Analog scale (VAS) of combined global symptoms of AR patients showed statistically significant improvement. Whereas, normal individuals, there was statistically significant improvement only in sneezing and combined global symptoms. Meanwhile, the change of each measurement score, combined global symptoms, and VAS of the symptoms in those with AR were significantly higher than those of normal individuals. Total nasal airflow, NAR, volume, and mean minimal cross-sectional area of AR patients tended to better improve after steam inhalation. The steam inhalation significantly improved nasal obstruction in AR patients, but no statistical significant difference between both groups for any parameters. The different response between the 2 groups may be due to different nasal mucosa sensitivity to stimuli.

USEFULNESS OF VARIOUS DYNAMIC AND STATIC PARAMETERS IN SLEEP MRI STUDIES -DO THEIR INCORPORATION IN ROUTINE REPORTING IN PATIENTS WITH OBSTRUCTIVE SLEEPAPNEA PROVE VALUABLE ?

Background: Sleep MRI is a new emerging non invasive modality in the preoperative evaluation of patients with obstructive sleep apnoea. Rather than subjective, the aim of the study is to evaluate the competency of certain dynamic and static parameters (variables and diemensions), that can be used in day to day reporting. Incorporating such parameters, may prove to be helpful in guiding surgical decision making. Materials and Methods: A retrospective analytical study included 27 subjects with OSA aged between 18 and 70 years using 1.5 T MRI . We measured variables such as the cross-sectional area and diameter of the retropalatal and retroglossal airway during the asleep and awakened states.We also measured comprehensive airway dimensions such as antero-posterior diameter of the tongue, midline saggital diameter of tongue, intermandibular rami distance, mentum spine distance and relative size of the tongue using the spine as the posterior border of the bony confines. Results: 21 patients had significant retropalatal airway compromise, and was evidenced by statistically significant variables in awakened and asleep states. The mean minimum anterior–posterior diameter (mm) of retropalatal airway during respiratory cycle was statistically significant measuring 3.1±1.5 mm in awaken state and 1.1±1.5 mm during asleep state (p- value 0.01). The mean minimum cross sectional area during respiratory cycle was statistically significant measuring 98±11 mm2 in awaken state and 63 ±12 mm2 during asleep state (p- value 0.04). 6 patients had significant retroglossal airway compromise, and was evidenced by statistically significant. The thickness of the soft palate and the relative size of the tongue (0.5± 0.01mm) was statistically significant in these patients (p- value 0.01). Conclusion: Our study shows that retropalatal airway is a significant cause of obstruction in patients with OSA, compared with retroglossal airway. We suggest that, when the compromise of the retroplatine aiway is to be evaluated, variables such as cross sectional area and antero-posterior diameter of the retropalatal airway during the respiratory phase in asleep and awakened states proves valuable and dimensions such as soft palate thickness as tool for objective measurement of OSA. When the compromise of the retroglossal aiway is to be evaluated, the relative size of the tongue , proves offers more advantage than the variables of airway compromise such as area and antero-posterior diameter.To further evaluate if some of our parameters correlate with the outcomes of the surgeries of OSA, a multivariate analysis would have been required.

Endonasal measurements by acoustic rhinometry in children: A preliminary study

The acoustic reflection method (ARM) is a non-invasive technique which uses the reflection of acoustic waves to measure the cross sectional area of nasal cavities in adults and patency of endotracheal tubes. Characteristics and volume of normal nasal cavities in pre-school children has so far not been studied. ObjectiveThe aim of this study was to determine the optimal ARM recording and the minimal cross-sectional area (MCA) and volume (NV) values in healthy children. DesignProspective monocentric study using the ARM in pre-school children (<6 years of age). Results - DiscussionSeventy children (age 2 to 5) were included in the study. Reliable measures were difficult to obtain in children younger than 2 years of age. The use of a standard nosepiece and a single-use surgical filter enabled reliable, serial recordings. Mean MCA values were 0.46, 0.53 and 0.58 cm2 in the 24–35, 36–47 and 48-60 months-old age groups, respectively. Mean NV values were 2.14, 2.59, and 2.86 cm3 in the same age groups. The MCA and NV values were significantly correlated with height, age and weight.In conclusion, the ARM is feasible in children over the age of 2 and seems to be a promising non-invasive tool to study the nasal cavity patency, anatomy, and volume.

The Association between the Cross-Sectional Area of the Dural Sac and Low Back Pain in a Large Population: The Wakayama Spine Study.

ObjectiveThe purpose of this study was to evaluate the relations between the degree of encroachment, measured as the cross-sectional area of the dural sac, and low back pain in a large population.MethodsIn this cross-sectional study, data from 802 participants (247 men, 555 women; mean age, 63.5 years) were analyzed. The measurement of the cross-sectional area of the dural sac from the level of L1/2 to L4/5 was taken using axial T2-weighted images. The minimum cross-sectional area was defined as the cross-sectional area of the dural sac at the most constricted level in the examined spine. Participants were divided into three groups according to minimum cross-sectional area measurement quartiles (less than the first quartile, between the first and third quartiles, and greater than the third quartile). A multivariate logistic regression analysis was used to estimate the association between the minimum cross-sectional area and the prevalence of low back pain.ResultsThe mean minimum cross-sectional area was 117.3 mm2 (men: 114.4 mm2; women: 118.6 mm2). A logistic regression analysis adjusted for age, sex, body mass index, and other confounding factors, including disc degeneration, showed that a narrow minimum cross-sectional area (smaller than the first quartile) was significantly associated with low back pain (odds ratio, 1.78; 95% confidence interval, 1.13–2.80 compared to the wide minimum cross-sectional area group: minimum cross-sectional area greater than the third quartile measured).ConclusionThis study showed that a narrow dural sac cross-sectional area was significantly associated with the presence of low back pain after adjustment for age, sex, and body mass index. Further investigations that include additional radiographic findings and psychological factors will continue to elucidate the causes of low back pain.

Caudal septoplasty: efficacy of a surgical technique-preliminnary report

Although not being the most frequent nasal septal deviations, those of the caudal septum account for many complaints. The correction of such defects has always been the subject of much controversy, and several different operative techniques have been described. AimTo assess the efficacy of a surgical technique for correcting caudal septal deviations. Materials and MethodsProspective study with preliminary reports of 10 patients who answered a standardized, specific questionnaire (the Nasal Obstruction Symptom Evaluation, or NOSE), underwent acoustic rhinometry and had their noses photographed. Caudal deviations were then corrected through a surgical technique whereby the entire deviated portion is removed and a straight cartilage segment is placed between the medial crura of the alar cartilages, through a retrograde approach, to support the nasal tip. Sixty days after all patients were reassessed. ResultsAs for the NOSE questionnaire, mean pre-operative and post-operative scores were 82.39 and 7.39 respectively (p<0.001). Pre-operative acoustic rhinometry showed mean minimum crosssectional area (MCA) values of 0.352 and 0.431 cm2, whereas mean post-operative values were 0.657 and 0.711 cm2(p<0.0001). ConclusionsThe study results prove, both subjectively (patient satisfaction as measured with a standardized questionnaire) and objectively (acoustic rhinometry findings), that the proposed technique for correction of caudal septal deviation is safe and effective.

Nasal response in patients with diisocyanate asthma.

To date, no studies have assessed nasal and bronchial response to diisocyanates during specific inhalation challenges (SIC). This study was performed to assess nasal response during SIC with diisocyanates (nasal and oral breathing) in patients with suspected occupational asthma due to these agents. Fourteen patients with suspected clinical history of diisocyanate-induced asthma were challenged with diisocynates in a 7m3 chamber. Nasal response testing during challenges was assessed by acoustic rhinometry, peak nasal inspiratory flow (PNIF), and visual analog scale (VAS), alongside bronchial responses. Eleven patients had a significant asthmatic response to diisocyanates. None reported clear work-related nasal symptoms. In patients with positive bronchial response to diisocyanates, nasal mean minimal cross-sectional area (MCA) decreased by 26.9%, nasal volume at 5 cm decreased by 33.5%, and PNIF decreased by 28.3%, all from baseline. A positive nasal response was elicited in 45%, 54%, and 45% of patients, respectively. A significant increase in VAS was observed in 4 patients. Three patients with negative bronchial response had a negative nasal response. SIC revealed an objective nasal response in around 50% of patients with occupational asthma due to diisocyanates, in spite of the fact that none of them reported work-related nasal symptoms. The clinical significance of this finding is a poor association between nasal symptoms at work and an objective nasal response during positive SIC with diisocyanates.

Effects of Long-Duration Wearing of N95 Respirator and Surgical Facemask: A Pilot Study

The protection efficacy of facemasks and respirators has been well documented. The change of human nasal functions after wearing N95 respirator and surgical facemask is not known. In a parallel group study, we recruited 87 healthy healthcare workers. Each of the volunteers attended two sessions, and wore N95 respirator in session 1 (S1) and surgical facemask in session 2 (S2) for 3 hours. Mean minimum cross sectional area (mMCA) of the two nasal airways via acoustic rhinometry and nasal resistance via rhinomanometry were measured before and immediately after the mask wearing. Rhinomanometry was repeated every 30 minutes for 1.5 hours after the removal of masks. A questionnaire was distributed to each of the volunteers, during the 3 hours mask wearing period, to report subjective feelings on discomfort level of breathing activity. Among 77 volunteers who completed both the two sessions, the mean nasal resistance immediately increased upon the removal of surgical facemask and N95 respirator. The mean nasal resistance was significantly higher in S1 than S2 at 0.5 hour and 1.5 hours after removal of the masks (p<0.01). There is no statistical difference on mMCA before and after mask wearing in both sessions (p=0.85). The discomfort level was increasing with time while wearing masks, with significantly higher magnitude in S1 (p<0.001). There is an increase of nasal resistance upon removal of N95 respirator and surgical facemask potentially due to nasal physiological changes. N95 respirator caused higher post-wearing nasal resistance than surgical facemask with different recovering routines.

Autospreading Spring Flap Technique for Reconstruction of the Middle Vault

Reconstruction of the middle third of the nose is crucial and middle vault insufficiency is possible following dorsal reduction in a primary rhinoplasty unless additional surgical measures are taken. The aim of this study was to define a novel suturing technique autospreading spring flap for middle vault reconstruction by suturing only the medial aspect of both upper lateral cartilages with septal quadrangular cartilage in a unique mattress suture and to mimic the natural anatomical configuration of the upper lateral and septal cartilages. This technique is intended to create functionality with aesthetic dorsal lines. Fifteen volunteers with a significant osseocartilaginous dorsal hump underwent open rhinoplasty. The middle vault was reestablished using the ASSF technique that appositions only the medial part of the upper lateral cartilages and suturing it to the dorsal septal cartilage. Appearance of the nose before and after the operation was evaluated by the patients using a visual analog scale. Acoustic rhinometry (AR) was carried out preoperatively and postoperatively to determine nasal valve patency. Preoperative and postoperative symptoms were evaluated and compared using the nasal obstruction symptom evaluation (NOSE) scale. Patients (mean age=32.2±6.3 years) were followed for a mean of 12.6 months. The preoperative NOSE score was 65.0±13 and the postoperative NOSE score was 7.7±10. Cosmetic evaluation revealed the mean patient preoperative VAS score was 32.5±20 and the postoperative VAS score was 88±9. AR revealed a mean minimal cross-sectional area of 1.56 cm2 that increased to 2.16 cm2 postoperatively. Intranasal total volume increased from 16.3 to 24.8 cm3 postoperatively. The newly defined autospreading spring flap suturing technique is a reliable method for reconstructing the nasal dorsum after humpectomy and for preventing middle vault and nasal valve collapse. The outcome was satisfactory, both aesthetically and functionally, but long-term follow-up is required. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nasal response in patients with diisocyanate asthma

To date, no studies have assessed nasal and bronchial response to diisocyanates during specific inhalation challenges (SIC). This study was performed to assess nasal response during SIC with diisocyanates (nasal and oral breathing) in patients with suspected occupational asthma due to these agents. Fourteen patients with suspected clinical history of diisocyanate-induced asthma were challenged with diisocynates in a 7m3 chamber. Nasal response testing during challenges was assessed by acoustic rhinometry, peak nasal inspiratory flow (PNIF), and visual analog scale (VAS), alongside bronchial responses. Eleven patients had a significant asthmatic response to diisocyanates. None reported clear work-related nasal symptoms. In patients with positive bronchial response to diisocyanates, nasal mean minimal cross-sectional area (MCA) decreased by 26.9%, nasal volume at 5 cm decreased by 33.5%, and PNIF decreased by 28.3%, all from baseline. A positive nasal response was elicited in 45%, 54%, and 45% of patients, respectively. A significant increase in VAS was observed in 4 patients. Three patients with negative bronchial response had a negative nasal response. SIC revealed an objective nasal response in around 50% of patients with occupational asthma due to diisocyanates, in spite of the fact that none of them reported work-related nasal symptoms. The clinical significance of this finding is a poor association between nasal symptoms at work and an objective nasal response during positive SIC with diisocyanates.

Upper Lateral Strut Graft: A Technique to Improve the Internal Nasal Valve

Internal nasal valve (INV) collapse can contribute significantly to nasal obstruction and may be caused by upper lateral cartilage (ULC) collapse medially or laterally. Surgical techniques addressing INV collapse have focused more on treating the narrowed INV angle, with less consideration of the lateral INV area. This article describes a technique to improve INV patency both medially and laterally. This study analyzes the changes in minimal cross-sectional area (MCA) at the INV after graft placement and determines whether these changes are significantly different for normal versus narrow INVs. Noses of six fixed cadavers were dissected by open rhinoplasty to release the ULCs from the septum. Upper lateral strut grafts were placed through subperichondrial pockets along the ULC undersurfaces and out over the piriform apertures into subperiosteal pockets. Grafts were secured to the dorsal septum. Acoustic rhinometry and nasal endoscopy were used to classify INVs before graft placement as narrow or normal and to assess changes at the INV after graft placement. Mean pregraft MCA was 0.58 cm(2). Mean MCA percent increase after graft placement was 22%. By INV type, percent increases were 51% for narrow INVs and 1% for normal INVs. Mean increases in MCA after graft placement were statistically significant for the entire group and for narrow INVs, with increases of 0.10 cm(2) (p = 0.03) and 0.22 cm(2) (p = 0.004), respectively. The upper lateral strut graft improved patency of cadaveric INVs, with statistically significant increases in the MCA most notable when placed for narrow INVs.

Acoustic rhinometry, rhinomanometry and visual analogue scale before and after septal surgery: a prospective 10‐year follow‐up

The aim of the study was to compare rhinomanometry, acoustic rhinometry and subjective estimation of the nasal obstruction before and after septoplasty and to evaluate the long-term results of septal surgery. Prospective long-term follow-up, before and after septoplasty. University tertiary-care hospital, referral centre. The study included 30 adult patients who were operated on because of septal deviation. Pre-operatively, acoustic rhinometry and active anterior rhinomanometry were performed on each subject after decongestion of the nose. A visual analogue scale for unilateral nasal obstruction was filled in by the patients. The measurements were repeated both 6 months and 10 years post-operatively. A significant change in acoustic values was found during the long-term follow-up of 10 years. The mean minimal cross-sectional area on the more obstructive side was 0.35 cm(2) pre-operatively. Six months after operation, it was 0.52 cm(2), and 10 years after operation, it was 0.68 cm(2). The mean resistance fell from pre-operative 1.16 Pa/mL/s to 0.41 Pa/mL/s during the first 6 months, but rose again to 1.21 Pa/mL/s after 10 years. Despite a tendency of improvement, no statistically significant change was found between pre-operative and postoperative values in VAS. Six months after operation 69% of the patients were satisfied with the result, and after ten years the amount of satisfied patients was 83%. We found an increase in acoustic values, but an increase in nasal resistance in the long-term follow-up. Other factors than nasal area may have an impact on nasal resistance and the feeling of nasal obstruction. The small size on the sample interfered with the results.

Provocation of nonallergic rhinitis subjects in response to simulated weather conditions using an environmental exposure chamber model

Nonallergic rhinitis (NAR) subjects present clinically with similar symptoms to subjects with allergic rhinitis, but which mechanistically are not IgE- mediated. NAR is difficult to study because of multiple, as yet unknown, disease mechanisms and lack of biomarkers and diagnostic tests. The purpose of this proof of concept pilot study was to develop an environmental exposure chamber (EEC) model to simulate weather conditions in a controlled setting to objectively diagnose NAR subjects and ultimately to investigate novel NAR therapies. Thirty-seven subjects with a history of NAR confirmed by negative skin-prick test to a panel of aeroallergens were tested with cold dry air (CDA) and temperature change challenges. Objective (acoustic rhinometry [AcR] and nasal secretions) and subjective measures (total nasal symptom scores [TNSSs]: congestion, rhinorrhea, and postnasal drip [0-3]) were collected. Data was presented as mean ± SEM and statistical significance was assessed by paired t-test. The NAR EEC AcR responders to CDA had a significant decrease in mean minimal cross-sectional area (MCA; a measure of nasal patency) of 22.2 ± 2.43% (p < 0.0001) and 6.7 ± 7.22% (not statistically significant) at 30 and 60 minutes, respectively, with a concomitant increase in TNSS of 1.0 ± 0.24 U and 1.4 ± 0.30 U, respectively. AcR responders to temperature change showed a significant decrease in mean MCA to warm air of 16.0 ± 3.82% (p < 0.001) and 19.4 ± 3.88% (p < 0.0001) at 30 and 60 minutes, respectively, with an increase of TNSS of 0.4 ± 0.25 U and 0.4 ± 0.27 U, respectively. With rapid conversion to cold air, further decrease in mean MCA accompanied by an increase in TNSS was observed at 30 and 60 minutes. Increase in rhinorrhea was highest for CDA and the cold air phase of the temperature change challenge. Using the NAR EEC model, significant symptoms were induced in response to simulated weather changes in NAR patient responders. This proof of concept pilot study shows that the EEC model provides a consistent and reliable method to phenotype weather-induced NAR subjects that could be used to investigate disease mechanisms and novel therapies for NAR.

Septal Batten Graft to Correct Cartilaginous Deformities in Endonasal Septoplasty

To evaluate the usefulness of septal batten grafts to correct cartilaginous septal deformities in endonasal septoplasty. Retrospective study. University medical center. Of 430 patients who underwent endonasal septoplasties from January 2006 to January 2011, 30 received septal batten grafts and were enrolled in the study. Twenty-eight patients were male and 2 were female. Thirty consecutive patients received septal batten grafts and were followed up for more than 6 months. Patterns of septal deformity, materials used for batten graft, surgical results, symptom improvement, findings of acoustic rhinometry, and surgical complications were investigated. Among the 30 patients, 5 were revision cases. Most of the deformities were characterized as moderate to severe degrees of curved or angulated deviations of the cartilaginous septum. The batten graft was performed with either septal cartilage (n = 21) or bony septum (n = 9). A straight septum was achieved in 90% of all procedures. Subjective symptoms of nasal obstruction were improved in all patients, as evaluated by the Nasal Obstruction Symptom Evaluation scale. Acoustic rhinometry revealed that after surgery the mean minimal cross-sectional area changed from 0.33 cm² to 0.42 cm² (P = .02) and the nasal volume from 4.71 mL to 6.28 mL (P = .02). There were no major complications, eg, septal perforation or saddle nose, and no revision surgery was needed. Endonasal septal batten graft is a safe, useful, and effective technique to straighten moderate to severe septal cartilage deformities that are otherwise not correctable via conventional septoplasty techniques.

Nasal patency after open rhinoplasty with spreader grafts

Spreader grafts have been used in cosmetic rhinoplasty, but little information is available about the objective results of treatment. This study sought to determine subjective and objective functional results of open cosmetic rhinoplasty with spreader grafts. Twenty patients (14 women, six men; mean age, 31 ± 6 years) had open cosmetic rhinoplasty. Surgery included dissection of the upper lateral cartilages, from the septum, and placement of spreader grafts, symmetrically, along the dorsal edge of the septal cartilage. Preoperative and postoperative evaluation included breathing quality score, acoustic rhinometry and a modified Glatzel mirror test. Evaluation after surgery (range, 5-18 months) showed significant improvement of breathing quality (before surgery, 8; after surgery, 9.4; P ≤ 0.001) and a mean minimal cross-sectional area of the left side (before surgery, 0.6 cm(2); after surgery, 0.9 cm(2); P ≤ 0.01). There was no significant change of the mean minimal cross-sectional area of the right side (acoustic rhinometry) or nasal patency (modified Glatzel mirror test) between preoperative and postoperative evaluation. Complications included postoperative synechiae in two patients and septal granuloma in one patient. Open structure rhinoplasty using spreader grafts is effective in reconstructing the internal nasal valve and preserving or improving nasal patency. IV (case series with preoperative and postoperative testing).

Correlation between acoustic rhinometry and visual analogue scale in children with no nasal symptoms: a prospective cohort study

Acoustic rhinometry is an objective tool to evaluate nasal obstruction. The aim of this study was to evaluate the usefulness of visual analogue scale (VAS) as a subjective tool for nasal obstruction and the correlation between acoustic rhinometry and VAS in children with no nasal symptoms. Unilateral acoustic values and VAS were measured at baseline and after decongestion of the nose. Tertiary academic hospital. The study included 124 children aged between 7 and 14 years with no permanent nasal symptoms. At baseline, the mean minimal cross-sectional area on the right side was 0.392 cm(2) (sd 0.094), and on the left side 0.360 cm(2) (sd 0.093), whereas the mean VAS on the right side was 7.43 (sd 2.50) and on the left side 6.81 (sd 3.01). After decongestion, the mean minimal cross-sectional area on the right and left sides were 0.421 cm(2) (sd 0.087) and 0.373 cm(2) (sd 0.11), respectively, whereas the mean VAS on the right and left sides were 8.77 (sd 2.02) and 8.54 (sd 2.14), respectively. At baseline, a significant correlation was found between VAS and minimal cross-sectional area, but no correlation was found between VAS and acoustic values after decongestion. We conclude that VAS shows potential as a subjective tool to investigate nasal obstruction in children over 7 years of age. There was a correlation between VAS and acoustic rhinometry in children with no nasal symptoms at baseline. No correlation was found in children with decongested normal nasal airways.

Objective evidence for the efficacy of surgical management of the deviated septum as a treatment for chronic nasal obstruction: a systematic review

Nasal septal surgery is a common procedure, but there are concerns that the benefits of this surgery are mainly cosmetic. The primary aim is to identify any functional benefits of septal surgery and provide any evidence of a change in patency of the nasal airway, as assessed by objective methods such as rhinomanometry, acoustic rhinometry and peak nasal inspiratory flow. Systematic review. A systematic search of the available literature was performed, using Pubmed, Medline (1950-November 2010), Embase (1947-November 2010) and the Cochrane Controlled Trials Register. Papers written in English that objectively compared pre- and post-surgical treatment of nasal obstruction in adults because of septal deviation were reviewed. Objective measurements of rhinomanometry, acoustic rhinometry and nasal peak inspiratory flow were specified within the search. Searches were restricted to surgery on the nasal septum, which included septoplasty, submucous resection and septal (deviation) corrective surgery. Seven studies (460 participants) involving rhinomanometry, six studies (182 participants) with acoustic rhinometry and one study (22 participants) using nasal peak inspiratory flow were included in the review. All the studies reported an objective improvement in nasal patency after septal surgery. Mean unilateral nasal resistance (data from six studies) decreased from preoperative 1.19 Pa/cm(3) /s to postoperative 0.39 Pa/cm(3) /s, mean minimum cross-sectional area (data from five studies) increased from preoperative 0.45 cm(2) to postoperative 0.61 cm(2) , median peak nasal inspiratory flow (data from one study) increased by 35 L/min after surgery. There is sufficient evidence in the literature to conclude that septal surgery improves objective measures of nasal patency and that improved nasal airflow may have beneficial effects for the patient.

Analysis of the upper airway by the acoustic reflection method in children with mucopolysaccharidosis

Upper airway obstruction is common in children with mucopolysaccharidosis. The acoustic reflection method is a noninvasive technique that can analyze the caliber of the upper airways. The aim of the study was to evaluate the feasibility of the acoustic reflection method in children with mucopolysaccharidosis, and to compare the characteristics of the upper airways evaluated by the acoustic reflection method in patients with mucopolysaccharidosis to matched healthy counterparts. Open, single center, prospective, study. Accurate acoustic reflection measurements could be obtained in 7 of 10 patients (mean age: 10.4 ± 3.9 years; mucopolysaccharidosis type II (n = 3); type IV (n = 2), type VI (n = 1), and fucosidosis (n = 1)). The mean minimum cross-sectional area was lower in mucopolysaccharidosis patients (1.6 ± 0.3 cm(2) ) as compared to 14 healthy counterparts (1.8 ± 0.3 cm(2); P = 0.03). The mean resistance of the airways was significantly higher in the MPS group (7.9 ± 1.8 cmH(2) O l(-1) sec) as compared to the controls (5.5 ± 1.2 cmH(2) O l(-1) sec; P = 0.006). This study is the first to analyze the upper airways by the noninvasive acoustic reflection method in children with mucopolysaccharidosis. Due to a lack of cooperation, reliable measurements could only be obtained in 70% of a selected group of patients. Children with mucopolysaccharidosis have significant upper airway obstruction as assessed by the reduction of the minimal cross-sectional area of the upper airways and the increase in airway resistance.

Assessment of 3-D nasal airway morphology in Southeast Asian adults with obstructive sleep apnea using acoustic rhinometry

The aim of the present study is to investigate nasal airway morphology in Asian adults with and without obstructive sleep apnea (OSA) using acoustic rhinometry (AR), principal components analysis (PCA), and 3-D finite-element analysis (FEA). One hundred eight adult Malays aged 18-65 years (mean ± SD, 33.2 ± 13.31) underwent clinical examination and limited channel polysomnography, providing 54 patients with OSA and 54 non-OSA controls. The mean minimal cross section area 1 (MCA1) and the mean minimal cross sectional area 2 (MCA2) were obtained from AR for all subjects and subjected to t tests. The OSA and control nasal airways were reconstructed in 3-D and subjected to PCA and FEA. The mean MCA1 and MCA2 using AR were found to be significantly smaller in the OSA group than in the control group (p < 0.001). Comparing the 3-D OSA and control nasal airways using PCA, the first two eigenvalues accounted for 94% of the total shape change, and statistical differences were found (p < 0.05). Similarly, comparing the nasal airways using FEA, the 3-D mean OSA nasal airway was significantly narrower in the OSA group compared to the control group. Specifically, decreases in size of approx. 10-22% were found in the nasal valve/head of inferior turbinate area. In conclusion, differences in nasal airway morphology are present when comparing patients with OSA to controls. These differences need to be recognized as they can improve our understanding of the etiological basis of obstructive sleep apnea and facilitate its subsequent management.