Measurement Of Nasal Resistance Research Articles

Nasal Obstruction: Overview of Pathophysiology and Presentation of a Clinically Relevant Preoperative Plan for Rhino(Septo)plasty.

Impairment of nasal breathing is a highly prevalent and bothersome symptom that affects daily functioning and/or sleep quality. Those surgeons dealing with patients seeking rhinoplasty need to carefully analyze the preoperative nasal breathing capacity and predict the positive or even negative impact of rhino(septo)plasty on nasal breathing. Given the lack of correlation between the subjective feeling of suboptimal nasal breathing and the objective measurements of nasal flow and nasal resistance, a critical and mainly clinical evaluation of all anatomical, mucosal, and sensory mechanisms involved in nasal obstruction is mandatory. Indeed, thermo-, mechano-, and chemosensory receptors on the nasal mucosa, airflow, and respiratory dynamics might all contribute to the overall perception of nasal breathing capacity. In this review, we provide an overview of the factors determining suboptimal nasal breathing including different diagnostic and experimental tests that can be performed to evaluate nasal flow and nasal resistance and current limitations in our understanding of the problem of nasal breathing in an individual patient. An algorithm for the preoperative or diagnostic workup for nasal obstruction is included that might be useful as a guide for clinicians dealing with patients seeking nose surgery.

Functional and Aesthetic Outcomes of Asymmetric Dorsal Preservation for Correction of I-Shaped Crooked Nose Deformity.

The study was designed to evaluate the effectiveness of the asymmetric dorsal preservation technique for correcting I-shaped crooked nose deformity (CND). Patients with I-shaped CND who underwent asymmetric dorsal preservation in the period from September 2020 to September 2021 were included in this retrospective study. The Rhinomanometry and Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) was used to assess the outcomes. Deviation angle (DA) measurements were used to evaluate the degree of crookedness. The results were recorded both preoperatively and 12 months postoperatively. Twenty-three patients were included in the study. Total nasal airflow and long-side nasal airflow were significantly higher 12 months postoperatively (p=0.001 each). Total nasal resistance, long-side nasal resistance, SCHNOS scores and DA measurements were significantly lower 12 months postoperatively (p<0.001 each). Asymmetric dorsal preservation is a successful alternative technique for correcting I-shaped CND and achieving optimal aesthetic and functional outcomes.

Correlational Analysis of Nasal Resistance and Acoustic Rhinometry Measurements With the Localization of Fungus Balls in the Paranasal Sinuses.

Objective: To investigate the reason for fungal balls (FBs) being localized in paranasal sinuses, we analyzed the clinical presentations of patients with FB rhinosinusitis (FBS). Methods: Clinical data, anatomical variation (ie, nasal septal deviation, concha bullosa, and Haller cell), as well as measurements of nasal resistance (NR), nasal cavity volume (NCV), and nasal cross-sectional area (NCA) using active anterior rhinomanometry and acoustic rhinometry were collected from FBS patients hospitalized in our hospital between January 2021 and December 2022. A retrospective analysis was conducted using IBM SPSS 19.0 to perform the Shapiro-Wilk test, t-test and logistic regression analysis. Results: A total of 95 FBS patients, including 33 male and 62 female patients, were included in this study. FBs in maxillary sinus were the most common (83, 87.4%), followed by sphenoid sinus (9, 9.5%). Logistic multivariate regression analysis revealed that a higher left-to-right NR ratio was associated with an increased likelihood of FBs being present in the left sinus [Odds ratios (OR) = 0.185; 95% CI, 0.061-0.558; P < .01]. When the ratio of the left-to-right second-minimum NCA was higher and the FB was more in the right sinus (OR = 3.194; 95% CI, 1.593-6.405; P = .001). Additionally, when the difference between left and right NCV was greater and FB occurred more commonly in the right sinus (OR = 1.435; 95% CI, 1.196-1.721; P < .001). Nonetheless, the presence of nasal septum deviation and concha bullosa did not significantly contribute to FB formation. Conclusions and significance: The differences in NR, NCA, and NCV between the affected and unaffected sides of nasal cavity are risk factors for the FB formation. To reduce FBS recurrence, it is important to focus on improving nasal ventilation during the surgical treatment.

Analysis of related factors for postoperative recurrence of antrochoanal polyps in children

Objective:To analyze the correlation between nasal resistance and lung function in children with allergic rhinitis（AR）, and explore whether AR children with increased nasal resistance are accompanied by potential lower respiratory tract involvement. Methods:A total of 88 children diagnosed with AR from December 2021 to December 2022 were selected as the study group, while 20 normal children were selected as the control group during the same period. Both the study group and the control group children underwent lung function tests, bronchodilator tests, and nasal resistance measurements. Spearman correlation analysis and multiple linear regression analysis were performed on the results of nasal resistance and lung function tests to explore the relationship and influencing factors between the two groups.According to the results of nasal resistance measurement, children with increased nasal resistance and abnormal lung function were divided into a mild increase in nasal resistance with abnormal lung function group and a moderate to severe increase in nasal resistance with abnormal lung function group. The degree of increased nasal resistance was analyzed to determine whether it would affect lung function. Results:The FEF25, FEF50, and FEF75 levels in the study group were significantly lower than those in the control group（P<0.05）. The FEV1of children with moderate to severe increase in AR nasal resistance was significantly lower than that of children with mild increase in AR nasal resistance（P<0.05）. There was a correlation between nasal resistance and FEV1/FVC, R20 in AR children, and FEV1/FVC, R20 were the influencing factors of nasal resistance in AR children（P<0.05）. There was no correlation between total serum IgE, lung function, and bronchodilation test in AR patients（P>0.05）. Conclusion:The nasal ventilation function of AR patients has changed, and there is a downward trend in small airway function. Children with moderate to severe increase in AR nasal resistance have a more significant decrease in lung ventilation function than those with mild increase. The nasal resistance of AR children is influenced by FEV1/FVC and R20, and FEV1/FVC and R20 decrease as the nasal resistance value increases. The improvement rate of lung function and FEV1 are not influencing factors for the elevation of total serum IgE.

Aromatic ointments for the common cold: what does the science say?

BackgroundUpper respiratory tract infections occur with an annual incidence of 17.2 billion cases globally. The negative impact that symptoms have on sleep is thought to slow the recovery process. Plant-derived aromatics have been used since ancient times to treat respiratory illnesses. In this narrative review, we summarize the use of aromatics for the symptomatic relief of upper respiratory tract infections and how this affects sleep quality.MethodsLiterature searches were conducted using a series of search terms and results were screened for relevance. Additional references were included according to the expert knowledge of the authors.DiscussionMultiple studies have observed that essential oil mixtures of aromatics enhance symptom relief for upper respiratory tract infections and their inhalation has been reported to have antitussive effects. Clinical trials assessing the efficacy of an ointment containing menthol, eucalyptus and camphor found patients to experience faster nasal cooling and decongestion times. Treatment with the same ointment also resulted in significant improvements in reported sleep quality. Aromatic treatment did not improve objective nasal airway measures in any of the studies.ConclusionWhilst not affecting objective measures of nasal airway resistance, the use of aromatics leads to improvements in a number of subjective sensations associated with the common cold. Such benefits result in better sleep, which likely aids recovery. Therefore, aromatics remain a well tolerated and effective option for the symptomatic relief of upper respiratory tract infections.

Comparison of rhinomanometric and computational fluid dynamic assessment of nasal resistance with respect to measurement accuracy.

Computational fluid dynamics (CFD)-based calculation of intranasal airflow became an important method in rhinologic research. Current evidence shows weak to moderate correlation as well as a systematic underprediction of nasal resistance by numerical simulations. In this study, we investigate whether these differences can be explained by measurement uncertainties caused by rhinomanometric devices and procedures. Furthermore, preliminary findings regarding the impact of tissue movements are reported. A retrospective sample of 17 patients, who reported impaired nasal breathing and for which rhinomanometric (RMM) measurements using two different devices as well as computed tomography scans were available, was investigated in this study. Three patients also exhibited a marked collapse of the nasal valve. Agreement between both rhinomanometric measurements as well as between rhinomanometry and CFD-based calculations was assessed using linear correlation and Bland-Altman analyses. These analyses were performed for the volume flow rates measured at trans-nasal pressure differences of 75 and 150Pa during inspiration and expiration. The correlation between volume flow rates measured using both RMM devices was good (R2 > 0.72 for all breathing states), and no relevant differences in measured flow rates was observed (21.6ml/s and 14.8ml/s for 75 and 150Pa, respectively). In contrast, correlation between RMM and CFD was poor (R2 < 0.5) and CFD systematically overpredicted RMM-based flow rate measurements (231.8ml/s and 328.3ml/s). No differences between patients with and without nasal valve collapse nor between inspiration and expiration were observed. Biases introduced during RMM measurements, by either the chosen device, the operator or other aspects as for example the nasal cycle, are not strong enough to explain the gross differences commonly reported between RMM- and CFD-based measurement of nasal resistance. Additionally, tissue movement during breathing is most likely also no sufficient explanation for these differences.

Rhinomanometric Evaluation of Patients with Nasal Obstruction Before and After Nasal Surgery

Background: Nasal obstruction is a common complaint in daily Otolaryngology practice. Rhinomanometric study is an objective tool for the evaluation of nasal obstruction. Objectives: To evaluate whether a correlation exists between the rhinomanomatric measurement of nasal resistance, nasal airflow, and the subjective sensation of airflow, pre and postoperatively. Materials and Methods: This study was conducted in the Otolaryngology Department at Basrah Teaching Hospital on 23 patients who prepared for nasal surgeries to improve their nasal obstruction complain. The study was covered the period of the 2004 year. The anterior rhinomanometry was done for all patients preoperatively (with and without decongestant) and post-operatively without decongestant. Results: Out of 23 patients, 15 (65.2%) were males. The age ranged from 17 to 45 years with a mean of 25.5 years ± 7.019. The most common associated symptom with nasal obstruction was rhinorrhea (n=15, 65.2%). Only 12 cases were attended by the postoperative evaluation. Three-quarters of them were showed clinical improvement, but 4 patients (34%) were showed rhinomanometric improvement (P-value = 0.002). There was no statistically significant difference between the pre- and postoperative rhinomanometric values without decongestant and the subjective sensation (P-value>0.05). Conclusion: The anterior rhinomanometry results didn’t add a significant value to the clinical evaluation of the patients with nasal obstruction.

Study on changes of nasal resistance based on 3D printing transparent nasal cavity models

Objective:To investigate the causal relationship between the minimum cross-sectional area of nasal cavity and nasal resistance. Methods:Thirty transparent detachable 3D printing nasal cavity models were made. The airway was completely blocked with sealing material at different anatomical sections. Then ventilatable nasal drainage tubes with different cross-sectional areas were used to pass through the nasal cavity. Nasal resistance was measured. SPSS was used for statistical analysis. Results:①The postoperative nasal resistances of patients and 3D printing nasal cavity models were （0.38±0.15）Pa· s/mL and （0.39±0.02）Pa· s/mL respectively. There was no statistical difference between the two groups.The preoperative nasal resistance of patients was （0.56±0.09）Pa· s/mL, and the postoperative nasal resistance of the models was significantly descreased by 31% compared with preoperative nasal resistance of the patients, with statistically significant difference（P<0.05）. ②When the ventilatable nasal drainage tubes with a cross-sectional area of 3.14 square millimeters was located in the the upper part of common meatus and the nasal valve area, the nasal cavity is moderately blocked, and the nasal resistances were （1.80±0.30） times and （2.02±0.36） times of that before the obstruction respectively. When the ventilatable nasal drainage tube was located in the lower part of common meatus,the nasal resistance was （1.68±0.28） times of that before the obstruction. ③When the ventilatable nasal drainage tubes with a cross-sectional area of 6.28 square millimeters and were located in the lower part of common meatus, the upper part of common meatus and nasal valve area, the nasal resistances were （1.44±0.23） times, （1.50±0.25） times and （1.60±0.27） times of those before obstruction, respectively. ④When the ventilatable nasal drainage tubes with a cross-sectional area of 9.42 square millimeters were located in the above areas, nasal ventilation was nearly normal without obvious nasal obstruction. The nasal resistances were （1.17±0.18） times, （1.26±0.21） times and （1.33±0.24） times of those before obstruction, respectively. ⑤The nasal resistance was statistically significant correlated with the cross-sectional area of the ventilation tubes and the obstruction sites. The correlation coefficients were -0.895 and 0.339, respectively （P<0.05）. Conclusion:①3D printing can quickly and accurately replicate anatomical structure of the nasal cavity, and can be used as a research method for quantifitative measurement of nasal resistance. ②The minimum cross-sectional area of nasal cavitiy is the main determinant of nasal resistance. ③The obstruction site is the secondary determinant of nasal resistance. When the degree of nasal obstruction is the same , the nasal resistance in the nasal valve area is sightly higher than that in the common meatus.

Application of the subjective and objective evaluation in functional rhinoplasty

Objective: To explore the subjective and objective evaluation methods in functional rhinoplasty. Methods: Sixty-four patients who underwent rhinoplasty in the Department of Otorhinolaryngology, the First Affiliated Hospital of Chongqing Medical University were included in this study from January 2017 to October 2018. There were 32 males and 32 females, with the age ranging from 18 to 45 years old. Before and 6 months after operation, nasal ventilation function was evaluated by Visual Analogue Scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE), nasal acoustic reflex and nasal resistance. Satisfaction with nasal appearance was evaluated by VAS, Rhinoplasty Outcome Evaluation (ROE) and facial proportions evaluation. Psychological state was assessed by Emotional Balance Scale and Rosenberg Self-esteem Scale. Finally, the Pearson correlation analysis of patient satisfaction was performed. SPSS 23.0 software was used for statistical analysis. Results: Compared with pre-operation, nasal obstruction VAS, NOSE scores, total nasal resistance and difference ratio of nasal resistance showed significantly decline after surgery (1.62±0.85 vs 7.56±1.44, 22.62±3.54 vs 69.75±7.85, (0.16±0.08) Pa·s/ml vs (0.31±0.43) Pa·s/ml, 0.33±0.28 vs 0.71±0.32, all P<0.05). VAS of appearance and ROE scores showed an increase after surgery (11.20±3.66 vs 2.70±0.97, 17.80±2.71 vs 7.50±1.12, all P<0.05). The measurement of the external nasal subunits showed that the length of the dorsum of the nose, the angle of the face to the nose, the angle of the frontal and the angle of the alar of the nose were obviously reduced ((29.33±4.26) mm vs (33.61±5.24) mm, (135.11±3.81)° vs (139.91±6.30)°, (130.63±2.88)° vs (136.74±5.72)°, (99.71±4.02)° vs (106.27±5.60)°, all P<0.05). The scores of postoperative Emotional Balance Scale and Rosenberg Self-esteem Scale increased significantly (5.88±1.54 vs 4.31±1.85, 28.31±2.64 vs 22.13±2.77, all P<0.05). The Pearson correlation analysis showed that patients' satisfaction was positively correlated with subjective score of nasal ventilation (VAS, NOSE), subjective score of nasal appearance (VAS, ROE) and emotional balance scale, while negatively correlated with nasal resistance, and not correlated with the measurement of external nasal subunit. There was a significant positive correlation between the subjective score of nasal ventilation and the measurement of nasal resistance, but there was no significant correlation between the subjective score of nasal appearance and the measurement of external nasal subunit. Conclusion: The subjective and objective evaluation of nasal ventilation function, aesthetics of nasal appearance and psychological state can evaluate the effect of functional rhinoplasty effectively.

Age- and Gender-Related Variability in Nasal Tip Support.

The age at which nasal tip support changes start to occur is unknown. Evaluation of nasal tip support is difficult, especially as the ideal nasal tip support pressure remains elusive. The aim of this study is to determine the nasal tip support pressure alterations relative to age and sex. The aim of this study is to determine the changers in resistance of the nasal tip support in relation to age and sex. This prospective clinical study was conducted between January and April 2019 at a tertiary health facility. Nasal tip resistances were measured in four different age-groups (20-29, 30-39, 40-64, and > 65years) with a digital Newton meter. A total of 159 patients with a minimum of 36 patients per group were included in the study. Nasal tip resistance measurements were compared among nasal tip displacement distances of 2, 3, and 4mm, focusing on age and sex. The nasal tip resistance of the 20-29 age-group was significantly higher at 2, 3, and 4mm nasal tip displacement distances, when compared with the 30-39 and 40-64 age-groups, whereas compared to the > 65years group, it was significantly higher at 3 and 4mm nasal tip displacement distances (p < 0.005). Nasal tip resistance of males was found to be significantly higher than that of females, at 3 and 4mm nasal tip displacement distances (p < 0.001). Nasal tip resistance is higher in males and universally decreases significantly after 30years of age while remaining constant at later ages. Therefore, surgeons should prefer nasal tip resistance increasing techniques in the rhinoplasty operations that are performed on patients even from early years of age, in order to maintain and strengthen the nasal tip resistance. 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.

The complexities of nasal airflow: theory and practice.

The objective of this study was to investigate the effects of nasal valve area, valve stiffness, and turbinate region cross-sectional area on airflow rate, nasal resistance, flow limitation, and inspiratory "hysteresis" by the use of a mathematical model of nasal airflow. The model of O'Neill and Tolley (Clin Otolaryngol Allied Sci 13: 273-277, 1988) describing the effects of valve area and stiffness on the nasal pressure-flow relationship was improved by the incorporation of additional terms involving 1) airflow through the turbinate region, 2) the dependence of the flow coefficients for the valve and turbinate region on the Reynolds number, and 3) effects of unsteady flow. The model was found to provide a good fit for normal values for nasal resistance and for pressure-flow curves reported in the literature for both congested and decongested states. Also, by showing the relative contribution of the nasal valve and turbinate region to nasal resistance, the model sheds light in explaining the generally poor correlation between nasal resistance measurements and the results from acoustic rhinometry. Furthermore, by proposing different flow conditions for the acceleration and deceleration phases of inspiration, the model produces an inspiratory loop (commonly referred to as hysteresis) consistent with those reported in the literature. With simulation of nasal flaring, the magnitude of the loop, the nasal resistance, and flow limitation all show change similar to that observed in the experimental results.NEW & NOTEWORTHY The present model provides considerable insight into some difficult conundrums in both clinical and technical aspects of nasal airflow. Also, the description of nasal airflow mechanics based on the Hagen-Poiseuille equation and Reynolds laminar-turbulent transition in long straight tubes, which has figured prominently in medical textbooks and journal articles for many years, is shown to be seriously in error at a fundamental level.

A Novel Approach for Investigating Upper Airway Hyperresponsiveness Using Micro-CT in Eosinophilic Upper Airway Inflammation such as Allergic Rhinitis Model.

Airway hyperresponsiveness (AHR) has been proposed as a feature of pathogenesis of eosinophilic upper airway inflammation such as allergic rhinitis (AR). The measurement system for upper AHR (UAHR) in rodents is poorly developed, although measurements of nasal resistance have been reported. Here we assessed UAHR by direct measurement of swelling of the nasal mucosa induced by intranasal methacholine (MCh) using micro-computed tomography (micro-CT). Micro-CT analysis was performed in both naïve and ovalbumin-induced AR mice following intranasal administration of MCh. The nasal cavity was segmented into two-dimensional horizontal and axial planes, and the data for nasal mucosa were acquired for the region of interest threshold. Then, a ratio between the nasal mucosa area and nasal cavity area was calculated as nasal mucosa index. Using our novel method, nasal cavity structure was clearly identified on micro-CT, and dose-dependent increased swelling of the nasal mucosa was observed upon MCh treatment. Moreover, the nasal mucosa index was significantly increased in AR mice compared to controls following MCh treatment, while ovalbumin administration did not affect swelling of the nasal mucosa in either group. This UAHR following MCh treatment was completely reversed by pretreatment with glucocorticoids. This novel approach using micro-CT for investigating UAHR reflects a precise assessment system for swelling of the nasal mucosa following MCh treatment; it not only sheds light on the mechanism of AR but also contributes to the development of new therapeutic drugs in AR patients.

The significance of eosinophils in the correlation of upper and lower airway inflammation in patients with chronic rhinitis

Objective: To explore the predictor of lower airway inflammation among the index of nasal inflammation by investigating the expression and association of eosinophils (EOS) in the upper-lower airways and blood of patients with chronic rhinitis. Methods: A total of 162 patients with allergic rhinitis (AR), 117 patients with non-allergic rhinitis (NAR) and 104 controls were enrolled from June 2010 to December 2013 from General Hospital of Eastern Theater Command, People's Liberation Army. All subjects were required detailed medical history collection and nasal resistance measurement. Skin prick test (SPT), blood total immunoglobin E (tIgE) and blood EOS, nasal lavage and induced sputum EOS, nasal provocation and bronchial provocation test (NPT, BPT), nasal and forced exhaled nitric oxide (NNO, FeNO) were performed in all patients. One-way analysis of variance was used for comparison between groups. LSD t test or Mann-Whitney U test was used for comparison between the two groups. Pearson or Spearman related parameter test was used for correlation analysis. Results: The nasal lavage EOS, NNO, induced sputum EOS, FeNO, blood EOS and tIgE were higher in the AR group than that in the NAR group (3.70[1.20, 14.23]/200 HP vs 1.40[0.20, 3.40]/200 HP, 673.50[466.80, 936.00] ppb vs 455.80[248.10, 705.60] ppb, 2.97[0.00, 10.63]% vs 1.00[0.23, 2.00]%, (49.28±26.37)ppb vs (34.07±19.11)ppb, 4.00[2.00, 7.00]% vs 2.00[1.00, 5.00]%, 208.01[61.70, 387.50] IU/ml vs 43.30[19.00, 122.00] IU/ml, F or χ(2) value was 11.442, 19.440, 70.727, 69.449, 47.453, 46.525, respectively, all P<0.05). But there was no significant difference in nasal resistance, NPT and BPT between the two groups. Nasal lavage EOS in AR group and NAR group was correlated with induced sputum EOS, FeNO, tIgE and blood EOS (r value of AR group was 0.448, 0.202, 0.159, 0.321, r value of NAR group was 0.442, 0.268, 0.268, 0.334, respectively, all P<0.05), but not with BPT. After adjustment for gender, age, height and weight, nasal EOS was positively correlated with sputum EOS. Multiple linear regression analysis showed that nasal EOS, blood EOS and SPT were factors affecting sputum EOS levels. The optimal threshold for nasal EOS to determine induced sputum EOS was 3.30/200 HP by (receiver operating characteristic,ROC) analysis. Conclusion: The nasal EOS is correlated with multiple lower airway and systemic inflammatory markers, and is a risk factor for the induced sputum EOS, which can be used as an inflammation biomarker to predict the lower air inflammation.

Computational investigation of dust mite allergens in a realistic human nasal cavity

Aim: Inhaled allergens from house dust mite (HDM) are a major source of allergic disease such as allergic rhinitis and asthma. It has been a challenge to properly evaluate health risks caused by HDM related allergens including mite bodies, eggs and fecal pellets. This paper presents a numerical study on particle deposition of dust mite allergens in a human nasal cavity.Materials and methods: A realistic nasal cavity model was reconstructed from CT scans and a Computational Fluid Dynamics analysis of steady airflow was simulated. The discrete phase model was used to trace particle trajectories of three dust mite related particles.Results: The flow and particle model were validated by comparing with nasal resistance measurement and previous literature respectively. Aerodynamic characteristics and deposition of dust mite allergens in the nasal cavity were analyzed under different breathing conditions including rest and exercising conditions.Conclusions: The numerical results revealed the roles of different nasal cavity regions in filtering various types of dust mite allergens with consideration of breathing conditions.

Treatment of Laryngopharyngeal Reflux May Decrease Subjective Symptoms of Nasal Congestion and Objective Measures of Nasal Resistance

Treatment of Laryngopharyngeal Reflux May Decrease Subjective Symptoms of Nasal Congestion and Objective Measures of Nasal Resistance

Nasal decongestants in monotherapy for the common cold.

Nasal decongestants in monotherapy for the common cold.

Aggravation of airway inflammation and hyper‐responsiveness following nasal challenge with Dermatophagoides pteronyssinus in perennial allergic rhinitis without symptoms of asthma

House dust mites are the most prevalent allergen causing sensitizations in patients with rhinitis and asthma in China. We aimed to investigate the changes in both upper and lower airway inflammation and responsiveness following Dermatophagoides pteronyssinus (Der-p) nasal provocation test (NPT) in rhinitis patients. Study subjects included 15 nonasthmatic Der-p-sensitized rhinitis (AR) patients with airway hyper-responsiveness (AHR) (AR+AHR+), 15 AR patients without AHR (AR+AHR-), 15 healthy controls (HCs) with Der-p sensitization (HC+DP+), and 15 HC without Der-p sensitization (HC+DP-). All subjects underwent Der-p NPT. Visual analogue scale (VAS) scores of nasal symptoms, nasal lavage and nasal airway resistance (NAR) measurement, sputum induction, and forced expiratory volume in 1 second (FEV1 ) were performed. Airway responsiveness to histamine bronchoprovocation (PD20 -FEV1 ) and exhaled nitric oxide (FeNO) was determined. NAR increased significantly in all subjects with the greatest effect seen in AR+AHR+ individuals. VAS increased in all subjects at 30 min and returned to baseline at 6 h, with significantly higher levels in AR+AHR+ and AR+AHR- subjects (P < 0.05). Eosinophils in nasal lavage fluid and sputum increased significantly after NPT in AR+AHR+ and AR+AHR- subjects (P < 0.001). FEV1 % and PD20 -FEV1 decreased and FeNO increased significantly after NPT only in AR+AHR+ subjects (P < 0.05). Nasal lavage eosinophil count was positively correlated with sputum eosinophil count and the level of FeNO and negatively correlated with FEV1 and PD20 . House dust mite nasal provocation test induces and aggravates both upper and lower airway inflammation and hyper-responsiveness in patients with persistent allergic rhinitis without asthmatic symptoms.

The effect of adenoidectomy on occlusal development and nasal cavity volume in children with recurrent middle ear infection

ObjectivesThe aim of the study was to examine the effect of adenoidectomy on occlusal/dentoalveolar development and nasal cavity volume in children who underwent tympanostomy tube insertion with or without adenoidectomy due to recurrent episodes of middle ear infection. MethodsThis prospective controlled study consisted of two randomly allocated treatment groups of children, younger than 2 years, who had underwent more than 3–5 events of middle ear infection during the last 6 months or 4–6 events during the last year. At the mean age of 17 months tympanostomy tube placement without adenoidectomy (Group I, n=63) tympanostomy tube placement with adenoidectomy (Group II, n=74) was performed. At the age of 5 years 41 children of the original Group I (14 females, 27 males, mean age 5.2 yrs, SD 0.17) and 59 children of the original Group II (17 females, 42 males, mean age 5.2 yrs, SD 0.18) participated in the re-examination, which included clinical orthodontic examination defining morphological and functional craniofacial status and occlusal bite index to measure upper dental arch dimensions. Acoustic rhinometry and anterior rhinomanometry was made by otorhinolaryngologist at the same day. ResultsNo statistically significant differences were found between the groups in the frequencies of morphological or functional characteristics or upper dental arch measurements or in the minimal cross-sectional areas or inspiratory nasal airway resistance measurements. ConclusionCombining adenoidectomy with tympanostomy tube insertion in the treatment of recurrent middle ear infection at an early age (under the age of 2 years) does not seem to make any difference in occlusal development in primary dentition at the age of 5 years as compared to tympanostomy tube insertion only. Since adenoid size was not evaluated, the findings do not allow interpretation that hypertrophic adenoids should not be removed in children with continuous mouth breathing or sleep disordered breathing.

Nasal steroids in snorers can decrease snoring frequency: a randomized placebo-controlled crossover trial.

Although it is anecdotally known that nasal obstruction is associated with snoring, it remains unknown whether the application of nasal steroids could decrease oral/oro-nasal breathing and increase nasal breathing, and subsequently decrease snoring indices. This study evaluated the effect of nasal budesonide on breathing route pattern and snoring. Twenty-four snorers were enrolled in a randomized, double-blind, crossover trial of 1-week treatment with nasal budesonide compared with 1-week intervention with nasal placebo. At the start and end of each treatment period, patients underwent nasal resistance measurement and overnight polysomnography with concomitant measurement of breathing route pattern and snoring. Twelve patients were randomly assigned to a 1-week treatment with nasal budesonide, followed by 2-week washout period and a 1-week intervention with the nasal placebo; and 12 patients were randomly assigned to a 1-week intervention with nasal placebo, followed by 2-week washout period and a 1-week treatment with nasal budesonide. Nasal budesonide was associated with a decrease in oral/oro-nasal breathing epochs and concomitant increase in nasal breathing epochs, decrease of snoring frequency by [median (interquartile range)] 15.8% (11.2-18.8%), and an increase of rapid eye movement sleep; snoring intensity decreased only in patients with increased baseline nasal resistance by 10.6% (6.8-14.3%). The change in nasal breathing epochs was inversely related to the change in snoring frequency (Rs = 0.503; P < 0.001). Nasal budesonide in snorers can increase nasal breathing epochs, modestly decrease snoring frequency and increase rapid eye movement sleep.

A Method to Quantify the Confounding Effect of the Nasal Cycle on Nasal Airway Obstruction

Objectives: (1) Develop a methodology to eliminate the confounding effect of the nasal cycle when comparing pre- and postsurgery nasal resistance measurements. (2) Illustrate this methodology by reporting nasal resistances derived from computational fluid dynamics (CFD) simulations in a test subject using computational models that span the full range of mucosal engorgement associated with the nasal cycle. Methods: A cohort of 40 nasal airway obstruction patients was reviewed to select the one patient with the greatest reciprocal change in turbinate engorgement between pre- and postsurgery computed tomography (CT) scans. Ten 3-dimensional anatomically accurate nasal cycling CFD models were created based on the pre- and postoperative CT scans. The thickness of the inferior turbinate, middle turbinate, and septal swell body was systematically increased/decreased by adding/removing layers of pixels around these structures using medical imaging software. Results: After surgery (septoplasty), without adjusting for the nasal cycle, nasal resistance decreased by 17% on the left side and by 69% on the right side, and total resistance decreased by 53%. However, after adjusting for cycling, the unilateral nasal resistance decreased by 50% and 43% on the left and right sides respectively, while bilateral resistance decreased by 47%. Conclusions: By simulating the nasal cycle using computational models, changes in nasal resistance due to surgery can be distinguished from physiological changes due to the nasal cycle. This ability can lead to more precise objective comparisons of pre- and postsurgery nasal resistance measurements and potentially more accurate virtual presurgery planning.