Difficulty In Nasal Breathing Research Articles

Use of Nasal Obstruction Symptom Evaluation Scale in Objective Evaluation of Symptomological Improvement in Post Septoplasty Patients

Introduction
 The complaint of nasal obstruction or difficulty in nasal breathing is highly subjective. Benefits of Septoplasty, as perceived by the patient, also varies widely with subjective satisfaction ranging from complete alleviation of symptoms to a total failure.
 Materials and Methods
 Fifty three patients above 18 years of age, with anatomical deviation of the nasal septum as the sole cause of obstruction and symptoms persisting for more than 3 months, underwent septoplasty. Nasal endoscopy was done for Mladina typing of the nasal septal deviation. Pre and post operative NOSE (Nasal Obstruction & Symptom Evaluation) score were analysed.
 Results
 Mean preoperative NOSE score was 11.98 ±1.23. On the 6th and 12th postoperative week follow up NOSE score was 3.13±1.30 & 1.05±0.87 respectively with p value <0.05. 
 Conclusion
 Mladina typing along with NOSE score will help in letting the patient know about his or her expected outcome following septoplasty.

Modern diagnosis and treatment in children with congenital basal encephalocele

The study group included 19 patients with basal encephalocele, aged 2 months to 18 years. Ten (59%) patients were operated on through a transnasal endoscopic approach; 3 (17.5%) patients were operated on through a transcranial approach; 4 (23.5%) patients were operated on using a combined approach: the patients underwent simultaneous elimination of a cranio-orbital region deformity using the basal transcranial approach as well as hernial sac resection and hernioplasty using the transnasal endoscopic approach. Two children had no surgery due to minimal symptoms and a lack of cerebrospinal fluid leak. Application of the algorithms for diagnosis and treatment of encephalocele, suggested by the authors, enabled making the timely diagnose, defining the optimal surgical tactics, and achieving good treatment results. A differentiated approach to the choice of a surgical technique for basal encephalocele, the use of auto-tissues for skull base reconstruction, intraoperative and postoperative lumbar drainage, and simultaneous elimination of deformity of the fronto-naso-orbital region enable avoiding complications and achieving good functional and aesthetic results.

Dental status, oral prosthesis and chewing ability in an adult and elderly population in southern Brazil

OBJECTIVE:The objective of this study was to explore the factors associated with inadequate chewing in an adult and elderly population of a city in the southern region of Brazil.METHODS:This was a cross-sectional study based on a population home-based inquiry (DCH-POP) in southern Brazil. Individuals were interviewed by trained interviewers to create a standardized procedure. In a pilot study, the Questionnaire of Human Communication Disorders (DCH-POP) was created and validated to identify self-reported speech and language, swallowing and hearing disorders. The outcome was dichotomized into either having adequate chewing or not, as assessed by a series of questions about chewing ability. Analyses of absolute and relative frequencies were measured according to the studied variables. A Poisson regression was applied at a significance level of 5%.RESULTS:A total of 1,246 people were interviewed. Inadequate chewing was found in 52 (5.6%) individuals, with a higher prevalence in the elderly (11.8%) than in adults (5.2%). In the final model, the following factors were associated with inadequate chewing: being 61 years of age or older (prevalence ratio or PR=9.03; 95% CI: 1.20-67.91), loss of teeth and use of unadjusted prosthesis (PR=3.50; 95% CI: 1.54-7.95), preference for foods of soft consistency (PR=9.34; 95% CI:4.66-8.70) and difficulty in nasal breathing (PR=2.82; 95% CI: 1.31-6.06).CONCLUSION:Age, oral health status through dental prosthesis, preference for foods of soft consistency and difficulty breathing through the nose were factors associated with chewing inability in adults and the elderly.

Correction of Symptomatic Chronic Nasal Airway Obstruction in Conjunction With Bimaxillary Orthognathic Surgery: Does It Complicate Recovery and Is It Effective?

The purpose of this study was to assess the safety and efficacy of intranasal procedures carried out simultaneously with bimaxillary orthognathic surgery. The authors executed a retrospective cohort study derived from patients treated by a single surgeon at 1 institution from 2004 through 2013 with a minimum follow-up of 1 year (range, 1 to 10 yr). An index study group consisting of a consecutive series of patients with symptomatic chronic obstructive nasal breathing (CONB) and a bimaxillary developmental dentofacial deformity (DFD) also involving the chin were identified. They underwent a minimum of: Le Fort I osteotomy, bilateral sagittal ramus osteotomies, septoplasty, inferior turbinate reduction (ITR), and osseous genioplasty. Study variables included age at operation, gender, pattern of presenting DFD, presence of obstructive sleep apnea, segmentation of the maxilla, and airway management. The primary outcome variable studied was residual CONB. During the study period, 262 patients met the inclusion criteria. Their age at operation averaged 25 years (range, 13 to 63 yr) and 134 were female (51%). The major patterns of presenting DFD included long face (29%) and maxillary deficiency (25%). No patients required nasal packing, reintubation, tracheostomy, or blood transfusion. In 6 of the 262 patients (2%), the intranasal procedures did not resolve nasal breathing difficulties. In these patients, procedures recommended included synechiae release (n = 3), revision septoplasty (n = 3), and further ITR (n = 4). An association between age at time of surgery and non-segmental Le Fort I osteotomy with the occurrence of residual nasal obstruction was confirmed. When completing septoplasty and ITR through a Le Fort I, airway management need not be altered from standard protocol. The management of CONB in conjunction with orthognathic surgery is highly effective, with few complications. Non-segmental Le Fort I in patients at least 40 years of age is more likely to be associated with residual CONB, but the incidence remains low.

Objective evaluation of nasal breathing based on rhinomanometric data

Currently, there are many objective diagnostic methods for nasal breathing difficulties. The main conventional method in otolaryngological practice is active rhinomanometry. The value of nasal resistance is considered as a diagnostic parameter of active anterior rhinomanometry. However, the results of the rhinomanometric measurements depend on race, age, gender, body mass index, and growth, etc. Thus, there is no evaluated criterion of physiological norm of nasal breathing according to the data from rhinomanometric studies. This fact significantly complicates the process of diagnosis and reduces diagnostic efficiency of rhinomanometry methods. For solving this problem, it is proposed to use additional spectral estimation data of the rhinomanometric studies using the modified covariance method. For this purpose, the spectral estimation software module is added to the software and hardware for rhinomanometric studies. The use of an advanced hardware and software system for rhinomanometric studies in clinical practice allows improving the diagnostic value of the active anterior rhinomanometry method.

The influence of nasal septum deformity degree on subjective nasal breathing assessment

Introduction. The aim of this paper is to determine the influence of nasal septum deformity degree on the subjective nasal breathing assessment as well as the existence of correlation between one side of the nose with nasal septum deformity and the subjective feeling of difficulty in breathing on that side in the subjects with different degrees of nasal septum deviation. Material and Methods. The research included 90 randomly chosen patients, who claimed to have nasal breathing difficulties. Every patient assessed subjectively which side of the nose made breathing difficult and scored the breathing on that side from 0 to 10 cm on the visual analogue scale. Results. The patients from the third group described their breathing as the most difficult, while the subjects from the first group claimed that their nasal breathing problems were the least difficult. The subjective feeling of heavy nasal breathing on the deformed nasal septum side was significantly different in all groups (H= 38.466, p= 0.000). In the second and the third group of patients there was a significant correlation between the deformed side of the nose and the subjective heavy breathing on that side (p< 0.05), whereas this correlation was not found in the first group (p> 0.05). Conclusion. The subjective feeling of difficulty in breathing on the deformed side of the nose is intensified with the degree of the nasal septum deformity, thus this feeling was reported only by the subjects with a higher degree of the nasal septum deformity.

Review of computational fluid dynamics in the assessment of nasal air flow and analysis of its limitations

Nasal breathing difficulties (NBD) are a widespread medical condition, yet decisions pertaining to the surgical treatment of chronic NBD still imply a significant degree of subjective judgement of the surgeon. The current standard objective examinations for nasal flow, e.g., rhinomanometry and acoustic rhinomanometry, do not suffice to reliably direct the surgeon on the extent of any necessary surgery. In the last two decades, several groups have therefore considered the numerical simulation of nasal airflow. Currently, these analyses take many hours of labor from the operator, and require a huge amount of computer time and the use of expensive commercial software. Most often, their results are insufficiently validated so that virtual surgery, which is the eventual application, is still absent in clinical practice. Very recently, however, attempts at considering the finest details of the flow are beginning to appear, for example unsteady turbulent simulations validated through laboratory measurements through particle image velocimetry. In this paper, we first discuss recent developments in how computational fluid dynamics (CFD) is helping surgeons improve their understanding of nasal physiology and the effect of surgical modifications on the airflow in the nasal cavity. In a second part, the procedural and modeling challenges that still prevent CFD from being routinely used in clinical practice are surveyed and critically discussed.

Treatment outcomes of pediatric rhinoplasty: The Asan Medical Center experience

ObjectivePerforming rhinoplasty in children has been an issue of some debate due to concerns about potential harmful effects on nasoseptal growth. However, there is a paucity of evidence describing the outcomes of pediatric rhinoplasty. This study presents our experience of performing this procedure in children of 17 years of age and younger. MethodsThe study population consisted of 64 Korean children between 4 and 17 years of age who underwent rhinoplasty between May 2003 and August 2011. Forty-six of the patients were boys and 18 were girls with a mean follow-up period of 59 months. The diagnosis of the patients, the extent of the surgical maneuver performed, and the surgical outcomes were reviewed. Subjective satisfaction of the patients was investigated by telephone interview. Surgical outcomes, which were judged by two independent ENT surgeons, were evaluated by comparing preoperative and postoperative photographs. Satisfaction scores were graded using a visual analog scale (from 1=satisfied, to 4=dissatisfied). Anthropometric measurements of nasal parameters were performed preoperatively and postoperatively. ResultsRhinoplasty was performed in our patient cohort due to a deviated nose (32.8%), nasal bone fracture (18.8%), flat nose (6.3%), nasal mass (4.7%), hump nose (3.1%), nasal dermoid sinus cyst (1.6%), and additional cosmetic rhinoplasty for planned septoplasty (32.8%). The median patient satisfaction score was 2.09 compared with a median doctor satisfaction score of 1.81. Anthropometric measurements showed statistically significant improvements in nasal tip projection, nasal length, dorsal height, and radix height after rhinoplasty. Seventeen patients (26.6%) experienced esthetic dissatisfaction such as deviation, tip depression, bulbous tip, short nose, and nostril asymmetry. Eight patients (12.5%) experienced postoperative difficulty in nasal breathing, and two patients (3.1%) complained of transient nasal pain after rhinoplasty. Six patients (9.4%) underwent revision surgery, and four patients (6.3%) were seriously considering a revision operation. ConclusionsThe outcome analysis in our series reveals that rhinoplasty in children is complicated by a high rate of revision and esthetic dissatisfaction. The results of this study may indicate that surgeons should have a conservative attitude and apply strict indication in selecting pediatric rhinoplasty candidates.

827 Evolution of Otitis Media in Children of the First 7 Years of Life in Moldova

BackgroundOtitis media (OM) is a common problem for primary care, pediatricians and otorhinolaryngologists.The Aimof our work is to analyze the evolution of OM in children of the first 7 years...

A patient presenting with concha bullosa in another concha bullosa: a case report

IntroductionAnatomic variations of the paranasal sinuses are very common. The paranasal sinus anatomy should be carefully examined prior to performing endoscopic sinus surgery in terms of both existent pathologies and anatomic variations. The anatomy of the paranasal sinuses and its variations have gained importance, along with advances in coronal paranasal sinus computed tomography and extensive use of endoscopic sinus surgery.Case presentationA 53-year-old Caucasian woman was admitted to our clinic with complaints of nasal breathing difficulties and headache persisting for a long time. Another concha bullosa was detected in the middle concha bullosa on preoperative paranasal computed tomography examination. It is known that the paranasal sinuses have a number of anatomical variations.ConclusionHerein we report a rare case, along with a review of the literature, to emphasize that a concha bullosa inside another concha bullosa should not be ignored.

Nasal septal abscess

Septum is the most important anatomical and functional structure of nose. Thus, any kind of damage to septum can cause serious structural deformity of nose. Although nasal trauma at childhood hood is seen frequently, septal heamatoma and abscess formation is very rare. Septal heamatoma and abscess cause serious nasal and systemic complications in children. We presented a 6 years-old boy with the complaining of difficulty in nasal breathing and diagnosed as septal abscess five days after a nasal trauma.

Alterações da cavidade nasal e do padrão respiratório após expansão maxilar

A deficiência transversal da maxila é uma anomalia dentofacial relacionada à diminuição do diâmetro do arco maxilar. Este tipo de deformidade está muitas vezes associado a deficiência respiratória nasal, sendo um importante fator etiopatogênico. O tratamento desta atresia pode ser realizado através da Expansão Rápida da Maxila ou Expansão Rápida da Maxila Cirurgicamente Assistida, ficando na dependência da idade do paciente. Ambos os procedimentos levarão a mudanças na estrutura craniofacial, especialmente na cavidade nasal. OBJETIVO: Através da descrição de trabalhos levantados na literatura, procurou-se relatar a relação existente entre a expansão maxilar, cavidade nasal e resistência aérea nasal. MÉTODO: Foi realizada uma tradicional revisão assistemática da literatura, utilizando trabalhos do tipo experimentais, incluindo os que utilizaram Expansão Rápida da Maxila e Expansão Rápida da Maxila Cirurgicamente Assistida, e excluindo os que utilizaram Expansão Maxilar por Osteotomia Segmentada para o tratamento da atresia maxilar. RESULTADO: Tanto a Expansão Rápida da Maxila quanto a Expansão Rápida da Maxila Cirurgicamente Assistida levam a mudanças dentofaciais, especialmente sobre a cavidade nasal, causando um aumento da largura nasal, o que pode levar à diminuição da Resistência Aérea Nasal. CONCLUSÃO: Através dos estudos cefalométricos ântero-posteriores, fica evidente o aumento da largura da cavidade nasal após expansão maxilar.

Isolation and phenotypic characterization of mucosal nasal lymphocytes by direct ex vivo analysis

Cellular inflammation of the nasal mucosa demonstrates a local immune response which plays an important role in allergic rhinitis. The aim of the present study was to characterize nasal mucosal lymphocytes regarding their activation and differentiation state by direct ex vivo flowcytometric analysis. Lymphocytes from the inferior turbinates were isolated by a mechanical method of preparation and, for comparison, from peripheral blood by Ficoll gradient centrifugation. Patients suffering from rhinitis or difficulty in nasal breathing were divided into an allergic (pollen-allergy, n = 13) and non-allergic group (n = 24). Expression of different T- and B-cell markers was determined by flowcytometric analysis. CD4+ T-cells from the nasal mucosa exhibited a memory phenotype (CD45RO+, 97%), were highly activated (CD69+, 43-73%), and showed low expression of the cutaneous lymphocyte antigen (CLA+, 5%). Nasal CD20+ B-lymphocytes expressed significantly higher levels of mIgE and lower levels of CD23 and CD80 than peripheral B-cells. Subsets of CD80+ (4%) and CD86+ (6%) CD20+ B-lymphocytes were identified in the nasal mucosa. No significant differences between allergic and non-allergic individuals were determined. As expected, the data show profound phenotypical differences between circulating peripheral blood and nasal mucosal lymphocytes. Activated memory lymphocytes are present in the nasal mucosa from allergic, but also non-allergic patients and may indicate to a significant role of a local inflammatory state without systemic criteria for allergy. In our study, we show that direct ex vivo isolation of lymphocytes is practicable method and offers a new technique to examine the local nasal allergic immune response using a multiparametric phenotypical analysis.

Prosthetic Management of Pharyngeal Flap–Related Snoring

The obturating pharyngeal flap used in correcting velopharyngeal insufficiency has been implicated in creating difficulty in nasal breathing for some patients and/or in causing hyponasal speech, obstructive sleep apnea, and snoring. This is a case report of an individually designed removable prosthesis that positions an acrylic tube through each port lateral to the pharyngeal flap, with the goal of preventing the collapse of the ports during sleep and the consequent snoring. The acrylic tubes maintain an opening through both lateral ports preventing the soft tissues of the lateral walls from vibrating against the pharyngeal flap (causing the snoring sound) and allowing nasal breathing. The acrylic tubes effectively eliminated the patient's problem of snoring. This case study demonstrates that snoring associated with a pharyngeal flap can be controlled prosthetically by maintaining an opening through the two lateral ports, preventing the soft tissues of the walls of the lateral ports from vibrating against the flap.

Adenoidectomy due to obstructive neonatal adenoid hypertrophy secondary to cytomegalovirus infection in an 8-week-old infant

Adenoid hypertrophy is a common feature of childhood. It is thought to be caused by the antigen stimulated increased activity of B lymphocytes. Obstructive adenoid hypertrophy on the other hand is extremely rare in the neonatal period. We present a 2-month-old female patient with difficulty in nasal breathing due to obstructive adenoid hypertrophy. Endoscopic examination, tissue removal and biopsy was performed. Lymphoid hyperplasia and inclusion-bearing cytomegalic cells within the endothelium were seen in the histopathologic examination. Cytomegalovirus (CMV) infection of the nasopharynx is very rare. An adenoidectomy was performed and the symptoms of the patients were immediately disappeared. To our knowledge this is the youngest case with CMV related adenoid hypertrophy necessitating adenoidectomy.

The role of turbinectomy in rhinoplasty.

Turbinectomy, in cases of inferior or middle turbinate hypertrophy, is one of the solutions for nasal breathing difficulties. For many decades, this procedure was controversial owing to the severe complications believed to occur after such an operation. Its performance was held to be within the responsibility of otolaryngologists. However, eventually most of these complications were found to be nonexistent, and the performance of turbinectomy became a simple surgical procedure. The turbinate hypertrophy, which often exists on the contralateral side of the deviated septum, blocks the correct reposition of the septum with the consequent nasal bone, and thus prevents the plastic surgeon from achieving a straight nose. Therefore, proper handling of both septal deviation and turbinate hypertrophy is an important aid for the plastic surgeon. This article is dealing with the various aspects of turbinate hypertrophy and its surgical handling.

Some features of rhinogenic and odontogenic sinusitis

Analysis of our observations of 37 patients with various forms of sinusitis and 76 case histories for 2 years made it possible to identify a number of features in the clinic and the course of sinusitis. Patients with a rhinogenic form of the disease (65 people) more often complained of headache (43), nasal breathing difficulties (27), nasal discharge (43). The inflammatory process was often bilateral (37), and the sinus disease was preceded by respiratory infections (influenza, acute respiratory infections). Rhinoscopy revealed a curvature of the nasal septum, polyps in the nose, hypertrophy of the turbinates. Conservative treatment gave good results.

CARCINOMA OF THE SPHENOID SINUSES WITH INVASION OF THE CRANIAL CAVITY

Carcinoma of the sphenoid sinuses is rare. A careful search of the literature shows only two cases of malignant disease of the sphenoid sinuses, which were recorded by White1among 125 patients with retrobulbar neuritis. The diagnosis of malignancy was made on biopsy material. Death was due to involvement of the central nervous system in the form of basilar meningitis. The two cases to be reported were diagnosed during life; in both, autopsy showed invasion of the cranial cavity compressing the adjacent nervous structures. REPORT OF CASES Case1.—M. F., a man, aged 43, a furrier, was admitted to the Montefiore Hospital on Nov. 17, 1927. In November, 1926, the patient had complained of difficulty in nasal breathing. He was subject to frequent colds. In May, 1927, following a submucous resection he experienced shooting pain in the nose and the right eye, boring pain in the right frontal region

Effect of nasal and tracheal breathing on the oxygen content in arterial blood

Iskhodya iz togo, chto pri sil'nykh zatrudneniyakh nosovogo dykhaniya, chelovek prinuzhden pol'zovat'sya dykhaniyem cherez rot, vazhno znat', kak otrazhayetsya eto Proceeding from the fact that with severe difficulty in nasal breathing, a person is forced to use breathing through the mouth, it is important to know how this latter affects various functions of the body.