Nasal Breathing Research Articles

Congenital basal encephaloceles involving functionally important structures

We reviewed 43 articles (78 cases) devoted to basal encephaloceles involving functionally important structures. Analysis included transsphenoidal and sphenoethmoidal hernias. Nasal breathing disorders were found in 76.9% of cases, decreased visual acuity - 53.8%, endocrine disorders - 44.9%, nasal CSF leakage - 14.1%, meningitis - 10.3%. Concomitant malformations occurred in 85.9%. Severe respiratory disorders (52.6%, p<0.05) and multiple concomitant malformations (71.7%, p<0.05) were more common among patients with sphenoethmoidal encephalocele. Among 78 patients, 73.1% underwent surgery while follow-up was preferable in 26.9% of cases. There was progression of endocrine disorders (9.5%), visual impairment (4.8%) and nasal breathing disorders (4.8%) in follow-up period. Surgical treatment also has many risks. Transcranial, transnasal, transoral and combined approaches are currently used. It was not possible to establish the most effective surgical approach due to heterogeneous clinical data. Postoperative complications occurred in 47.4% of cases (endocrine disorders - 33.3%, CSF leakage - 8.8%, visual impairment - 1.8%, infectious complications - 14%). Mortality rate was 3.5%. Congenital basal encephalocele involving functionally important structures is an extremely rare developmental defect. Such patients often have concomitant anomalies. Comprehensive examination is necessary to estimate the structures included in hernial sac and concomitant diseases. Treatment strategy should be determined individually after thorough examination and comparison of all risks. Surgical treatment is associated with high risk of complications due to damage to the structures comprising encephalocele.

CLINICAL AND MORPHOLOGICAL CHARACTERISTICS AND EVALUATION OF TORUS TUBARIUS IN CHILDREN WITH PHARYNGEAL TONSIL HYPERTROPHY

Introduction: Among children with hypertrophy of pharyngeal tonsils undergoing adenoidectomy, 31.3% of cases show hypertrophy of the torus tubarius, even in the absence of middle ear pathology. However, the nature of the changes in this anatomical area in these children has not been described.&#x0D; The aim of the study: to investigate and evaluate morphological changes of pharyngeal tonsil and torus tubarius in children with hypertrophy of pharyngeal tonsil.&#x0D; Materials and methods: histological investigation and scanning electron microscopy were performed on fragments of pharyngeal tonsil and torus tubarius, obtained during adenoidectomy of 12 children with nasal breathing disturbances (Group 1) and 13 children with concomitant inflammatory diseases of the upper respiratory tract (Group 2).&#x0D; Results: In patients of Group 2, changes in the pharyngeal tonsil were more pronounced, showing inflammatory alterations such as infiltration by polymorphonuclear leukocytes in the covering epithelium and subepithelial layer, as well as lymphocytes in the covering epithelium, along with the presence of fibrosis compared to patients of Group 1. Additionally, samples covered by biofilms were significantly more frequently identified in Group 2 compared to Group 1 (53.8% vs. 16.6%, p&lt;0.05). The mucosal changes in the torus tubarius corresponded to the nature of the changes observed in the pharyngeal tonsil in the respective group. Biofilms in the torus tubarius samples were found in 38.5% of cases in Group 2 and 8.3% of cases in Group 1 (p&lt;0.05).&#x0D; Conclusions: 1. In children with hypertrophy of pharyngeal tonsil and torus tubarius, the morphological characteristics of the mucous membrane of torus tubarius are similar to those observed in the mucous membrane of pharyngeal tonsil of the respective group. 2. Biofilms were reliably more frequently identified on the surface of pharyngeal tonsil and torus tubarius in children with upper respiratory tract infections than in patients with nasal breathing disturbances. 3. The detected changes provide a basis for revising the therapeutic approach to hypertrophic torus tubarius in children with pharyngeal tonsil hypertrophy.

COMPARATIVE ANALYSIS OF THE EFFICIENCY OF DIFFERENT METHODS OF OSTEOTOMY WHEN PERFORMING CLOSED RHINOPLASTY

The aim. Increasing the effectiveness of treatment of patients with primary deformity of the nasal skeleton with a pronounced violation of the function of nasal breathing, by improving existing and developing new methods of reconstructive surgery of the nose.&#x0D; Materials and methods. 38 patients participated in the study. They were divided into two groups of 19 patients each. The gender and age distribution in both groups was approximately the same. The control group had rhinoplasty performed using a traditional osteotomy. Endonasal continuous osteotomy was performed using a 4 mm chisel. The research group underwent a combination of piezoelectric surgery and combined transcutaneous access, during rhinoplasty. At the same time, a 3 mm chisel was used for lateral and transverse lateral osteotomies, and a piezotome was used to remove the hump, medial and transverse dorsal osteotomies. All patients of both groups underwent only primary rhinoplasty in a closed manner.&#x0D; Results. Postoperative symptoms and complications were studied in both groups: perforation of the mucous membrane, narrowing of the nasal airways, bony irregularities, eyelid swelling, periorbital ecchymoses, as well as overall patient satisfaction. Symptoms were evaluated on the first day after surgery, 3 days after surgery, and 1 week after treatment. When comparing the obtained data, a statistically significant decrease in intra- and post-operative complications was found when performing rhinoplasty using piezoelectric surgery in combination with transcutaneous access. Also, piezotome osteotomy in combination with transcutaneous access has a number of advantages over classic osteotomy, which consist in reducing traumatic complications, obtaining more stable bone structures during surgery, which gives a better predicted result of rhinoplasty, and therefore, greater patient satisfaction.&#x0D; Conclusions. Performing a combination of piezotome osteotomy with a transcutaneous approach improves the postoperative period for patients and contributes to a better rhinoplasty result due to fewer complications.

Aspiration efficiency and respiratory tract deposition of indoor suspended micro-particles during steady and transient breathings

The assessment of potential health risks from exposure to airborne contaminants and the inhalability of microparticles through human nasal breathing is crucial for the design of ventilation systems. In this study, using a standing computer-simulated person (CSP) directly linked to a numerical model of the respiratory tract, we investigated the aspiration efficiency (AE) of microparticles ranging between 1 and 80 μm under steady and transient breathing conditions. Two ventilation scenarios with displacement and mixed ventilation systems (DV and MV) were assumed for AE calculations. To determine the appropriate particle injection location, we investigated the position of highly inhaled particles corresponding to the breathing zone using a reverse particle-tracking simulation with reversed time progression. Additionally, the total and regional deposition fractions (TDF and RDF) of the inhaled microparticles on the respiratory wall surfaces were evaluated using the Lagrangian approach. The results indicate that the transient breathing cycle showed relatively higher AE and TDF rates compared to the assumed steady inhalation conditions, particularly for the size range 1–10 μm. An insignificant variation was observed in the AE and RDF results between different ventilation systems. However, microparticles in the MV room showed slightly higher AE than the DV system. Moreover, AE and penetration ratio were highly sensitive to the initially assumed particle density. For a comprehensive and accurate assessment of inhalation exposure to microparticles, we should predict the heterogeneous flow field formed around the human body and then analyze the AE and TDF in the respiratory tract during realistic transient breathing.

Քթի միջնապատի ուղղումը մանկական տարիքում

Pediatric septoplasty has been one of the most controversial topics discussed among ENT and plastic surgeons: The aim of the study is to evaluate the outcome of septoplasty several years after performing it during the pediatric age, and if it contributes subsequently to the recurrent deformation of the nasal septum or the external nasal structure. The study also touches on the notion of whether adenoidectomy and/or inferior turbinate reduction without correcting the deviated nasal septum are enough to restore nasal breathing. The study included 56 children aged from 5 to 15 years. All the participating patients were diagnosed with deviated nasal septum, but were divided into 2 groups according to the surgical techniques performed. The first group included 24 patients and their difficult nasal breathing was conditioned by deviated nasal septum, adenoid tissue hypertrophy with 5 of the children also having inferior turbinate hypertrophy. However, they all underwent adenoidectomy and inferior turbinate radiofrequency reduction only. The second group included 32 patients with difficult nasal breathing caused by deviated nasal septum, adenoid tissue hypertrophy with 11 children also having inferior turbinate hypertrophy. All the patients in this group underwent septoplasty, adenoidectomy and where indicated inferior turbinate radiofrequency reduction. All the 24 patients included in the first group exhibited improvement in nasal breathing index from 231,6 ± 9,26 cm3 up to 427,0±5,6 cm3 (p&lt;0,05). As for the snoring loudness scale, there was improvement from 2,6±0,1 to 1,3±0,1 (p&lt;0,05), but without complete disappearance. Patients included in the second group which totalled 32 in number saw improvement in nasal breathing index from 228,5±7,29 cm3 to 592,9±5,29 cm3 (p&lt;0,05) while snoring loudness scale improved from 2,47±0,09 to 0,09±0,05 (p&lt;0,05).

Refinement of the acute inhalation limit test for inert, nano-sized dusts by an in silico dosimetry-based evaluation: case study for the dissolution of a regulatory dilemma.

This case study aims to describe the dilemma faced when exposing rats to very high concentrations of fine, pulverulent materials for acute inhalation studies and to address the regulatory question of whether the effects seen here are relevant to humans and the subject of classification according to the Globally Harmonized System of Classification and Labeling of Chemicals (GHS). Many powders match the definition of nanomaterials in the EU; therefore, information on acute inhalation testing of powders up to the GHS cutoff of 5mg/L is required. However, testing rats at such a high aerosol concentration can cause physical obstruction of the airways and even mortality by suffocation. Therefore, to evaluate whether the physical effects on airway obstruction in rats exposed to 5mg/L for 4hours and alternative exposures to 1 and 2mg/L are relevant for humans, an in silico evaluation of aerosol deposition was conducted using the multiple-path particle dosimetry (MPPD) model. For this evaluation, actual exposure conditions for an organic, nano-sized pigment which produced 100% lethality in rats at 5mg/L, but not at 1mg/L, were used to assess the potential for airway obstruction in rats and accordingly in humans. As an indicator of the potential for airway obstruction, the ratio of the diameter of the deposited, aggregated aerosol to airway diameter was calculated for each exposure condition. For rats exposed to 5mg/L for 4h, approximately 75% of tracheobronchial and 22% of pulmonary/alveolar airways were considered vulnerable to significant or complete obstruction (ratios >0.5). In humans, an equivalent exposure resulted in just over 96% of human tracheobronchial airways that received deposited mass to airway diameter ratios between 0.3 and 0.4 (nasal) or 0.4 and 0.5 (oral), with no airways with ratios >0.5. For the pulmonary/alveolar region, ∼88% of the airways following nasal or oral breathing were predicted to have deposited aerosol diameter to airway diameter ratios <0.1, with no airways with ratios >0.5. Thus, the in silico results obtained for rats are in line with the pathological findings of the animal test. The predicted results in humans, however, affirm the hypothesis of a rat-specific high dose effect which does not justify a classification according to GHS.

Home Based Walking Exercises and Alternative Nasal Breathing Decrease Blood Pressure in Pre-Elderly People with Hypertension

The condition known as hypertension is brought on by the body's elevated blood pressure as a result of the heart pounding too hard. Hypertension is caused by a variety of causes, including both modifiable and unmodifiable ones. The purpose of this study is to evaluate the impact of alternate nostril breathing and walking exercise at home on the blood pressure of senior hypertension patients. A quasi-experiment with a pre-post test control group design methodology is used in the research design. Using the Total Sampling approach, 50 respondents with hypertension made up the research sample. In two weeks, the intervention was performed four times. The paired t-test results indicate that the combination of alternate nostril breathing and home-based walking exercise has an effect on blood pressure in the treatment group (both diastolic and systolic have p values = 0.000), while the control group experiences no change in blood pressure (diastolic has p values = 0.200 and systolic has p values = 0.195). The findings of the Independent T-Test demonstrated variations in blood pressure changes in both the systolic and diastolic domains between the treatment and control groups (diastolic p-value = 0.000), and systolic (p-value = 0.000). The findings of the Independent T-Test demonstrated variations in blood pressure changes in both the systolic and diastolic domains between the treatment and control groups ,diastolic (p-value = 0.000), and systolic (p-value = 0.000). Systolic and diastolic blood pressure drop as a result of an increase in endorphin chemicals and a decrease in cortisol. This calms and relaxes the body and balances the actions of the sympathetic and parasympathetic nervous systems. It is advised that individuals with pre-elderly hypertension who are able to independently implement combination therapies in an attempt to control their blood pressure. Kata kunci: Home Based Walking Exercise, Alternate Nostril Breathing, Pre-Elderly, Hypertension

Cytokine profile of nasal polyps and clinical characteristics of patients with polypous rhinosinisitis at different degree of therapeutic control and disease severity

The issues of recurrencies in chronic rhinosinusitis with nasal polyps (CRSwNP) still remain unresolved. Therefore, detection patients with uncontrolled clinical course of CRSwNP is required.The aim of the present study was to assess cytokine profile in nasal polyps as well as clinical characteristics of patients with CRSwNP at varying levels of therapeutic control.The study included 99 patients with chronic rhinosinusitis. The contents of interferon IFNγ, interleukin IL- 1β, IL-4, IL-5, IL-13, tumor necrosis factor TNFα, transforming growth factors TGF-β1, TGF-β2, TGF-β3 were measured in polyp tissue samples by means of multiplex analysis. The patients were treated according to a stepwise СRSwNP therapeutic algorithm [9]. Following observation for 5 years, all patients were divided into groups, as based on medical control degree. Group 1 included patients with mild CRSwNP, who mainly received stage I and II treatment for the entire observation period. Group 2 was presented by moderate- severity CRSwNP, with stage II or III therapy according to the referred algorithm. Group 3 included the patients with severe CRSwNP who received one or more stage IV courses. The patients underwent repeated SNOT-22 questionnaire, endoscopic examination, clinical assessment. In case of bronchial asthma (BA), ACQ-7 was repeated. Initial cytokine profile of nasal polyps was analyzed by the mentioned clinical groups.Results:After 5 years of observations in group 1 (mild CRSwNP), we found a minimal decrease in quality of life (SNOT-22), severity of nasal congestion, or smell impairment. Bronchial asthma duration in these patients was significantly lower compared to group 3, the patients had better asthma control level. Cytokine profile of nasal polyps was characterized by the highest IL-4 concentration, average values IL-1β, TNFα, IFNγ and minimal TGF-β1 values.In group 2 (moderate CRSwNP), we noted more pronouced impairment of smell, nasal congestion and quality of life. Bronchial asthma was less controlled than in group 1. The maximal concentrations of IFNγ, IL-1β, TNFα, IL-5, TGF-β1, TGF-β2 were registered.In group 3 with poor CRSwNP control, the highest SNOT-22 scores, severity of difficulty in nasal breathing, impaired sense of smell were revealed. Duration of bronchial asthma was longer, with lowest levels of medical control. In nasal polyps, minimal levels of IFNγ, IL-1β, TNFα, IL-4, IL-5, TGF-β2, TGF-β3 were noted.Treatment of patients depending on the clinical phenotypes of CRSwNP in the presence/absence of allergic rhinitis or bronchial asthma may improve control and reduce incidence of relapses in CRSwNP.

Regional associations between inspiratory tongue dilatory movement and genioglossus activity during wakefulness in people with obstructive sleep apnoea.

Inspiratory tongue dilatory movement is believed to be mediated via changes in neural drive to genioglossus. However, this has not been studied during quiet breathing in humans. Therefore, this study investigated this relationship and its potential role in obstructive sleep apnoea (OSA). During awake supine quiet nasal breathing, inspiratory tongue dilatory movement, quantified with tagged magnetic resonance imaging, and inspiratory phasic genioglossus EMG normalised to maximum EMG were measured in nine controls [apnoea-hypopnea index (AHI) ≤5 events/h] and 37 people with untreated OSA (AHI >5 events/h). Measurements were obtained for 156 neuromuscular compartments (85%). Analysis was adjusted for nadir epiglottic pressure during inspiration. Only for 106 compartments (68%) was a larger anterior (dilatory) movement associated with a higher phasic EMG [mixed linear regression, beta=0.089, 95% CI [0.000, 0.178], t(99)=1.995, P=0.049, hereafter EMG↗/mvt↗]. For the remaining 50 (32%) compartments, a larger dilatory movement was associated with a lower phasic EMG [mixed linear regression, beta=-0.123, 95% CI [-0.224, -0.022], t(43)=-2.458, P=0.018, hereafter EMG↘/mvt↗]. OSA participants had a higher odds of having at least one decoupled EMG↘/mvt↗ compartment (binary logistic regression, odds ratio [95% CI]: 7.53 [1.19, 47.47] (P=0.032). Dilatory tongue movement was minimal (>1 mm) in nearly all participants with only EMG↗/mvt↗ compartments (86%, 18/21). These results demonstrate that upper airway dilatory mechanics cannot be predicted from genioglossus EMG, particularly in people with OSA. Tongue movement associated with minimal genioglossus activity suggests co-activation of other airway dilator muscles. KEY POINTS: Inspiratory tongue movement is thought to be mediated through changes in genioglossus activity. However, it is unknown if this relationship is altered by obstructive sleep apnoea (OSA). During awake supine quiet nasal breathing, inspiratory tongue movement, quantified with tagged magnetic resonance imaging (MRI), and inspiratory phasic genioglossus EMG normalised to maximum EMG were measured in four tongue compartments of people with and without OSA. Larger tongue anterior (dilatory) movement was associated with higher phasic genioglossus EMG for 68% of compartments. OSA participants had an ∼7-times higher odds of having at least one compartment for which a larger anterior tongue movement was not associated with a higher phasic EMG than controls. Therefore, higher genioglossus phasic EMG does not consistently translate into tongue dilatory movement, particularly in people with OSA. Large dilatory tongue movements can occur despite minimal genioglossus inspiratory activity, suggesting co-activation of other pharyngeal muscles.

Therapy of acute rhinosinusitis in patients with allergic rhinitis: possibilities for implementing advanced control of inflammation

Introduction. Allergic rhinitis (AR) in conjunction with acute infectious rhinosinusitis (ARS) can lead to increased inflammation and contributes to a more severe course of ARS.Aim. To study the effect of some non-sedating H1-antihistamines on the severity of clinical presentations in adult patients with ARS and underlying AR as part of routine medical practice.Materials and methods. Group 1 (75 patients) and Group 2 (85 patients) were generated through simple randomization from the patient population with ARS and underlying AR, who were prescribed benzhydryl-piperazinyl-butylmethylxanthine succinate (Teoritin® MF, 4 mg/day) or desloratadine (INN, 5 mg/day), respectively. The course of therapy was 14 days. The estimated parameters included changes in indices of nasal symptoms, rhinoscopic and non-nasal symptoms during follow-up visits, time to reach zero indices, the proportions of patients, whose symptoms reduced after 3 and 7 days of treatment, the need for the use of nasal decongestants and changes in quality of life measures.Results and discussion. During the first 3 days of treatment, nasal breathing improved in 91% (95% CI 81–96%) of patients in Group 1 vs 56% (95% CI 45–67%) in Group 2, p &lt; 0.001; rhinorrhea was relieved in 76% (95% CI 65–85%) and 62% (95% CI 51–72%) in Groups 1 and 2, respectively. By Day 7 of treatment, complete restoration of nasal breathing was observed in 71% of patients in Group 1 (95% CI 59–80%), and in 41% (95% CI 31–52%) in Group 2 (p = 0.014); rhinorrhea was relieved in 61%(95% CI 49–72%) of patients in Group 1 and 37% (95% CI 27–48%) in Group 2, p = 0.001. Decongestants were used by 20%(95% CI 12–31%) of patients in Group 1, and by 35% (95% CI 25–47%) of patients in Group 2, p = 0.031. The between-group difference was significant in terms of duration and frequency of adjuvant therapy, p &lt; 0.05.Conclusion. In comparison with desloratadine, it provided a more pronounced reduction of nasal and non-nasal symptoms, as well as relief of rhinoscopic signs of inflammation in a shorter time. The use of Teoritin® MF contributed to the reduction in the need (duration and frequency) for nasal decongestants.

Allergic rhinitis: a comprehensive view of the problem

Currently, allergic sensitization is considered as one of the key causes of the development of chronic inflammatory processes in the nasal cavity and paranasal sinuses. The choice of optimal drugs for the treatment of allergic rhinitis still remains a relevant, socially significant and interdisciplinary problem. The article analyzes the modern strategy for the treatment of allergic rhinitis and assesses the incidence of comorbid pathology associated with allergic sensitization in patients with this pathology. In accordance with the latest clinical guidelines, a discussion of a stepwise approach to the treatment of allergic rhinitis was carried out. Based on data from a number of studies, the advantages of prescribing intranasal corticosteroids (InGCS) and leukotriene receptor antagonists (ALR) in the treatment of allergic rhinitis, including when combined with bronchial asthma and chronic rhinosinusitis with nasal polyps, have been identified. Among the officially registered drugs for the basic treatment of allergic rhinitis, the characteristics of the original intranasal spray mometasone furoate and the leukotriene receptor blocker montelukast are described in detail. The discussion describes the possibilities of potentiating the effects of topical corticosteroids through combination with leukotriene receptor antagonists. A clinical example demonstrates the feasibility of using a combination of the intranasal corticosteroid Nasonex with the leukotriene receptor blocker Singulair to control the course of allergic rhinitis and chronic rhinosinusitis with nasal polyps and, as a consequence, prevent the development of remodeling of the respiratory tract mucosa in such patients. During a follow-up examination after 3 months of therapy, the patient noted a subjective improvement in general well-being, nasal breathing, sense of smell, normalization of sleep, and a significant decrease in nasal discharge. There is no need for decongestants, sneezing is not a concern, and there is no respiratory discomfort. The combined use of ALR and InGCS enhances the anti-inflammatory effect of therapy.

Quality of life of children with allergic rinitis and ways of correction

Introduction. Allergic rhinitis is a common disorder that significantly impairs the children’s quality of life. The problem is particularly pertinent in relation to the paediatric population living in areas with advanced manufacturing industries, where well-known trigger factors, being added by increased concentration of pollutants in the atmospheric air, further complicate the selection of an effective course of treatment.Aim. To determine the effectiveness of a course of treatment with an antihistamine medicine Cetirizine based on the assessment of quality-of-life criteria for children with intermittent allergic rhinitis (IAR) in the Chelyabinsk region.Materials and methods. A prospective study of 147 children with respiratory allergic diseases living in the Chelyabinsk region was conducted. The quality of life of children who received a course of treatment with the antihistamine medicine was assessed using the Paediatric Quality-of-Life inventory (PedsQL) that consisted of combined Likert scales (school life, social, physical functioning, etc.), clinical symptoms were assessed using a developed visual analogue scale.Results and discussion. The assessment findings confirmed that the use of Cetirizine in the complex therapy of intermittent allergic rhinitis and associated comorbid conditions made it possible to significantly improve the clinical symptoms and quality of life of children over the entire treatment period.The most striking positive response in the form of decreased nasal obstruction was seen during the prescribed treatment in patients of Groups 1 and 2. Thus, the filling VAS ratings for children with mild to moderate IAR showed that only 10 (20%) patients in Group 1 experienced mild nasal breathing difficulty. Patients with severe IAR reported a decrease in nasal obstruction only by the end of two-month treatment.Conclusion. Cetirizine demonstrated a good effect of blocking H1-histamine receptors, high bioavailability, good tolerability and safety in the treatment of allergic rhinitis in children with comorbid conditions.

Modern view on the problems of secretory otitis media in children

Anti-inflammatory therapy as part of the treatment of exudative otitis media (EOM) that develops in rhinitis and rhinosinusitis is included in various treatment regimens. If conservative therapy for EOM is ineffective, surgical intervention in the form of various variants of adenotomy and removal of secretions from the tympanic cavity is considered. The authors selected and described in detail a clinical case of observation and treatment of EOM in a 7-year-old child, which allowed to highlight approaches to the diagnosis of the disease, assess her concomitant diseases, choose a method for surgical treatment and conservative therapy with a drug containing tuaminoheptane and acetylcysteine. Eustachian tube drainage followed by the use of an anticongestive drug to treat rhinosinusitis in a 7-year-old girl with EOM showed high effectiveness. The advantages of the drug are as follows: a direct unloading effect, the possibility of evacuation of thickening secretions from the nasal cavity and nasopharynx due to the drug containing acetylcysteine and tuaminoheptane. Thus, the tubular dysfunction in children can be associated with various reasons: inflammatory processes in the nasopharynx and paranasal sinuses (viral and bacterial infection), allergic (exposure to various allergens). EOM may develop in all types of tubular dysfunction in children. The adverse effects of long-term tympanostomy in chronic EOM has led to the search for alternatives. The long-term eustachian tube drainage can be regarded as this method. The anticongestive agent for rhinosinusitis can be used in children with EOM from the age of 6 years. The advantages of the drug include a direct unloading effect, minimal contraindications, restoration of nasal breathing without systemic exposure in frequently ill children, and the possibility of evacuation of thickening secretions from the nasal cavity and nasopharynx. In summary, an anticongestive agent containing acetylcysteine and tuaminoheptane can be recommended for use in paediatric otorhinolaryngological practice to treat acute and subacute rhinitis in children with EOM.

Comparison of ventilatory parameters with nasal versus oral breathing during submaximal exercise in patients with cardiac disease and healthy people

Abstract Introduction Inefficient ventilation, namely a high ventilation/carbon dioxide production ratio (VE/VCO2) is a well established predictor for disease progression and mortality in patients with heart failure (HF). Two previous studies in healthy people have found improved ventilatory efficiency with nasal compared to oral breathing during submaximal exercise. No study has compared nasal with oral breathing in patients with HF or coronary heart disease. Method Four study groups were recruited: Patients with HF, patients with acute or chronic coronary syndrome (ACS/CCS), old healthy controls (age&amp;gt;45 years) and young healthy controls (age&amp;gt;20 years and &amp;lt;35 years). Acute measurements of 5 min (after 3 min warm-up) with nasal and 5 min with oral breathing in randomized order were performed at 50% peak power. Ventilation parameters were averaged over the last minute of each condition and analysed by linear mixed models adjusted for body mass index. Results We present data of 8 patients with HF, 8 with ACS/CCS, 10 old and 15 young healthy controls. Minute ventilation, breathing frequency and end-tidal oxygen partial pressure (PETO2) were significantly lower and tidal volume and end-tidal carbon dioxide partial pressure (PETCO2) significantly higher during nasal compared to oral breathing in all groups (Figure 1). Differences between breathing modes were between 5-20% and similar in all groups except for breathing frequency that declined more from oral to nasal breathing, namely by 27%, in patients with HF compared to the other groups. The largest discrepancies between patients and healthy controls were found for VE/VCO2 ratio, PETCO2 and PETO2. Conclusion Nasal breathing during submaximal exercise significantly improved the abnormal breathing pattern of patients with HF and ACS/CCS. Nasal breathing during exercise may be promising in patients with inefficient ventilation as it increases PETCO2 and is likely to increase arterial partial CO2 pressure, a known vasodilator, herewith facilitating perfusion of the working musculature.Figure 1

A simple home test to differentiate habitual from pathological mouth breathing.

Mouth breathing (MB) is defined as breathing through the mouth alone or the mouth and the nose for more than six months. Unfortunately, after managing its mechanical causes, MB may continue due to habit, obscuring the results of surgical correction of nasal breathing and misleading to unnecessary or aggressive maneuvers. to develop and evaluate a new test to define children of habitual MB. Design: a prospective observational study conducted from May 2022 to February 2023. multicenter; outpatient university clinics and a private ENT center. 577 children aged 2-12 years and complaining of MB during sleep (±daytime) for ≥6 months were assessed for eligibility, 340 were excluded due to a lack of inclusion criteria, 29 declined or discontinued participation, and 208 were enrolled. Of these, 180 gave reliable data. After about 1h of the child's sleep, the parent applies one warmed hand to close the child's open mouth recording his awakeness time (AT) for a maximum of 3min for three nights. On the next visit, the child's examination started for obstruction causes, including endoscopy, and the test results were collected. The AT was compared to examination results aiming to find a significant diagnostic relation. Children with no abnormality in the clinical and endoscopic examination were considered habitual mouth breathers. Among 94 males and 86 females aged 2-12 years, MB duration ranged from 6 to 42 months, with a mean of 15.9. The home test results were presented by the mean AT in seconds. The awakeness time (AT) could discriminate patients' abnormalities at a cut-off level of <133s, with 98.5% sensitivity and 89.7% specificity. Results <133s are considered positive. Positive results mean the presence of a cause of obstruction. Negative results suggest no reason could be detected by endoscope or clinical examination. True positive children were 120 (66.7%), and 12 (6.7%) were false positive. True negative children were 43 (23.9%), and 5 (2.8%) were false negative. Test results ≥133s are associated with habitual MB. We recommend the test for the initial assessment of night MB.

On the comparison between pre- and post-surgery nasal anatomies via computational fluid dynamics

Nasal breathing difficulties (NBD) are widespread and difficult to diagnose; the failure rate of their surgical corrections is high. Computational fluid dynamics (CFD) enables diagnosis of NBD and surgery planning, by comparing a pre-operative (pre-op) situation with the outcome of virtual surgery (post-op). An equivalent comparison is involved when considering distinct anatomies in the search for the functionally normal nose. Currently, this comparison is carried out in more than one way, under the implicit assumption that results are unchanged, which reflects our limited understanding of the driver of the respiratory function. The study describes how to set up a meaningful comparison. A pre-op anatomy, derived via segmentation from a CT scan, is compared with a post-op anatomy obtained via virtual surgery. State-of-the-art numerical simulations for a steady inspiration carry out the comparison under three types of global constraints, derived from the field of turbulent flow control: a constant pressure drop (CPG) between external ambient and throat, a constant flow rate (CFR) through the airways and a constant power input (CPI) from the lungs can be enforced. A significant difference in the quantities of interest is observed depending on the type of comparison. Global quantities (flow rate, pressure drop and nasal resistance) as well as local ones are affected. The type of flow forcing affects the outcome of the comparison between pre-op and post-op anatomies. Among the three available options, we argue that CPG is the least adequate. Arguments favouring either CFR or CPI are presented.

Pemberian Inhalasi Minyak Kayu Putih Untuk Memperbaiki Pola Napas Tidak Efektif Pada Anak Dengan Bronkitis

&lt;p&gt;&lt;em&gt;There are 1.6 million persons who have bronchitis in Indonesia. Coughing, wheezing, sputum buildup, and shortness of breath are common symptoms. We must be mindful of the efficiency of breathing patterns when considering these symptoms. The goal of this study was to identify inefficient breathing techniques used by nurses to provide bronchitis-stricken An. A with nursing care. An. A is the focus of this case study in a scientific journal, and the study's findings include cough and runny nose, RR 32 beats per minute, additional rhonchi noises, SPO2 92%, body temperature 36.8 oC, and pulse 100 beats per minute. Airway control using eucalyptus oil inhalation was the intervention that was used. The major treatment for An's respiratory pattern issues was a straightforward inhalation of eucalyptus oil, and the findings of the case study were achieved following nursing care for airway management for three consecutive days. Increased inspiratory pressure, moderately decreased dyspnea, moderately decreased use of accessory muscles, decreased orthopnea, moderately decreased nasal breathing, improved respiratory rate, and improved respiratory depth are all signs that A can be substantially resolved. This demonstrates how eucalyptus oil can help bronchitis patients breathe more easily.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;strong&gt;&lt;em&gt;Keyword: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;children, bronchitis, ineffective breathing pattern, simple inhalation&lt;/em&gt;&lt;br /&gt;&lt;/strong&gt;&lt;/p&gt;

Effect of breathing patterns on mandibular cortical bone quality in children and establishment of a preliminary screening model

ObjectiveThis retrospective study analyzed breathing patterns and age subgroups effect on cortical bone quality of the mandible in growing subjects, aiming to explore the application value of facial skeletal pattern combined with cortical bone density detection in early screening diagnosis of mouth breathing.MethodsOne hundred twenty-six participants were divided into four groups: mouth breathing group (7–9, 10–12 years old) and nasal breathing group (7–9, 10–12 years old). The mandibular anterior, middle, and posterior cortical bone mineral density (CBMD), cortical bone width (MCW), ANB, and FMA values were measured. Independent T-test and Mann–Whitney U test were used to compare the measured values. Binary logistic regression was employed to analyze the correlation between measured variables and the children’s breathing patterns. ROC analysis was used to determine the ability of the cortical bone density measurements in early screening diagnosis of MB.ResultsMouth breathing had a negative impact on CBMD and MCW of the pre-mandibular (Pog) in subjects aged 7–9 years and also impacted the development of (Pog) and submandibular (Me) sites in subjects aged 10–12 years. Older children in the nasal breathing group have higher CBMD, MCW, and SNB values and lower FMA values. Single-factor and multiple-factor logistic binary regression analysis showed that FMA, MSPogCBMD, MSPogMCW, and ANB are correlated factors for children at risk of mouth breathing.ConclusionMouth breathing pattern is closely associated with decreased mandibular CBMD and MCW values in children aged 7–12, where the anterior (Pog) and inferior (Me) sites of anterior mandible are more significantly affected. Furthermore, in combination with facial skeletal pattern, it provides a basis for the early warning diagnosis of mouth breathing.

Acute nasal breathing lowers diastolic blood pressure and increases parasympathetic contributions to heart rate variability in young adults.

There is growing interest in how breathing pace, pattern, and training (e.g., device-guided or -resisted breathing) affect cardiovascular health. It is unknown whether the route of breathing (nasal vs. oral) affects prognostic cardiovascular variables. Because nasal breathing can improve other physiological variables (e.g., airway dilation), we hypothesized that nasal compared with oral breathing would acutely lower blood pressure (BP) and improve heart rate variability (HRV) metrics. We tested 20 adults in this study [13 females/7 males; age: 18(1) years, median (IQR); body mass index: 23 ± 2 kg·m-2, means ± SD]. We compared variables between nasal- and oral-only breathing (random order, five min each) using paired, two-tailed t tests or Wilcoxon signed-rank paired tests with significance set to P < 0.05. We report the median (interquartile range) for diastolic BP and means ± SD for all other variables. We found that nasal breathing was associated with a lower mean BP (nasal: 84 ± 7 vs. oral: 86 ± 5 mmHg, P = 0.006, Cohen's d = 0.70) and diastolic BP [nasal: 68(8) vs. oral: 72(5) mmHg, P < 0.001, Rank-biserial correlation = 0.89] but not systolic BP (nasal: 116 ± 11 vs. oral: 117 ± 9 mmHg, P = 0.48, Cohen's d = 0.16) or heart rate (HR; nasal: 74 ± 10 vs. oral: 75 ± 8 beats·min-1, P = 0.90, Cohen's d = 0.03). We also found that nasal breathing was associated with a higher high-frequency (HF) contribution to HRV (nasal: 59 ± 19 vs. oral: 52 ± 21%, P = 0.04, Cohen's d = 0.50) and a lower low frequency-to-HF ratio at rest (nasal: 0.9 ± 0.8 vs. oral: 1.2 ± 0.9, P = 0.04, Cohen's d = 0.49). These data suggest that nasal compared with oral breathing acutely 1) lowers mean and diastolic BP, 2) does not affect systolic BP or heart rate, and 3) increases parasympathetic contributions to HRV.NEW & NOTEWORTHY There is growing interest in how breathing pace, pattern, and training (e.g., device-guided or -resisted breathing) affect prognostic cardiovascular variables. However, the potential effects of the breathing route on prognostic cardiovascular variables are unclear. These data suggest that nasal compared with oral breathing 1) lowers mean and diastolic blood pressure (BP), 2) does not affect systolic BP or heart rate (HR), and 3) increases parasympathetic contributions to heart rate variability (HRV). These data suggest that acute nasal breathing improves several prognostic cardiovascular variables.

Obstructed nasal breathing with eyelid swelling

Obstructed nasal breathing with eyelid swelling