Nasal Function Research Articles

The impact of surgical masks on the nasal function in the COVID-19 era

Background The Covid-19 pandemics has obliged to using different types of personal protective devices (PPD) for a prolonged time of the day, especially in the Health Centers, with preference of surgical masks (SM) during the first pandemic waves. Aims/Objectives This study was designed to assess the eventual changes of the nasal respiratory condition during continuous SM wearing. Material and methods Fourteen healthcare professionals filled a visual analogue scale (VAS) questionnaire for the detection of eventual nasal breathing impairment or symptoms. Nasal resistance and flow values were obtained via the active anterior rhinomanometry (AAR) that was performed under the basal condition, as well as immediately after wearing the surgical mask (SM) and 3 h after its continuous use. Results The increase of inspiratory resistance was significantly correlated to the reduction of the maximum flux, when comparing SM parameters to the basal ones (r = –0.70, p < .05). At VAS evaluation, SM wearing showed to induce itching in 70% of the subjects, nasal dryness in 55%, nasal blockage in 50%, headache in 39%, watery nasal discharge in 20% and sneezing in 18%. Conclusions and significance The SMs do not induce evident physiological variations of the nasal function due to a compensatory respiratory mechanism that, despite a progressive increase of nasal resistances, is not inducing significant changes of the nasal fluxes.

Comparative Effectiveness of Cartilage Grafts in Functional Rhinoplasty for Nasal Sidewall Collapse.

Objective: To compare the patient-reported outcomes among patients with nasal obstruction undergoing two rhinoplasty techniques to a control group. Methods: Prospective longitudinal study in a university-based tertiary care medical center. All patients undergoing functional septorhinoplasty for correction of lateral wall insufficiency between October 2015 and March 2019 were included; n = 704, mean age (standard deviation) 39.0 (15.4) years, 52.7% females. Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) and FACE-Q subscales pre- and postoperatively. Patients were divided into three cohorts: spreader and lateral crural strut (LCS) grafts (n = 141), spreader and alar rim (AR) grafts (n = 104), and the control spreader grafts alone (n = 218). Results: The median NOSE scores at last postoperative visit were improved from baseline (p < 0.001) for all cohorts. The FACE-Q nasal satisfaction median scores also improved postoperatively in all cohorts, AR, LCS, and spreader, respectively (p = 0.001, p < 0.001, and p < 0.0001). Conclusions: There was no detectable difference in the improved subjective nasal function, nor adverse aesthetic outcomes in the patients with lateral wall insufficiency treated with functional rhinoplasty techniques in this study.

Nasal function and CPAP use in patients with obstructive sleep apnoea: a systematic review.

This systematic review was conducted to answer the following 3 questions: 'Does nasal pathology affect CPAP use?', 'What is the effect of CPAP on the nose?'and 'Does treatment of nasal pathology affect CPAP use?'. Pubmed and Scopus databases were searched for articles relevant to the study questions up to October 2020. Sixty-three articles were selected, of which a majority were observational studies. Most studies identified a correlation between larger nasal cross-sectional area or lower nasal resistance and higher CPAP compliance or lower CPAP pressures; however, nasal symptoms at baseline did not appear to affect CPAP use. The effect of CPAP on the nose remains uncertain: while most studies suggested increased mucosal inflammation with CPAP, those investigating symptoms presented contradictory results, with some reporting an increase and others an improvement in nasal symptoms. Evidence is clearer for nasal surgery leading to an increase in CPAP compliance and a decrease in CPAP pressures, whereas there is little evidence available for the use of topical nasal steroids. There appears to be a link between nasal volumes or nasal resistance and CPAP compliance, an increase in nasal inflammation caused by CPAP and a beneficial effect of nasal surgery on CPAP usage, but no significant effect of CPAP on nasal patency or effect of topical steroids on CPAP compliance. Results are more mitigated with regard to the effect of nasal symptoms on CPAP use and vice versa, and further research in this area would help identify patients who may benefit from additional support or treatment alongside CPAP.

Effects of different nasal packs on nasal functions after septoplasty

Effects of different nasal packs on nasal functions after septoplasty

A Preliminary Report on the Correlation Between Nasal Function and the Different Phases of the Nasal Cycle.

To explore whether the different phases of the nasal cycle have a significant effect on nasal temperature, the nasal mucosal clearance rate, and levels of nasal nitric oxide (nNO) and to investigate the correlation between these nasal conditions. The study participants were divided into 2 groups: the control group and the rhinitis group. The participants' nasal temperature, cilia clearance rate, and nNO levels were measured during different phases of the nasal cycle (the congestion phase and decongestion phase) in the control group and before and after undergoing inferior turbinate ablation in the rhinitis group. The temperature of the nasal cavity in the control group was significantly higher in the congestion phase than in the decongestion phase (P = .0025), while in the rhinitis group, the temperature of the nasal cavity decreased significantly after inferior turbinate ablation (P = .001). In the control group, the nasal mucosa clearance time was significantly shorter in the congestion phase than in the decongestion phase (P = .001), and in the rhinitis group, the clearance time of the nasal mucosa was significantly shortened after the operation (P = .0025). In the control group, the levels of nNO were significantly higher in the congestion phase than in the decongestion phase (P = .025), while in the rhinitis group, nNO levels decreased significantly after the operation (P = .005). The function of the nasal cavity changes in different phases of the nasal cycle. Therefore, when evaluating the impact of various factors on nasal function, factors associated with the nasal cycle should also be considered. Inferior turbinate plasma ablation can improve the ciliary function of the nasal mucosa, reduce the temperature of the nasal cavity, and reduce nNO levels.

The nasal mutualist Dolosigranulum pigrum AMBR11 supports homeostasis via multiple mechanisms

SummaryComparing the nasal microbiome of healthy individuals and chronic rhinosinusitis (CRS) patients revealed Dolosigranulum pigrum as a species clearly associated with nasal health, although isolates obtained from healthy individuals are scarce. In this study, we explored the properties of this understudied lactic acid bacterium by integrating comparative genomics, habitat mining, cultivation, and functional characterization of interaction capacities. Mining 10.000 samples from the Earth Microbiome Project of 17 habitat types revealed that Dolosigranulum is mainly associated with the human nasal cavity. D. pigrum AMBR11 isolated from the nose of a healthy individual exerted antimicrobial activity against Staphylococcus aureus, decreased proinflammatory cytokine production in airway epithelial cells, and Galleria mellonella larvae mortality induced by this important nasal pathobiont. Furthermore, the strain protected the nasal barrier function in a mouse model using interleukin-4 as disruptive cytokine. Hence, D. pigrum AMBR11 is a mutualist with high potential as topical live biotherapeutic product.

Analysis of clinical effect of nasal endoscope-assisted nasal columella approach for simultaneous correction of nasal septum deviation and crooked nose deformity

Objective:To analyze the clinical effect of nasal endoscope-assisted nasal columella approach in the correction of nasal septum deviation and crooked nose deformity. Methods:The clinical data of 33 patients with deviation of nasal septum with crooked nose deformity in First Affiliate Hospital of Air Force Military Medical University from January 2016 to June 2019 were collected. All patients underwent surgery under general anesthesia. Nasal columella inverted "V" incision was used to expose and release. The deviated nasal septum cartilage and bone were removed with the assistance of nasal endoscope. Twelve（36.4%） patients underwent osteotomy of nasal bone and frontal process of maxilla at the same time, 13（39.4%） patients used autologous nasal septum to reshape the tip, back and external nose. Results:During a follow-up of 18 months to 60 months, 30（90.9%） patients were satisfied with the improvement of postoperative nasal function, 3（9.1%） patients were basically satisfied; 23（69.7%） patients were satisfied with the appearance of the nose after operation, 8（24.2%） patients were basically satisfied, and 2（6.1%） patients were dissatisfied. No postoperative complications such as nasal adhesion, nasal septum perforation, nasal septum hematoma and nasal dorsal collapse occurred in all patients. Conclusion:The nasal endoscope-assisted nasal columella approach and the correction of nasal septum deviation and crooked nose deformity can solve the nasal deformity and nasal ventilation function at the same time, realize the unity of cosmetology and function, and reduce the frequency and cost of surgical treatment at the same time. The effect is good, and the patients benefit greatly.

The Merits of the External Rhinoplasty.

The authors present their views on the merits of external rhinoplasty in the context of a renewed awareness of the endonasal approach. Why do we continue to perform rhinoplasty via an open approach? The benefits of this technique such as its unparalleled exposure, the opportunity for technical precision, and the ability to better preserve nasal function are thoroughly explored. The criticisms of this technique are presented and discussed. The authors thoughts on rhinoplasty as a whole are examined.

Age-Related Inflammatory Balance Shift, Nasal Barrier Function, and Cerebro-Morphological Status in Healthy and Diseased Rodents

Increased blood–brain barrier (BBB) permeability and extensive neuronal changes have been described earlier in both healthy and pathological aging like apolipoprotein B-100 (APOB-100) and amyloid precursor protein (APP)–presenilin-1 (PSEN1) transgenic mouse models. APOB-100 hypertriglyceridemic model is a useful tool to study the link between cerebrovascular pathology and neurodegeneration, while APP–PSEN1 humanized mouse is a model of Alzheimer’s disease. The aim of the current study was to characterize the inflammatory changes in the brain with healthy aging and in neurodegeneration. Also, the cerebro-morphological and cognitive alterations have been investigated. The nose-to-brain delivery of a P-glycoprotein substrate model drug (quinidine) was monitored in the disease models and compared with the age-matched controls. Our results revealed an inflammatory balance shift in both the healthy aged and neurodegenerative models. In normal aging monocyte chemoattractant protein-1, stem cell factor and Rantes were highly upregulated indicating a stimulated leukocyte status. In APOB-100 mice, vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF-BB), and interleukin-17A (IL-17A) were induced (vascular reaction), while in APP–PSEN1 mice resistin, IL-17A and GM-CSF were mostly upregulated. The nasal drug absorption was similar in the brain and blood indicating the molecular bypass of the BBB. The learning and memory tests showed no difference in the cognitive performance of healthy aged and young animals. Based on these results, it can be concluded that various markers of chronic inflammation are present in healthy aged and diseased animals. In APOB-100 mice, a cerebro-ventricular dilation can also be observed. For development of proper anti-aging and neuroprotective compounds, further studies focusing on the above inflammatory targets are suggested.

Extended L-shaped Spreader Graft for Correction of Combined Dorsal and Caudal Nasal Septal Deviations.

Summary:Although a wide range of surgical techniques have been proposed to straighten the deviated cartilaginous nasal dorsum and maximize nasal function, recurrence is common because of cartilage memory and scar contractures. An extended L-shaped spreader graft, a permanent support, was developed to correct functional and aesthetic problems, to prevent recurrence, and to maintain the correction of the septum stable and strong. This technique was utilized in 16 cases of deviated cartilaginous dorsum. All patients were subjected to a detailed history, physical examination, CT scan of the nose, and photographic documentation preoperatively. The patients were followed up during a period of 3 months to 4 years. According to physical examination, postoperative photography, and patients’ satisfaction, the final results were categorized as excellent, good, or poor. The results were as follows: 14 patients (87.5%) were classified as excellent, as their noses were completely straight, and this was consistent with physical examination and postoperative photographs. Two patients (12.5%) were classified as good because there was a minimal residual deviation according to either photographs or clinical examinations. This minimal deformity was not experienced by the patients. In conclusion, consistent, reproducible results were achieved with using the autologous extended L-shaped spreader graft for controlling and maintenance of the dorsal and caudal septal deviation after correction. It is one piece of L-shaped graft of autogenous cartilage fixed to the original septal L-strut. It is regarded as an anatomical graft that provides sustained cephalocaudal support, preserves pliability of the lobule, and maintains stability as an independent stabilizer for the native strut.

Evaluation of Nasal Function and Upper Airway Morphology After Bi-Maxillary Surgery Using Rhinomanometry and Computed Tomography.

This study was performed to evaluate changes in nasal airflow, nasal airway resistance, nasal cross-sectional area, pharyngeal horizontal area, nasopharyngeal and oropharyngeal volume following Le Fort I osteotomy (L1) impaction with sagittal split ramus osteotomy (SSRO) in classes II and III. The subjects consisted of 35 patients (6 males and 29 females, 70 sides) 17 of which were diagnosed as class II and 18 as class III who underwent L1 and SSRO. Nasal airflow and resistance were measured using the rhinomanometry system (GM NR-6 EXECUTIVE) before and at 1 and 6 months after surgery. Nasal, cross-sectional area, and volume were measured using a 3-dimensional computed tomography respectively, before and 1-year after surgery. Although a significant decrease was found in nasal volume after surgery (P = 0.0042), there was no difference between before and after surgery in the nasal airway resistance in class II.A significant decrease in nasal volume was found after surgery (P = 0.0005) and there were no postoperative changes in both nasal airflow and resistance in class III. The study suggested that L1 impaction with SSRO did not worsen nasal function such as nasal airflow and nasal airway resistance, although nasal volume significantly decreased in both groups.

Changes in Nasal Function after Maxillary Movements

مقدمه: تغییر موقعیت فک بالا بطور معمول جزیی از درمان بدشکلی های اسکلتال می باشد. جهت انجام این جابجایی ها تکنیک جراحی استئوتومی لفورت 1 معرفی گردید و از زمان معرفی آن تاکنون جراحان به اثر اجتناب ناپذیر آن در فرم و عملکرد حفره بینی پی برده اند. تعدادی از محققین تاکنون با استفاده از جریان و مقاومت هوای بینی به بررسی این تغییرات پرداخته اند. با در نظر گرفتن این مهم، بر آن شدیم تا تغییرات جریان هوای بینی و مقاومت آن را بعد از جراحی های جابجایی ماگزیلا ارزیابی نماییم. مواد و روش ها: تعداد 21 بیمار ارجاع شده به بخش جراحی دهان، فک و صورت دانشکده دندانپزشکی مشهد در این مطالعه حضور داشتند. کلیه این بیماران به جراحی لفورت 1 نیاز داشتند و به سه گروه جابجایی قدامی، جابجایی فوقانی و جابجایی فوقانی-خلفی تقسیم شدند. جهت انجام بررسی های لازم، تست راینومانومتری قدامی و رادیوگرافی لترال سفالومتری 1 هفته قبل از عمل و 3 ماه پس از آن از کلیه بیماران اخذ شد. داده ها بوسیله آزمون آنالیز واریانس یک طرفه، t زوجی، کروسکال والیس، ویلکاکسون تجزیه و تحلیل شدند. سطح معنی داری 05/0 بود. یافته ها: با توجه به بررسی های راینومانومتریک و رادیوگرافیک، بیشترین بهبودی در عملکرد بینی مربوط به گروه جابجایی فوقانی و کمترین تغییر مثبت در نتیجه جابجایی قدامی فک بالا بوده است. بطور کلی و بدون در نظر گرفتن گروه های ذکر شده، میانگین جریان هوا و مقاومت در برابر عبور هوا به دنبال جراحی های جابجایی ماگزیلا به ترتیب افزایش و کاهش داشته است اما هیچکدام از این تغییرات از لحاظ آماری معنی دار نبوده اند. نتیجه گیری: چناچه جراحی ماگزیلا با تکنیک صحیح انجام گردد، اختلالی در تنفس ایجاد نمی کند.

ОПЫТ ПРИМЕНЕНИЯ ТАМПОНОВ НОСОВЫХ С СОХРАНЕНИЕМ ФУНКЦИИ НОСОВОГО ДЫХАНИЯ

Nasal tampons should provide effective hemostasis while maintaining the function of nasal breathing, and not produce a traumatic effect on the mucous membrane of the nasal cavity. Within the frames of the research work in the Republican Scientific and Practical Center of Otorhinolaryngology, together with LLC «Advantmed», nasal tampons with preservation of the nasal breathing function of several sizes (14×64×7 mm and 19×84×7 mm) have been developed and manufactured. A registration certificate for a medical device has been received. Objectives. To evaluate the effectiveness of the use of nasal tampons while maintaining the nasal breathing function. In the course of the work, the time of stopping bleeding has been measured, patients have been surveyed concerning preservation of their nasal breathing function during tamponade of the nasal cavity, comfort of the tamponade of the nasal cavity using a 10-point visual analogue scale has been assessed by the patients, the degree of edema and hyperemia of the nasal mucosa has been determined, the presence of scabs and fibrin plaque during endoscopic examination of the nasal cavity using a 3-point visual analogue scale has also been determined. Results. Nasal tampons with preservation of the nasal breathing function have good hemostatic quality: the speed of stopping bleeding was 5±1 seconds compared to 9±1 seconds in case of glove-gauze tamponade (p&lt;0.05). When questionnairing all patients (100%) during the period of using the developed medical device, the function of nasal breathing was determined as sufficient. Conclusions. Tamponade of the nasal cavity using nasal tampons while maintaining the nasal breathing function is better tolerated by patients than the glove-gauze one (the comfort of tamponade of the nasal cavity according to the visual analogue scale varied from 4 to 6 points (with an average value of 4.9±0.6 points) in comparison with 5-8 points (on an average 6.8±0.3 points), respectively (p&lt;0.05)). It has a less pronounced traumatic effect on the mucous membrane of the nasal cavity compared to that of the glove-gauze tamponade.

Nasal Mucociliary Clearance in Prolonged Tracheostomy Patients: A Prospective Case-Control Study.

Prolonged tracheostomy bypasses the upper airways leading to absence or reduction of nasal airflow. This altered nasal physiology not only impairs olfaction but also may cause mucociliary dysfunction and consequent nasal crusting and rhinosinusitis.To objectively evaluate the extent of nasal mucociliary impairment in patients with prolonged duration of tracheostomy.This is a prospective case-control study done in a tertiary care center wherein the nasal mucocilary function was assessed by saccharin test in patients who were tracheostomized for a period of more than 4weeks and the saccharin transit time (time taken to appreciate the sweet taste after endoscopic insertion of saccharin pellet on anterior end of inferior turbinate) was compared by the same test in age and sex matched healthy individuals. The saccharin transit time in the two groups was statistically analyzed using student t-test. Mean saccharin transit time in 30 patients with prolonged tracheostomy was 934.97s with a standard deviation of 75.95s whereas in 30 controls, the meantime was 447.4s with a standard deviation of 63.22s, which was statistically significant (p < 0.001). Conclusion Prolonged duration of tracheostomy leads to impaired nasal mucociliary clearance, which in turn could cause chronic rhinosinusitis.

Comparison of Therapeutic Effects and Olfactory Function of Oral Glucocorticoid and Intranasal Glucocorticoid on Chronic Rhinosinusitis Patients with Nasal Polyps.

To compare the therapeutic effects and olfactory function of oral glucocorticoid and intranasal glucocorticoid in patients with chronic rhinosinusitis (CRS) with nasal polyps. Experimental study. Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, from January 2018 to November 2019. One hundred and twenty-two CRS patients with nasal polyps were randomly divided into Group A and Group B with 61 cases in each group. Group A received local application of glucocorticoid (dexamethasone) after nasal endoscopic surgery. Group B received oral glucocorticoid (prednisone) one week before operation and three weeks after operation. Clinical effects of the two groups were compared. Total effective rate of Group B was higher than that of Group A (p=0. 023), recurrence rate in Group B was lower than that in Group A (p=0.015). Nasal airway resistance and olfactory function scores of Group B were lower than those of Group A at one month, three months and six months after operation (all p <0.001). There was no difference in the incidence of adverse reactions between the two groups (p=0. 649). Compared with intranasal glucocorticoid, oral glucocorticoid can obviously improve the therapeutic effect and olfactory function of patients, and the postoperative recurrence rate is lower. Key Words: Sinusitis, Nasal polyps, Endoscopic sinus surgery, Glucocorticoid.

Grafts in Endonasal Rhinoplasty.

Rhinoplasty is arguably one of the most challenging but rewarding procedures for the facial plastic surgeon. To adequately improve facial aesthetic parameters and preserve nasal function, the appropriate utilization of grafts is of utmost importance. While there is no best method, I found that in my hands, the endonasal approach allowed me to achieve greater control over my results by limiting dissection, utilizing less cartilage, and minimizing variables. In this manuscript, I outline the surgical pearls I have developed throughout my career that have helped me execute these grafts efficiently and effectively.

Numerical Simulation of Nasal Airflow Aerodynamics, and Warming and Humidification in Models of Clival Chordoma Pre and Post-Endoscopic Endonasal Surgery

ObjectivesTo study the effect of endoscopic endonasal surgery on nasal function for the treatment of clival chordoma. MethodsPre and post-operative computed tomography (CT) scans of a case of chordoma treated with an endoscopic endonasal approach (EEA) were collected retrospectively, and models of the nasal cavity were reconstructed so that a subsequent numerical simulation of nasal airflow characteristics, warming, and humidification could be conducted. ResultsMiddle turbinectomy resulted in redistribution of airflow within the nasal cavity, and the most significant changes occurred in the middle section. Consistent with the results of airflow evaluation, it was found that the change in nasal anatomical structure significantly reduced warming and humidification. Nasal humidification decreased substantially when postoperative loss of mucosa was taken into consideration. The H2O mass fraction of pharynx in inspiration phase were significantly correlated with airway surface-to-volume ratio (SVR). ConclusionsThe EEA for chordoma significantly affected nasal function. Attention should be paid to the protection of nasal structure and the associated mucosa.

PP14 Presentation Time: 3:39 PM: Brachytherapy vs. External Beam Radiotherapy as Nose Preserving Treatment Strategies for Cancer of the Nasal Vestibule

Purpose: Squamous cell carcinoma of the nasal vestibule is a rare tumor. It is usually diagnosed in Wang T1-T2 stage due to its readily visible location. Primary radiotherapy is often the preferred treatment for preservation of cosmesis and nasal function. Another important consideration in treatment of this tumor is avoiding mutilating salvage nose amputations. However, due to practice variation and lack of comparative trials, there is no consensus on preference for brachytherapy or external beam radiotherapy.

Effect of sleep-disturbed breathing on maxillofacial growth and development in school-aged children

ABSTRACT Purpose : In children, snoring and apnoea cause impairments in growth, cognitive function, attention, and school performance. In this study, we aimed to identify the association between craniofacial disharmony and paediatric sleep-disordered breathing. Materials and Methods : Forty-one patients with malocclusion (19 boys; 22 girls; mean age, 10.0 ± 2.1 years) were selected from our hospital. The relationship between maxillofacial morphology, pharyngeal airway form, and nasal respiratory function was examined using cephalometric analysis and skeletal patterns. All patients underwent portable monitoring with an overnight out-of-centre sleep testing protocol that could be performed at home using a portable computerized monitoring system. Results : The respiratory disturbance index was significantly greater in patients with mandibular retrusion than those with malocclusion. Arterial oxygen saturation and nasopharyngeal area were significantly smaller in participants with Class II malocclusion than in those with other types of malocclusion. Moreover, dental cast model analyses confirmed that patients with reduced transverse maxillary dimensions had a higher obstructive sleep apnoea syndrome (OSAS) risk than those with malocclusion. Therefore, patients with mandibular retrusion have a higher OSAS risk than those with other types of malocclusion. Conclusion : Childhood maxillofacial morphology may influence adult OSAS, and early treatment for children with OSAS may help prevent adult OSAS.

The role of fiberoptic sinoscopy in evaluation the effect of surgically rapid maxillary expansion on the nasal airways

Aim : To evaluate the effect of surgically assisted rapid maxillary expansion on the nasal airway assissted by nasofibroscopy. Subjects and methods: Nine Patients were included in the present study. They were consecutive patients selected from the oral and maxillofacial surgery department that referred from orthodontic department Faculty of Dental Medicine, Al-Azhar University, Assuit branch in the period from September 2017 to October 2019 . They were adult patients of both sexes (3 males and 6 females). All patients were subjected to history taking , sinoscopic nasal examination. All patients had maxillary transverse deficiency associated primarily with functional impairments, such as posterior uni- or bilateral cross bite, dental crowding, reduced nasal respiratory function or anterior-posterior skeletal anomalies and they were indicated for surgically assisted rapid maxillary expansion. Preoperative intracanine and intramolar distances (C1, C2, M1, M2 ) was measured by digital caliper on Study cast. Measuring area of both nasal cavities by nasofibroscopy were done in ENT department of Al Azhar university hospital, Assuit. The operation was conducted under general anesthesia. After surgery, clinical evaluations ware done at intervals of 2, 4, 7 and 15 days and then all data obtained from nasofibroscopy by pixels and transformed by typography program in to millimeters. Result: Results of the current study have indicated that nasofibroscopy showed that was improvement in nasal obstruction after maxillary expansion. Conclusion: Surgically assisted rapid maxillary expansion is an effective method of widening the nasal passages and reducing nasal resistance that assisted by nasofibroscopy.