Nasal Inspiratory Flow Research Articles

Morphofunctional changes following adenotonsillectomy of obstructive sleep apnea children: a case series analysis

ObjectiveTo perform a case series analysis of the changes in the pulmonary artery systolic pressure (PASP), nasal inspiratory flow (NIF), upper airway volume, obstructive apnea/hypopnea index (OAHI), and the maxillomandibular three-dimensional (3D) morphology after adenotonsillectomy (T&A) of obstructive sleep apnea children (OSA).Materials and methodsRetrospective assessment of files from 1002 children screened between 2012 and 2020 in a hospital-based mouth-breather referral center. From this universe, 15 obstructive sleep apnea children (7 females; 8 males), ages 4.1 to 8.9 years old (mean age of 5.4 years ± 1.3), who presented indications of tonsillectomy and/or adenoidectomy were selected. The complete baseline examination (T0) was carried out before T&A and a second complete examination (T1) was made 18.7-month follow-up after T&A (ranging from 12 to 30 months). Eleven patients were submitted to T&A, and four patients had indications but did not receive authorization for surgery from the public health system. According to the protocol of the outpatient clinic for OSA patients, Doppler echocardiography, polysomnography, rhinomanometry, and computed tomography imaging was performed at (T0) and (T1).ResultsPASP decreased 16.6% after T&A. NIF increased more in T&A children (40.3%) than in non-T&A children (16.8%). The upper airway volume increased in T&A and non-T&A children, but greater volumetric gain (45.6%) was found in the nasopharynx of T&A patients. OAHI did not change in six T&A children (55%) and three non-T&A children (75%). The maxilla displaced downward and backward relative to the cranial base in six T&A children (55%) and two untreated children (50%). Nine of the T&A children (85%) and three untreated children (75%) presented extensive condylar growth and increased mandibular length. The qualitative 3D assessment showed similar morphological 3D changes in T&A and non-T&A patients.ConclusionPulmonary artery systolic pressure decreased, nasal inspiratory flow increased, and nasopharynx volume increased following adenotonsillectomy, but obstructive apnea/hypopnea index and maxillomandibular morphology were similar in surgical and non-surgical patients.

Study of Nasal Fractional Exhaled Nitric Oxide (FENO) in Children with Allergic Rhinitis

(1) Background: Exhaled nitric oxide (NO) has been considered as a biomarker of airway inflammation. The measurement of fractional exhaled NO (FENO) is a valuable test for assessing local inflammation in subjects with allergic rhinitis (AR). (2) Objective: To evaluate (a) the correlation between nasal FENO with anthropometric characteristics, symptoms of AR and nasal peak flows in children without and with AR; and (b) the cut-off of nasal FENO for diagnosis of AR in symptomatic children. (3) Methods: The study was a descriptive and cross-sectional study in subjects with and without AR < 18 years old. All clinical and functional characteristics of the study subjects were recorded for analysis. They were divided into healthy subjects for the control group and subjects with AR who met all inclusion criteria. (4) Results: 100 subjects (14 ± 3 years) were included, including 32 control subjects and 68 patients with AR. Nasal FENO in AR patients was significantly higher than in control subjects: 985 ± 232 ppb vs. 229 ± 65 ppb (p < 0.001). In control subjects, nasal FENO was not correlated with anthropometric characteristics and nasal inspiratory or expiratory peak flows (IPF or EPF) (p > 0.05). There was a correlation between nasal FENO and AR symptoms in AR patients and nasal IPF and EPF (p = 0.001 and 0.0001, respectively). The cut-off of nasal FENO for positive AR diagnosis with the highest specificity and sensitivity was ≥794 ppb (96.7% and 92.6%, respectively). (5) Conclusion: The use of nasal FENO as a biomarker of AR provides a useful tool and additional armamentarium in the management of allergic rhinitis.

Inspiratory Muscle Training and Nasal High Flow in Difficult Weaning

Inspiratory Muscle Training and Nasal High Flow in Difficult Weaning

Assessment of respiratory muscle strength and airflow before and after microimplant-assisted rapid palatal expansion.

To assess alterations in respiratory muscle strength and inspiratory and expiratory peak flow, as well as skeletal and dental changes in patients diagnosed with transverse maxillary deficiency before and after microimplant-assisted rapid maxillary expansion (MARPE). Twenty patients (13 female and 7 male) were assessed by respiratory tests in three different periods: T0 initial, T1 immediately after expansion, and T2 after 5 months. Tests included: maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), oral expiratory peak flow, and inspiratory nasal flow. Cone-beam computed tomography measurements were performed in the maxillary arch, nasal cavity, and airway before and immediately after expansion. There was a significant increase in MIP between T0 and T2 and MEP between T0 and T1 (P<.05). Oral and nasal peak flow increased immediately after and 5 months later, especially in patients with initial signs of airway obstruction (P<.05). In addition, after expansion there was a significant enlargement of the nasal cavity, alveolar bone, and interdental widths at the premolar and molar region. Molars tipped buccally (P<.05) but no difference was found in premolar inclination. MARPE increased airway volume significantly. Skeletal changes promoted by MARPE directly affected airway volume, resulting in a significant improvement in muscle strength and nasal and oral peak flow.

Effects of maxillary skeletal expansion on respiratory function and sport performance in a para-athlete – A case report

The aim of this case report was to demonstrate the effects of the Maxillary Skeletal Expander (MSE) used to orthopedically correct a maxillary constriction, on the respiratory functions and swimming performance of a Para-athlete. Cone-beam computed tomography (CBCT) images taken before and after MSE activation were used to demonstrate the disarticulation of midpalatal suture, and the changes involved in dental and nasomaxillary structures, nasal cavity and pharyngeal airway. Respiratory tests included: maximum inspiratory and expiratory pressure, oral peak expiratory flow and inspiratory nasal flow. The 6-min-walk and heart rate recovery tests were also performed. Patient's swimming performances during national swimming competitions were compared. CBCT images showed that palatal expansion was 5.91 mm at the suture, and that nasal and pharyngeal airways increased in volume by 31%. All respiratory indices improved after MSE activation. The 6-min walk test and heart rate recovery test performance also improved after the maxillary expansion. Patient's swimming performance in all category were anemic prior to the treatment, but performance improved considerably after the expansion, particularly the 100 m-Backstroke modality. MSE treatment had a significant positive impact in respiratory functions and sport performance.

Peak oral and nasal inspiratory flows in asthmatics from a low income community in Rio de Janeiro, Brazil

Peak oral and nasal inspiratory flows in asthmatics from a low income community in Rio de Janeiro, Brazil

Randomized Trials of Nasal Patency and Dermal Tolerability With External Nasal Dilators in Healthy Volunteers.

BackgroundExternal nasal dilator strips are used as nonpharmacological therapy to reduce snoring and daytime sleepiness. In a product improvement initiative, a marketed strip (BRNS) and 2 prototype nasal strips were evaluated.ObjectiveTo compare the nasal patency and multiple-use dermal tolerability of the BRNS and prototype nasal strips using both objective and subject-reported outcome measures.MethodsTwo studies were conducted separately in healthy volunteers ≥18 years of age. A single-day nasal patency randomized crossover study assessed minimal cross-sectional area (MCA; second restriction) and nasal volume (using acoustic rhinometry); nasal inspiratory flow and resistance (using posterior rhinomanometry); and subject-reported evaluations of the BRNS compared with the butterfly strip and teardrop strip prototypes. A single-center, randomized, controlled, parallel-group, evaluator-blinded study assessed dermal tolerability of the BRNS and the butterfly strip over 7 consecutive nights of use, using the Dermal Response Scale (DRS) and subject-reported comfort and ease of removal.ResultsIn the Patency study (N = 50), all 3 strips demonstrated significant improvement from baseline in MCA, nasal volume, and nasal flow parameters (resistance and peak flow). The prototype strips demonstrated significantly more improvement in nasal volume than the BRNS, and the butterfly strip showed significantly more improvement in MCA than the BRNS; all strips were similar with respect to nasal flow and subject-reported nasal breathing outcomes. In the Dermal Tolerability study (N = 82), all subjects scored 0 (no evidence of irritation) on the DRS at all 7 morning assessments; the BRNS was numerically, but not significantly, superior to the butterfly strip on subject-reported outcomes.ConclusionThe Patency study demonstrated significant improvement from baseline in nasal dimensions and flow for all 3 evaluated strips; between-strip differences were confined to nasal dimensions. Both the BRNS and butterfly strip were generally well tolerated, with no evidence of dermal response over 7 consecutive nights of use.ClinicalTrials.gov identifiers: NCT01105949 and NCT01495494

Efficacy of a Nasal Spray fromCitrus limonandCydonia oblongafor the Treatment of Hay Fever Symptoms-A Randomized, Placebo Controlled Cross-Over Study

Nasal spray from lemon and quince (LQNS) is used to treat hay fever symptoms and has been shown to inhibit histamine release from mast cells in vitro. Forty-three patients with grass pollen allergy (GPA) were randomized to be treated either with placebo or LQNS for one week, respectively, in a cross-over study. At baseline and after the respective treatments patients were provoked with grass pollen allergen. Outcome parameters were nasal flow measured with rhinomanometry (primary), a nasal symptom score, histamine in the nasal mucus and tolerability. In the per protocol population absolute inspiratory nasal flow 10 and 20 min after provocation was higher with LQNS compared to placebo (-37 ± 87 mL/s; p = 0.027 and -44 ± 85 mL/s; p = 0.022). The nasal symptom score showed a trend (3.3 ± 1.8 in the placebo and 2.8 ± 1.5 in the LQNS group; p = 0.070) in favor of LQNS; the histamine concentration was not significantly different between the groups. Tolerability of both, LQNS and placebo, was rated as very good. LQNS seems to have an anti-allergic effect in patients with GPA. Copyright © 2016 John Wiley & Sons, Ltd.

The Effect of Novel Combination Therapy with Azelastine Hydrochloride and Fluticasone Propionate in Allergic Rhinitis

Background: Allergic rhinitis is a prevalent condition in the community and impairs quality of life. Treatment often requires combination of different topical treatment. We wanted to assess the effect of combination steroid and antihistamine nasal spray in patients who have failed primary therapy. Secondary aims were to analyse the multidomain impact of rhinitis, financial costs incurred and impact on quality of life. Method: We analysed fifty-three patients who were referred to the specialist hospital having failed primary care treatment for nasal and sinus disease. The MSNOT-20 is a disease specific validated questionnaire to identify rhinitis and its response to treatment. Patients were re-assessed following one month of treatment use. Skin prick testing and nasal inspiratory peak flow were also used. Results: All subjects had improvement in their symptoms following treatment (31.6 (10.69) vs. 11 (4.18)-mean and standard deviation before and after treatment respectively, p<0.05). There was improvement in each subgroup, statistically significant in all except the emotional subgroup. Common allergens identified in sufferers were grass, house dust mite and tree pollen. The majority of patients were in the working age bracket and 90% had to take time off work due to their symptoms. Conclusion: There is significant impact on quality of life and education/work-based complications of rhinitis. Combination intranasal steroid with intranasal antihistamine is effective at improving symptomatology of allergic rhinitis, this was also demonstrated through patient comments. MSNOT-20 is once again proven as a useful tool in detecting rhinitis, its impact and disease response to treatment.

Omalizumab in the treatment of aspirin-exacerbated respiratory disease

Omalizumab in the treatment of aspirin-exacerbated respiratory disease

Evaluation of the nasal contractility capacity in postmenopausal women.

The aim of this study was to objectively compare nasal contractility in premenopausal and postmenopausal patients by means of rhinomanometry, acoustic rhinometry, and peak inspiratory nasal flow. Design: prospective, clinical case-controlled study. Setting: university tertiary-care hospital, referral center. Participants: the study included 97 participants divided into two groups: 49 postmenopausal (the study group) and 48 premenopausal (control) females. Nasal evaluations were made utilizing anterior rhinoscopy, peak inspiratory nasal flow, acoustic rhinometry, and anterior rhinomanometry. The differences between before and after decongestant application of Minimal Cross-sectional Area (MCA) 1, Minimal Cross-sectional Area (MCA) 2, Peak inspiratory nasal flow (PNIF), Rhinomanometry (RMM), Flow, and Volume values were been statistically significant in both postmenopausal and premenopausal group (control). Before and after all the subjects were administered nasal decongestant, nasal contractility was evaluated using objective nasal tests (acoustic rhinometry, rhinomanometry, and peak inspiratory nasal flow. Results showed that erectile tissues were not affected after menopause: postmenopausal women have the same nasal contractility capacity as premonopausal women.

Evaluation of the nasal contractility capacity in postmenopausal women

The aim of this study was to objectively compare nasal contractility in premenopausal and postmenopausal patients by means of rhinomanometry, acoustic rhinometry, and peak inspiratory nasal flow. Design: prospective, clinical case-controlled study. Setting: university tertiary-care hospital, referral center. Participants: the study included 97 participants divided into two groups: 49 postmenopausal (the study group) and 48 premenopausal (control) females. Nasal evaluations were made utilizing anterior rhinoscopy, peak inspiratory nasal flow, acoustic rhinometry, and anterior rhinomanometry. The differences between before and after decongestant application of Minimal Cross-sectional Area (MCA) 1, Minimal Cross-sectional Area (MCA) 2, Peak inspiratory nasal flow (PNIF), Rhinomanometry (RMM), Flow, and Volume values were been statistically significant in both postmenopausal and premenopausal group (control). Before and after all the subjects were administered nasal decongestant, nasal contractility was evaluated using objective nasal tests (acoustic rhinometry, rhinomanometry, and peak inspiratory nasal flow. Results showed that erectile tissues were not affected after menopause: postmenopausal women have the same nasal contractility capacity as premonopausal women.

The influence of nasal abnormalities in adherence to continuous positive airway pressure device therapy in obstructive sleep apnea patients. What role does the nose play?

Haddad et al. analyzed the effect of nasal abnormalities in adherence to continuous positive airway pressure (CPAP) therapy [1]. The findings of that study underline the fact that nasal parameters such as the degree of septal deviation, the hypertrophy of the inferior turbinate, and nasal peak inspiratory flow do not predict CPAP adherence in subjects with moderate or severe obstructive sleep apnea (OSA). However, there are some aspects that may be of interest in performing an analysis as several papers documenting the role of the nose on OSA syndrome have been published in the literature. Combining the fact that the ideal method or test for the correct evaluation of nasal functions in OSA does not exist yet and that adherence to CPAP is the consequence of many factors, we suggest an explanation why it is so hard to demonstrate the role of the nose in CPAP adherence.

Computational fluid dynamics study of the effect of posture on airflow characteristics inside the nasal cavity

Background: Postural changes in nasal airway resistances are of clinical importance when assessing patientswith nasal obstruction. Computed tomography (CT) that is used in computational fluid dynamics (CFD) studiesis obtained in a supine position, and it is therefore important to identify whether different positions such assupine, prone, and standing/sitting have any influence on flow behavior inside the nasal cavity. Objectives: To study the effect of posture on modeling nasal airflow and evaluate its influence in determiningwall shear stress and other parameters. Method: A three-dimensional nasal cavity model was constructed based on CT images of a healthy Malaysianadult nose. Navier-Stokes and continuity equations for steady airflow were solved to examine inspiratory nasalflow. Results: Around a 0.3% change in the average static pressure is observed while changing from a sitting to supineposition. A significant drop in velocity was seen while shifting from sitting to supine position. Conclusion: The gravity effect resulting from postural change influences flow parameters suggesting thatfuture CFD studies should consider posture when conducting analyses. The implication of this study on postureholds importance in future studies of drug delivery though the nasal cavity. Keywords: CFD, posture, resistance, velocity, wall shear stress

Hybrid Mesh for Nasal Airflow Studies

The accuracy of the numerical result is closely related to mesh density as well as its distribution. Mesh plays a very significant role in the outcome of numerical simulation. Many nasal airflow studies have employed unstructured mesh and more recently hybrid mesh scheme has been utilized considering the complexity of anatomical architecture. The objective of this study is to compare the results of hybrid mesh with unstructured mesh and study its effect on the flow parameters inside the nasal cavity. A three-dimensional nasal cavity model is reconstructed based on computed tomographic images of a healthy Malaysian adult nose. Navier-Stokes equation for steady airflow is solved numerically to examine inspiratory nasal flow. The pressure drop obtained using the unstructured computational grid is about 22.6 Pa for a flow rate of 20 L/min, whereas the hybrid mesh resulted in 17.8 Pa for the same flow rate. The maximum velocity obtained at the nasal valve using unstructured grid is 4.18 m/s and that with hybrid mesh is around 4.76 m/s. Hybrid mesh reported lower grid convergence index (GCI) than the unstructured mesh. Significant differences between unstructured mesh and hybrid mesh are determined highlighting the usefulness of hybrid mesh for nasal airflow studies.

Reversible nasal airway obstruction: does change in nasal peak inspiratory flow following decongestion predict response to topical steroids in chronic rhinosinusitis patients?

Predicting which chronic rhinosinusitis patients have nasal obstruction due to reversible mucosal inflammation could prevent unnecessary surgery. To investigate whether the change in nasal peak inspiratory flow following maximal decongestion (i.e. mucosal reversibility) at first visit predicts the response to topical steroids in chronic rhinosinusitis patients, as measured by the 22-item Sinonasal Outcome Test. Prospective study of 128 consecutive new adult patients presenting with nasal obstruction due to chronic rhinosinusitis (January 2008 to July 2010). The 22-item Sinonasal Outcome Test questionnaire was administered and the nasal peak inspiratory flow assessed. Following maximal nasal decongestion, the nasal peak inspiratory flow was again tested and the difference calculated. Topical steroids were administered for at least six weeks. The 22-item Sinonasal Outcome Test was then repeated and the difference calculated. Data were analysed using means and correlation studies (Spearman's rank correlation). There was no correlation between the pre- versus post-decongestion nasal peak inspiratory flow difference and the pre- versus post-steroid 22-item Sinonasal Outcome Test difference, in chronic rhinosinusitis patients with or without nasal polyps. The difference between pre- and post-decongestion nasal peak inspiratory flow does not predict chronic rhinosinusitis patients' response to topical steroids.

Sino‐Nasal Characteristics in Asthmatic Patients

The Unified Airways Hypothesis suggests an involvement of the upper airways in asthma. We aimed to evaluate the association between subjective sino-nasal complaints, nasal air flow, and sino-nasal quality of life (QOL) in patients with asthma compared with nonasthmatic subjects. Case-control study. A tertiary referral center. Symptoms, quality of life, and nasal airflow were assessed in 91 asthmatics and 95 nonasthmatic controls with Visual Analog Scale (VAS, 0-100), Sino-Nasal Outcome Test (SNOT-20), and Peak Nasal Inspiratory Flow (PNIF), respectively. Asthma and allergy status were assessed by Asthma Control Questionnaire (ACQ) and skin prick test or specific IgE. Asthmatic patients (men/women, 37/54; mean age, 43.7 years; range, 19-64 years) reported significantly more nasal obstruction (mean VAS, 37 mm; SD = 26, 95% CI, 32-43 vs 9 mm, SD = 11, 95% CI, 7-11, P < .001) and lower sino-nasal quality of life (mean SNOT-20, 1.3; SD = 0.8, 95% CI, 1.1-1.5 vs 0.4, SD = 0.5, 95% CI, 0.3-0.5, P < .001) than controls (men/women, 42/53; mean age, 43.8 years; range, 20-65 years). PNIF was significantly lower in asthmatic patients than controls (mean PNIF, 84 l/min; SD = 24, 95% CI, 79-89 vs 100 l/min SD = 24, 95% CI, 95-105, P < .001). Both allergic and nonallergic asthma were associated with increased sino-nasal symptoms, reduced sino-nasal QOL, and reduced inspiratory nasal air flow compared to controls. This provides further evidence of the clinical importance of the upper airway in the diagnostic and therapeutic management of asthma patients beyond the scope of allergy.

ENT Function in a 14-Days Guinness Scuba Dive

Scuba diving is known to affect the rhino-pharyngo-tubaric district (RPT unit). The aim of the study was to document function modifications of the RPT unit in 6 Italian divers (3 men and 3 women) who lived for 14 days consecutively at a depth of 8-10 m, breathing air (21% oxygen) at a pressure ranging between 1.8 and 2 ATA. RPT and inner ear assessment were carried out before the dive (TIME 0) and 24 h (TIME 1) after resurfacing, in order to investigate diving-related RPT and inner ear alterations. Physical examination after resurfacing revealed: fungal external otitis, otoscopic findings consistent with middle ear barotraumas and rhinosinusitis. Rhino-manometry showed a remarkable increase in inspiratory nasal flow and a substantial decrease in nasal resistance. No epithelial cell disruption was retrieved comparing pre and post resurfacing samples. Post-diving tubaric dysfunction was found. Pure tone audiometry revealed a bilateral 40 dB HL hearing loss at 4 kHz in 1 diver. Relevant PTA functions did not seem to be affected by the experiment, no remarkable changes were found at the Sensory Organisation Test and at the Motor Control Test. The 14-day underwater period had a positive effect on nasal flows and resistances.

The Nose as a Target Organ in the Diagnosis of Severe Aspirin-exacerbated Respiratory Disease

The nasal provocation test (NPT) with lysine aspirin is a useful tool in the diagnosis of aspirin-exacerbated respiratory disease (AERD), previously reffered to as Samter's disease. The aim of the present study focuses on methodological interventions to show the usefulness of the NPT with lysine aspirin in differentiating AERD patients from aspirin-tolerant asthma (ATA) patients to improve the diagnostic efficacy and minimize the risk for adverse reactions compared with the gold standard. Thirty AERD patients comprised the active study group while the control group consisted of 25 ATA patients. A combination of objective nasal aerodynamic response (i.e., nasal inspiratory flow and nasal inspiratory resistance) was evaluated by active anterior rhinomanometry and the subjective clinical nasal and extranasal symptoms (including forced expiratory volume) were monitored throughout the challenge. Fifty-five NPTs were successfully completed: sensitivity, 87%; specificity, 100%; positive predictive value, 100%; negative predictive value, 86%; global efficacy, 92.72%. No severe adverse reactions were recorded. The present NPT with lysine aspirin proved to be a safe, efficient, and a timesaving method in the diagnosis of patients with AERD, even in those with severe rhinitis-rhinosinusitis and/or recurrent nasal polyposis.

Comparative responses to nasal allergen challenge in allergic rhinitic subjects with or without asthma

BackgroundNasal allergen challenge (NAC) is useful to study the pathophysiology of rhinitis, and multiple challenges may more adequately approximate natural exposure.ObjectiveTo determine the effect of 4 consecutive daily NAC, on clinical and inflammatory parameters in rhinitics with or without asthma.MethodsRhinitic subjects were recruited: 19 with mild asthma and 13 without asthma. Subjects underwent a control challenge (normal saline) followed by 4 consecutive daily NAC. Allergen challenge consisted of spraying the chosen allergen extract into each nostril until a positive nasal response occurred. Symptoms were recorded on a Likert scale, and oral peak expiratory and nasal peak inspiratory flows allowed assessment of a nasal blockage index (NBI), for a period of 7 hours. Induced sputum and nasal lavage were performed on control day and after 1 and 4 days of NAC.ResultsCompared with the control day, there was a significant increase in symptom scores and NBI 10 minutes after each last daily NAC in both groups (p < 0.05). Symptom scores and NBI were similar for the 2 groups, except for nasal obstruction and rhinorrhea, which were more marked in subjects with asthma and rhinitis, respectively. Nasal lavage eosinophils were increased after 4 days of challenges in both groups, but there was no change in sputum eosinophils. No cumulative effect or any late response were observed in any of the groups over the challenge period.ConclusionMultiple NAC may be a useful tool to study the pathophysiology of allergic rhinitis or its relationships with asthma.Trial registrationClinicalTrials.gov NCT01286129