Nasal Obstruction In Patients Research Articles

Congenital Nasal Pyriform Aperture Stenosis: Conservative Management

This case series outlines the advantages of using 0.1% intranasal dexamethasone drops (IDD) to treat nasal obstruction in patients with congenital pyriform aperture stenosis (PAS). Five consecutive cases of PAS were reviewed. Three patients were treated with IDD alone, and 2 were treated surgically and had residual postoperative nasal obstruction before IDD. Four patients in follow-up (mean, 1 year) were weaned off the steroid drops with good breathing results. One patient developed iatrogenic Cushing's disease, and another, who was initially treated with surgery, eventually required nasal vestibular stenosis repair in addition to IDD. This study is the first to review the use of IDD in treating PAS. The potential impact of midnasal stenosis is discussed, and a conservative management algorithm for patients with PAS is presented. Careful surveillance for potential side effects of IDD is recommended, especially in cases that require elevated doses.

Desloratadine‐montelukast combination improves quality of life and decreases nasal obstruction in patients with perennial allergic rhinitis

The effects of desloratadine-montelukast combination on quality of life (QoL) and nasal airflow of patients with perennial allergic rhinitis (PAR) has not been reported. The objective of this work was investigate the efficacy of desloratadine-montelukast combination on nasal obstruction and health-related quality of life (HRQL) of patients with PAR. The patients with PAR (n = 40) were assessed using acoustic rhinometry (AcR) and Rhinoconjunctivitis QoL Questionnaire (RQLQ) before therapy. Desloratadine-montelukast fixed-dose combination treatment was applied to every patient once daily. The AcR and RQLQ score were reevaluated at the first and third months; and statistical comparison of pretreatment and posttreatment results was performed. Nasal symptoms and signs such as itching, sneezing, discharge, congestion, and edema, and color change of turbinates have been decreased after treatment. In AcR, minimum cross-sectional area (MCA) measurements and volume results were increased after the treatment. Correlation was found between the volume results and nasal discharge and/or congestion in right nasal passages. In left nasal passages, statistical relation was observed between the MCA and itching and/or change of turbinate color (p < 0.05). A significant decrease in the overall RQLQ score was determined at the first and third months of therapy. The difference between scores at baseline and end of the first and third months for all domains was statically significant (p < 0.001). The treatment difference in change from the first month to the end of the third month was statistically significant (p < 0.05). Desloratadine-montelukast combination therapy causes subjective and objective decrease in nasal obstruction, reduces the other symptoms of PAR and improves the disease-specific QoL.

The Lateral Crural Underlay Spring Graft

The objective of this study is to evaluate the functional and aesthetic results obtained from the use of the lateral crural underlay spring (LCUS) graft for the treatment of internal and external nasal valve collapse. In this retrospective study, preoperative and postoperative functional and aesthetic results were compared in patients undergoing treatment for internal or external nasal valve collapse. Results were scored by means of a questionnaire and visual analog scale completed by the patients. Eight patients were recruited and included in this study: 6 (75%) had an improvement in their functional scores, 1 (12%) remained unchanged, and 1 (12%) scored worse. The mean difference in functional scores after the intervention was 9.4 points (p < 0.005). There was no significant difference in aesthetic scores. We found evidence that the LCUS graft is effective for relieving nasal obstruction in patients with internal, external, or combined nasal valve collapse. The amount of increased sidewall tension and rigidity as well as the increase in nasal valve angle and cross-sectional area are determined by the length of the graft, which can be varied according to need.

Coblation Turbinate Reduction in Patient with Nasal Obstruction

Chronic nasal obstruction is a common symptom and usually comes from mucosal disease associated with turbinate hypertrophy. Diverse surgical treatments have been used to improve chronic nasal obstruction in patients with inferior turbinate hypertrophy. However, there is no common consensus about the values of the various methods. The ideal turbinate surgery should effectively decrease the volume of turbinate, keep physiologic function of nose, and avoid complications. Recently, office-based inferior turbinate reduction using radiofrequency energy has been gaining popularity. In this article, the efficacy and morbidity of coblation turbinate reduc tion for nasal obstruction will be reviewed.

The Usefulness of Nasal Packing with Vaseline Gauze and Airway Silicone Splint after Closed Reduction of Nasal Bone Fracture

Packing after closed reduction of a nasal bone fracture causes inconvenient nasal obstruction in patients. We packed the superior meatus with Vaseline gauze to support the nasal bone, and packed the middle nasal meatus with a Doyle Combo Splint consisting of an airway tube, a silastic sheet, and an expandable sponge to reduce the inconvenience. In addition, we aimed to objectively identify whether this method not only enables nasal respiration but also sufficiently supports the reduced nasal bone. Nasal ventilation was measured via spirometry 1 day before surgery and compared to 1 day after surgery. To compare support of the reduced nasal bone by the 2 methods, 2 plastic surgeons assessed the displacementon X-rays taken after the surgery and after removing the packing. The extent of nasal obstruction, dry mouth, sleep disturbance, headache, and swallowing difficulty were compared with visual analog scales (VAS) on a pre-discharge survey. In the experimental group, the nasal respiration volume 1 day after surgery remained at 71.3%±6.84% on average compared to 1 day prior to surgery. Support of the reduced bone in the experimental group (2.80±0.4) was not significantly different from the control group (2.88±0.33). The VAS scores for all survey items were lower in the experimental group than in the control group, where a lower score indicated a lower level of inconvenience. The nasal cavity packing described here maintained objective measures of nasal respiration and supported the reduced bone similar to conventional methods. Maintaining nasal respiration reduced the inconvenience to patients, which demonstrates that this packing method is useful.

Postoperative Evaluation of Silicone Airway Splint in Nasal Bone Fracture Treatment

BackgroundPacking after closed reduction of a nasal bone fracture causes inconvenient nasal obstruction in patients. We packed the superior meatus with Vaseline gauze to support the nasal bone, and packed the middle nasal meatus with a Doyle Combo Splint consisting of an airway tube, a silastic sheet, and an expandable sponge to reduce the inconvenience. In addition, we aimed to objectively identify whether this method not only enables nasal respiration but also sufficiently supports the reduced nasal bone.MethodsNasal ventilation was measured via spirometry 1 day before surgery and compared to 1 day after surgery. To compare support of the reduced nasal bone by the 2 methods, 2 plastic surgeons assessed the displacementon X-rays taken after the surgery and after removing the packing. The extent of nasal obstruction, dry mouth, sleep disturbance, headache, and swallowing difficulty were compared with visual analog scales (VAS) on a pre-discharge survey.ResultsIn the experimental group, the nasal respiration volume 1 day after surgery remained at 71.3%±6.84% on average compared to 1 day prior to surgery. Support of the reduced bone in the experimental group (2.80±0.4) was not significantly different from the control group (2.88±0.33). The VAS scores for all survey items were lower in the experimental group than in the control group, where a lower score indicated a lower level of inconvenience.ConclusionsThe nasal cavity packing described here maintained objective measures of nasal respiration and supported the reduced bone similar to conventional methods. Maintaining nasal respiration reduced the inconvenience to patients, which demonstrates that this packing method is useful.

Acquired nasopharyngeal stenosis in a patient with sarcoidosis

Acquired nasopharyngeal stenosis typically occurs as a result of surgery or irradiation of the nasopharynx. Sarcoidosis has numerous manifestations in the head and neck region, although an association with nasopharyngeal stenosis has not previously been reported. A 40-year-old man with sarcoidosis developed severe acquired nasopharyngeal stenosis. This was successfully managed with balloon dilatation, followed by pharyngoplasty with local pharyngeal flap reconstruction. This report is intended to prompt consideration of nasopharyngeal stenosis as a potential cause of nasal obstruction in patients with sarcoidosis, and to draw attention to the need to consider sarcoidosis in the differential diagnosis of patients with acquired nasopharyngeal stenosis. We also demonstrate the viability of pharyngoplasty in the management of nasopharyngeal stenosis in the setting of sarcoidosis.

Treatment outcomes and predictors for systemic steroids in nasal polyposis

Conclusion: Systemic steroids improve nasal symptoms such as sneezing, purulent rhinorrhea, and nasal obstruction in patients with nasal polyposis, regardless of measurable response to systemic steroid. A history of allergic rhinitis is an independent prognostic factor for favorable response of nasal polyposis to systemic steroid. Overexpression of glucocorticoid receptor β is associated with glucocorticoid resistance. Objectives: This study was conducted to evaluate treatment outcomes and clinically useful predictive factors for systemic steroids in nasal polyposis. Methods: The study involved 47 consecutive patients diagnosed with nasal polyposis from December 2008 to May 2010. Twenty milligrams of prednisolone were administered daily for 14 days. The following parameters were analyzed: subjective nasal symptoms, history of allergic rhinitis and asthma, SNOT-20 score, olfactory function test, bronchial hyperreactivity, blood eosionophil count, atopy, Lund-Mackay score, tissue eosinophil infiltration ratio, and expression of glucocorticoid receptor α and β in the nasal polyp epithelium. Results: In all, 62% of the patients were responders, i.e. had a decreased polyp size >25% after treatment. SNOT-20 score tended to decrease for all patients but significantly only for the responder group (p < 0.01). Eighteen of the responders had a medical history of allergic rhinitis, but only five of the nonresponders did (p = 0.026, Odds ratio = 4.26). Responder group polyps showed significantly less immunoreactivity of glucocorticoid receptor β than polyps from the nonresponder group.

Nasal Obstruction in Patients with Obstructive Sleep Apnea Syndrome

Objective: 1) Evaluate the prevalence of the symptom of nasal obstruction in patients with obstructive sleep apnea syndrome. 2) Identify which polysomnographic variables were most altered by nasal obstruction. Method: A transversal study was performed through the analysis of overnight polysomnography in association with the Epworth’s Sleepiness Scale, nasal symptoms and clinical assessment of sleep. In this study, 80 patients were evaluated between March and July of 2010, both male and female, with snoring and apnea complaints. Results: No statistically significant differences between the groups regarding age, gender, body mass index and neck circumference were observed. We found that patients with nasal obstruction were more likely to have a severe obstructive sleep apnea (apnea/hypopnea index &gt;30 per hour of sleep) with an increase of 35.71% in comparison with those without nasal obstruction ( P = .028), as well as an increase in hypopnea index( P = .026)and latency for REM stage ( P = .020). There was no correlation between excessive daytime sleepiness complaints and the symptom of nasal obstruction. Conclusion: Patients with a nasal obstruction complaint are more likely to present a severe obstructive sleep apnea, hypopnea events and a higher latency of paradoxal sleep stage.

A Theoretical Cause of Nasal Obstruction in Patients with Repaired Cleft Palate

During cleft palate repair, mucoperiosteal flaps are elevated from the palatal shelves and the nasal septum to accomplish tension-free closure of the nasal floor. This study was designed to geometrically describe how palate repair inherently limits airflow by decreasing nasal cavity cross-sectional area and increasing nasal airflow resistance. In addition, this study investigates whether the width of the repaired cleft palate directly affects the degree of postoperative airflow resistance. A simplified geometric model of normal nasal cavity anatomy was compared with an equivalent schematic representing an individual with an unrepaired palatal cleft. Mathematical equations approximating the cross-sectional areas of normal and cleft nasal cavities were created. The theoretical postoperative loss of nasal cavity cross-sectional area was then considered for both unilateral and bilateral palatal clefts. According to this geometric model, the cross-sectional area of the nasal cavity is decreased in patients who undergo cleft repair. Repaired bilateral clefts experience a greater area loss than their unilateral counterparts. Nasal cavity resistance is higher in patients who have undergone cleft repair than in individuals who have not undergone cleft repair. because tension-free closure of the nasal floor inherently reduces cross-sectional breathing area. The wider the cleft, the higher the resistance to nasal airflow postoperatively. This iatrogenic source of nasal resistance is likely additive to other anatomic contributors to airflow resistance observed in individuals with cleft nasal deformities.

Sensation of nasal patency compared to rhinomanometric results after septoplasty

The primary aim of the present study was to investigate the relationship between the subjective sensation of nasal airflow resistance, the rhinoscopic findings and the objective measures of nasal obstruction in patients followed up after septoplasty. A further goal was to determine which of the above modalities is most suitable for assessment of the severity of nasal obstruction and which best indicates the need for surgery. 86 patients who had previously undergone septoplastic surgery were recruited. Objective and subjective measures of nasal obstruction were recorded by using active anterior rhinomanometry, rhinoscopy and a visual analogue scale. The Spearman rank order correlation model revealed a significant correlation between the VAS score and the airway resistance of the more obstructed nasal cavity (r = 0.24); furthermore, between the VAS score and rhinoscopic findings (r = 0.35). By applying the generalized linear model, we also found significant relation between the VAS score and the rhinomanometric data, and between the rhinoscopic findings and the airway resistance of the more obstructed nasal cavity (p = 0.02). The correlation between the subjective sensation of nasal airflow resistance, the rhinoscopic findings, and the rhinomanometric data proved to be significant, but weak even in the group of patients that underwent septoplasty. Every postoperative complaint should therefore be evaluated carefully. Rhinomanometry is an appropriate diagnostic tool with which to determine the measure of obstruction caused by nasal pathological factors. It is suitable for making objective the patients' complaints. Rhinoscopy, beyond the assessment of the degree of obstruction, is capable of analysis of its cause. The decision as to the need for surgery should be based on rhinoscopy, or nasal endoscopy, and can be supported by pathologically elevated resistance of the more obstructed nasal cavity.

Mechanism of nasal obstruction in patients with allergic rhinitis

SummaryNasal obstruction is a crucial symptom in allergic rhinitis (AR) patients and may affect the quality of life. It is caused mostly by nasal mucosal obstruction, and to a lesser extent, fluid secretion. Mucosal congestion is primarily a vascular phenomenon comprising vasodilatation of capacitance vessels (cavernous sinus) and oedema formation due to plasma leakage from post‐capillary venules. The nose has a complex microvascular anatomy consisting of capacitance vessels, arteriovenous anastomosis, and subepithelial and periglandular capillaries. Nasal congestion is explained by the effects of local mediators exerting potent vasodilatation or increasing permeability of nasal blood vessels and nerves. Capacitance vessels usually constrict because of constant sympathetic tone. They distend by a variety of stimuli such as loss of continuous sympathetic stimulation on the sinusoids, direct vasodilatation by vasoactive substances, contraction of cushion veins, and compression of venules by distended arteries in the intraosseous bony canals of periosteal space. Although topical application of histamine can cause vasodilatation and oedema, histamine is not likely a major mediator causative of nasal congestion in AR. Nasal vascular dilatation elicited by cysleukotriene 1 (cysLT1) may be induced by nitric oxide produced through cysLT1 receptor activation. Thromboxane A2 may cause capacitance vessel dilatation through a contraction of cushion veins. Potentiation of vasoconstrictor action of steroids has been reported since the 1950s. Glucocorticoids (GCs) have two fundamentally different vascular effects: classic action modifying the transcription of pro‐inflammatory genes and acute non‐genomic action (within minutes) that increases the vasomotor tone. The non‐genomic effect is likely related to binding of GCs to the plasma membrane and inhibition of extraneuronal monoamine transporter on vascular smooth muscle cells, thereby increasing noradrenaline concentrations at α1‐adrenoceptors. Genomic vascular effects include the reduction of vessel density, decrease of hyperperfusion, reduction of inflammatory microvascular hyperpermeability, and decreased influx and activation of inflammatory cells. These effects require hours to manifest themselves physiologically.

Visual analog scale (VAS) and nasal obstruction in persistent allergic rhinitis

Objective Nasal airflow resistance, as measured by rhinomanometry, is frequently impaired in allergic rhinitis (AR). However, rhinomanometry is scarcely available. The aim of this study was to verify the suitability of the use of visual analog scales (VAS) as a surrogate for rhinomanometry in quantifying nasal obstruction in patients with persistent allergic rhinitis. Study Design Prospective study on patients with allergic rhinitis. Setting ENT clinic. Subjects and Methods Fifty patients (27 males, mean age 23 years, SD 2.24) were studied. VAS for nasal obstruction and other AR symptoms and rhinomanometry were performed in all patients. Results A significant, very strong correlation has been observed between VAS for nasal obstruction and nasal airflow resistance (Spearman r = 0.879, P < 0.001). Moreover, a significant correlation exists between VAS for rhinorrhea and resistance (Spearman r = 0.313, P = 0.027). Conclusion The use of VAS for assessing the nasal obstruction appears clinically relevant in that it allows, with good reliability, the quantification of this symptom in the absence of rhinomanometry.

Clinical effects of nasal glucocorticoid on amelioration of nasal obstruction in patients with persistent non-allergic rhinitis

To observe the efficacy of nasal glucocorticoid continuously used for 12 weeks on nasal obstruction in patients with persistent non-allergic rhinitis (PNAR). The changes of nasal obstruction, nasal resistance, nasal mucous membrane and quality of life in 47 patients with PNAR were observed. The efficacy of nasal glucocorticoid (Mometasone Furoate Nasal Spray, MFNS 200 microg/day) on patients with PNAR was evaluated. The results of nasal glucocorticoid (MFNS) continuously used for 12 weeks demonstrated: (1) After treatment, the nasal obstruction, nasal discharge, nasal obstruction related dizziness, headache, hyposmia, daily life activity, whole body fatigue, mental status were significantly improved (P < 0.05). (2) Nasal resistance showed significant amelioration (pre-treatment = 0.28 +/- 0.10, post- treatment = 0.16 +/- 0.05; F = 91.471, P < 0.05). (3) SF-36 questionnaire revealed that role physical, bodily pain, general health, role emotional had significant amelioration (P < 0.01). (4) SNOT-20 questionnaire revealed that the defatigation, impaired concentration, pinch the nose, nasal discharging into the throat, sleep quality had significant amelioration (P < 0.01). (5) Continued treatment for 12 weeks was better than 4 weeks, continued treatment had good effect. The study shows that nasal glucocorticoid improved the nasal obstruction, nasal resistance, nasal mucous membrane and quality of life in patients with PNAR.

The role of the nose in the pathogenesis of obstructive sleep apnea

To define the relationship between obstructive sleep apnea (OSA) and nasal obstruction, we have reviewed the literature on epidemiological, physiological, and randomized controlled studies in which the relationship between nasal obstruction and OSA was investigated. Data from observational studies suggest that nasal obstruction contributes to the pathogenesis of OSA. Recently, studies have mainly focused on the effects of therapeutic interventions on the nose and OSA. Eleven trials with randomized controlled designs were found; external nasal dilators were used in five studies, topically applied steroids in one, nasal decongestants in three, and surgical treatment in two studies. Data from these studies showed only minor improvement in the symptoms and severity of OSA. The current evidence suggests that the nose may not play a significant role in the pathogenesis of OSA. The impact of treating nasal obstruction in patients with OSA on long-term outcome remains to be defined more accurately through randomized controlled trials of medical and surgical therapies with large numbers of patients.

The spontaneous course of nasal obstruction in patients with normal nasal airway resistance

The spontaneous course of nasal obstruction in patients with normal nasal airway resistance

Efficacy of Odiosoft-Rhino in Assessment of Nasal Obstruction: A Comparative Study with Acoustic Rhinometry after Treatment with Budesonide Nasal Spray in Patients with Perennial Allergic Rhinitis

Odiosoft-Rhino (OR) is new software and equipment that can be used to measure changes in nasal obstruction after intranasal steroid treatment. OR is a promising method for measuring the degree of nasal obstruction. OR can precisely analyze nasal sound spectra in decibels, which is generated by nasal airflow. We studied the reliability of OR for assessing declining nasal obstruction after budesonide nasal spray treatment. Sixty-five patients with perennial allergic rhinitis (PAR) were enrolled in the study, and 52 of these patients completed the study. Nasal endoscopic examination, acoustic rhinometry (AR), and OR were performed and symptom scores were compared before and after 3 months of treatment with intranasal budesonide. All of the patients received 7 days of placebo treatment before receiving budesonide. There was a significant difference in the visual analog scores of nasal obstruction and in the examination scores before and after the treatment for both the right and the left nasal cavities. Pretreatment AR findings and OR findings in the 2000- to 4000-Hz and 4000- to 6000-Hz intervals for both sides were significantly different from the posttreatment measurements (p = 0.000). Both AR and OR can assess the efficacy of budesonide nasal spray treatment for nasal obstruction in patients with PAR. Both AR and OR are effective for assessing nasal obstruction and monitoring treatment efficacy but, as a simple and noninvasive test, OR can be used with confidence.

The role of the nose in the pathogenesis of obstructive sleep apnoea and snoring

Data from observational studies suggest that nasal obstruction contributes to the pathogenesis of snoring and obstructive sleep apnoea (OSA). To define more accurately the relationship between snoring, OSA and nasal obstruction, the current authors have summarised the literature on epidemiological and physiological studies, and performed a systematic review of randomised controlled trials in which the effects of treating nasal obstruction on snoring and OSA were investigated. Searches of bibliographical databases revealed nine trials with randomised controlled design. External nasal dilators were used in five studies, topically applied steroids in one, nasal decongestants in two, and surgical treatment in one study. Data from studies using nasal dilators, intranasal steroids and decongestants to relieve nasal congestion showed beneficial effects on sleep architecture, but only minor improvement of OSA symptoms or severity. Snoring seemed to be reduced by nasal dilators. Nasal surgery also had minimal impact on OSA symptoms. In conclusion, chronic nasal obstruction seems to play a minor role in the pathogenesis of obstructive sleep apnoea, and seems to be of some relevance in the origin of snoring. The impact of treating nasal obstruction in patients with snoring and obstructive sleep apnoea on long-term outcome remains to be defined through randomised controlled trials of medical and surgical therapies.

Expiratory nasal sound analysis as a new method for evaluation of nasal obstruction in patients with nasal septal deviation: comparison of expiratory nasal sounds from both deviated and normal nasal cavity

The reliability of nasal obstruction measurements could be improved, and several new techniques are being developed. Our objective was to investigate the use of a new software program, Odiosoft-Rhino, in the assessment of nasal obstruction via analysis of the sounds of nasal expiration. We compared the nasal symptom scores and Odiosoft-Rhino and acoustic rhinometry test results for 61 patients with known nasal septal deviation. We found a significant difference, and a correlation, between Odiosoft-Rhino results at 2000-4000 Hz and 4000-6000 Hz intervals, and the minimal cross-sectional area 2.2 cm from the nostril, in the right nasal cavity in patients with right-sided deviations. Similar results were observed for the left nasal cavity in patients with left-sided deviations. The Odiosoft-Rhino software test is noninvasive, requires minimal cooperation and experience, and provides results that can be saved as digital data. Additionally, data from the Odiosoft-Rhino test are strongly correlated with acoustic rhinometry results and visual analogue scores of nasal obstruction. It seems that sound intensity within the 2000-4000 Hz and 4000-6000 Hz intervals is more sensitive than other sound intensity intervals. Thus, we speculate that Odiosoft-Rhino testing could be used as a new diagnostic method in order to evaluate nasal airflow in clinical practice.

Identification of Viruses in Patients With Postviral Olfactory Dysfunction

Objective: Causative viruses of postviral olfactory dysfunction (PVOD) have not yet been identified. The aim of this study was to investigate causative viruses in patients with PVOD. Study Design and Methods: Nasal discharge was collected from 24 patients with PVOD. We investigated the presence of 10 viruses in nasal discharge and examined the time course, with regard to changes in olfactory dysfunction and nasal obstruction in patients with PVOD, using questionnaires, acoustic rhinometry, and olfactory tests. Results: Rhinoviruses were detected in 10 patients by electrophoresis. Rhinoviruses were also confirmed in four patients by nucleotide sequences. Viral serotypes were identified to be human rhinovirus (HRV)‐40, HRV‐75, HRV‐78, and HRV‐80. One of the four patients complained of anosmia, whereas another complained of dysosmia. Olfactory testing did not show significant improvement at 4, 8, 11, and 24 weeks after the first visit in the four patients, although results of acoustic rhinometry significantly improved. Two of the four patients complained of olfactory dysfunction even 6 months after the first visit. Coronavirus and parainfluenza virus were detected in one patient each, and Epstein‐Barr viruses were detected in three patients. Conclusions: This study for the first time detected rhinovirus, coronavirus, parainfluenza virus, and Epstein‐Barr virus in nasal discharge of patients with PVOD. Furthermore, the present study suggests that rhinoviruses can cause olfactory dysfunction through mechanisms other than nasal obstruction and that rhinoviruses can induce various severities and different time courses of olfactory dysfunction.