Nasal Obstruction In Patients Research Articles

Comparative Study on the Long‐Term Effectiveness Between Coblation‐ and Microdebrider‐Assisted Partial Turbinoplasty

Various surgical methods have been tried to relieve the symptoms of nasal obstruction in patients with inferior turbinate hypertrophy. Recently, coblation that uses the radiofrequency and microdebrider is being increasingly used in turbinate surgery. The aim of this study was to compare the long-term postoperative outcome between the coblation- and microdebrider-assisted partial turbinoplasty. We selected 60 patients for this prospective study who had nasal obstruction and hypertrophied turbinate mucosa that was refractory to medical treatment. Thirty patients were treated with coblation (group 1) and 30 patients were treated with microdebrider (group 2). Postoperative changes in degree of nasal obstruction were evaluated prospectively at 3, 6, and 12 months after the procedure. A cross-sectional area of second notch and volume of nasal cavity were compared at 12 months after operation. Operation time, duration of crust formation, postnasal drip, and postoperative bleeding were also compared. Nasal obstruction was improved significantly in both groups at 3, 6, and 12 months after the procedure. However, when compared between two groups, symptom improvement was statistically significant in group 2 at 12 months after surgery. Acoustic rhinometry performed at 12 months demonstrated a significant increase of cross-sectional area of second notch and volume of nasal cavity in group 2 in comparison with group 1. There were no significant differences in degree of postnasal drip, operation time, or duration of crust formation between the two groups. This study suggests that microdebrider-assisted partial turbinoplasty is more effective and satisfactory in long-term relief of nasal obstruction and reduction in mucosal volume of anterior head of inferior turbinate.

Efficacy of a Leukotriene Receptor Antagonist in the Treatment of Perennial Allergic Rhinitis

The objectives of this study were to investigate the efficacy of leukotriene receptor antagonists in the treatment of perennial allergic rhinitis. The study was designed as a randomized, 14-day treatment to compare the efficacy of zafirlukast, loratadine, and the combination of loratadine and pseudoephedrine in the treatment of perennial allergic rhinitis. Rhinitis symptom scores, acoustic rhinometry, and rhinomanometry were used to evaluate the efficacy. The results showed that after a 14-day treatment period, patients in all treatment groups had a lower mean score for the symptoms of rhinorrhea, nasal itching, and nasal obstruction (p < .05). Patients who took zafirlukast did not report a significant decrease in sneezing score (p = .1456), but the decrease in nasal obstruction score was more pronounced than in those who took loratadine or loratadine- pseudoephedrine (p = .014). However, the results of acoustic rhinometry and rhinomanometry did not have a significant difference among the three groups (p > .05). The study concluded that zafirlukast seemed to have a better effect on relieving the symptom of nasal obstruction in patients with perennial allergic rhinitis, but the actual mechanism needs further investigation.

Oral antihistamines for the symptom of nasal obstruction in persistent allergic rhinitis – a systematic review of randomized controlled trials

Oral antihistamines are recommended by a World Health Organisation working group as a first-line pharmacological treatment in mild persistent allergic rhinitis. There is, however, uncertainty with respect to their effectiveness for a common symptom, that of nasal obstruction. To test the null hypothesis that oral antihistamines have no effect on the symptom of nasal obstruction in a clinical setting in patients with persistent allergic rhinitis. Protocol based review of double-blind randomized controlled trials of oral antihistamine (i.e. drugs considered to act as a histamine receptor type-1 antagonist) vs. placebo. A search was carried out for published and unpublished trials. Individuals had to be age 12 years or older (with a diagnosis confirmed by skin prick tests, IgE blood tests or nasal allergen challenge), experiencing their normal allergen exposure. A symptom score for nasal obstruction had to be recorded. Predetermined quality criteria were applied. Treating their data as 4-point scores, a meta-analysis was carried out for studies, which provided enough data to be pooled. Meta-analysis found a weighted mean difference of -0.52 in favour of treatment for patient-assessed symptom scores (95% confidence interval (CI)-0.73,-0.31, P<0.00001), and of -0.33 in favour of treatment for healthcare worker assessed scores (95% CI -0.49, -0.16, P = 0.0001). Oral antihistamines cause statistically significant improvement in the symptom of nasal obstruction in patients with persistent allergic rhinitis.

The Phosphodiesterase 4 Inhibitor Prevents Antigen-induced Biphasic Nasal Obstruction in Brown Norway Rats

ABSTRACT Background Nasal obstruction is considered the most serious problem for patients with allergic rhinitis. We have previously established a model of nasal obstruction in guinea pigs. In the present study, we tried to establish an allergic model of nasal obstruction using Brown Norway (BN) rats to evaluate the effects of phosphodiesterase (PDE) 4 inhibitors in this model. Methods The volume of the nasal cavity was measured with an acoustic rhinometer. Decrease in the volume of the nasal cavity was taken as nasal obstruction. BN rats were actively sensitized with ovalbumin conjugated with aluminium hydroxide. Intranasal antigen instillation induced biphasic nasal obstruction in sensitized BN rats. Results Early and late phase responses (EPR and LPR) were observed peaking at 0.5 and 6 hours after the antigen challenge, respectively. Chlorpheniramine did not inhibit EPR or LPR at 10 mg/kg, although the dose was sufficient for the compound to exert its anti-histamine activity. Prednisolone inhibited both responses at 30 mg/kg. Rolipram and CDP-840, PDE4 inhibitors, inhibited both responses at 100 mg/kg. KF19514, a PDE1/4 dual inhibitor, inhibited EPR at 0.1 mg/kg or more and inhibited LPR at 10 mg/kg. Conclusions The present study provides a simple model of allergic biphasic nasal obstruction in BN rats, and also suggests that the PDE4 inhibitor may alleviate nasal obstruction in patients with allergic rhinitis.

Influence of nasal obstruction in face dimensions according to different growth phases

Objectives: The objectives of this study are investigating the facial and occlusal abnormalities in different phases of growth and correlate them to nasal obstruction in patients that need orthodontic treatment. Methods: We selected 86 patients from 6 to 25 years old (37 male; 49 female) that needed orthodontic treatment. They were divided according to the skeletal phase of maturity (hand and wrist x-ray) into 3 phases of growth (prepuberal, puberal and postpuberal). Patients were submitted to ENT doctor’s exam to determine if nasal obstruction was present. Patients were submitted to the orthodontist’s examination that evaluated also the orthodontic casts, lateral and frontal cephalometric x-rays. Facial and dental findings of patients with and without nasal obstruction were compared by statistical analysis. Results: This series showed that nasal obstruction was present in around half of the patients. It was associated to: higher frequency of dolychofacial pattern, class II skeletal pattern, palatal atresia, skeletal openbite, smaller nasal wideness, distance intermolars decreased, smaller maxillary and mandibular dimensions, and increased overjet. The majority of these characteristics were more prevalent in puberal and postpuberal phases of growth and in patients with a dolychofacial pattern. Conclusion: These findings suggest that the longer the nasal obstruction, the worse the orthodontic abnormalities, mainly in dolychofacial patients and that the multidisciplinary approach may be very important to a successful treatment.

Nasal Obstruction in Patients with Seasonal Allergic Rhinitis: Relationships between Allergic Inflammation and Nasal Airflow

Background: Nasal obstruction is a typical symptom of allergic rhinitis. Allergic rhinitis is characterized by a Th2-dependent inflammation. The aim of this study was to evaluate the possible relationships between allergic inflammation, including inflammatory cells and cytokine pattern, and nasal airflow in patients with nasal obstruction due to seasonal allergic rhinitis. Methods: Fifty patients (31 males and 19 females, mean age 31.9 ± 4.8 years) with seasonal allergic rhinitis were evaluated during the pollen season. All of them had moderate to severe nasal obstruction. Total symptom score, rhinomanometry, nasal lavage, and nasal scraping were assessed in all subjects. Inflammatory cells were counted by conventional staining; IL-4, IL-5, IL-8, and IFNγ were measured by immunoassay on fluids recovered from nasal lavage. Results: Significant positive relationships were demonstrated between eosinophil infiltration and IL-4 levels (p < 0.0001), eosinophils and IL-5 levels (p < 0.0001), and eosinophils and IL-8 levels (p < 0.0001). Significant negative relationships were demonstrated between eosinophil infiltration and IFNγ levels (p < 0.0001) and eosinophil infiltration and nasal airflow (p < 0.001). Conclusions: This study demonstrates the close connection between Th2 cytokines and eosinophil infiltration. In addition, there is clear evidence concerning the relationship between eosinophil infiltration and nasal airflow. These findings constitute first evidence of the relationship between nasal airflow impairment and Th2-related inflammation in seasonal allergic rhinitis.

Sleep apnea and the nasal airway.

Sleep apnea and the nasal airway.

Argon plasma coagulation for intractable nasal obstruction occurring in patients with allergic rhinitis.

New surgical treatment for the intractable nasal obstruction in patients with nasal allergy by using Argon Plasma Coagulator (APC) was introduced. Of patients with allergic rhinitis treated at our institute, 28 patients complaining nasal obstruction were treated APC surgery. Epithelization of the mucosa of inferior turbinate was almost completely accomplished at 4 weeks after surgery, at which time mucosal swelling was reduced, and nasal obstruction was ameliorated in all cases, though a crust and fibrin membrane adhered to the mucosa between 2 to 4 weeks after surgery, resulting in temporary exacerbation of nasal obstruction. Nasal obstruction was again aggravated in only one patient about 6 months after surgery, but such symptom could be ameliorated by re-coagulation. No bleeding and no smoke occurred in the operation. No morbidity was also noticed after operation. APC is easy to perform safely and effectively compared with another laser surgeries, and is useful for intractable nasal obstruction occurring in patients with allergic rhinitis.

Impact and modulation of nasal obstruction.

Nasal obstruction, the leading symptom of allergic rhinitis, results from the combined activity of early- and late-phase allergic reactions. Desloratadine inhibits both early- and late-phase inflammatory mediators in vitro. Thus, double-blind, placebo-controlled, randomized, crossover trials were conducted to assess the efficacy of desloratadine against nasal obstruction, measured objectively and subjectively, during controlled exposure of patients with seasonal allergic rhinitis to allergen. Positive results were obtained in three single-dose studies; desloratadine 5 mg resulted in a greater improvement from baseline than did placebo in the total symptom score and the nasal obstruction symptom score (P </= 0.02). Desloratadine was more effective than placebo in a multiple-dose study; desloratadine 5 mg was given once daily for 7 days, and a 6-h allergen challenge was administered at the end of treatment compared with placebo. Desloratadine treatment was associated with less deterioration from baseline in the mean nasal airflow (P < 0.05) and in the mean severity score for the symptom of nasal obstruction (P < 0.03). Desloratadine significantly reduces the severity of nasal obstruction in patients with seasonal allergic rhinitis.

Involvement of vascular endothelial growth factor in nasal obstruction in patients with nasal allergy

ABSTRACT It has recently been shown that vascular endothelial growth factor (VEGF) enhances vascular permeability and that mast cells produce VEGF, suggesting the involvement of VEGF in allergic diseases. In the present study we quantitatively analyzed VEGF in the nasal lavage fluid of patients with nasal allergy. We performed nasal antigen challenge with Japanese cedar pollen antigen in 10 healthy adult volunteers and in 10 cedar pollen IgE-positive patients with nasal allergy. In all patients with nasal allergy, VEGF and histamine levels in the nasal lavage fluid reached a peak 30 min after antigen challenge, then returned to prechallenge values 2 h after antigen challenge. In these patients, the histamine level increased three-fold, while the VEGF level increased 10-fold. However, in all healthy adult volunteers, VEGF and histamine levels did not increase. A stronger correlation was noted between the ratio of decreased nasal cavity volume and the ratio of increased VEGF levels (R = 0.823; P P

Clinical Significance of Nasal Peak Inspiratory Flow Rate in Patients with Chronic Cough

Background : The upper respiratory tract is the primary target organ of various airborne pollutants and is easily accessible part of the respiratory tract, and also is the predominant structure where chronic cough originates. The nasal peak inspiratory flow(PIFn), which is the peak inspiratory flow via nose with nasal mask and spirometry, could be a reliable parameter of nasal obstruction. The validity of PIFn has been evaluated in several studies by assessing the correlation between PIFn measurements and other parameters of nasal air flow. This study was designed to show the reproducibility of PIFn, the difference of PIFn between patients with chronic cough and normal subjects, and the usefulness of PIFn in the evaluation of nasal obstruction in patients with chronic cough. Methods : PIFn was measured by spirometry with nasal mask, twice a day for 3 consecutive days in 7 young normal subjects to evaluate validity of the test. In 32 patients with chronic cough and 25 age-matched normal subjects, PIFn and pulmonary function test(, pred, FVC, and FVC% pred) were measured at first visiting. Results : Values of PIFn, , and FVC were nearly constant in 7 young normal adults. Patients with chronic cough were 32 (14 males and 18 females) and the mean age was years. Normal subjects were 32(22 males and 10 females) and the mean age was years. There was no significant difference of age and pulmonary function test between patients with chronic cough and normal subjects(p vs. ; p=0.02). The postnasal drip syndrome(PNDS) comprised the majority of patients with chronic cough(27). The PIFn in patients with PNDS was significantly lower than that of normal subjects (meanSD ; vs. , p=0.006). Conclusion : There was a significant difference of PIFn between patients with chronic cough and normal subjects. Among the patients with chronic cough, patients with PNDS showed the most significant difference with normal subjects in PIFn. The PIFn could be a useful parameter of nasal obstruction in patients with chronic cough, especially in patients with PNDS.

The nose and obstructive sleep apnea.

The role of the nasal passage in the pathophysiology of obstructive sleep apnea (OSA) is still controversial. To this end, induction of acute nasal obstruction in healthy volunteers is associated with sleep fragmentation and an increase in the number of obstructive and central apneas. Moreover, nasal topical anesthesia, which alters nasal reflexes, is associated with an increase in the number of obstructive and central apneas during sleep. Although nasal resistance is increased in patients with OSA, chronic nasal obstruction appears to play no significant role in the genesis, maintenance, or severity of OSA. Moreover, surgical correction of nasal obstruction does not alleviate OSA appreciably. The purpose of this review is to outline the current body of knowledge on the pathophysiology, diagnosis, and treatment of nasal obstruction in patients with OSA.

Objective and subjective assessment of nasal obstruction in patients undergoing endoscopic sinus surgery.

Functional endoscopic sinus surgery (FESS) is the surgical treatment of choice for many physicians in chronic inflammatory diseases of the sinuses. Although subjective benefit has been claimed after surgery, there are not enough studies reporting objective improvement. We evaluated 40 patients undergoing FESS for chronic and recurrent sinusitis with visual analog scale (VAS) scoring of sensation of nasal obstruction and active anterior rhinomanometry of nasal resistance. The results of postoperative measurements demonstrated that baseline total nasal resistance measured with rhinomanometry and evaluated with VAS scoring (baseline and after decongestion) were significantly lower than preoperative measurements. However, improvement in nasal resistance was not statistically significant after decongestion, whereas VAS scoring was. These findings indicate that FESS improves nasal mucosal edema but does not change the structural anatomy of the nose.

小青竜湯(TJ-19)の鼻アレルギー患者の鼻閉塞に対する効果

小青竜湯(TJ-19)の鼻アレルギー患者の鼻閉塞に対する効果

The Role of Mucosal Oedema in Nasal Obstruction in Patients with Septal Pathology

The degree of mucosal edema was assessed using the decongestion effect achieved with vasoconstrictor spray in 102 patients referred for septoplasty. In preoperative rhinomanometry it was found that 62 patients had high postdecongestion nasal airway resistance (NAR) compared with control material, whereas in 40 cases, NAR was normal before operation. Our results show that the decongestion effect was higher, both pre- and postoperatively, in patients with high preoperative postdecongestion NAR. Although surgery succeeded in normalizing the mean decongestion values in these patients, there still remained considerable mucosal congestion compared to cases with low preoperative resistance. We conclude that a marked septal structural pathology causes not only high postdecongestion resistance, but that abnormal structures of the nasal airway also cause mucosal hypertrophy, mucosal irritation, and inflammation, which is measurable with rhinomanometry as elevated baseline resistance and higher decongestion effect.

アゼプチンの鼻アレルギー鼻閉に対する効果

アゼプチンの鼻アレルギー鼻閉に対する効果

The Efficacy of Turbinate Surgery for the Relief of Nasal Obstruction

To study the role of turbinate surgery 60 consecutive patients complaining of nasal airway obstruction were evaluated. All patients had a deviated nasal septum and turbinate hypertrophy and had received medical therapy of at least 8 weeks duration. Plain x-rays or computerized tomography scans of the paranasal sinuses excluded sinusitis. Each patient was randomized into one of three groups. Group I underwent septoplasty for correction of the deviated nasal septum. Group II underwent bilateral anterior turbinectomy, and Group III underwent both septoplasty and bilateral anterior turbinectomy. All patients were evaluated preoperatively and on at least one postoperative visit for their subjective perception of improvement or worsening of nasal obstruction. Likewise, all patients underwent anterior rhinomanometry preoperatively and postoperatively. The data revealed no significant difference in reduction of the nasal airway resistance as measured by rhinomanometry for Groups I and II. The patients’ own perceptions of improvement, however, were augmented when turbinectomy was performed (Groups II and III). We conclude that anterior turbinectomy is a useful operation in alleviating the sense of nasal obstruction in patients with hypertrophied inferior turbinates.

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

Sixty-seven patients, candidates for septoplasty in the years 1976-1978 because of nasal obstruction and deviated nasal septum, but not having surgery because their nasal airway resistance was normal, were reviewed in 1982 and again in 1989. Between 1982 and 1989, 6% of the patients became free of their respective nasal complaints, and 18% of their nasal obstruction, the corresponding overall figures for the period between 1976 and 1978, and 1989, being 20 and 36%. In fact, the majority of the patients were suffering from vasomotor rhinitis and because in so many cases nasal obstruction tends to disappear as time goes on, a conservative waiting policy would seem to be an appropriate approach to treatment.

Picture of the Month

The statements listed below are best associated with which of the above figures: (a) Following nasal trauma, this lesion is associated with progressive nasal obstruction. (b) This mass is a cause of nasal obstruction in patients with allergic rhinitis or chronic sinusitis. (c) This condition should be considered in the differential diagnosis of any newborn or infant with nasal obstruction. <h3>Denouement and Discussion</h3> A nasal septal abscess should be considered in patients presenting with progressive nasal obstruction following nasal trauma. The abscess usually presents as an erythematous, tender nasal mass that may completely obstruct the airway either unilaterally or bilaterally (Fig 1). The treatment of choice is incision and drainage with the placement of a drain and nasal packing. Septal hematomas may progress to suppuration and ultimately dissolution of the septal cartilage. This may occur as early as 48 hours, resulting in a long-term cosmetic deformity.

Exercise-Induced Nasal Obstruction in Patients with Allergic Rhinitis

Exercise-induced nasal obstruction was studied in 90 patients with allergic rhinitis and 26 normal subjects. Allergic patients as well as normal subjects showed marked decreases of nasal resistance immediately after exercise. In allergic patients, however, the total nasal resistance returned to the pre-exercise level quickly after exercise and surpassed it. Meanwhile, the total nasal resistance gradually returned to the pre-exercise level in the post-exercise period in normal subjects. The profile of the total nasal resistance changes in the allergic patients was statistically different from that in the normal subjects. As far as unilateral nasal resistance is concerned, marked increases of nasal resistance appeared 10–30 minutes after exercise in 20 of 90 allergic patients. On the contrary, this phenomenon was not found in any normal subject. This unilateral nasal obstruction, which appeared only in allergic patients, is probably due to excessive dilatation of the capacitance vessels in the nasal mucosa and considered to appear as an enhancement of the nasal cycle. In this paper, the role of the nasal cycle is discussed in relation to exercise-induced nasal obstruction.