Sensation Of Nasal Obstruction Research Articles

Nasal Patency Measurement: State of the Art of Acoustic Rhinometry.

Nasal obstruction is one of the main symptoms of different nasal pathologies. Many physiological and pathological conditions can produce nasal airflow impairment causing nasal obstruction and affecting patients' quality of life. There are different methods for the measurement of nasal obstruction, but in clinical practice the most common used are acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flow. This review describes the fundamentals of acoustic rhinometry, its normal values, the different physiological and pathological conditions that can modify nasal patency, and the utility of this instrument for the measurement of nasal obstruction in clinical practice. Acoustic rhinometry is a simple test, so it is suitable for measurements in the pediatric population, i.e., for evaluating adenoid hypertrophy. Acoustic rhinometry normal values are available, unilaterally and bilaterally for pediatric and adult populations. Acoustic rhinometry has been demonstrated to be reproducible and even superior to rhinomanometry when measuring nasal modifications during challenges. It is possible to use acoustic rhinometry before and after nasal surgery. Measuring nasal cavities volume and cross-sectional area, acoustic rhinometry is particularly indicated in rhinosurgery, especially for the evaluation of spreader grafts. Brief considerations about the correlation between nasal symptoms, in particular the subjective sensation of nasal obstruction, and the acoustic rhinometry results as well as the correlation of acoustic rhinometry with other methods for the measurement of nasal obstruction are also reported. Objective and subjective evaluation of nasal obstruction gives different information that together optimizes the diagnosis and the treatment of rhinologic patients. Acoustic rhinometry alone or in combination of other instruments for the measurement of nasal obstruction or patency should be used regularly in every outpatient clinic that treats patients with nasal obstruction as there is an increasing need of evidence-based therapies.

Empty Nose Syndrome with Unilateral Ethmoidal Mucopyocoele – An Extremely Rare Presentation

Introduction Empty nose syndrome (ENS) is a poorly understood and rare iatrogenic disorder resulting from the destruction of normal nasal tissue. ENS is a recognized complication after turbinate excision. These patients suffer from endonasal crusting and dryness and a paradoxical sensation of nasal obstruction. These complications of ENS predispose these patients to recurrent sino-nasal infections. Case report Here we have reported the case of a 20-year-old female with right-sided nasal obstruction and headache. On diagnostic nasal endoscopy (DNE), the right nasal cavity was devoid of all anatomical landmarks. A hidden ethmoidal mucopyocoele was identified on radiological evaluation . This was drained surgically. Patient’s symptoms improved drastically postoperatively. Conclusion Despite the fact that occurrence of rhino-sinusitis is common in patients of ENS, a mucocoele or mucopyocoele has never been reported previously. To the best of our knowledge, this is the first ever reported case of ENS with ethmoidal mucopyocoele in a young, immuno-competent patient.

Endoscopic unilateral anterior ethmoid artery flap with or without cartilage graft for nasal septal perforation repair.

The authors conducted a retrospective cohort study between June 2020 and June 2022. Our study included all adult patients with septal perforation due to trauma (operative and self-induced) lasting for more than one year. Patients underwent an endoscopic repair of a perforation and a questionnaire regarding subjective quality of life was completed at 3 months postoperatively. A total of 18 patients were included in our study. The main symptoms were crusting (100%), bleeding (38.85%), whistling (16.6%), anosmia (16.6), and nasal obstruction sensation (11%). The mean perforation size was 13.6mm, ranging between 4mm and 28mm. Number of years with the perforation (ranged between 2 and 16 years) with a mean of 4.876±1.645 years and a mode of 2 years. All cases were repaired using an endoscopic unilateral anterior ethmoid artery flap with or without cartilage.There were no intraoperative complications but postoperatively, these included pain, ranging between a score of 2 and 8 on the pain score chart, (the mean score was five and mode was four, appeared in six patients), which was treated with over-the-counter painkillers. In addition, there was one patient (5%) with a residual small perforation (2mm). All patients were happy to fill out postoperative patient satisfaction questionnaires after 3 months. The mean was 21.8889 ±1.655 points and the mode, 25 points (highest possible score), appeared four times. The lowest scoring questionnaire summated to 15 points. The endoscopic unilateral anterior ethmoid artery nasal flap with or without cartilage graft has proven to be a reliable and a valuable graft that, with proper planning, can provide excellent results with minimal morbidity for nasal septal perforation repair.

INCIDENCE OF ATROPHIC RHINITIS AFTER PARTIAL INFERIOR TURBINECTOMY: A RETROSPECTIVE COHORT STUDY

Background: Inferior turbinate hypertrophy is a common nding while evaluating the patients with Allergic Rhinitis, Chronic Rhinitis, Non-Allergic Rhinitis, Hormonal Changes, Acute sinus infection and medications. Turbinate hypertrophy causes signicant impact on patient's quality of life as it causes sensation of nasal obstruction, difculty in sleeping and epistaxis due to altered and turbulent ow of air current in nasal cavity and patients tend to go for surgical management when the medical management fails. The nasal obstruction is generally relieved after surgery but patient with a roomy nasal cavity is also at risk of developing Atrophic Rhinitis. We present a retrospective cohort study to compare the incidence of post operative Atrophic Rhinitis in two groups with one group of patients undergoing Partial turbinectomy under endoscopic guidance and other group undergoing turbinate reduction using a Turbinate Scissor. All the patients included in the study underwent the procedure in the Department of Otorhinolaryngology-Head and Neck Surgery in MBS Hospital, Kota over a period from July 2020 to December 2021. This retrospective study includes 126 pa Methods: tients as per the inclusion criteria described in the following article out of which 74 patients (52M, 22F) underwent Partial Inferior Turbinectomy using a microdebrider under endoscopic guidance and 52 patients (37M, 15F) underwent the Procedure using Turbinate scissors and the incidence of Atrophic Rhinitis was noted in the post operative follow up period and the data obtained was put to statistical evaluation. Atrophic Rhinitis was noted in a total Results: of 2 patients out of which 1 patient underwent the procedure using microdebrider and1patient underwent the procedure using Turbinate scissors. It was noted that there was no difference in gender distribution of Atrophic Rhinitis as well as the use of Microdebrider did not offer any advantage in reducing the incidence post operative Atrophic Rhinitis (p-value 0.811).

Trigeminal impairment in treatment-refractory chronic nasal obstruction.

Patients with anatomically unexplained, chronic nasal obstruction (CNO) that is refractory to medical treatment pose a challenge for clinicians. A surgical solution, addressing mechanical obstacles, is unsuited for these patients. CNO may result from disrupted airflow perception due to activation of the intranasal trigeminal system; therefore, aim of this study is to evaluate if intranasal trigeminal function of these CNO patients is decreased. In this retrospective cross-sectional study, we compared 143 CNO patients and 58 healthy volunteers, between 18 to 80 years old. We assessed nasal patency by means of rhinomanometry (RM) and measured susceptibility of intranasal trigeminal system by the trigeminal lateralization task (TLT). TLT scores were significantly lower in CNO patients compared to controls (p less than 0.001), but RM scores were not different between groups. Accordingly, TLT allowed to identify CNO patients with an accuracy of the area under the curve (AUC) of 0.78, while the value for RM was at chance (AUC=0.47). CNO patients showed normal reaction to vasoconstrictive agents with significantly lower RM values after Xylomethazoline application. Results suggest that reported nasal obstruction in CNO patients without any obvious anatomical obstacle and resistant to medical treatment may be linked to decreased perception of nasal airflow rather than physical obstruction. In this sub-set of CNO patients, trigeminal testing more adequately reflects the reported obstruction than nasal resistance assessment does. In future studies, the relation of the trigeminal status and the subjective sensation of nasal obstruction needs to be addressed with validated patient rated outcome measures (PROMs).

Party Lines and Other Mucosal Crimes: Nasal Septal Perforation: A Review of Common and Uncommon Causes

Nasal septal perforation refers to the abnormal communication of the nasal cavities via a defect in the nasal septum. Clinical symptoms, if present, include bleeding, crusting, a sensation of nasal obstruction, and whistling noises during inhalation. The mucoperichondrium of the nasal cavity contains most of the nasal septal vasculature and sandwiches the relatively avascular septal cartilage. An insult to the mucoperichondrium on both sides of the septal cartilage in approximately the same area results in ischemic necrosis of the septal cartilage, which leads to nasal septal perforation. Nasal septal perforation is a common end to an expansive list of etiologies that occur due to ischemic necrosis or direct erosion of the osteocartilaginous nasal septum from a tumor or infection. Imaging alone is typically insufficient to establish the exact underlying etiology. However, there are imaging features that may narrow the differential diagnosis or suggest less common causes, particularly malignancy. Radiologists can also identify lesions that place the nasal septum at risk, such as for a nasal septal hematoma or an abscess. Preoperative imaging allows for the evaluation of the size of the defect, as well as other areas of osseous and cartilaginous destruction in the palate, sinus walls, or orbits, that may need surgical reconstruction.Learning Objective: Describe nasal septal anatomy, pathophysiology of nasal septal perforation, and the differential diagnosis for causes of nasal septal perforation.

Trigeminal endonasal perception - an outcome predictor for septoplasty.

No adequate test exists to predict outcome after septoplasty. Despite adequate surgery, patients still might experience nasal breathing impairment. The aim of this study was to determine if pre-operative trigeminal sensitivity can predict satisfaction after septoplasty. Single centre prospective cohort study in tertiary referral centre with follow-up time of 6 weeks postoperatively. Patients scheduled for septoplasty or septorhinoplasty with turbinoplasty were consecutively selected the day before surgery. Standard preoperative examinations (acoustic rhinometry and Sniffin’ Sticks 12 test), the evaluation of nasal obstruction on a visual analogue scale (VAS) and the trigeminal lateralisation task were performed before and 6 weeks after surgery. Biopsies were taken during surgery and TRPV1 mRNA expression was measured by PCR. Thirty patients were included with a median age of 29 years and equal gender distribution. Trigeminal perception and sensation of nasal obstruction showed a significant correlation: preoperative lateralisation test scores, representing endonasal trigeminal sensitivity, correlated significantly with the mean VAS change scores, which demonstrate subjective improvement. A lateralisation test score of 31.5 and more had a sensitivity of 88% to predict an improvement of more than 3 VAS points. Additionally, high TRPV1 mRNA expression was linked with good postoperative VAS scores. The preoperative evaluation of the trigeminal sensitivity could improve patients’ selection for septoplasty with a higher rate of satisfaction. Endonasal trigeminal sensitivity is directly linked with subjective outcome. Therefore, patients with low trigeminal sensitivity should undergo septoplasty only after thorough counselling.

Narrowed Posterior Nasal Airway Limits Efficacy of Anterior Septoplasty.

Background: Predicting symptomatic relief after septoplasty has been difficult. Minimal cross-sectional area (mCSA) measured by acoustic rhinometry and airflow resistance (R) measured by rhinomanometry have been used to select surgical candidates with mixed success. An important assumption is that mCSA and resistance are tightly coupled, but studies have reported weak or no correlation. Recently, we proposed the Bernoulli Obstruction Theory as an explanation, where tight coupling between mCSA and R is only predicted below a critical mCSA (Acrit). Methods: The nasal airway and septum of 10 healthy subjects were reconstructed from computed tomography scans. Simulated anterior septal deviations of increasing severity were created. Computational fluid dynamics simulations were performed to quantify mCSA, resistance, and flow in the healthy septum model and four simulated septal deviation models for each subject (total of 50 models). Results: A tighter coupling between mCSA and resistance was found below Acrit, estimated to be 0.20 cm2 (a very severe deviation). Above Acrit, enlarging the mCSA had a smaller effect in patients with narrower cross-sectional area in the postvalve region (CSAPV). Conclusions: Two patterns of flow increase are expected with septoplasty. Below Acrit, enlarging mCSA predictably increases flow. Above Acrit, the effect size of increasing mCSA depends on CSAPV. Unrecognized small CSAPV may explain persistent sensation of nasal obstruction after septoplasty. Our data suggest that inferior turbinate reduction ipsilateral to a septal deviation may amplify airflow benefits after septoplasty in patients with a narrow CSAPV.

Peak nasal inspiratory flow measurement and visual analogue scale in a large adult population.

Nasal obstruction is the most common symptom in nasal diseases. It can be evaluated objectively, that is by means of peak nasal inspiratory flow (PNIF) measures and/or subjectively by means of validated questionnaires. However, it has been reported that there is a lack of reliable correlation between subjective and objective measurements of nasal obstruction. The aim of the present study was to evaluate the correlation between PNIF measurements and the subjective sensation of nasal obstruction measured by means of a visual analogue scale (VAS) in a large population of consecutive rhinologic patients. Prospective clinical study. Tertiary rhinological referral centre. A total of 641 consecutive subjects were enrolled. Visual analogue scale and PNIF were performed to assess nasal obstruction. Nasal septal deviation was classified according to Mladina classification, and its severity was assessed using three levels of severity. Although weak, there was a significant negative correlation (r=-0.13, P=0.001) between PNIF and VAS. Dividing the population in those affected by nasal septal deviation (NSD) and those affected by chronic rhinosinusitis (CRS), a week negative correlation between PNIF and VAS was again confirmed in both groups (r=-0.208, P=0.006 for NSD and r=-0.13, P=0.04 for CRS). Peak nasal inspiratory flow and VAS were also evaluated according to the grade of polyps and the type and level of septal deviation. Visual analogue scale and PNIF significantly correlated, although with a low degree, in a large population of rhinologic patients. Peak nasal inspiratory flow, being cheap and simple to use, could be a good candidate to assist clinicians dealing with "airway" diseases in their daily clinical practice in order to provide comprehensive information on nasal function. Peak nasal inspiratory flow can in fact give some important rough insights on VAS, but these measurements cannot be alternative to each other.

Evaluation of Nasal Resistance by Rhinomanometry before and after Endoscopic Sinus Surgery

AbstractWith the objective of identifying the factors affecting the nasal resistance in patients undergoing sinus surgery, we evaluated the data of 95 patients with chronic sinusitis who underwent endoscopic sinus surgery (ESS) between 2015 and 2018 at our hospital. We determined the nasal resistance by rhinomanometry and also patients' sensation of nasal obstruction before surgery and 3 months after the ESS. In total, 49 bilateral and 46 unilateral ESS procedures were performed, including ESS alone, ESS + septoplasty, and ESS + septoplasty + conchotomy. In addition, the surgical cases were classified into single sinus or polysinus surgery, and groups with or without polyps. We compared the nasal resistance and degree of change in the nasal resistance among the groups. The same comparisons were also conducted separately in cases with nasal resistance levels of >0.25 Pa/cm3/s. Nasal resistance improved following the ESS in both the bilateral and unilateral cases. In almost all the subgroups, the nasal resistance improved following ESS with the exception of the ESS with septoplasty group with nasal resistance levels of >0.25 Pa/cm3/s. The degree of change in the nasal resistance was not significantly different between the ESS alone, ESS + septoplasty, and ESS + septoplasty + conchotomy groups. Similarly, the degree of change in the nasal resistance was also not significantly different between the single sinus and polysinus surgery or between patients with and without polyps. Furthermore, there were no differences among the above groups of patients with >0.25 Pa/cm3/s either. The patients' sensation of nasal obstruction improved following the ESS. The nasal resistance measured by rhinomanometry was weakly correlated with the sensation of nasal obstruction prior to the ESS; however, the nasal resistance following the ESS and the degree of change of the nasal resistance following the ESS were not correlated with the sensation of nasal obstruction or the degree of change in the sensation of nasal obstruction. Future studies are needed for a precise clarification of the factors that affect nasal resistance.

A CFD approach to understand nasoseptal perforations.

Nasoseptal perforations (NSP) are becoming common in the modern world, and can cause a wide variety of symptoms, including a sensation of nasal obstruction, epistaxis, crusting, dryness, headache, nasal pain and a whistling sound. There is an extensive range of surgical treatment techniques, but reported results were rarely statistically significant. The lack of consistent surgical results may be related to the lack of knowledge about the pathophysiology of NSP and how they affect the nasal flow. Computational fluid dynamics (CFD) has proved to be a very useful tool to study nasal function. We have used CFD software (the program MECOMLAND® and the Digbody® tool for virtual surgery) to investigate the behaviour of the parameters R-[Formula: see text] based on CFD results, when four subjects underwent virtual surgery to induce a septal perforation: two subjects with healthy noses and two patients suffering from nasal airway obstruction. For each case a CFD study was performed, before and after creating an anterior (close to nostrils) or a posterior (close to choanae) NSP. In all cases analyzed, a posterior septal perforation did not result in a significant volumetric flow rate [Formula: see text] through the perforation between nasal passages. However, for anterior defects only in those nasal cavities considered diseased or unhealthy, high values of [Formula: see text] were found. The induced NSP only rendered significant flow alterations in noses with preexisting nasal airway obstruction alterations, whereas in nasal cavities considered as normal the creation of a NSP did not produce significant differences between both sides. We strongly suggest that this finding can explain the variety of symptoms and the number of asymptomatic patients bearing NSP.

Adult acute rhinosinusitis guidelines worldwide: similarities and disparities.

Acute rhinosinusitis (ARS) is a common respiratory infection that poses a major public healthcare burden with respect to antibiotic consumption and related morbidity. Position statements and national ARS guidelines have been published worldwide, aiming to define diagnostic criteria and outline treatment options. Our objective was to analyze the similarities and disparities between such guidelines. We conducted an electronic database search for ARS guidelines using relevant keywords between January 1, 1989, through December 31, 2017. Overall, 25 guidelines from 39 countries were retrieved: 8 from 8 developed countries, and 17 from 31 developing countries. Representative guidelines from developing and developed countries from America, Europe, Africa, Asia, and Oceania were evaluated. We compared the bibliographic data, diagnostic criteria, and treatment recommendations of selected guidelines. In most developed countries, otorhinolaryngological societies published ARS guidelines, whereas the Ministry of Health formulated the guidelines or adopted generic guidelines prepared by an international organization in developing countries. Many similarities in the diagnostic criteria were found, such as purulent nasal discharge and nasal obstruction sensation. In contrast, maxillary culture as a diagnostic tool was mentioned in developed countries, while it was generally ignored in developing countries. The watchful waiting (WW) policy and abstaining from immediate antibiotics was unanimously adopted in developed countries, which was only partly embraced in developing countries. The recommended universal first-line antibiotic therapy is amoxicillin, with or without clavulanic acid, whereas options for second-line and third-line antibiotic therapies varied. ARS guidelines from different countries have many similarities. Specific recommendations are tailored to local epidemiology and healthcare accessibility.

Surgical Correction of Alar Collapse with Alar Batten Graft : Technique and Results

Background: nasal valve collapse has great perception of nasal obstruction. The alar batten graft technique has proven to be a valid method for treatment of external and internal valve collapse. Aim: the aim of the present study was to evaluate a two year experience and follow up for external nasal valve collapse treatment using alar batten graft technique regarding results and complications. Patients and Methods: this prospective study was carried out on 18 patients attended the ENT and Plastic Surgery outpatient clinics of Al-Azhar University hospitals from January, 2014 to January 2016. Written consent was taken from every patient. All patients were complaining of nasal obstruction of gradual onset and progressive course with 7 years average. All patients were subjected to detailed history taking and questionnaire including the NOSE scale. Surgical correction was performed to all patients using the alar batten graft harvested from the septa cartilage or conchal cartilage. Postoperative results recorded in relation to subjective sensation of nasal obstruction and aesthetic appearance of the nose. Results: eleven patients (61.1%) were males and seven (38.9%) were females. Their age ranged from 18 to 45 years with a mean of 32±2. Bilateral obstruction was found in 33.3% of cases and unilateral obstruction in 66.7% of cases. There were 22.2%, 27.8%, and 50.0% of the cases had moderate, fair, and severe obstruction, respectively. Postoperatively, these figures were changed to no obstruction77.8% (P=0.0), mild 0.0%, moderate 11.1%, fair 11.1%, and sever 0.0%(P=0.0005). The technique significantly abolishes the severe nasal obstruction. Postoperative complications include 1 case with graft resorption (4.2%) and 1 case of graft displacement (4.2%). Both were improved on subsequent surgery. Regarding postoperative findings there was tenderness and hypertrophic postauricular scar in 5.5% of patient and nasal tip edema in 22.2%, all resolved. In the early postoperative period, 33.3% of patients complained of fullness in the supraalar region. Conclusion: Successful surgical correction of nasal obstruction requires the precise diagnosis of the anatomic point of collapse. Alar batten graft improves the rigidity of lower lateral cartilage preventing collapse of the lateral nasal wall preventing collapse during moderate and deep inspiration. The graft varies according to the severity of the obstruction and size of the collapsible area of the lateral nasal wall. The septal cartilage is usually sufficient. The technique significantly improves nasal breathing.

Adaptation and validation of the Dutch version of the nasal obstruction symptom evaluation (NOSE) scale

The nasal obstruction symptom evaluation (NOSE) scale is a validated disease-specific, self-completed questionnaire for the assessment of quality of life related to nasal obstruction. The aim of this study was to validate the Dutch (NL-NOSE) questionnaire. A prospective instrument validation study was performed in a tertiary academic referral center. Guidelines for the cross-cultural adaptation process from the original English language scale into a Dutch language version were followed. Patients undergoing functional septoplasty or septorhinoplasty and asymptomatic controls completed the questionnaire both before and 3 months after surgery to test reliability and validity. Additionally, we explored the possibility to reduce the NOSE scale even further using graded response models. 129 patients and 50 controls were included. Internal consistency (Cronbach’s alpha 0.82) and test–retest reliability (intraclass correlation coefficient 0.89) were good. The instrument showed excellent between-group discrimination (Mann–Whitney U = 85, p < 0.001) and high response sensitivity to change (Wilcoxon rank p < 0.001). The NL-NOSE correlated well with the score on a visual analog scale measuring the subjective sensation of nasal obstruction, with exception of item 4 (trouble sleeping). Item 4 provided the least information to the total scale and item 3 (trouble breathing through nose) the most, particularly in the postoperative group. The Dutch version of the NOSE (NL-NOSE) demonstrated satisfactory reliability and validity. We recommend the use of the NL-NOSE as a validated instrument to measure subjective severity of nasal obstruction in Dutch adult patients.

Intranasal trigeminal function in patients with empty nose syndrome.

Trigeminal nerve mediates the perception of nasal airflow. This study examines whether impaired intranasal trigeminal function is a part of the paradoxical nasal obstruction sensation in patients with empty nose syndrome (ENS). Prospective case-control study in a tertiary hospital. Three groups were examined: 1) ENS patients with previous bilateral near total inferior turbinectomy, 2) patients who underwent near total inferior turbinate removal (ITR) without ENS symptoms, and 3) control participants. All participants examined with active anterior rhinomanometry, olfactory testing (extended Sniffin' Sticks test), and trigeminal testing (lateralization task using menthol and odorless solvent). Seventy-one participants were included (21 ENS patients, 18 ITR patients, and 31 controls). Analyses revealed that ENS patients had significantly lower scores on trigeminal lateralization testing than the ITR group and controls. The ENS group had also significantly lower scores in olfactory testing than controls. No statistical differences were found in rhinomanometry between groups. The gender factor was not associated with the chemosensory testing; however, this was not the case with the age factor, as trigeminal test results were negatively correlated. This study demonstrates significantly impaired intranasal trigeminal function in ENS patients when compared with ITR patients and controls. Further prospective studies are needed to clarify the role of preoperative trigeminal function of these patients and the contribution of surgery to this impairment. 3b. Laryngoscope, 127:1263-1267, 2017.

Correlation between Subjective Nasal Patency and Intranasal Airflow Distribution.

Objectives (1) Analyze the relationship between intranasal airflow distribution and subjective nasal patency in healthy and nasal airway obstruction (NAO) cohorts using computational fluid dynamics (CFD). (2) Determine whether intranasal airflow distribution is an important objective measure of airflow sensation that should be considered in future NAO virtual surgery planning. Study Design Cross-sectional. Setting Academic tertiary medical center and academic dental clinic. Subjects and Methods Three-dimensional models of nasal anatomy were created based on computed tomography scans of 15 patients with NAO and 15 healthy subjects and used to run CFD simulations of nasal airflow and mucosal cooling. Subjective nasal patency was quantified with a visual analog scale (VAS) and the Nasal Obstruction Symptom Evaluation (NOSE). Regional distribution of nasal airflow (inferior, middle, and superior) was quantified in coronal cross sections in the narrowest nasal cavity. The Pearson correlation coefficient was used to quantify the correlation between subjective scores and regional airflows. Results Healthy subjects had significantly higher middle airflow than patients with NAO. Subjective nasal patency had no correlation with inferior and superior airflows but a high correlation with middle airflow (| r| = 0.64 and | r| = 0.76 for VAS and NOSE, respectively). Anterior septal deviations tended to shift airflow inferiorly, reducing middle airflow and reducing mucosal cooling in some patients with NAO. Conclusion Reduced middle airflow correlates with the sensation of nasal obstruction, possibly due to a reduction in mucosal cooling in this region. Further research is needed to elucidate the role of intranasal airflow distribution in the sensation of nasal airflow.

Evaluation of nasal patency by visual analogue scale/nasal obstruction symptom evaluation questionnaires and anterior active rhinomanometry after septoplasty: a retrospective one-year follow-up cohort study.

To assess the efficacy of septoplasty and the correlation between the subjective evaluations of a visual analogue scale (VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and active anterior rhinomanometry of the nasal airway after septoplasty. A retrospective, individual cohort study. Ear, Nose and Throat Department, Taipei City Hospital, Taipei, Taiwan. Fifty patients with chronic nasal obstruction were enrolled in the study. All 50 patients underwent septoplasty because of nasal septal deviation. Another 28 patients without nasal symptoms served as controls. VAS, NOSE and active anterior rhinomanometry were used to measure the sensation of nasal obstruction. All measurements were performed in both groups preoperatively and then repeated on three postoperative visits (3, 6 and 12 months). The mean VAS score, NOSE score and the nasal resistance in the narrow side of the nose in the study group showed reduced symptoms at 3, 6 and 12 months postoperatively compared with the respective preoperative measurements (P < 0.001, all). The VAS and NOSE scores did not significantly correlate with total nasal resistance preoperatively or postoperatively. The VAS and nasal resistance in the obstructed nasal cavity correlated significantly preoperatively (P < 0.05), but not postoperatively. The subjective and objective symptoms of nasal obstruction had improved 1 year after septoplasty. A significant correlation between VAS scores and nasal resistance in the narrow side of the nose was found before surgery. The subjective and objective measurements of nasal obstruction lacked significant correlation postoperatively.

The role of trigeminal function in the sensation of nasal obstruction in chronic rhinosinusitis.

Trigeminal sensation (TS) within the nasal cavity is important for the perception of nasal airflow. The objective of this study is to examine whether impaired TS contributes to the sensation of nasal obstruction in patients with chronic rhinosinusitis (CRS). Prospective case-control study conducted in a tertiary referral rhinology clinic. Cases consisted of CRS patients with subjective nasal obstruction, not previously treated with oral corticoids. Controls consisted of patients without CRS. Neither group demonstrated obvious anatomical obstructions. Both groups underwent peak nasal inspiratory flows (PNIF), olfactory testing (quick eight-item odor identification test), and trigeminal testing (lateralization task using eucalyptol and odorless solvent). A total of 28 subjects (14 CRS patients and 14 controls) were recruited. Analyses revealed no statistical differences in age (P = .93), gender (P = .47), or PNIF (P = .82) between the two groups, but they differed in Lund-Mackay scores (P < .001). There was no significant difference in olfactory testing (P = .15). CRS patients had significantly lower scores on trigeminal lateralization testing than controls (P = .007). Linear regression revealed that Lund-Mackay scores contributed a significant amount of variance to trigeminal lateralization scores, controlling for age and sex (F = 5.93, P = .004, R(2) = 0.43). This is the first study to demonstrate that patients with CRS have lower TS than healthy controls. Our results suggest defective TS could play a role in the sensation of nasal obstruction in CRS. 3b. Laryngoscope, 126:E174-E178, 2016.

Adaptation and validation of the Spanish version of the Nasal Obstruction Symptom Evaluation (NOSE) Scale.

The Nasal Obstruction Symptom Evaluation (NOSE) scale is a symptom-specific, self-completed questionnaire for assessing quality of life related to nasal obstruction or its treatment in patients with septal deviation. The aim of this study was to validate the Spanish adaptation of the NOSE, thus allowing comparison across studies and international multicenter projects. Multicenter prospective instrument validation study. Guidelines for the cross-cultural adaptation process from the original English language scale into a Spanish language version were followed. The psychometric properties (reproducibility, reliability, validity, responsiveness) of the Spanish version ("NOSE-e" for "NOSE-espanol") were assessed in 58 consecutive patients undergoing septoplasty (both before and 3 months after surgery) and 58 matched asymptomatic controls. Test-retest reliability and internal consistency reliability were adequate. The NOSE-e demonstrated satisfactory construct validity. Positive correlations between the NOSE-e scores and the score of a visual analog scale measuring the subjective sensation of nasal obstruction were found. The instrument showed excellent between-groups discrimination and high response sensitivity to change. The Spanish version of the NOSE (NOSE-e) is a valid tool for measuring the subjective severity of nasal obstruction, and its use is recommended.

Adaptation and validation of the Spanish version of the Nasal Obstruction Symptom Evaluation (NOSE) Scale

The Nasal Obstruction Symptom Evaluation (NOSE) scale is a symptom-specific, self-completed questionnaire for assessing quality of life related to nasal obstruction or its treatment in patients with septal deviation. The aim of this study was to validate the Spanish adaptation of the NOSE, thus allowing comparison across studies and international multicenter projects. Multicenter prospective instrument validation study. Guidelines for the cross-cultural adaptation process from the original English language scale into a Spanish language version were followed. The psychometric properties (reproducibility, reliability, validity, responsiveness) of the Spanish version ("NOSE-e" for "NOSE-espanol") were assessed in 58 consecutive patients undergoing septoplasty (both before and 3 months after surgery) and 58 matched asymptomatic controls. Test-retest reliability and internal consistency reliability were adequate. The NOSE-e demonstrated satisfactory construct validity. Positive correlations between the NOSE-e scores and the score of a visual analog scale measuring the subjective sensation of nasal obstruction were found. The instrument showed excellent between-groups discrimination and high response sensitivity to change. The Spanish version of the NOSE (NOSE-e) is a valid tool for measuring the subjective severity of nasal obstruction, and its use is recommended.