Nasal Resistance Research Articles

Outcome of nasal measurements in patients with OSA – Mounting evidence of a nasal endotype

BackgroundIncreased nasal resistance as measured by 4-phase rhinomanometry is associated with a paucity of apneas relative to hypopneas in obstructive sleep apnea (OSA) patients. The ratio of hypopneas to apneas for a given apnea hypopnea index (AHI) may influence treatment choice. This study aimed to investigate if OSA patients with an elevated hypopnea apnea ratio are associated with differences in acoustic rhinometry measurements. MethodsOne hundred and thirty-nine (n = 139) OSA patients (AHI >5) were enrolled in this prospective case-control study (all male). OSA Diagnosis was established through a type three sleep study. Both acoustic rhinometry and 4-phase rhinomanometry were performed on all patients at baseline and after decongestion. Possible associations between apnea-hypopnea index, oxygen desaturation index, nadir oxygen saturation, apnea index, hypopnea index, hypopnea to apnea ratio and body mass index and were analysed using multiple logistic and linear regression models. ResultsThe acoustic rhinometry measurements minimal cross-sectional area, total volume and minimal cross-sectional areas are significantly smaller in patients with increased nasal resistance as measured by 4-phase rhinomanometry (P < 0.01). No consistent statistically significant associations were found between the acoustic rhinometry variables, and the respiratory variables analysed in the sleep studies. OSA patients with an elevated hypopnea apnea ratio are more than 4 times more likely to present with increased nasal resistance measured by 4-phase rhinomanometry (OR = 4.4, 95% CI [1.5–13.2], P < 0.01). ConclusionsAcoustic rhinometry is significantly associated with 4-phase rhinomanometry. However, acoustic rhinometry measurements are not associated with the respiratory indices routinely measured in OSA in a clinical setting. 4-phase rhinomanometry is a more suitable method for detecting clinically relevant nasal obstruction in obstructive sleep apnea patients.

Role of craniofacial phenotypes in the response to oral appliance therapy for obstructive sleep apnea.

Mandibular advancement device (MAD) is a good alternative for patients with obstructive sleep apnea (OSA). However, the treatment response varies among individuals. This study aimed to explore the role of craniofacial features in the response to MADs to improve prognostication and patient selection. The retrospective trial contained 42 males aged 41.5±9.0 years, and with an apnea-hypopnea index (AHI) of 21.5±13.8 events/h. According to the mandibular plane angle, participants were divided into three groups: low angle (n=13), average angle (n=14), and high angle (n=15). Under monitor of home sleep testing, adjustable MADs were used to titrate the mandible forward from 0 mm with an increment of 0.5 mm every day. The polysomnography outcomes, mandibular protrusion amounts, changes in upper airway MRI measurements, and nasal resistance were compared among three groups. The normalization rate (AHI < 5 /h) was 92.3%, 57.1%, and 46.7% respectively in the low, average, and high angle groups (p=0.027). The effective protrusion where AHI was reduced by half was 20 (11.3~37.5) %, 31.3 (23.6~50) %, and 50 (36.9~64.9) % of the maximal mandibular protrusion, in the low, average, and high angle groups (p=0.004). Multivariate logistic regression revealed that increased gonion angle (OR=0.878) and baseline AHI(OR=0.868) can reduce the probability of normalization. The high mandibular plane angle might be an unfavorable factor to MAD treatment and more protrusion was needed to achieve a 50% reduction in AHI. Vertical craniofacial pattern (gonion angle) and baseline AHI constituted the model for predicting the effect of MADs.

Analysis of nasal resistance regulation mechanism during postural changes in patients with obstructive sleep apnea by measuring heart rate variability.

Changes in nasal resistance (NR) during postural changes are influenced by venous filling pressure and autonomic nervous system mediation, and heart rate variability (HRV) can reflect changes in the autonomic nervous system. This study aimed to explore the regulatory mechanisms of NR in patients with obstructive sleep apnea (OSA) during postural changes. Healthy controls (apnea-hypopnea index < 5 events/h) and patients with OSA were recruited. NR and electrocardiogram data were collected in sitting, supine, left-lateral, and right-lateral postures. HRV parameters were obtained by analyzing the electrocardiogram data from each posture. Subgroups were divided according to sitting-supine NR changes, and HRV parameters were compared between different postures and groups/subgroups. In total, 34 healthy controls and 39 patients with OSA (mean apnea-hypopnea index 34.34 ± 22.44 events/h) were recruited. During sitting-supine postural changes, the NR increased in the control group but did not change significantly in the OSA group. None of the autonomic nervous system-related HRV parameters changed significantly. After the groups were divided into NR-elevated and NR-unchanged subgroups, sympathetic activity-related HRV parameters were higher in the NR-unchanged subgroup but only statistically significant in the OSA group. When comparing the left and right postures, there was no significant change in NR; however, the OSA group had lower parasympathetic activity-related HRV parameters when in the right posture. During postural changes from the sitting to supine positions, the total NR increases, and this increment is smaller in patients with OSA. This is likely due to overregulation of sympathetic activity, which may occur in patients with OSA. Shi Y, Lou H, Wang H, etal. Analysis of nasal resistance regulation mechanism during postural changes in obstructive sleep apnea patients by measuring heart rate variability. J Clin Sleep Med. 2023;19(4):643-650.

Voice characteristics in patients with nasal congestion and enlarged pharyngeal tonsils

ABSTRACT Purpose The purpose of this study was to investigate the voice characteristics in patients with nasal congestion and enlarged pharyngeal tonsils. Materials and Methods Twenty-two children with an adenoidal-nasopharyngeal (AN) ratio of <0.5 and nasal cavity resistance of ≤0.25 Pa/cm3/s were assigned to the normal group. Twenty-five children with an AN ratio of <0.5 and nasal cavity resistance of ≥0.5 Pa/cm3/s were classified into the nasal congestion group. Nineteen children with an AN ratio of ≥0.63 and nasal cavity resistance of ≤0.25 Pa/cm3/s were defined as the enlarged pharyngeal tonsils group. The test sound /N/ has a characteristic antiformants (AF). The fourth formant (F4), the formant frequency, was calculated to relativize formant frequencies that vary with vocal tract length. The AF divided by F4 (AF/F4) was also calculated. Results The group with enlarged pharyngeal tonsils had the largest AF/F4. The nasal breathing group had the next largest AF/F4, and the normal group had the smallest AF/F4. Conclusion Stenosed vocal tracts with nasal congestion or enlarged pharyngeal tonsils showed an increased frequency due to obstruction of ventilation, and the AF/F4 ratio in the enlarged pharyngeal tonsils group was greater than that of the nasal congestion group. Voice analysis is a potential no-invasive method of distinguishing between nasal congestion and enlarged pharyngeal tonsils.

Patência nasal em crianças respiradoras orais

ABSTRACT Several studies have shown the importance of quantitative assessment in nasal patency and functional status of the upper airways to provide clinical and diagnostic information in oral breather individuals, which are of great interest to speech therapy. The aim of the study was to evaluate the effect of nasal saline solution irrigation on the upper airways through nasal aeration and active anterior rhinomanometry in oral breathing children. This was an eight case series study, carried out in children aged 7 to 10 years with an otorhinolaryngological clinical diagnosis of mouth breathing. The study consisted of three stages: (I) initial evaluation; (II) intervention; and (III) final evaluation. The questionnaires of the Index for the Identification of Oral Breathing Signs and Symptoms and disease-specific quality of life in pediatric patients with sinonasal complaints were applied, nasal aeration assessments and the anterior active rhinomanometry exam were carried out. The intervention was performed by irrigating nasal saline solution with 10ml. Afterwards, they were re-evaluated by nasal aeration evaluation and rhinomanometry to compare the results. Regarding nasal aeration and rhinomanometry evaluation, from the 16 comparative measurements between pre and post nasal irrigation, we obtained significant changes in nasal aeration and nasal resistance. Nasal irrigation resulted in improvement in nasal aeration measurements while nasal flow measurements from rhinomanometry remained unchanged considering pre and post nasal irrigation.

OBJECTIVE EVALUATION OF SUBLINGUAL IMMUNOTHERAPY FOR PEDIATRIC ALLERGIC RHINITIS RESPOND TO SQ HOUSE DUST MITE

Sublingual immunotherapy (SLIT) has become applicable to insurance for children in Japan in 2018. However, as for the efficacy of SLIT for children, objective evaluation methods have not been sufficiently investigated. We investigated the efficacy of SLIT as both subjective and objective evaluation in 44 children with allergic rhinitis sensitized to house dust mite who started the treatment in the summer of 2018 in our hospital. The children and their patients wrote the allergy diary every day, and in winter/spring/summer vacations, they answered Japanese allergic rhinitis quality of life standard questionnaire and were evaluated with nasal provocation test, blood test, rhinomanometry for 3 years. 29 (66%) of the 44 children continued SLIT for 3 years. Symptom scores, QOL scores, symptom medication scores halved in a year and the effect lasted in the second and third year. Nasal provocation test and rhinomanometry showed significant improvement. Specific IgE increased transiently and then decreased. Specific IgG4 increased annually. The present study showed a decrease in scores not only for subjective assessments but also for objective evaluation methods, the house dust nasal provocation test and the nasal airway resistance.

Structural and functional changes of nasal cavity and maxillary sinus in patients with skeletal class III malocclusion 1year after bimaxillary surgery.

This study aimed to analyse changes in the nasal cavity and maxillary sinus structure and function in patients with skeletal class III malocclusion 1 year after bimaxillary surgery. In this study, cone-beam computed tomography (CBCT) images of 20 patients (10 men and 10 women; mean age 24.3± 3.4 years) with skeletal class III malocclusion who underwent Le Fort I osteotomy and bilateral sagittal split osteotomy were obtained before and 1 year after the surgery. CBCT data were stored opened with element 3D (E3D) to establish a nasal airway model (the paranasal sinus includes only the maxillary sinus). Ansys (ANSYS) software is used for simulation and analysis. The maxillary sinus and nasal cavity volumes decreased significantly 1 year after the surgery. After surgery, the volume of nasal cavity decreased by 13.5%, and the average volume of maxillary sinus decreased by 7.8%. There was no significant difference in the degree of deviation of the septum and nasal cavity resistance, and air distribution in the maxillary sinus did not change. The nasal cavity wall shear stress change was similar to that before surgery. The maxillary sinus volume and nasal cavity volume of patients with skeletal class III malocclusion changed significantly after bimaxillary surgery, but there was no significant change in nasal ventilation function 1 year after surgery.

Порівняльний аналіз коефіцієнтів аеродинамічного носового опору за даними передньої та задньої активної риноманометрії

The paper deals with a comparative analysis of aerodynamic nose drag coefficients based on the data of front and rear active rhinomanometry. Functional disorders of nasal breathing in the future lead to further complications of the upper and lower respiratory system, reduce the quality of life and lead to other pathological conditions. The diagnosis of such disorders is complicated by the low prevalence of nasal breathing testing tools (rhinomanometers) in medical practice and the peculiarities of functional research methods, which are particularly related to the low repeatability of results and the lack of a clear correlation between diagnostic data and the patient's objective feelings. The obtained data on the total coefficients of aerodynamic nasal resistance, which are determined using the methods of front and rear active rhinomanometry, correspond quite clearly to each other within 12%. The values of the total coefficients of nasal resistance, obtained by the method of posterior rhinomanometry, in all typical cases differ to a lesser extent. The perspective of the work is to gather statistical data to determine the features of nasal breathing testing to obtain accurate personalized values of nasal resistance coefficients in different breathing modes, taking into account individual variability.

Complex Approach to the Diagnosis of Children with Nasal and Nasopharyngeal Pathology. Key Results

Background. Nasal and nasopharyngeal pathology is one of the most important and widespread challenge in pediatrics and pediatric otorhinolaryngology. Prolonged nasal breathing difficulty can be caused by various diseases and their combinations. It requires multidisciplinary approach to diagnosis with the involvement of modern examination methods and pathogenetic treatment. Objective. The aim of the study is to develop complex technology for the management of children with nasal and nasopharyngeal pathologies. Methods. The study included 240 children aged from 6 to 18 years. All patients were divided into 3 groups, comparable by sex and age: Group 1 – 85 patients with confirmed ENT-organ disease, Group 2 — 104 patients with confirmed allergic disease, control group — 51 somatically healthy patients who did not have any ENT-organ or allergic diseases. Examination procedures: diagnostic nasopharyngeal endoscopy, rhinomanometry (RMM), rhinoresistometry (RRM), olfactometry. Results. The obtained results (RRM, RMM) have shown that air flow rate in nasal cavity increased due to nasal resistance decrease. Nasal resistance was higher and air flow rate was lower in all children with various ENT-organs or allergic diseases compared to the control group. Nasal resistance decreased in all study groups (significantly in children with aggravation of allergic diseases of airways and ENT-organs diseases) as well as air flow rate increased in all study groups (significantly in Group 1 and 2) after anemisation of nasal mucosa with decongestants. Apparently, it can be associated not only with anatomical features (nasal septum deviation), but also with inflammatory features of nasal cavity and nasopharynx (adenoid hypertrophy and inflammation, persistent swelling of nasal mucosa at allergic rhinitis). We would like to present the algorithm for diagnosis of children with nasal and nasopharyngeal pathologies according to the study results. The following practical guidelines have been proposed: 1) all patients with complaints on prolonged nasal breathing difficulties require not only otorhinolaryngologist examination, but also diagnostic endoscopy of nasal cavity and nasopharynx; 2) in case of nasal septum deviation and complaints on prolonged nasal breathing difficulties, it is necessary to perform functional methods for nasal breathing evaluating (RRM, RMM) to choose adequate treatment method; 3) the use of RRM, RMM would help to choose the optimal treatment approach in children with complaints on prolonged nasal breathing difficulties and confirmed diagnosis of allergic disease (allergic rhinitis, hay fever, etc.), also associated with adenoid hypertrophy and/or nasal cavity and nasopharynx inflammatory diseases; 4) all patients with confirmed chronic diseases of ENT-organs should be examined by allergist, and, if necessary, should undergo comprehensive allergological examination. Conclusion. The developed complex approach to the management of children with nasal cavity and nasopharynx pathology is innovative and represents the technology of personalized use of modern, objective methods for diagnosing the nasal cavity and nasopharynx state. The presented diagnostic algorithm and practical guidelines allow us to establish diagnosis and choose the treatment tactics within a short time. The use of these studies in clinical practice will allow to monitor the therapy efficacy (including various pharmacotherapeutic strategies) for nasal cavity and nasopharynx diseases in children. Timely examination and pathogenetic treatment will allow to prevent the chronization of pathological process in ENT-organs. This is especially crucial in childhood as it provides children with the best chance of healthy growth and development.

Impact of the Location of Nasal Septal Deviation on the Nasal Airflow and Air Conditioning Characteristics.

The location of nasal septal deviation (NSD) directly impacts nasal physiology. The objective is to examine, using computational fluid dynamics (CFD), the difference in the airflow and air conditioning characteristics according to the location of NSD. Twenty patients with septal deviation were divided into two: 10 caudal septal deviation (CSD) and 10 posterior septal deviation (PSD). Physiological variables were compared and numerical models for nasal cavity were created with CT scans. Cases with CSD had distinctive features including restricted airflow partition, larger nasal resistance, and decreased surface heat flux in the more obstructed side (MOS), and lower humidity and air temperature in the lesser obstructed side (LOS). Physiological differences were observed according to the location of septal deviation, CSD cases exhibit significantly more asymmetric airflow characteristics and air conditioning capacity between LOS and MOS.

Subendotyping of Dermatophagoides pteronyssinus–Induced Rhinitis and Its Impact on Respiratory Comorbidities

The impact of delayed hypersensitivity to Dermatophagoides pteronyssinus (DP) on comorbidities of allergic rhinitis (AR) is unknown. The primary end point was to test the hypothesis that DP-induced AR could be divided into 2 subendotypes on the basis of presence or absence of a delayed-type mite sensitization detected by the positive result of atopy patch test for DP (DP-APT). The second end point was to evaluate differences in the long-term risk of respiratory comorbidities and nasal airway response to mite exposure. In a prospective observational study, we included 472 patients with DP-induced AR. A total of 343 patients had positive results of skin prick test/serum specific IgE and DP-APT and were assigned to a subendotype with both IgE- and T-cell-mediated mite sensitization (BMSS). The remaining 129 patients without delayed-type mite sensitization were included in the subendotype with only IgE-mediated mite sensitization. Nasal allergen provocation test with active anterior rhinomanometry, paranasal sinuses computed tomography scan, nasal endoscopy, and spirometry were performed. At baseline, BMSS showed a larger increase in nasal airway resistance, total nasal score, and visual analogue scale score to mite exposure. During a 15-year follow-up, 56 patients developed chronic rhinosinusitis with nasal polyps, with higher incidence in BMSS than in the subendotype with only IgE-mediated mite sensitization (50 patients, 14.6% vs 6 patients, 12.4%; P < .001). BMSS also showed a higher incidence of conjunctivitis (25.7% vs 12.4%; P < .01). The rate of adult-onset asthma did not differ between groups, but patients with BMSS showed a more frequent link to chronic rhinosinusitis with nasal polyps (6 of 29 patients, 20.7% vs 0 of 10 patients, 0%). DP-APT independently predicted chronic rhinosinusitis with nasal polyps and conjunctivitis. Two subendotypes with significantly different clinical outcome can be identified among patients with DP-induced AR according to the presence of delayed-type mite sensitization detected by positive DP-APT result.

Computational Analyses of Physiologic Effects After Midvault Repair Techniques in Rhinoplasty

Background: Midvault reconstruction is an essential element of functional rhinoplasty. An improved understanding of airflow patterns after spreader graft (SG) or spreader flap (SF) techniques can inform surgical techniques based on individual anatomy. Objectives: The objective of this study was to compare the physiologic changes related to nasal function after midvault reconstruction with SF and SG. Methods: Soft tissue elevation (STE), SG, and SF were performed in sequence on 5 cadaveric specimens. Computational modeling was used to simulate airflow, heat transfer, and humidity in three-dimensional nasal airway reconstructions of each specimen. Results: Median bilateral airflow-rates (L/min) were similar for STE (29.4), SF (27.6), and SG (28.9), and were not statistically significant (STE vs SF: P = 1.0, power = 5%; STE vs SG: P = .31, power = 16%; SF vs SG: P = .42, power = 14%). Both SF and SG had increased unilateral airflow volume (L/min) through the more obstructed nasal passage (median: STE 10.3, SF 12.2, SG 12.7), but these differences were not significant (STE vs SF: P = .19, power = 24%; STE vs SG P = .19, power = 30%). Furthermore, SF and SG had decreased unilateral nasal resistance (Pa s/mL) on the more obstructed side (median: STE 0.085, SF 0.072, SG 0.062) (STE vs SF: P = .13, power = 23%; STE vs SG P = .13, power = 24%). For all 3 models, heat flux distribution was greater in the anterior portion of the nasal passage than the posterior portions. Conclusions: Differences in nasal airflow and resistance after SF and SG were not statistically significant, but both procedures resulted in higher airflow rates and decreased nasal resistance through the more obstructed nasal passage.

Antiallergic activities of shallot (Allium ascalonicum L.) and its therapeutic effects in allergic rhinitis.

Onion has antiallergic activity but lack of evidence for shallot. To determine whether shallot owns similar antiallergic activity to onion and its therapeutic effects in allergic rhinitis when added to standard treatment. In-vitro β-hexosaminidase inhibitory activities of shallot was compared with onion on RBL-2H3 cells. In clinical study, a randomized, double-blind, placebo-controlled trial was performed. Sixteen AR patients were randomized equally into the controls who received cetirizine 10 mg once daily and placebo capsules for 4 weeks, and the treatment who received 3g of oral shallot per day (equivalent to 1 ½ bulbs) and cetirizine. Visual analog scores of overall symptoms (VAS), total nasal and ocular symptom scores (TNSS and TOSS), nasal airway resistance (NAR), and adverse events were assessed. Shallot extract at 200 μg/mL had an average β-hexosaminidase inhibition rate of 97% while onion extract had 73%. HPLC chromatograms (λ = 290nm) of both plants showed nearly identical patterns of quercetin compounds, such as quercetin 3,4'-diglucoside, quercetin 4'-glucoside, and quercetin. After 4-week of treatment, 62.5% of patients in shallot group and 37.5% of patients in control group showed improvement of post-treatment VAS. TNSS were significantly reduced in both groups, however no difference between groups (P = 0.18). TOSS were significantly improved only in the shallot group (P = 0.01). Adverse events from shallot were not different from placebo. Shallot had antiallergic activity and similar quercetin compounds to onion. The shallot oral supplement and cetirizine was shown to improve the overall AR symptoms more than cetirizine alone.

Should Mandibular Symphyseal Distraction Osteogenesis be considered in OSA Surgery?

Surgical maxillary expansion for the treatment of obstructive sleep apnea (OSA) has become common place. To maximize airway improvement, over-expansion of the maxilla can occur, resulting in an excessively widened maxilla that creates a mismatch to the mandible. Therefore, mandibular symphyseal distraction osteogenesis (MSDO) to widen the mandible along with maxillary expansion is being increasingly advocated in OSA surgery. The authors discuss their 20-year experience with MSDO and surgical maxillary expansion. They also analyze the airway impact between Distraction Osteogenesis Maxillary Expansion (DOME) and Endoscopically-Assisted Surgical Expansion (EASE) based on currently available computational fluid dynamic (CFD) data, which has implications in whether MSDO needs to be considered. The goal of surgical maxillary expansion is to enlarge the nasal cavity and reduce the airway resistance. CFD data demonstrates that EASE results in a much greater reduction in airway resistance as compared to DOME. EASE achieved a 12-fold reduction in nasal airway resistance compared to 3-fold reduction by DOME; a 12-fold reduction of retropalatal airway resistance as compared to 3-fold reduction by DOME; a 10-fold reduction of oropharyngeal airway resistance as compared to a 3-fold reduction by DOME, and an 8-fold reduction of hypopharygeal airway resistance as compared to a 3-fold reduction by DOME. Because there is no physiologic basis or data that demonstrates mandibular widening improves OSA, an airway centric surgical expansion technique such as EASE can achieve a much greater airway impact without needing excessive maxillary widening, thus eliminating the necessity MSDO.

Nasal airflow patterns in a patient with septal deviation and comparison with a healthy nasal cavity using computational fluid dynamics

Background and objective: Causes for nasal airway obstruction (NAO) are many but septum deviation is the most prevalent etiology. A deviated septum affects the airflow dynamics in the human nasal cavity, which in turn affects the physiological functions of the nasal cavity like heating, humidification, and filtration capabilities. The present study investigates and compares the airflow patterns in a healthy nasal cavity to a septal deviated nasal cavity.Methods: Two nasal airway models are considered and compared in this study. One with a septal deviation and the second with a healthy patent nasal cavity. Airflow analysis is carried out by developing the CT scans into 3D models using Materialise MIMICS (Materialise, Ann Arbor, MI), and then using the FLUENT solver of ANSYS 2020R2. The simulations are carried out for airflows ranging in laminar and turbulent flows using the SST k-ω turbulence model. Polyhedral meshes are used and the mesh check using Grid Convergence Index studies is adopted.Results: The pressure and velocity profiles are assessed for a wide range of mass flow rates. The results indicate a turbulent flow pattern for mass flow rates over 15 LPM. The velocity profiles show aberrated flow profiles in a septal deviated nasal cavity where the peak velocity is observed at the mid-nasal region rather than the nasal valve region. There was a 38% to 55% higher nasal resistance in the septal deviated nasal cavity as compared to a normal and healthy nasal cavity. The pressure drop in the septal deviated nasal cavity is higher by 60%–120% when compared to a healthy nasal cavity.Conclusion: The septal deviated nasal cavity greatly affects the nasal airflow distribution resulting in higher velocities in the mid-nasal region, increased pressure drop and higher nasal resistance. Hence the NAO with septal deviation has to be rectified with proper surgical procedures.

Porridge for influenza: Protocol for a systematic review and meta-analysis.

Influenza is a common disease. If it is not treated in time, it may induce related chronic respiratory diseases and seriously endanger people's health. Porridge, as a food of the East, has been recorded by doctors of all ages to treat influenza with porridge. However, due to insufficient research, there is a certain controversy about porridge in the treatment of influenza. We therefore plan to conduct a systematic review and meta-analysis to collect data from all published studies on this issue in order to obtain reliable evidence. We will search for relevant trials in various databases published by December 2022. To study the efficacy and safety of a RCT of porridge in the treatment of influenza. Standardized data tables will be used to complete data search and extraction in duplicate. All differences will be resolved by consensus. The main result was to observe the symptom score of influenza patients, and the secondary results included body temperature, nasal secretions, nasal resistance and viral culture titers in the nasal secretions. Data synthesis and statistical analysis will be performed for each outcome with Stata V.14.0. Our study will be a systematic review and meta-analysis to evaluate the efficacy and safety of porridge in the treatment of influenza. The conclusion of this study has a certain reference value for the clinical use of porridge in the treatment of influenza.

Specific local nasal immunotherapy: Single center experience on 324 patients

ObjectiveTo evaluate the efficacy and safety of specific local nasal immunotherapy (LNIT) in patients with allergic rhinitis. Materials and methodsA retrospective single-center study of 324 patients with allergic rhinitis (191 allergic to mites, 133 allergic to Grarninaceae or Parietaria pollen) treated with specific LNIT was carried out. As control group, 158 patients without allergic rhinitis were enrolled. All patients were evaluated before and after 32 weeks of treatment by subjective analysis of their self-reported symptoms and by objective analysis of nasal provocation test, nasal resistance by anterior rhinomanometry, and mucociliary clearance time. ResultsClinical efficacy of LNIT for allergy to mites and pollens was confirmed by the differences in the symptoms score between the active group and the placebo group. The nasal provocation test and the rhinomanometric analysis confirm the result with a difference statistically significant. No differnces in mucociliary clearance time were found. ConclusionsSpecific LNIT is a valide alternative to subcutaneous and sublingual administration. It is effective, safe, well tolerated by the patient, it can be done at home with fewer systemic reactions.

Long-term Outcomes of Turbinate Surgery in Patients With Allergic Rhinitis

Turbinate surgery is an effective treatment for allergic rhinitis (AR) refractory to medical treatment. However, the long-term outcomes of turbinate surgery are still unclear and have not yet been confirmed by a meta-analysis and systematic review of the literature. To investigate the long-term outcomes and safety of turbinate surgery in AR by performing a meta-analysis. MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov were searched through April 2021. Studies that analyzed turbinate surgery alone, had a follow-up period of more than 1 year, examined long-term efficacy of turbinate surgery, used current turbinate surgery methods, and were published in a peer-reviewed journal were included. Full-text reviews were performed by 2 independent reviewers. Conflicts were resolved by a third reviewer. Descriptive and quantitative data were extracted; weighted mean difference (WMD) was synthesized under a random-effects model. Heterogeneity was assessed using the Q statistic and the I2 metric. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. The long-term outcomes of turbinate surgery on subjective nasal symptoms and objective parameters. Of the 3962 citations retrieved, 18 studies comprising 1411 patients were included. Findings showed significantly decreased symptom scores in nasal obstruction (WMD, 4.60, 95% CI, 3.43-5.76), rhinorrhea (WMD, 3.12; 95% CI, 1.97-4.28), sneezing (WMD, 2.64; 95% CI, 1.74-3.54), itching (WMD, 1.75; 95% CI, 1.20-2.30), and nasal resistance (WMD, 0.16; 95% CI, 0.08-0.24) and a significant increased total nasal volume (WMD, 0.96; 95% CI, 0.73-1.19). There was no significant difference in the occurrence of any complication. More than 1 year after surgery, the improvements in nasal obstruction (WMD, 5.18; 95% CI, 3.00-7.37), rhinorrhea (WMD, 3.57; 95% CI, 1.78-5.37), and sneezing (WMD, 2.95; 95% CI, 1.58-4.32) were maintained. In this systematic review and meta-analysis, turbinate surgery was associated with positive outcomes in AR and maintained the association during long-term follow-up. The rate of complications is also low. These findings can guide the preoperative counseling of patients with AR being considered for turbinate surgery.

Improvements in airflow characteristics and effect on the NOSE score after septoturbinoplasty: A computational fluid dynamics analysis.

Septoturbinoplasty is a surgical procedure that can improve nasal congestion symptoms in patients with nasal septal deviation and inferior turbinate hypertrophy. However, it is unclear which physical domains of nasal airflow after septoturbinoplasty are related to symptomatic improvement. This work employs computational fluid dynamics modeling to identify the physical variables and domains associated with symptomatic improvement. Sixteen numerical models were generated using eight patients' pre- and postoperative computed tomography scans. Changes in unilateral nasal resistance, surface heat flux, relative humidity, and air temperature and their correlations with improvement in the Nasal Obstruction Symptom Evaluation (NOSE) score were analyzed. The NOSE score significantly improved after septoturbinoplasty, from 14.4 ± 3.6 to 4.0 ± 4.2 (p < 0.001). The surgery not only increased the airflow partition on the more obstructed side (MOS) from 31.6 ± 9.6 to 41.9 ± 4.7% (p = 0.043), but also reduced the unilateral nasal resistance in the MOS from 0.200 ± 0.095 to 0.066 ± 0.055 Pa/(mL·s) (p = 0.004). Improvement in the NOSE score correlated significantly with the reduction in unilateral nasal resistance in the preoperative MOS (r = 0.81). Also, improvement in the NOSE score correlated better with the increase in surface heat flux in the preoperative MOS region from the nasal valve to the choanae (r = 0.87) than in the vestibule area (r = 0.63). Therefore, unilateral nasal resistance and mucous cooling in the preoperative MOS can explain the perceived improvement in symptoms after septoturbinoplasty. Moreover, the physical domain between the nasal valve and the choanae might be more relevant to patient-reported patency than the vestibule area.

Effect of Maxillary Expansion Treatment Protocols On Maxillary Sinus Volume, Pharyngeal Airway Volume, and Hyoid Bone Position: A Prospective, Cone Beam Computed Tomography (CBCT) Study

Aim: This study aimed to investigate the changes in maxillary sinus volume, pharyngeal airway volume, and hyoid bone position in patients treated with Rapid Maxillary Expansion (RME) and Alternate Rapid Maxillary Expansion and Constriction (AltRaMEC) – Facemask therapy and compare between the groups. Materials and Methods: The records of 15 patients between the age group of 8-14 years with Class I and Class III malocclusion were collected, and the patients were assigned into two groups. The first group comprised of 8patients (4 girls and 4 boys) who were treated with Rapid Maxillary Expansion. The second group comprised 7 patients (5 boys and 2 girls) treated with expansion devices using Alt-RaMEC protocol followed by maxillary protraction using a facemask. Pre and post-treatment CBCT scans were obtained and analyzed for changes in the pharyngeal airway, maxillary sinus volume, and hyoid bone position. The maxillary sinus volume was calculated in 3 dimensions by measuring the craniocaudal height, anteroposterior depth, and mediolateral width. Measurements were taken before and after the procedure to compare the groups and between the groups. The data were analyzed using Paired t-test and an Independent t-test. Results: In the RME group, a significant increase in the total maxillary sinus volume (mean difference = 520±576.57mm3), especially in the craniocaudal height, was seen, but no changes were noted in the pharyngeal airway and hyoid position. The AltRAMEC group showed a statistically significant increase in the maxillary sinus volume (anteroposteriorly) and nasopharyngeal volume with a p-value &lt;0.005. Comparing the maxillary sinus volume changes in RME and AltRAMEC groups showed a statistically significant increase in the volume of the maxillary sinuses in both groups, significantly higher in the RME group. Conclusion: RME and AltRAMEC protocol followed by facemask therapy caused a significant increase in the maxillary sinus volume, while no changes were noted in the nasopharynx, oropharynx, hypopharynx, and hyoid bone position. While comparing the treatment effects between the groups, RME showed a greater increase in maxillary sinus volume (p &lt; 0.05), specifically in the anteroposterior dimension. Since there are no changes in airway volume and hyoid position with the skeletal expansion protocols, there will be no difference in nasal resistance to airflow.