Nose Breathing Research Articles

NEW COMPLICATION OF ASSISTED VENTILATION IN THE NEONATE: STRICTURE AFTER NASOTRACHEAL INTUBATION

The purpose of this paper is to report a potentially serious complication of nasotracheal intubation in the neonate, not previously reported. In our nurseries over the last 1½ years, 130 surviving infants received ventilatory support with a Bournes respirator and nasotracheal airway. Primary diagnosis was idiopathic respiratory distress syndrome (IRDS) in 98, meconium aspiration in 9, sepsis in 2, diaphragmatic hernia in 5, apnea in 3, post operative support in 13. Four infants developed unilateral nasal strictures. All weighed less than 1600 grams, were intubated in the first 4 days of life with 3.0 mm or 3.5 mm portex tubes, for duration of intubation 3, 3, 8 and 48 days respectively. Only one tube change was required and that in the 48 day baby. Etiology of the stricture is unknown. Three have been seen in follow up at 4 or 6 months; the involved nasal passageway was patent but very diminished in size. There have been no apparent problems associated with the strictures to date. These findings are particularly important to those using any form of ventilatory support involving both nares because development of bilateral nasal strictures in infants who are obligate nose breathers could potentially be lethal.

Effects of adenoidectomy on dentition and nasopharynx

The purpose of the present study was to determine whether adenoidectomy (and hence a change to nose breathing) is followed by: (1) a change in the inclination of upper and lower incisors. (2) a change in the width of the upper arch, and/or (3) an effect on the sagittal depth of the bony nasopharynx.The clinical material comprised the children in a previous study who were at least 8 years old and in whom the upper and lower incisors had erupted before the initial examination, which was followed by adenoidectomy. A second examination was made 1 year later. The group undergoing adenoidectomy numbered thirty-seven children, and there were thirty-seven controls.All the children were examined with respect to forty-six variables, grouped under the headings of anamnesis, adenoids, dentition, airflow, and skeleton.Measurements were obtained for each child from lateral radiographs and casts, and the nasal airflow was recorded in liters per minute.Group means for the two examinations have been compared and relationships have been studied with the aid of simple correlation analysis and multiple regression analysis.It was found that in the year between the examinations, the children who underwent adenoidectomy had undergone a significantly greater increase than the controls in the angle of the upper and lower incisors, respectively, to the nasion-sella and the mandibular lines. The adenoidectomy group also had a significantly greater increase in the mean width of the upper arch between the first molars, this width being enlarged most in the children who had switched from mouth to nose breathing after adenoidectomy. Furthermore, the mean sagittal depth of the nasopharynx had increased only for the children who underwent adenoidectomy, the increment in this group being significantly different from 0.The study accordingly demonstrates that dentitional changes occur after adenoidectomy in children who were mouth breathers preoperatively because of nasal obstruction. The size of the nasopharyngeal cavity also changed in the children who switched from mouth to nose breathing after adenoidectomy.Since the dentition seems to be affected to some extent by the combined occurrence of adenoids and mouth breathing, an assessment of indications for adenoidectomy should include orthodontic evaluations.

Effects of adenoidectomy on mode of breathing, size of adenoids and nasal airflow.

The purpose of the present study was to investigate if mouth breathers become nose breathers after adenoidectomy, if the size of adenoids become normalized after adenoidectomy, how permanent the resul

Radiocephalometric analysis of anteroposterior nasopharyngeal dimensions in 6-to 12-year-old mouth breathers compared with nose breathers.

The purpose of the present study was to calculate the average anteroposterior size of the nasopharyngeal airway in 109 children (54 mouth breathers, in whom adenoidectomy was indicated for nasal obstruction, and 55 nose breathers) from 6 to 12 years of age, in order to obtain cephalometric standard; from these standards, one is able to judge the extent to which nose breathing may be obstructed. The results show when planning orthodontic therapy, in which it is desirable to assess the ability of the patient to breath through the nose, a clinical record of the mode of breathing can be supplemented with radiocephalometric data on the anteroposterior size of the nasopharyngeal airway.

Infant monkeys--a model for crib death.

Recent reports suggest that sudden infant death syndrome (SIDS) may be related to an inappropriate diving reflex or obligate nose breathing. Immersion of the neonatal monkey's face in cold (14 C) water, or nasal occlusion resulted in apnea which is occasionally persistent, bradycardia, and relative hypertension. In the same monkeys at an older age, apnea never persisted after removal of the diving stimulus, and there was no obligate nose breathing. The study documents a dive reflex and obligate nose breathing and concludes that the infant monkey is a suitable model for the study of SIDS. We suggest, however, that the fatal factor in crib death may be the failure to interrupt apnea however the apnea was initiated. The failure to resume respiration may represent an inappropriate return to the apneic state of the fetus.

SUDDEN UNEXPECTED DEATH (SUD)

To the Editor .—Dr. Shaw's hypothesis that sudden unexpected death in infancy results from obstruction of the nasal airway to obligate nose breathers (Amer J Dis Child 119 :416-418, 1970) is indeed intriguing. It is widely held that phenylephrine nose drops are contraindicated in young infants (less than 6 months of age) due to the rebound mucosal edema which follows their use. It would be interesting to know if any of Dr. Shaw's patients had received phenylephrine nose drops shortly before their death. Certainly if Dr. Shaw's hypothesis is correct, vigorous efforts should be made to warn physicians and parents of the danger of administering decongestant nose drops to young infants. Such a program may lead to a reduction in the mortality due to SUD.

The nasal resistance of newborn infants

The resistance of the nasal air passages, which is an important factor in the mechanics of respiration in newborn infants, was found to be about one fourth of the total lung resistance. It would appear that the nasal passages contribute a relatively smaller part (slightly less than half) of the airway resistance than in adults. The reason for “obligatory” nose breathing in newborn infants may be found in the pattern of phylogenetic development of oropharyngeal and nasal structures.

The veloepiglottic sphincter and obligate. Nose breathing in the neonate

SUMMARY A case of phenylketonuria in an American Negro infant is reported. The importance of routine testing for phenylketonuria in all newborn children is emphasized. We wish to acknowledge the assistance of Mrs.

THE DEPOSITION OF AEROSOLS IN THE RESPIRATORY TRACT. I. MATHEMATICAL ANALYSIS AND COMPARISON WITH EXPERIMENTAL DATA.

The deposition of aerosol in the human respiratory tract was calculated as a function of the particle size and particle density of the aerosol, the manner of breathing, and various parameters which control the degree of mixing of inspired air with the dead space air and with the lung air. The computations were performed on an electronic computer, which allowed a full analysis of the effects of the various parameters. Agreement between the computed total deposition curves, and published experimental data was very satisfactory. The computed curves exhibited the minimum in total deposition previously established experimentally, in the region of 0.3 μ. The maximum in the alveolar deposition curve was about 1 μ for particles of unit density, confirming the results of Brown, Cook, Ney, and Hatch for nose breathing. Its position was a function of the density of the aerosol particles, but was relatively insensitive to the tidal volume and other breathing parameters. The opposite held in regard to the value of the maximum, which was totally uninfluenced by the particle density, but was affected by the breathing parameters.

PARTITIONING OF RESPIRATORY FLOW RESISTANCE IN MAN.

Measurements of flow resistance of various components of the respiratory system were measured in adult male subjects in the sitting position. Nasal resistance is the largest single component being nearly one-half the total and two-thirds of the airway resistance during nose breathing. It is highly nonlinear, and shows much variability. During mouth breathing upper airway resistance (mouth, pharynx, glottis, larynx and upper trachea) is also markedly nonlinear, and accounts for one-third the total airway resistance. Lower airway resistance is approximately linear up to flows of 2 liters/sec. Pulmonary tissue resistance is low as reported in this study. Chest wall resistance is nearly linear up to flow rates of 2 liters/sec and accounts for slightly less than half the total respiratory resistance during mouth breathing and 10–19% during nasal breathing. larynx; airways; chest wall; nose Submitted on December 16, 1963

Treatment of Hay Fever by Securing Normal Nostrils.

Hartford, Conn., Aug. 20, 1906. To the Editor: —InThe Journal, August 18, Dr. Dunbar Roy writes that at the session of the Association held at Atlantic City in 1904 I claimed to cure hay fever simply forcing patients to become absolute nose breathers. Dr. Roy is in error. I did and do claim to cure hay fever by giving my patients nostrils as nearly normal as possible, and then insisting that they breathe through the nose as Nature intended they should. The perusal of my monograph, Mouth Breathing, should make clear to the reader what I consider necessary in a general way, not only for the relief but cure of the hay-fever patient, also what I consider harmful to that patient. I have yet to find a hay-fever patient at any period with normal nostrils, although I often find them with nothing more abnormal than a few irritable