Objective Measures Of Nasal Obstruction Research Articles

Internal Nasal Valve Collapse Treatment by Endonasal Hyaluronic Acid Injection.

Internal nasal valve collapse (IVC) is a common functional complication of rhinoplasty and injecting hyaluronic acid is one of the treatment options available, but its effectiveness has never been evaluated. The objective of this study was to assess the evolution of IVC after injection of hyaluronic acid using objective and subjective measures of nasal obstruction. A prospective interventional study was conducted. Adult patients consulting for nasal obstruction after (septo)rhinoplasty and diagnosed with IVC were included. Patients underwent 4-phase rhinomanometry, completed nasal obstruction symptoms evaluation (NOSE) and visual analog scale (VAS) questionnaires and received hyaluronic acid injections. Measurements were repeated immediately, one month and one year later. The primary outcome measure was the proportion of patients below the rhinomanometric diagnostic threshold for IVC at one month. Among the 22 patients included, 20 (91%) had rhinomanometry measurements below the diagnostic threshold for IVC one month after injection. It decreased to 53% (8/15 patients) at one year post injection. The mean NOSE score decreased from 74.5 (± 18.0) before injection to 35.2 (± 23.3) after injection (p < 0.0001). The mean VAS score decreased from 7.0 (± 1.4) before injection to 3.4 (± 1.9) after injection (p < 0.0001). In these patients with post-(septo)rhinoplasty IVC, hyaluronic acid injection into the internal nasal valve substantially improved subjective and objective measures of nasal obstruction. These results suggest hyaluronic acid injection (performed as described) is an effective treatment for IVC and is an excellent alternative to surgical treatment. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

Correlation of Nasal Mucosal Temperature With Subjective Nasal Patency in Healthy Individuals.

Historically, otolaryngologists have focused on nasal resistance to airflow and minimum airspace cross-sectional area as objective measures of nasal obstruction using methods such as rhinomanometry and acoustic rhinometry. However, subjective sensation of nasal patency may be more associated with activation of cold receptors by inspired air than with respiratory effort. To investigate whether subjective nasal patency correlates with nasal mucosal temperature in healthy individuals. Healthy adult volunteers first completed the Nasal Obstruction Symptom Evaluation (NOSE) and a unilateral visual analog scale to quantify subjective nasal patency. A miniaturized thermocouple sensor was then used to record nasal mucosal temperature bilaterally in 2 locations along the nasal septum: at the vestibule and across from the inferior turbinate head. Nasal mucosal temperature and subjective patency scores in healthy individuals. The 22 healthy adult volunteers (12 [55%] male; mean [SD] age, 28.3 [7.0] years) had a mean (SD) NOSE score of 5.9 (8.4) (range, 0-30) and unilateral VAS score of 1.2 (1.4) (range, 0-5). The range of temperature oscillations during the breathing cycle, defined as the difference between end-expiratory and end-inspiratory temperatures, was greater during deep breaths (mean [SD] change in temperature, 6.2°C [2.6°C]) than during resting breathing (mean [SD] change in temperature, 4.2°C [2.3°C]) in both locations (P < .001). Mucosal temperature measured at the right vestibule had a statistically significant correlation with both right-side visual analog scale score (Pearson r = -0.55; 95% CI, -0.79 to -0.17; P = .008) and NOSE score (Pearson r = -0.47; 95% CI, -0.74 to -0.06; P = .03). No other statistically significant correlations were found between mucosal temperature and subjective nasal patency scores. Nasal mucosal temperature was lower (mean of 1.5°C lower) in the first cavity to be measured, which was the right cavity in all participants. The greater mucosal temperature oscillations during deep breathing are consistent with the common experience that airflow sensation is enhanced during deep breaths, thus supporting the hypothesis that mucosal cooling plays a central role in nasal airflow sensation. A possible correlation was found between subjective nasal patency scores and nasal mucosal temperature, but our results were inconsistent. The higher temperature in the left cavity suggests that the sensor irritated the nasal mucosa, affecting the correlation between patency scores and mucosal temperature. Future studies should consider noncontact temperature sensors to prevent mucosa irritation. NA.

The Effect of Vibrissae on Subjective and Objective Measures of Nasal Obstruction

Nasal congestion and/or obstruction represents a prevalent and extensively studied problem. No published research exists that describes the impact of nasal hair (vibrissae) on nasal obstruction. To assess the impact of nasal vibrissae on subjective and objective measurements of nasal obstruction. In this prospective study, 30 healthy participants without nasal symptoms were assessed for baseline vibrissae density and were treated with a topical decongestant. The subjects were then asked to subjectively assess nasal breathing by using four questions from the Nasal Obstruction Symptom Evaluation instrument before undergoing rhinomanometry. Nasal vibrissae were then trimmed, and the participants repeated the subjective and objective assessments. Pre- and postintervention outcomes, including symptom scores, nasal airflow, and resistance, were compared by using statistical analysis. Statistically significant improvement was noted in subjects' nasal airway specific symptom scores and in objective measurements of their nasal airway. Patients with moderate or many vibrissae at baseline were noted to have greater likelihood of improvement in subjective and objective obstruction assessments than patients rated with few. In these 30 subjects, statistically significant improvement occurred in both subjective and objective assessments of nasal obstruction, particularly in patients with greater density of vibrissae. These findings support further study of the potential benefit of the reduction of vibrissae density in some patients with nasal obstruction.

Are measurements of peak nasal flow useful for evaluating nasal obstruction in patients with allergic rhinitis?

Background: Nasal obstruction is one of the most bothering allergic rhinitis (AR) symptoms and there is a need for objective parameters to complement clinical evaluation due to blunted perception in many patients. In this study we compare measures of peak nasal inspiratory flow (PNIF) and peak nasal expiratory flow (PNEF) in patients with AR and in individuals without nasal symptoms and correlate them with the perception of nasal obstruction. Methods: A comparative cross-sectional study was conducted in 64 AR patients and 67 individuals without nasal symptoms aged between 16 and 50 years. All subjects had PNIF and PNEF measures and subjective evaluations of nasal obstruction were done through a visual analogue scale (VAS) and a symptoms questionnaire. Results: The results show a lower PNIF and PNEF in AR patients compared to controls. There was no correlation between VAS score and PNIF and PNEF. There was a weak inverse correlation between PNIF and symptoms score. Conclusion: Objective measures of nasal obstruction, especially PNIF, can give useful informations on aspects of the disease different from those obtained from the patient`s perception.

Are measurements of peak nasal flow useful for evaluating nasal obstruction in patients with allergic rhinitis?

Nasal obstruction is one of the most bothering allergic rhinitis (AR) symptoms and there is a need for objective parameters to complement clinical evaluation due to blunted perception in many patients. In this study we compare measures of peak nasal inspiratory flow (PNIF) and peak nasal expiratory flow (PNEF) in patients with AR and in individuals without nasal symptoms and correlate them with the perception of nasal obstruction. A comparative cross-sectional study was conducted in 64 AR patients and 67 individuals without nasal symptoms aged between 16 and 50 years. All subjects had PNIF and PNEF measures and subjective evaluations of nasal obstruction were done through a visual analogue scale (VAS) and a symptoms questionnaire. The results show a lower PNIF and PNEF in AR patients compared to controls. There was no correlation between VAS score and PNIF and PNEF. There was a weak inverse correlation between PNIF and symptoms score. Objective measures of nasal obstruction, especially PNIF, can give useful informations on aspects of the disease dif- ferent from those obtained from the patient`s perception.

The Effect of Vibrissae on Subjective and Objective Measures of Nasal Obstruction

Objectives: (1) Recognize the impact of nasal vibrissae on subjective and objective measures of nasal obstruction. (2) Apply presented data to make informed recommendations to patients regarding vibrissae reduction as an adjunct or alternative to other treatments for nasal obstruction. Methods: In this prospective study, 30 healthy participants without nasal symptoms were assessed for baseline vibrissae concentration and treated with a topical decongestant. Subjects were then asked to subjectively assess nasal breathing using the NOSE instrument prior to undergoing rhinomanometry. Nasal vibrissae were then trimmed, and participants repeated the subjective and objective assessments. Pre- and post-intervention outcomes including NOSE values, airflow, and resistance were compared using statistical analysis. Results: Statistically significant improvement was noted in subjects’ NOSE assessment of nasal obstruction (80% average improvement, P &lt; .001) and 2 of 4 questionnaire outcomes ( P = .016, .083, P = .031, and P = .25). Statistically significant improvements occurred in objective measurement of inspiratory: flow ( P = .009); effective total resistance ( P = .003); and average vertex (maximum) resistance ( P = .029). Patients with moderate or severe vibrissae at baseline were noted to have more improvement in subjective and objective obstruction assessments than patients rated mild. Conclusions: In these 30 subjects, strong statistically significant improvement occurred in both subjective and objective assessments of nasal obstruction, particularly in patients with more dense vibrissae. These data suggest consideration of reduction of vibrissae density in patients complaining of nasal obstruction. Furthermore, the role of nasal vibrissae should be considered in any study examining the impact of medical or surgical interventions on nasal obstruction.

Nasal Symptoms, Resistance, and AHI Contributions to Subjective Sleep Outcomes

Objectives: The contribution of nasal obstruction to sleep related quality of life is poorly understood. This study assesses the contribution of: 1) nasal symptoms and effective nasal resistance;2) AHI to sleep-related quality of life. Methods: 70 unselected adult patients (age 52.2 (13.9) years) undergoing polysomnography at an academic sleep center were evaluated with four phase rhinomanometry (RhinoLab, Rendsburg, Germany ) in the upright and supine body positions and completed validated quality of life measures. Results: AHI demonstrated no associations with nasal obstruction symptom questionnaire (NOSE), insomnia score (PSQI), hypersomnia (ESS), or functional quality of life (FOSQ-10). However, both nasal symptoms (NOSE) and resistance (Rsupine/effective) were associated with sleep metrics. NOSE was associated with insomnia, hypersomnia, and QOL (r = 0.44,0.29, and 0.40 respectively, all p &lt; 0.01) while Rsupine/effective was associated with hypersomnia (r=0.24,p&lt;0.02) and a trend to insomnia (p&lt; 0.09). No association with change in upright to supine resistance was observed. In the group with OSA (AHI &gt; 5/hr., n= 49) and without OSA (AHI &lt; 5/hr.,n=21) nasal symptoms and Rsupine/effective maintained associations (r=0.30 and 0.32 p&lt;0.05) with hypersomnia (ESS) but not AHI (p=NS) in either group. Conclusions: In a sleep lab cohort referred for evaluation of possible sleep disordered breathing, both subjective and objective measures of nasal obstruction but not AHI contribute to sleep related subjective outcomes. Further research is needed on the nasal contribution to sleep disorders independent of AHI.

Oral and Nasal Steroids for Nasal Polyps

Oral and Nasal Steroids for Nasal Polyps

Sensation of nasal patency compared to rhinomanometric results after septoplasty

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

Efficacy of inferior turbinate coblation for treatment of nasal obstruction

To determine the efficacy of inferior turbinate coblation for the treatment of nasal obstruction. Twenty patients awaiting submucosal diathermy to the inferior turbinates were recruited into the study. All underwent inferior turbinate coblation. Pre-operative and post-operative nasal function was investigated using posterior rhinomanometry and subjective symptom scales. There was no significant increase in nasal conductance two weeks after inferior turbinate coblation (p = 0.159). However, three months after inferior turbinate coblation, median nasal conductance had increased significantly, from 203 to 324 cm3/s (p = 0.004). The median increase in nasal conductance was 73 cm3/s or 43.5 per cent. Post-operative visual analogue patients' reported post-operative visual analogue scales scores for nasal obstruction decreased significantly, both two weeks (p = 0.006) and three months after inferior turbinate coblation (p = 0.001) when compared to Pre-operative values. There was no change in the reported severity of rhinorrhoea, nasal itching or sneezing. There was a significant relationship (rho = -0.57, p = 0.014) between pre-operative nasal conductance and change in nasal conductance after inferior turbinate coblation. This study confirms the short-term efficacy of inferior turbinate coblation for the treatment of nasal obstruction. The benefit was greatest in patients with lower pre-operative nasal conductance. Objective measures of nasal obstruction may be important when selecting patients for inferior turbinate coblation.

Short-term effect of argon plasma coagulation of the inferior turbinate in patients with perennial nasal allergy

The aim of this study was to clarify the short-term effects of argon plasma coagulation (APC) of the inferior turbinate in patients with perennial nasal allergy. In a retrospective study, 32 patients with perennial allergic rhinitis were treated by inferior turbinate reduction using APC. Grades of nasal stuffiness, rhinorrhea, sneezing, nasal airflow resistance (NAR) and overall seriousness were evaluated before and then 1–4 and 8 weeks after APC. Subjective symptoms were assessed using a questionnaire in which nasal stuffiness, rhinorrhea and sneezing were graded on a four-point scale (severe, moderate, mild and none) using the Severity Criteria of Symptoms of Nasal Allergy issued by the Japanese Society of Allergology. NAR was measured using active anterior rhinomanometry (AAR) at the 100 Pa point; this was deemed to be an objective measurement of nasal obstruction. The numbers of patients examined before and 1–4 and 8 weeks after APC were 32, 31, 25, 17, 18 and 14, respectively. Both nasal stuffiness and NAR were significantly improved 2 weeks after APC, overall seriousness was significantly improved after 3 weeks and rhinorrhea was improved after 4 weeks. Sneezing did not significantly improve during this study. There was no significant change in the grades of the examined parameters during the period between 4 and 8 weeks after APC. The beneficial effects of APC begin to appear within 2 weeks after APC and no further improvement after about 4 weeks.

アレルギー性鼻炎の鼻閉に対するフマル酸エメダスチンの有効性

The effect of emedastine difumarate on nasal obstruction was examined in 21 patients (8 males and 13 females, average age: 26.3 years) with perennial nasal allergy. The patients received 2 mg of emedastine difumarate twice a day for one or two weeks. Objective measurement of nasal obstruction was performed by active anterior rhinomanometry using nozzle before and after treatment. Nasal resistance at the point of ΔP100Pa in inspiration was calculated for the analysis. For the statistical analysis the paired t test was applied.The decrease in the subjective symptom score was significant. However, there was a small but ot statistically significant decrease [0.416 Pa/(ml/sec)→0.360 Pa/(ml/sec)] in nasal resistance inn all cases. A significant decrease [0.500 Pa/(ml/sec)→0.307 Pa/(ml/sec), p < 0.05] in nasal resistance was noted in patients who had complained of slight nasal obstruction.Our findings confirm the efficacy of emedastine difumarOate in the treatment of nasal obstruction in allergic rhinitis.