Objective Measures Of Nasal Patency Research Articles

Perioperative adjuvant therapy with short course of dupilumab with ESS for recurrent CRSwNP.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is associated with a high rate of disease recurrence following endoscopic sinus surgery (ESS). Type 2 disease is associated with a higher incidence of recurrence and is believed to impact disease resolution via interference with epithelial healing and pathogen immunity. We wished to verify if perioperative control of Type 2 inflammation with an anti-IL4/IL13 targeting monoclonal antibody and during the resolution period following surgery leads to better control of the disease long term. In this prospective, placebo-controlled, double-blinded trial. Thirty adult subjects with recurrent CRSwNP underwent ESS plus or minus 14 weeks of perioperative dupilumab, initiated 4 weeks (two injections) pre-ESS. Subjective and objective parameters of nasal patency, olfaction, quality of life (QoL), and adverse events were monitored up to 52 weeks post-ESS. Microbiological culture was performed to characterize pathogens colonization under both conditions. ESS safely improved subjective and objective measures of nasal patency, olfaction, and QoL in both groups. Olfaction was conserved longer in the dupilumab-treated group, with 33.3% of subjects presenting anosmia at 12 months after ESS in the dupilumab group compared to 50.0% with placebo. This was associated with persistent decreases in serum IgE, which were not seen with placebo treatment. No unusual safety signals were observed. Short-course adjuvant perioperative treatment with dupilumab is associated with improved long-term olfactory outcomes and persistent lowering of serum IgE.

Short-term Haze Exposure Predisposes Healthy Volunteers to Nasal Inflammation.

PurposeThis study aimed to investigate the impact of short-term haze exposure on nasal inflammation in healthy volunteers.MethodsThirty-three healthy university students were assessed for nasal symptoms, nasal patency, upper and lower respiratory tract nitric oxide (NO) as well as inflammatory mediators and neuropeptides in nasal secretions before and after a 5-day haze episode. Peripheral blood mononuclear cells (PBMCs) were stimulated with particulate matter with an aerodynamic diameter of less than 2.5 μm (PM2.5), and cytokines in the supernatants were examined.ResultsMild nasal symptoms were reported by some participants during the haze episode. Objective measures of nasal patency demonstrated that nasal airway resistance was significantly increased from baseline levels, while nasal cavity volume and minimum cross-sectional area were significantly decreased. Similarly, the levels of nasal and exhaled NO, eotaxin, interleukin (IL)-5, chemokine (C-C motif) ligand 17, IL-8, substance P, nerve growth factor and vasoactive intestinal peptides in nasal secretions were significantly increased from baseline values following the haze episode. In contrast, the levels of interferon-γ, IL-10, transforming growth factor-β and neuropeptide Y were significantly decreased. Incubation with 0.1-10 μg/mL PM2.5 significantly increased release of IL-1β, IL-4, IL-5, IL-8 and IL-10 from PBMCs.ConclusionsShort-term haze exposure may lead to nasal inflammation and hypersensitivity in healthy subjects predominantly by Th2 cytokine-mediated immune responses.

Septoplasty: is it possible to identify potential "predictors" of surgical success?

SUMMARYSeptoplasty is one of the most frequent surgical procedures performed by otolaryngologists. Despite successful surgical correction, many patients are not satisfied with their outcomes. So far, in clinical practice there is no consensus of opinion about the reliability of objective measurements of nasal patency and the correlation between objective measurements and subjective nasal patency symptoms. This study aims to assess the reasons for patient dissatisfaction after septoplasty and optimise pre-operative diagnostic management to predict surgical outcomes. We analysed 494 patients undergoing septoplasties with turbinoplasty by subjective Nasal Obstruction Symptom Evaluation questionnaire (NOSE) and objective active anterior rhinomanometric measurements before surgery and after 6 months. In our series, 17% had postoperative septal re-displacement; all patients had an anterior deviations at baseline. We found that the type of septal deviation, anterior vs posterior, was a significant predictor of postoperative functional improvement, whereas demographic characteristics as age, gender and smoke habit were not. Our data suggest that the anterior segment of the nasal septum was the most critical area for nasal airway resistance and more difficult to manage because it is likely to re-displace vs the posterior one and for this reason it represents a negative predictor of postoperative satisfaction.

Topical nasal decongestant oxymetazoline (0.05%) provides relief of nasal symptoms for 12 hours.

Nasal congestion, often referred to as stuffy nose or blocked nose is one of the most prevalent and bothersome symptoms of an upper respiratory tract infection. Oxymetazoline, a widely used intranasal decongestant, offers fast symptom relief, but little is known about the duration of effect. The results of 2 randomized, double-blind, vehicle-controlled, single-dose, parallel, clinical studies (Study 1, n=67; Study 2, n=61) in which the efficacy of an oxymetazoline (0.05% Oxy) nasal spray in patients with acute coryzal rhinitis was assessed over a 12-hour time-period. Data were collected on both subjective relief of nasal congestion (6-point nasal congestion scale) and objective measures of nasal patency (anterior rhinomanometry) in both studies. A pooled study analysis showed statistically significant changes from baseline in subjective nasal congestion for 0.05% oxymetazoline and vehicle at each hourly time-point from Hour 1 through Hour 12 (marginally significant at Hour 11). An objective measure of nasal flow was statistically significant at each time-point up to 12 hours. Adverse events on either treatment were infrequent. The number of subjects who achieved an improvement in subjective nasal congestion scores of at least 1.0 was significantly higher in the Oxy group vs. vehicle at all hourly time-points on a 6-point nasal congestion scale. This study shows for the first time, that oxymetazoline provides both statistically significant and clinically meaningful relief of nasal congestion and improves nasal airflow for up to 12 hours following a single dose.

A Study of Correlation between Subjective Sensation of Nose Block and Objective Assessment of Nasal Patency by Cold Spatula Test in a Patient with Nose Block

ABSTRACT The complaint of a nose block is often a complex clinical problem by itself. There is no consensus about the value of objective measurements of nasal patency. However, the perception of nasal airflow ultimately is a subjective sensation and, therefore, difficult to quantify. In this study, we have objectively evaluated 75 patients coming to our institute with the complaint of nose block. The mean area of air blast of both the nasal cavities of each patient was calculated by cold spatula test using modified “Glatzel mirror (GM),” and the subjective sensation of nose block was compared on each visit. We observed that both medical and surgical interventions objectively did improve the area of air blast in both unilateral and bilateral nose block patients. This also correlated with the increase in subjective sensation of relief from nose block in the patients. Thus, we could conclude that in patients with nose block, both medical and surgical interventions improved the area of air blast (p < 0.001), which correlated with the subjective sensation of relief in nose block. Thus, in standard conditions, cold spatula test using modified GM can be used to objectively evaluate the nasal patency. How to cite this article Kapadia PB, Chaudhari AV, Contractor JA, Patel RB, Suratwala JN, Patel JA. A Study of Correlation between Subjective Sensation of Nose Block and Objective Assessment of Nasal Patency by Cold Spatula Test in a Patient with Nose Block. Clin Rhinol An Int J 2017;10(1):1-5.

Peak nasal inspiratory flow correlates with quality of life in functional endoscopic sinus surgery.

Whilst nasal function and airflow improve subjectively following functional endoscopic sinus surgery (FESS), a clinically useful and objective tool for quantifying such improvement is lacking. The peak nasal inspiratory flow (PNIF) metre offers convenient and objective measures of nasal patency. However, it has not yet been established whether changes in PNIF after surgery reflect changes in subjective disease burden. In this study we aimed to determine whether changes in PNIF correlate with commonly used subjective symptom and quality of life outcome measures following FESS for chronic rhinosinusitis (CRS). Prospective cohort. Royal National Throat Nose and Ear Hospital. Thirty-seven patients undergoing FESS for CRS, with or without polyps (21 male, mean age 48.8). PNIF, "SNOT-22", "NOSE" and "VAS" questionnaires were performed before and after surgery. In all patients, there was a strong negative correlation between change in PNIF and change in "SNOT-22" score following surgery (Pearson r=-.64, P<.0001). Strong negative correlations were also seen during subgroup analysis of patients with and without polyps (r=-.57, P=.006 and r=-.67, P=.005, respectively). Change in PNIF correlated significantly with change in "NOSE" score following surgery in all patients and those without polyps (r=-.54, P=.0005 and r=-.68, P=.003). There were no significant correlations between PNIF and VAS (nasal obstruction). Changes in PNIF after FESS appear to best reflect improvements in quality of life in CRS as measured using the "SNOT-22" questionnaire.

Simulating the nasal cycle with computational fluid dynamics.

(1) To develop a method to account for the confounding effect of the nasal cycle when comparing preoperative and postoperative objective measures of nasal patency. (2) To illustrate this method by reporting objective measures derived from computational fluid dynamics (CFD) models spanning the full range of mucosal engorgement associated with the nasal cycle in 2 subjects. Retrospective. Academic tertiary medical center. A cohort of 24 patients with nasal airway obstruction was reviewed to select the 2 patients with the greatest reciprocal change in mucosal engorgement between preoperative and postoperative computed tomography (CT) scans. Three-dimensional anatomic models were created based on the preoperative and postoperative CT scans. Nasal cycling models were also created by gradually changing the thickness of the inferior turbinate, middle turbinate, and septal swell body. Moreover, CFD was used to simulate airflow and to calculate nasal resistance and the average heat flux. Before accounting for the nasal cycle, patient A appeared to have a paradoxical worsening nasal obstruction in the right cavity postoperatively. After accounting for the nasal cycle, patient A had small improvements in objective measures postoperatively. The magnitude of the surgical effect also differed in patient B after accounting for the nasal cycle. By simulating the nasal cycle and comparing models in similar congestive states, surgical changes in nasal patency can be distinguished from physiological changes associated with the nasal cycle. This ability can lead to more precise comparisons of preoperative and postoperative objective measures and potentially more accurate virtual surgery planning.

Analiza porównawcza wyników leczenia zaburzeń drożności nosa z zastosowaniem septoplastyki i septokonchoplastyki

The nasal septal deviation coexistent with turbinate hypertrophy is considered one of the most common causes of nasal patency disorders. There is no doubt that septoplasty in most such cases is a proper treatment method. It is more difficult to clearly identify indications and predict the consequences of septoconchoplasty. The main aim of this study is to compare the impact of each of these procedures on subjective and objective measures of nasal patency. The authors retrospectively reviewed 132 medical records of patients treated in the Department of Otolaryngology, Medical University of Warsaw in the period from March 2012 to January 2013 due to nasal obstruction. Each patient had septoplasty or septoconchoplasty performed. Before treatment, each patient responded to questions in a standardized questionnaire SNOT 20. In addition, each patient was performed upon for anterior rhinomanometry before and after shrinking the nasal mucosa. Finally, the study involved a group of 30 people – 15 after septoplasty (group A) and the same number after septoconchoplasty (group B), who attended control examination carried out by the same scheme 6 weeks and 6 months after surgery. SNOT 20 poll was repeated 6 months after surgery. Analysis of the rhinomanometry results showed no statistically significant differences between the two treatment groups. Average values of the nasal resistance after surgery as compared to their baseline values in all measurements were smaller in each of the groups but the differences were also not statistically significant. However, comparing the results of the subjective assessment of nasal patency and associated signs and symptoms showed statistically significant differences between pre and postoperative results in both groups and the patients of group B felt more improvement than patients in group A. The study authorizes the conclusion that in justified cases septoconchoplasty gives better results than septoplasty.

Does Perception of Nasal Patency Correlate with Mucosal Cooling after Surgery for Nasal Obstruction?

Objectives: 1) Quantify heat fluxes (ie, mucosal cooling) spatially in the nasal passages of nasal airway obstruction (NAO) patients before and after surgery using computational fluid dynamics (CFD). 2) Develop methods to correlate heat fluxes with patient-reported symptoms, as measured by the nasal obstruction symptom evaluation (NOSE) and the visual analog score (VAS). Methods: Computed tomography (CT) scans of 10 patients were obtained before and after surgery to relieve NAO. Three-dimensional models of each patient’s nasal anatomy were used to run steady-state CFD simulations of airflow and heat transfer during inspiration. The importance of anatomic location for perception of nasal patency was evaluated by comparing heat fluxes in the nasal vestibule vs. the entire nasal cavity, and by evaluating the percentage of nasal mucosa exposed to heat fluxes greater than 500 W/m2. Results: Post-operatively, heat fluxes were statistically higher on the pre-operative most obstructed side, for the nasal vestibule alone and the entire nasal cavity (p values &lt; 0.01). A larger area of nasal mucosa was exposed to heat fluxes &gt; 500 W/m2 after surgery than before. The best correlation between subjective and objective measures of nasal patency was obtained for NOSE against heat flux in the entire most obstructed nasal cavity (r = −0.81). Conclusions: A significant increase in heat fluxes (ie, mucosal cooling) correlates well with patients’ perception of better nasal patency after NAO surgery. CFD-derived heat fluxes may prove to be a valuable predictor of success in NAO surgery.

Re: Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence

Background: There is no consensus about the value of objective measurements of nasal patency. Objective: To assess the correlation between the subjective sense of nasal patency and the outcomes found with rhinomanometry and acoustic rhinometry. Type of review: Structured literature search. Search strategy and evaluation method: Review of English-language articles in which correlations were sought between subjective nasal patency symptoms and objective scores as found with rhinomanometry [nasal airway resistance (NAR)] and acoustic rhinometry [minimal cross-sectional area (MCA)]. Correlations were related to unilateral or combined assessment of nasal passages and to symptomatic nasal obstruction or unobstructed nasal breathing. Results: Sixteen studies with a level of evidence II-a or II-b fit the inclusion criteria and were further analysed. Almost every possible combination of correlations or lack thereof in relation to the variables included was found. However, when obstructive symptoms were present, a correlation between the patency symptoms with nasal airway resistance and minimal crosssectional area was found more often than in the absence of symptoms. In cases of bilateral assessment a correlation was found almost as often as it was not between patency symptoms and total nasal airway resistance or combined minimal crosssectional areas, while in the limited amount of studies in which unilateral assessment was done a correlation was found each time between patency symptoms and nasal airway resistance. Conclusions: The correlation between the outcomes found with rhinomanometry and acoustic rhinometry and an individual’s subjective sensation of nasal patency remains uncertain. Based on this review, it seems that the chance of a correlation is greater when each nasal passage is assessed individually and when obstructive symptoms are present. There still seems to be only a limited argument for the use of rhinomanometry or acoustic rhinometry in routine rhinologic practice or for quantifying surgical results. Clin. Otolaryngol. 2009, 34, 518–525.

Objective evidence for the efficacy of surgical management of the deviated septum as a treatment for chronic nasal obstruction: a systematic review

Nasal septal surgery is a common procedure, but there are concerns that the benefits of this surgery are mainly cosmetic. The primary aim is to identify any functional benefits of septal surgery and provide any evidence of a change in patency of the nasal airway, as assessed by objective methods such as rhinomanometry, acoustic rhinometry and peak nasal inspiratory flow. Systematic review. A systematic search of the available literature was performed, using Pubmed, Medline (1950-November 2010), Embase (1947-November 2010) and the Cochrane Controlled Trials Register. Papers written in English that objectively compared pre- and post-surgical treatment of nasal obstruction in adults because of septal deviation were reviewed. Objective measurements of rhinomanometry, acoustic rhinometry and nasal peak inspiratory flow were specified within the search. Searches were restricted to surgery on the nasal septum, which included septoplasty, submucous resection and septal (deviation) corrective surgery. Seven studies (460 participants) involving rhinomanometry, six studies (182 participants) with acoustic rhinometry and one study (22 participants) using nasal peak inspiratory flow were included in the review. All the studies reported an objective improvement in nasal patency after septal surgery. Mean unilateral nasal resistance (data from six studies) decreased from preoperative 1.19 Pa/cm(3) /s to postoperative 0.39 Pa/cm(3) /s, mean minimum cross-sectional area (data from five studies) increased from preoperative 0.45 cm(2) to postoperative 0.61 cm(2) , median peak nasal inspiratory flow (data from one study) increased by 35 L/min after surgery. There is sufficient evidence in the literature to conclude that septal surgery improves objective measures of nasal patency and that improved nasal airflow may have beneficial effects for the patient.