Peak Nasal Inspiratory Flow Research Articles

The effect of single kinetic oscillation stimulation treatment on nonallergic rhinitis.

Kinetic oscillation stimulation (KOS) is a new treatment method for nonallergic rhinitis (NAR), usually delivered twice with a 2- to 4-week interval, and thought to stabilize autonomous dysregulation in the nasal mucosa. We aimed to assess the long-term (1 year) results following one KOS treatment amongst patients with NAR. KOS was administered through a latex balloon placed in the patient's nasal cavity. The balloon is connected to a device that fills the balloon with air pulses, thus vibrating the balloon for 10 min per side. Outcomes were evaluated through patient-reported outcome measures (Sino-Nasal Outcome Test 22 [SNOT-22], Total Nasal Symptom Score [TNSS], Nasal Obstruction Symptom Evaluation [NOSE], and 15D) and measures of patency (rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow [PNIF], and clinical inferior turbinate size). Pre-treatment actions were repeated at 1, 3, 6, and 12 months. In all 49 patients, we found significant improvement in the SNOT-22, NOSE, and TNSS scores. At 12 months, SNOT-22 improved from 44 to 34, NOSE from 60 to 45, TNSS from 8 to 7, and PNIF from 80 to 100 L/min (p < .005 for all). We observed no major complications. One KOS treatment appears to provide NAR patients with a subjective symptom improvement for at least 1 year, thus possibly decreasing the need for invasive treatment methods. III.

Symptom Assessment of Patients with Allergic Rhinitis Using an Allergen Exposure Chamber

Allergen exposure chambers (AECs) are clinical facilities that allow the exposure of participants to allergenic and non-allergenic airborne particles. They provide stable particle concentrations under controlled environmental conditions. This is of great importance both for diagnostic purposes and for the monitoring of treatment effects. Here, a protocol and the technical prerequisites for performing a safe and effective allergen challenge in subjects sensitized to airborne allergens (i.e., house dust mite [HDM]) in the ALL-MED AEC are presented. With this method, triggering allergic symptoms corresponds to natural exposure. This can be used for an allergy diagnosis or as a plausible endpoint in clinical trials, particularly for allergen immunotherapy (AIT). A controlled environment (temperature, humidity, and carbon dioxide [CO2]) in the chamber must be maintained. Allergen particles must be dispersed evenly within the AEC at stable levels throughout the challenge. For this presentation, allergic rhinitis (AR) patients sensitive to HDM allergens were enrolled. AR symptoms were assessed by the following parameters: total nasal symptom score (TNSS), acoustic rhinometry (ARM), peak nasal inspiratory flow (PNIF), and nasal secretion weight. The safety of the procedure was assessed by the peak expiratory flow rate (PEFR) and the forced expiratory volume in the first second (FEV1). The allergic subjects developed symptoms within 120 min of the trial. On average, the most intense symptoms appeared after 60-90 min and, after reaching a plateau, remained stable until the end of the trial.

Peak nasal inspiratory flow in chronic obstructive pulmonary disease.

The nasal airflow in chronic obstructive pulmonary disease (COPD) is poorly characterized. Peak nasal inspiratory flow (PNIF) is a valuable instrument for assessing nasal airflow and the effect of pulmonary pathology such as COPD on PNIF remains unknown. To test the hypothesis that nasal airflow is reduced in COPD, we assessed airflow using PNIF in COPD and a control group. We also explored whether there is an association between COPD, chronic rhinosinusitis without nasal polyps (CRSsNP), and other predefined covariates with PNIF. Ninety patients with COPD and 67 controls underwent PNIF and spirometry. The associations between PNIF and COPD and pre-bronchodilator forced expiratory volume in the first second (FEV1) (% predicted) were assessed by multivariable linear regression in two separate models. PNIF was significantly lower in the COPD group than in the control group. Multivariable linear regression showed that COPD and pre-bronchodilator FEV1 (% predicted) were significantly associated with lower PNIF after adjustment for age, sex, CRSsNP, weight and height. CRSsNP was not associated with PNIF in either of the adjusted regression analyses. PNIF is lower in COPD than in a control group. The finding of a low PNIF in the absence of disease in the upper airways may be due to obstructive lower airways diseases and special care should be taken when interpreting PNIF values in patients with COPD or reduced FEV1.

The association between allergic rhinitis and airway dysfunction and nasal endothelial damage and oxidative stress.

Although lower airway hyperresponsiveness is present in approximately one in three patients with allergic rhinitis (AR), the underlying mechanism remains unclear. To evaluate nasal patency and pulmonary functions in AR independently of the presence of asthma and to investigate the relationships between these and nasal oxidative stress parameters and endothelial damage. Seventy adolescents with AR (AR group - 27 with asthma and 43 without asthma) and 30 healthy controls (HC group) were included in this prospective, cross-sectional study. Endocan and oxidative biomarkers [total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI)] in nasal lavage fluid specimens; peak nasal inspiratory flow (PNIF); fractional exhaled nitric oxide (FeNO), and impulse oscillometry (zR5, zR20, and R5-20 for resistance and zX5 and zX20 for reactance) were investigated. Nasal endocan, TOS, and OSI values were higher in the AR group and TAS in the HC group. There was no difference between AR groups with and without asthma in terms of nasal endocan and oxidative biomarkers. FeNO levels and airway resistance (zR5, zR20, and R5-20) were higher in the AR group than in the HC group. However, there was no difference between the groups in PNIF. X5 was higher among the AR without asthma than in the other groups. Correlation between OSI and R5-20 was observed in the AR group. In the linear regression model, (logged) OSI was significantly predicted (logged) R5-20. The airways of adolescents with AR without asthma were as much affected as those of the AR with asthma, and this effect was associated with nasal endothelial damage and an increase in oxidative stress.

Effects of tongue right positioner use on tongue pressure: a pilot study

The effectiveness of the tongue right positioner (TRP) use on oral and swallowing functions remains unclear. To investigate the effects of TRP use on tongue function in patients with dysphagia. This interventional study included eight participants with dysphagia who visited a university dental hospital. The measurement variables included tongue pressure (TP) as the primary outcome and lip and tongue movements, peak nasal inspiratory flow, and changes in the tongue and suprahyoid muscle regions on ultrasonography as the secondary outcomes. Each participant was asked to use a TRP for at least 8 h every night for 2 months. The measurement variables before and after the intervention were compared using the paired t test and Wilcoxon signed-rank test. TP after intervention (31.5 ± 13.1 kPa) was significantly higher than that before intervention (23.0 ± 13.4 kPa), while other measurement variables did not significantly improve. Numerous exercises have been suggested to improve TP; however, most require patients’ adherence to instructions. In contrast, although participants did not perform active exercises, most participants in this study observed an improved TP. Our findings show that TRP can greatly improve TP after 2 months of usage.Trial registration number: University Hospital Medical Information Network Clinical Trials Registry (UMIN000040253, date of first registration: 27/04/2020).

Relationship Between Rhinitis, Nasal Obstruction and Hypothyroidism: A Follow Up Study with Pre-post Treatment with Levothyroxine.

Hypothyroidism is the most common form of thyroid disorder in India, while, Rhinitis and Nasal obstruction are frequent complaints treated on regular basis in ENT OPD. Studies show that there is relationship between Rhinitis and Nasal obstruction with hypothyroidism. To assess the improvement in symptoms associated with Rhinitis and nasal obstruction in patients with hypothyroidism after treating with levothyroxine. 50 patients presenting in ENT OPD with rhinitis and nasal obstruction and diagnosed with hypothyroidism were selected. Complete history was taken and clinical examination was performed, Nasal Obstruction Symptom Evaluation Score, (NOSE) and Peak nasal inspiratory flow rate (PNIF) were noted. Biochemically proven hypothyroid patients were treated with adequate dosage of Levothyroxine. The patients were followed up and the above-mentioned tests were repeated at regular intervals (1month and 3month), Changes in these readings were recorded and maintained. Significant difference was found in TSH level, NOSE questionnaire, and PNIF reading in patients with hypothyroidism after treatment with levothyroxine (P value < 0.001). This was most commonly noted to occur in young and middle-aged population of age 15years to 50years (88%). In our study - An attempt was made to correlate the symptomatology with hypothyroidism. Treatment with levothyroxine in patients with rhinitis, nasal obstruction and biochemically proven hypothyroidism was found to be effective in improvement of symptoms. It was found that there is significant association between hypothyroid status and rhinitis with nasal obstruction.

Measuring Nasal Patency and the Sense of Smell in CRSwNP Patients Treated with Dupilumab.

Chronic rhinosinusitis with nasal polyps (CRSwNP) in the most severe forms is associated with a poor quality of life. Dupilumab has been suggested as an add-on treatment option for severe CRSwNP. Severe CRSwNP patients treated with dupilumab in different rhinological units were followed up at 1, 3, 6 and 12 months from the first administration and were considered for this study. At baseline (T0) and at each follow-up, patients underwent nasal endoscopy and completed the sinonasal outcome test (SNOT)-22, a visual analogue scale (VAS) for smell/nasal obstruction, peak nasal inspiratory flow (PNIF) and the Sniffin' Sticks identification test (SSIT). The aim of the present study was to evaluate the effects of dupilumab in patients with severe uncontrolled CRSwNP on recovering nasal obstruction and smell impairment. Moreover, the method between PNIF and SSIT with the highest correlation with patients' response to dupilumab was evaluated. One hundred forty-seven patients were included. All parameters improved during treatment (p < 0.001). At T0, no correlations were found between PNIF and nasal symptoms. Nevertheless, during the following evaluations significant correlations between PNIF changes and both nasal symptoms and NPS were observed (p < 0.05). At T0, SSIT did not correlate with SNOT-22. Similarly to PNIF, during the follow-up SSIT changes significantly correlated with nasal symptom and NPS (p < 0.05). Comparing PNIF and SSIT correlations with SNOT-22 and NPS, PNIF showed a higher correlation with both. Dupilumab improves nasal obstruction and the sense of smell. PNIF and SSIT are effective tools in monitoring patients' response to dupilumab.

Diamine Oxidase Activity Deficit and Idiopathic Rhinitis: A New Subgroup of Non-Allergic Rhinitis?

Idiopathic rhinitis represents more than 50% of non-allergic rhinitis, a heterogeneous group that involves the symptomatic inflammation of the nasal mucosa. The TRPV1 receptor of unmyelinated C-type neurons appears to be involved in its pathophysiology. Histamine, whose main catabolic enzyme is DAO, is one of the mediators that can activate this receptor. The failure of DAO causes an increase in the level of histamine in the body and, consequently, the activation of TRPV1. The objective was to investigate the existence of a DAO enzyme activity deficit in idiopathic rhinitis and its correlation with symptoms. A cross-sectional study was conducted in 116 idiopathic rhinitis patients, and DAO activity, nasal peak inspiratory flow, and rhinitis severity were recorded. The prevalence of a DAO activity deficit was 41.38% (95%CI 0.33−0.50; p = 0.05). The DAO activity in patients with mild rhinitis was 52.93 ± 8.72 HDU/mL, in those with moderate rhinitis it was 120.33 ± 71.63 HDU/mL, and in those with severe rhinitis it was 92.58 ± 27.75 HDU/mL (p = 0.006). The NPIF in patients with a DAO activity deficit was 107.92 ± 34.05 L/min, compared to 72.35 ± 27.16 L/min in patients with normal enzymatic activity (p < 0.001), demonstrating a linear correlation between activity levels and nasal obstruction (−0.45; p < 0.001). Therefore, patients with a DAO deficiency and idiopathic rhinitis could present a milder disease course, because the repeated and continuous activation of TRPV1 led to a partial or total decrease in their response (desensitization). This new theory represents a different perspective for the study of idiopathic rhinitis and its relationship with TRPV1, with the regulation or modulation of the desensitization of TRPV1 being an important therapeutic target for patients with idiopathic rhinitis in the future.

Effects of cleaning spray use on eyes, airways, and ergonomic load

BackgroundCleaning workers are exposed to chemicals and high physical workload, commonly resulting in airway problems and pain. In this study the response in the upper airways and the physical workload following airborne and ergonomic exposure of cleaning spray was investigated.MethodsA survey was answered by professional cleaning workers to investigate their use of cleaning sprays and the perceived effects on eyes, airways and musculoskeletal pain. A human chamber exposure study was then conducted with 11 professional cleaning workers and 8 non-professional cleaning workers to investigate the airborne exposure, acute effects on eyes and airways, and physical load during cleaning with sprays, foam application and microfiber cloths premoistened with water. All cleaning products used were bleach, chlorine, and ammonia free. The medical assessment included eye and airway parameters, inflammatory markers in blood and nasal lavage, as well as technical recordings of the physical workload.ResultsA high frequency of spray use (77%) was found among the 225 professional cleaning workers that answered the survey. Based on the survey, there was an eight times higher risk (p < 0.001) of self-experienced symptoms (including symptoms in the nose, eyes and throat, coughing or difficulty breathing) when they used sprays compared to when they cleaned with other methods. During the chamber study, when switching from spray to foam, the airborne particle and volatile organic compound (VOC) concentrations showed a decrease by 7 and 2.5 times, respectively. For the whole group, the peak nasal inspiratory flow decreased (-10.9 L/min, p = 0.01) during spray use compared to using only water-premoistened microfiber cloths. These effects were lower during foam use (-4.7 L/min, p = 0.19). The technical recordings showed a high physical workload regardless of cleaning with spray or with water.ConclusionSwitching from a spraying to a foaming nozzle decreases the exposure of both airborne particles and VOCs, and thereby reduces eye and airway effects, and does not increase the ergonomic load. If the use of cleaning products tested in this study, i.e. bleach, chlorine, and ammonia free, cannot be avoided, foam application is preferable to spray application to improve the occupational environment.

Peak nasal inspiratory flow in children and adolescents with sickle cell disease: a case-control study.

Sickle cell disease is the most frequent of the hereditary hemoglobinopathies and it presents multisystemic effects. A manifestation that is commonly found in sickle cell disease is upper airway obstruction, particularly adenotonsillar hypertrophy. This study aims to evaluate the peak nasal inspiratory flow measurements of children and adolescents with sickle cell disease. This is a case-control study on children aged between 8 and 15 years who were diagnosed with sickle cell disease. Peak nasal inspiratory flow measurements were obtained from patients. A total of 279 patients were enrolled in this study, with 93 in the case group and 186 in the control group. The case group had an 82.83% chance of having lower peak nasal inspiratory flow values than the control group. In the case group, 75% of the peak nasal inspiratory flow values were in the lower standards, whereas in the control group, only 25% were in the lower standards. This study showed a high prevalence of reduced peak nasal inspiratory flow values in children with sickle cell disease and could certainly be incorporated into the day-to-day clinical evaluation of patients as a screening instrument.

Phase III study of Phlai capsules in the treatment of allergic rhinitis: A randomized, double-blind, placebo-controlled trial.

Preclinical studies demonstrated anti-inflammatory effects of Zingiber montanum (J.König) Link ex Dietr.(Phlai). However, its clinical effect on allergic rhinitis (AR) is not evident. We sought to assess the efficacy and safety of Phlai for treating AR. A phase 3, randomized, double-blind, placebo-controlled study was conducted. Patients with AR were randomized into three groups and received Phlai 100 mg or Phlai 200 mg or placebo once a day for four weeks. The primary outcome was a change in the reflective total five symptom score (rT5SS). The secondary outcomes were the change in the instantaneous total five symptom score (iT5SS), the reflective individual symptom scores (rhinorrhea, nasal congestion, sneezing, itchy nose, itchy eyes), Rhinoconjunctivitis Quality of Life-36 Questionnaire (RCQ-36) score, peak nasal inspiratory flow (PNIF), and adverse events. Two hundred and sixty-two patients were enrolled. Compared with placebo, Phlai 100 mg improved rT5SS [adjusted mean difference (aMD) -0.62; 95%CI -1.22, -0.03; p = 0.039], rhinorrhea (aMD -0.19; 95%CI -0.37, 0.002; p = 0.048), itchy nose (aMD -0.24; 95%CI -0.43, -0.05; p = 0.011), and itchy eyes (aMD -0.19; 95%CI -0.36, -0.02; p = 0.033) at week 4. Nasal obstruction, sneezing, iT5SS, overall RCQ-36 score, PNIF did not reach statistical significance. Phlai 200 mg did not bring additional benefits compared to 100 mg. Adverse events were similar among groups. Phlai was safe. At four weeks, there were small improvements in rT5SS, together with the individual symptoms of rhinorrhea, itchy nose, and itchy eyes.

Biologic treatment for severe chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis.

Chronic rhinosinusitis with nasal polyps is often severe, debilitating and difficult to treat. Biologics that target key inflammatory pathways have the potential to treat this disease; this study aimed to evaluate their effectiveness. Systematic review and meta-analysis of randomised controlled trials of biologics in chronic rhinosinusitis with nasal polyps. Primary outcomes were extent of disease, objective disease severity and disease-specific quality of life, with outcomes measured at different end-of-treatment timepoints in different studies (range 16-52 weeks). Eleven trials were identified with 2035 participants. Ten studies reported change in polyp size, estimating a reduction of -1.25 in the treatment group. Six studies reported reduction in Lund-Mackay score where the pooled mean difference was -4.90. Five studies included peak nasal inspiratory flow with a pooled mean difference of 33.54, indicating improved nasal airflow. Seven studies reported change in olfactory score with an overall pooled effect of 6.56 suggesting improved olfaction. The SNOT-22 score in nine studies gave an overall pooled effect of -14.53, indicating improved quality of life. Biologics can be effective in treating nasal polyps, with reduction in polyp size and extent of disease, and improved sense of smell and quality of life. There is significant heterogeneity in the outcomes for individual biologics, highlighting the need for further studies.

Peak Nasal Inspiratory Flow Values and Visual Analog Scale in Snoring Patients

Peak Nasal Inspiratory Flow Values and Visual Analog Scale in Snoring Patients

Prospective study on the functional outcome of septoplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A thorough assessment of nasal obstruction remains a matter of debate with no accepted subjective and objective measurement tools. The purpose of this study was to use a cost-effective tool for objective assessment of nasal obstruction and compare it with subjective scores.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a longitudinal, prospective study conducted at a tertiary care center on patients undergoing septoplasty for deviated nasal septum (DNS) from March 2016 to August 2017. All patients were assessed pre- and post-operatively at 3 months with nasal peak inspiratory flow, sino-nasal outcome test (SNOT-22) and nasal obstruction symptom evaluation (NOSE) questionnaire to determine post-operative improvement and correlation between objective and subjective scores. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 64 patients were included in the study with 16 females and 48 males. Male patients had higher peak nasal inspiratory flow (PNIF) score post-operatively. Younger patients (less than 25 years) showed significant subjective improvement compared to older patients post-operatively using NOSE questionnaire. Significant improvement in PNIF, SNOT-22 and NOSE scores post-operatively using paired student-t test. There was moderate correlation between PNIF values and subjective scores before surgery and excellent correlation between the subjective SNOT-22 and NOSE scores before and after surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; PNIF is a cheap, portable, and convenient method for assessing nasal patency. Subjective and objective scores have good correlation, with improvement in all scores post-surgery. Men may show more objective improvement and early intervention at younger age may provide more subjective improvement.&lt;/p&gt;

Generic Health-Related Quality-of-Life Changes after Rhinoplasty: A Prospective Study with Long-Term Results.

Our objective was to investigate changes in specific generic health-related quality-of-life (HRQoL) domains achieved by rhinoplasty, to investigate whether modifications of somatic-, psychologic-, and social-related HRQoL domains are different in patients with functional or aesthetic motivation for rhinoplasty, and to investigate if HRQoL changes are related to a functional or an aesthetic nasal improvement. This was a prospective study with 1 year of follow-up. Fifty-four consecutive Caucasian patients submitted to rhinoplasty were evaluated with 36-item Short Form Health Survey (SF-36) and EuroQuality-of-Life 5 Domain (EQ-5D) questionnaires. To correlate changes in generic HRQoL with functional and aesthetic modifications achieved by rhinoplasty, evaluation of patients also included assessment of Peak Nasal Inspiratory Flow and Nasal Obstruction Symptom Evaluation, Visual Analogue Scale for nasal airway obstruction (NAO), and Rhinoplasty Outcome Evaluation scores.Modifications in each generic HRQoL health-domain were analyzed to investigate the possible relation with motivation for surgery and with functional or aesthetic improvement. There was a significant improvement in EQ-5D (p < 0.001), EQ-5D VAS (p = 0.002) and in the SF-36 domains of general health (p < 0.001), energy (p < 0.001), physical functioning (p < 0.001), physical limitation (p = 0.005), pain (p = 0.003), and well-being (p = 0.018). Improvement was significant in groups of patients with NAO or in whom a septoplasty was performed and was associated with patient-reported functional improvement. There was a significant improvement in health change (p < 0.001), verified in all groups of patients. This prospective study with long-term results demonstrates that rhinoplasty significantly improves most domains of generic HRQoL. This improvement is associated with patient-reported functional improvement. Emotional limitation and social functioning are not significantly changed by rhinoplasty. IV.

Efficacy and safety of a hypertonic nasal wash solution containing sea algae extracts in patients that underwent surgical correction of a deviated nasal septum and radiofrequency turbinate volume reduction.

The objective of this study was to evaluate efficacy and safety of a Hypertonic Seawater Solution (2.3% NaCl) containing brown and blue-green Algae (HSS-A) in comparison to Isotonic Saline Solution (ISS) regarding the improvement of nasal breathing in patients that have undergone surgical correction of a deviated nasal septum and radiofrequency turbinate volume reduction. A total of 101 individuals were enrolled in the study (HSS-A: 57; ISS: 44). Nasal breathing was evaluated using a Peak Nasal Inspiratory Flow (PNIF) measurement device at four timepoints: prior to surgical intervention (up to 30 days pre-surgery) and at the 2nd, 10th and 20th postoperative days. On the 20th postoperative day, patients also answered a Nasal Surgical Questionnaire (NSQ) evaluating breathing ability and overall satisfaction from the use of both nasal sprays. No significant differences were observed in PNIF measurements between groups at different points. On the 20th postoperative day, NSQ analysis showed that ISS-treated patients had more frequently moderate nasal bleeding compared to the HSS-A group (85.7% vs. 14.3%, p=0.038). No other statistically significant differences were observed between groups. When NSQ parameters were evaluated in a binary mode, a trend for reduced crusting scores was seen in the HSS-A group (15.9% vs. 35.5% in ISS, p=0.053). No safety concerns were reported throughout the study. In patients that have undergone surgical correction of a deviated nasal septum and radiofrequency turbinate volume reduction, PNIF values did not differ significantly in patients receiving HSS-A and ISS solutions. Nasal bleeding was more frequent in ISS patients versus HSS-A. Overall, both solutions provided symptomatic relief and use satisfaction in the absence of side effects.

Semi-occluded Nasal Tract Exercises (SONTEs): Nasal Tube in Water Exercises Using Nasal Consonants

This study analyzes the effects of the vocal exercises called semi-occluded nasal tract exercises (SONTEs), which were carried out with a new appliance that extends the nasal cavity as a part of the vocal tract. The acoustic, aerodynamic and electroglottographic (EGG) measurements were compared with those of the traditional semi-occluded vocal tract exercises (SOVTEs) of phonation in water. In this study, 34 women were randomly asked to perform phonation in water for 5 min through the nasal and oral routes with the sounds /m/ and /ɔ/, respectively, using a tube with a submersion depth of 5 cm. The acoustic, aerodynamic and EGG measurements before and after the exercises were analyzed using the appropriate statistical methods. No significant difference was found in the time and frequency domain parameters before and after the exercises, except for the amplitude perturbation quotient (APQ) values, which decreased after both exercises. In addition, there was no significant difference in any aerodynamic parameters before and after the exercises, but the mean SPL values significantly increased after both exercises. The oral and nasal peak inspiratory flow rates increased after both exercises, but the increase peaked after the SONTEs implementation. As expected, the EGG-jitter and EGG-periodicity values had a reciprocal interaction with each other, while differences were observed between the values of the vocal fold movements measured in both exercises. SONTEs may be as effective as the conventional SOVTEs because it made tube phonation into water possible through artificial extension of the nasal cavity and increased the resonant effect by using the positive effects based on the principles of SOVTEs.

Olfactory stimulation may modulate the sensation of nasal patency.

The sensation of nasal patency can be induced by inhaling menthol, which predominantly produces trigeminal stimulation. It remains unclear whether olfactory stimulation can also induce or modulate the sensation of nasal patency. A total of 118 participants (normosmia: n=67, olfactory dysfunction: n=51) were exposed to four odors in a randomized order: 1) phenylethanol (PEA), 2) menthol, 3) a mixture of PEA and menthol, 4) nearly odorless propylene glycol. The odors were presented by nasal clips. After the nasal clip had been removed, the participants rated relative nasal patency (RNP) from - 50 to +50, and their peak nasal inspiratory flow (PNIF) was measured. Repeated measures analysis of variance was used to examine the difference of RNP and PNIF among the four conditions and the influence of olfactory function. The RNPs, other than PNIFs, differed between the four conditions. Menthol induced the highest RNP, followed by the mixed solution, PEA and the odorless condition. Normosmic participants, but not those with olfactory dysfunction, responded to PEA significantly higher than odorless condition with regard to RNP. The correlation analysis showed that the better the subjective or measured olfactory performance, the greater the PEA-induced sensation of nasal patency. A specific olfactory stimulant that selectively induces olfactory perception can also evoke and modulate the sensation of nasal patency. Hence, patients might benefit from exposing themselves to odors in order to relieve the annoying nasal obstruction.

Comparative Study of Endoscopic and Conventional Septoturbinoplasty in Patients with Nasal Airway Obstruction

Objectives: The goal of our study was to perform endoscopic septoplasty with or without turbinate reduction and also to determine its postoperative subjective and objective improvements. Methods: This was a hospital-based pre and post clinical trial study of 63 patients with nasal septal deviation treated with endoscopic and conventional septoplasty with or without turbinoplasty from 2013 to 2016. Nasal airway patency was recorded before and 2.7 months after surgical treatment using a visual analogue scale (VAS), Glatzel mirror test and bilateral peak nasal inspiratory flow (PNIF) measure. Results: Endoscopic (27 patients) and conventional septoturbinoplasty (36 patients) was performed on 63 patients (40 males; 23 females) with a mean age of 35 years. The results showed a significant improvement of nasal passage condition in scales of VAS, Glatzel mirror test, and bilateral PNIF values after surgery in both groups. In both surgical techniques septoplasty with turbinate reduction showed better improvement in VAS and bilateral PNIF scores than septoplasty alone. Conclusion: The application of endoscopic technology has an advantage of precise visualization and is a valuable tool especially when it is used for educational reasons. Subjective and objective improvements were confirmed equally in both endoscopic and conventional groups.

Effectiveness of Dupilumab in the Treatment of Patients with Uncontrolled Severe CRSwNP: A "Real-Life" Observational Study in Naïve and Post-Surgical Patients.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) represents 25–30% of all CRS cases, and in the most severe forms it is associated with a poor quality of life and a high rate of nasal polyps’ recurrence after surgery. Dupilumab has been suggested as a treatment option for severe CRSwNP. Methods: Patients with severe CRSwNP receiving dupilumab from January 2021 were followed up at 1, 3, 6, 9 and 12 months from the first administration and were considered for this study. At baseline and at each follow-up, patients underwent nasal endoscopy and completed the Sinonasal Outcome Test (SNOT)-22, a Visual Analogue Scale (VAS) for smell/nasal obstruction, the Nasal Congestion Score and the Asthma Control Test. Peak nasal inspiratory flow (PNIF), a smell test, nasal cytology and blood eosinophilia were also evaluated. Results: Forty-seven patients were included in the study. Of these, 33 patients had a history of previous surgery (ESS) and had recurrent nasal polyps, while 14 patients were naïve to nasal surgery. Both subjective and objective parameters improved after biological treatment and were correlated with each other (p < 0.05), except for the SNOT-22 and the nasal polyp’s score. No correlations were found between nasal and blood eosinophilia. No differences were observed when comparing the post-surgical and the naïve groups. Conclusions: Dupilumab improves nasal obstruction and the sense of smell and reduces the level of local inflammation in severe CRSwNP patients in a similar way in both naïve and post-surgical patients.