Total Nasal Resistance Research Articles

Total Nasal Resistance among Sasang Constitutional Types: A Population-Based Study in Korea

Total Nasal Resistance among Sasang Constitutional Types: A Population-Based Study in Korea

Subjective and objective assessments of seasonal effect in children with seasonal allergic rhinitis

BackgroundEpidemiological and clinical studies suggest a relationship between rhinitis and asthma. Upper and lower airways may be influenced by a common inflammatory process. ObjectiveThis study aimed to investigate the relationships between rhinitis symptom scores, and both nasal and bronchial airflow among children with seasonal allergic rhinitis (SAR) by means of spirometric and rhinomanometric measurement during and outside the pollen season. MethodsTwenty-nine children with both seasonal allergic rhinitis and asthma (AR+A), 30 children with SAR and no asthma (AR) and 36 non-allergic healthy children were evaluated prospectively during and outside the pollen season. Symptom severity was evaluated using both total symptom score and visual analog score (VAS). All participants also received rhinomanometric evaluation and pulmonary function testing. ResultsIn children with SAR the median total nasal flow, FEV1, FEF25–75 values were lower than control group during pollen season (p=0.01, p<0.001 and p<0.001 respectively). They had also higher total nasal resistance compared with control groups (p=0.01). Nasal symptom scores were higher among patients with concurrent asthma than patients who had only SAR out of pollen season (p<0.001). There was no significant difference between SAR participants with or without asthma and control group in terms of total nasal flow and total nasal resistance measured out of season (p=0.105 and p=0.19). FEF25–75 values of patients with and without asthma were significantly lower than those of controls out of season (p=0.022, p<0.001 respectively). ConclusionOur data suggests that as the presence of AR worsens asthma control, the presence of asthma may worsen symptoms of AR out of pollen season. We found that total nasal flow, FEV1, FEF25–75 values of patients with SAR were lower than those of controls out of season. FEF25–75 values of patients with asthma and without asthma were significantly lower than those of controls out of season. Thus, a careful evaluation of lower airways should be performed in even patients with seasonal allergic rhinitis alone.

Nasal histamine responses in nonallergic rhinitis with eosinophilic syndrome.

Background:Nonallergic rhinitis with eosinophilic syndrome (NARES) is persistent, without atopy, but with ≥25% nasal eosinophilia. Hypereosinophilia seems to contribute to nasal mucosa dysfunction.Objectives:This analytical case-control study aimed at assessing the presence and severity of nonspecific nasal hyperactivity and at finding out whether eosinophilia may be correlated with the respiratory and mucociliary clearance functions.Materials:The symptom score was assessed in 38 patients and 15 controls whose nasal smear was also tested for eosinophils and mucociliary transport (MCT). Nonspecific nasal provocation tests (NSNPT) with histamine were also carried out, and total nasal resistance (TNR) was determined.Results:The symptom score of NARES after NSNPT were not significantly different from the control group, and there was poor or no correlation among the single symptoms and the differences studied for every nasal reactivity class. This correlation improved when using the composite symptom score. The most severe eosinophilia was observed in high reactivity groups, and it was correlated with an increase in TNR. MCT worsened as eosinophilia and nasal reactivity increased. Unlike controls, a significant correlation was observed between the increase in MCT and TNR.Conclusions:In NARES, nonspecific nasal hyperreactivity is the result of epithelial damage produced by eosinophilic inflammation, which causes MCT slow down, an increase in TNR, and nasal reactivity classes, with possible impact on classification, prognosis, and treatment control.

Nasal Surgery improves Continuous Positive Airway Pressure compliance and Daytime Sleepiness in Obstructive Sleep Apnea Syndrome

Background: The pressure level during nasal continuous positive airway pressure (CPAP) and the compliance may be influenced by the improvement in nasal patency resulting from nasal surgery. Methods: We investigated 12 male OSAS patients, diagnosed by standard polysomnography, nasal airflow resistance, and Epworth sleepiness scale (ESS), who were evaluated before and after nasal surgery under the use of CPAP. Results: The total nasal resistance was reduced after nasal surgery in all OSAS patients. A significant difference was observed in the ESS scores postoperatively. Nasal surgery significantly improved both the CPAP pressure and the compliance in all patients. Conclusion: Nasal continuous positive airway pressure (CPAP) intolerance in obstructive sleep apnea syndrome (OSAS) patients can be adequately improved by nasal surgery. The improvement of CPAP compliance may be brought about by the reduction in applied CPAP pressure after the improvement of nasal patency.

Rhinomanometric reference intervals for normal total nasal airflow resistance.

Reference intervals (RIs) or mean values for normal total nasal airflow resistance are essential for the diagnosis of nasal obstruction. Data relating to nasal airflow are not standardised, and valid and reliable RIs do not exist for the time being. This meta-analysis aimed to determine such “standard” 95%-RIs. Research of related literature listed in Medline, Embase, Cochrane, and Web of Science databases. Airflow resistance data were gathered from 38 studies using active anterior rhinomanometry at a differential pressure of 150Pa to examine patients under congested and decongested mucosal conditions. In the meta-analysis overall values and RIs for normal total nasal airflow resistance under congested nasal mucosal conditions were calculated for all subjects at 0.25Pa/cm3/s (95%-RI 0.10-0.40Pa/cm3/s), adults regardless of gender at 0.25Pa/cm3/s (95%-RI 0.12-0.38Pa/cm3/s), men at 0.24Pa/cm3/s (95%-RI 0.09-0.39Pa/cm3/s), and women at 0.26Pa/cm3/s (95%-RI 0.08-0.44Pa/cm3/s). Asian, African and Caucasian ethnic groups exhibited rising airflow resistance mean values: 0.23Pa/cm3/s (95%-RI 0.08-0.39Pa/cm3/s), 0.25Pa/cm3/s (95%-RI 0.11-0.38Pa/cm3/s) and 0.26Pa/cm3/s (95%-RI 0.13-0.38Pa/cm3/s), respectively. Lower overall mean values resulted under decongested nasal mucosal conditions. The reference intervals and mean values ascertained in this meta-analysis improve the diagnosis of nasal obstruction and may represent a useful supplement in existing guidelines for the standardisation of rhinomanometric measurements.

The effects of pregnancy on nasal physiology.

Nasal congestion that is not present before pregnancy represents a distinct clinical entity called pregnancy rhinitis. The aim of this study is to evaluate the clinical characteristics of nasal physiology over the course of pregnancy. The study was conducted with 85 pregnant women and 26 nonpregnant controls. We measured nasal airway patency objectively via acoustic rhinometry (ARM) and anterior rhinomanometry (RMM) and subjectively via the Nasal Obstruction Symptom Evaluation (NOSE) scale in each trimester and compared the results to those of the controls. The NOSE scores of control and pregnant women showed no difference (p = 0.866). Minimal cross-sectional area (MCA1; minimal cross sectional area at nasal valve and MCA2; minimal cross sectional area at the level where the head of inferior turbinate is placed) decreased significantly between the first and third trimesters: first trimester 0.37 cm(2), third trimester 0.31 cm(2). There was no difference between each trimester with regard to total nasal resistance. The correlation analysis between the NOSE score and both total volume and MCA1 in all patients showed no significance (r = -0.10, p = 0.318; r = -0.04, p = 0.654, respectively). Pregnancy affects nasal physiology adversely and impairs nasal breathing in some women. However, based on the findings of this study, we concluded that this clinical entity may not be considered as a disease without complementary symptoms despite the presence of objective changes in nasal parameters.

Does Septoplasty Affect Middle Ear Pressure and Eustachian Tube Function?

Objective: To investigate the effects of septoplasty on middle ear pressure and Eustachian tube function. Materials and Methods: Patients who were suffering from nasal obstruction and underwent septoplasty due to nasal septal deviation and healthy volunteers not suffering from nasal obstruction were involved in the study. Nasal patency was evaluated by rhinomanometry, and middle ear pressure and Eustachian tube function were evaluated by tympanometry. Total nasal resistance (TNR) and tympanometric peak pressure (TPP) values were used for this purpose. If TPP changed more than ±10 daPa with Valsalva and Toynbee maneuvers, the Eustachian tube function of that ear was accepted as good. Rhinomanometry and tympanometry measurements were performed for patients in the preoperative period and in the 1st and 3rd postoperative months. To determine the normative levels of TNR, rhinomanometry was performed in the control group. Results: Twenty-three patients and 30 volunteers were involved in the study. The preoperative TNR values of the patients were remarkably higher than the control group (p 0.05). Middle ear pressures and Eustachian tube function did not differ significantly in the 1st and 3rd postoperative months compared to the preoperative period (p>0.05). Conclusion: It was found that septoplasty did not affect middle ear pressure and Eustachian tube function.

Study on the correlation between subjective symptoms and function of nasal ventilation in nonallergic rhinitis with eosinophilia syndrome

Objective To analyze the correlation between subjective symptoms and function of nasal ventila-tion in nonallergic rhinitis with eosinophilia syndrome （ NARES） ,in order to provide the basis for the clinical diagno-sis.Methods 44 patients with NARES were selected as the NARES group ,and 50 healthy people were selected as the control group at the same time .The total nasal resistance （ TNR ） , MCA of the two groups were compared , and Pearson or Spearman correlation was used to analyze the subjective symptoms and objective test indexes in patients with NARES.Results Before contraction,the TNR values of NARES group in 75Pa and 150Pa were higher than those of the control group （Mann-Whiteny Z=7.365,8.125,all P〈0.05）.After contraction,the differences of TNR values in 75Pa and 150Pa,MCA,the correlation analysis in 8 subjective symptoms and 7 objective index of NARES had no statistically significant differences between the two groups （ all P 〉0.05）.Conclusion The correlation between subjective symptoms and function of nasal ventilation in NARES patients is not obvious .Clinical diagnosis should be comprehensive ,in case of missed diagnosis and misdiagnosis . Key words: Rhinitis; Eosinophilia

Combined radiofrequency volumetric tissue reduction and lateral outfracture of hypertrophic inferior turbinate in the treatment of chronic rhinitis: short‐term and long‐term outcome

Radiofrequency volumetric tissue reduction (RFVTR) of hypertrophic inferior turbinate (IT) is an effective way to treat patients with intractable nasal mucosal obstruction. We evaluated the effectiveness of combined RFVTR and lateral outfracture (LO) of hypertrophic IT in chronic rhinitis (CR) patients on reduction of nasal obstruction, rhinorrhea, and nasal pruritus both short and long term. Seventy-three patients with CR who failed medical treatment were recruited to undergo combined RFVTR and LO of hypertrophic IT. Nasal congestion scores were recorded before the operation, and immediately, 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and 3 years after the operation. Rhinorrhea and pruritic score as well as total nasal airway resistance (TNAR) and total nasal airflow (TNAF) (measured by active anterior rhinomanometry) were recorded before the operation, and 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and 3 years after the operation. Forty-five patients completed the follow-up period of 3 years. Subjects consisted of 25 male and 20 female patients, with an average age of 31 years. Nasal congestion scores were significantly improved immediately after the operation. Nasal congestion scores and TNAR values were significantly decreased whereas TNAF values were significantly increased at every time point postoperatively. Rhinorrhea and pruritic scores were also significantly improved at every time point after 2 weeks postoperatively. Combined RFVTR and LO of hypertrophic IT is an effective treatment for nasal obstruction, rhinorrhea, and nasal pruritus in CR and the result lasts up to 3 years postoperatively.

Rhinomanometric reference intervals for normal total nasal airflow resistance

Reference intervals (RIs) or mean values for normal total nasal airflow resistance are essential for the diagnosis of nasal obstruction. Data relating to nasal airflow are not standardised, and valid and reliable RIs do not exist for the time being. This meta-analysis aimed to determine such “standard” 95%-RIs. Research of related literature listed in Medline, Embase, Cochrane, and Web of Science databases. Airflow resistance data were gathered from 38 studies using active anterior rhinomanometry at a differential pressure of 150Pa to examine patients under congested and decongested mucosal conditions. In the meta-analysis overall values and RIs for normal total nasal airflow resistance under congested nasal mucosal conditions were calculated for all subjects at 0.25Pa/cm3/s (95%-RI 0.10-0.40Pa/cm3/s), adults regardless of gender at 0.25Pa/cm3/s (95%-RI 0.12-0.38Pa/cm3/s), men at 0.24Pa/cm3/s (95%-RI 0.09-0.39Pa/cm3/s), and women at 0.26Pa/cm3/s (95%-RI 0.08-0.44Pa/cm3/s). Asian, African and Caucasian ethnic groups exhibited rising airflow resistance mean values: 0.23Pa/cm3/s (95%-RI 0.08-0.39Pa/cm3/s), 0.25Pa/cm3/s (95%-RI 0.11-0.38Pa/cm3/s) and 0.26Pa/cm3/s (95%-RI 0.13-0.38Pa/cm3/s), respectively. Lower overall mean values resulted under decongested nasal mucosal conditions. The reference intervals and mean values ascertained in this meta-analysis improve the diagnosis of nasal obstruction and may represent a useful supplement in existing guidelines for the standardisation of rhinomanometric measurements.

Correlation between nasal airflow characteristics and clinical relevance of nasal septal deviation to nasal airway obstruction

Since the imbalance of the nasal cavities due to nasal septal deviation (NSD) is a commonly observed anatomic variation in healthy adults, clinicians must often decide whether or not it is clinically relevant to the symptoms of nasal airway obstruction (NAO). Main reason for this is a lack of data correlating the symptoms of NAO with objective findings. The aim of our study is to find the correlation between fluid dynamic parameters and the anatomy of nasal cavity with NSD by numerical simulation. We generated 6 computational models of nasal cavities with NSD were created from computed tomographic images: 3 symptomatic patients with NAO and 3 asymptomatic patients. Computational fluid dynamics (CFD) was used to simulate steady inspiratory airflows in each nasal cavity model and compare the fluid dynamic properties of each. In the symptomatic cases, the pressure drop from the naris to the end of the septum was larger, and more uneven flow partitioning was observed. Local maximum velocity and wall shear stress were higher in the symptomatic group than in the asymptomatic group. The symptoms of NAO seem to be related more to the nasal resistance from the naris to the end of the septum than to the total nasal resistance from naris to nasopharynx. Factors correlated with NAO by CFD can be used as elements in patient-specific objective diagnostic tools for NAO in the presence of NSD.

Total nasal resistance among Sasang constitutional types: a population-based study in Korea

BackgroundThere have been many attempts to find an objective phenotype by Sasang constitutional types (SCTs) on an anatomical, physiological, and psychological basis, but there has been no research on total nasal resistance (TNR) among SCTs.MethodsWe assessed the value of the TNR in the SCTs classified by an integrated diagnostic model. Included in the study were 1,346 individuals (701 males, 645 females) who participated in the Korean Genome and Epidemiology Study (KoGES). The TNR was measured by active anterior rhinomanometry (AAR) at transnasal pressures of 100 and 150 Pascal (Pa).ResultsThe average TNR was 0.186 ± 0.004 Pa/cm3/second at 100 Pa in the Tae-eum (TE), 0.193 ± 0.007 in the So-eum (SE), and 0.208 ± 0.005 in the So-yang (SY) types. Under condition of 150 Pa the TE type had a TNR value of 0.217 ± 0.004, the SE type was 0.230 ± 0.008, and the SY type was 0.243 ± 0.005. Higher values of TNR were more likely to be reported in the SY type at 100 Pa and 150 Pa. In the stratified analysis by sex, the SY type in males and females tended to have higher TNR value than the TE and SE types at transnasal pressure of both 100 Pa and 150 Pa.ConclusionsThese results provide new approaches to understand the functional characteristics among the SCTs in terms of nasal physiology. Further studies are required to clarify contributing factors for such a difference.

Prospective Study of the Impact of Thyroid Hormone Replacement on Nasal Functions in Hypothyroid Patients

Objectives: Thyroid hormone deficiency is known to have many systemic effects on the human body. Although some of these manifestations are very well known, its effect on nasal functions has not been studied thoroughly. In this paper, evaluation of nasal functions in hypothyroid patients was performed, and their subsequent response to thyroid hormone replacement was prospectively studied. Methods: Prospective evaluation of nasal functions and concurrent determination of serum thyroid status was executed in a cohort of post-operative total thyroidectomy patients prior to and following thyroid hormone replacement therapy. Nasal function parameters, including nasalance, nasal resistance, mucociliary transport, and olfaction, are compared before and after treatment using paired samples t-test. Results: Twenty-four post-thyroidectomy patients (15 female, 9 male; mean age 34.96±12.47) were included in the study. All subjects were hypothyroid (mean TSH 129.2±64.46 mIU/L) prior to replacement. Following hormone therapy, their mean TSH dropped to 1.58±0.88 mIU/L. Nasalance showed a significant increase from 45.67±8.41 to 49.63±9.26 (p=0.0069) after replacement. Change in total nasal resistance from 0.28±0.16 Pa/cm3/s to 0.29±0.13 Pa/cm3/s was non-significant ( P = 0.7747). Mucociliary transport time decreased significantly from 9.62±4.00 min to 5.70±2.07 min after replacement ( P &lt; 0.0001). Olfaction was measured by a visual analog scale (VAS) and Brief Smell Identification Test (B-SIT). VAS showed a significant improvement from 7.12±2.30 to 8.66±0.96 ( P &lt; 0.0001), and B-SIT also revealed a significant improvement from 35.08±31.34 to 80.17±23.52 ( P &lt; 0.0001) after replacement. Conclusions: Thyroid hormone replacement therapy following total thyroidectomy has a measurable impact on nasalance, mucociliary transport, and olfaction in hypothyroid patients.

Anterior Rhinomanometry and Determination of Nasal Mucociliary Clearance Time With the Saccharin Test in Children With Crimean-Congo Hemorrhagic Fever

Crimean-Congo hemorrhagic fever (CCHF), like other viral infections, may prolong mucociliary clearance time and increase nasal resistance in children. The aim of the present prospective case-control study was to study, using saccharin and anterior rhinomanometry tests, whether CCHF infections caused any change in nasal physiology. Overall, 40 subjects, 20 of whom had CCHF (group 1) and 20 of whom were healthy controls (group 2), were enrolled in this study. The definitive diagnosis of CCHF infection was made based on typical clinical and epidemiological findings and detection of CCHF virus-specific IgM by ELISA or of genomic segments of the CCHF virus by reverse transcription-polymerase chain reaction. Anterior rhinomanometry was performed in all participants according to current recommendations of the Committee Report on Standardization of Rhinomanometry. A saccharin test was used to evaluate mucociliary clearance, and nasal mucociliary clearance time was assessed with the saccharin test as described previously. In our patients, the mean time from the application of saccharin crystals to the first feeling of a sweet taste was 6.77 ± 3.25 minutes (range 2-16 min). In terms of the mean time from the application of saccharin crystals to the first feeling of a sweet taste, there was no difference between two groups. The mean total air flow was 637.60 ± 76.18 mL/s (range 490-760 mL/s). The mean total nasal airway resistance was 0.24 ± 0.03 Pa/mL s (range 0.20-0.31 Pa/mL s). In terms of the degree of nasal air flow and nasal airway resistance and the total air flow and total nasal airway resistance of each nostril, there was no difference between the 2 groups. The results obtained in anterior rhinomanometry and saccharin test showed that there was no statistically significant difference between CCHF (+) patients and controls. These results suggest us that CCHF virus infection does not affect nasal physiology. However, this is the first study performed on this issue and further studies on larger series need to be performed.

The role of upper and lower airway patency in chronic rhinosinusitis with nasal polyps and asthma

To investigate the role of airway patency and factors associated with airway patency in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma. Retrospective study. The upper and lower airway patency of 140 patients with CRSwNP and asthma (asthma group) and 42 patients with CRSwNP without asthma (nonasthma control group) was measured using acoustic rhinometry, rhinomanometry, and spirometry. Total serum immunoglobulin E and eosinophil counts were also compared. The severity of nasal diseases in these patients was assessed via the Lund-Mackay score (LMS) and Lund-Kennedy score (LKS). There was no difference between the asthma and nonasthma groups in terms of total nasal resistance at 75 Pa (R(75T)), bilateral minimum cross-sectional area (MCA(R+L)), or bilateral nasal cavity volume between 0 and 7.0 cm(3) (V7(R+L)). Forced expiratory volume in 1 second (FEV(1)) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF(25-75)) of the asthma group were significantly lower than those of the nonasthma group. FEV(1) and FEF(25-75) were not correlated with R(75T), MCA(R+L), V7(R+L), or severity of nasal disease. For the patients with asthma, LMS and serum eosinophil counts were independent predictors of MCA(R+L). The presence of asthma may not influence upper airway patency in CRSwNP patients. In CRSwNP patients with asthma, impairment of upper airway patency was associated with changes in LMS and eosinophilia, and in these patients lower airway patency was significantly lower than that of the control group (without asthma). In CRSwNP patients with asthma, there was little or no association between upper and lower airway patency.

Objective and subjective assessments of nasal obstruction in children and adolescents with allergic rhinitis

To correlate objective assessment of nasal obstruction, as measured by acoustic rhinometry (volume of the first 5 cm of the nasal cavity) and active anterior rhinomanometry (total nasal airway resistance), with its subjective evaluation (obstruction scores). Thirty patients, aged 7 to 18 years, with persistent allergic rhinitis and thirty controls were enrolled. The obstruction score was reported for the whole nasal cavity and for each nostril separately. The three variables were measured at baseline and after induction of nasal obstruction. There were significant and negative correlations between resistance and nasal volume in all groups and scenarios, except for the most obstructed nostril, in the control group, post-obstruction. For the whole nasal cavity, there was no significant correlation between objective and subjective variables except between score and total nasal cavity volume in the control group, post-obstruction. Regarding the most obstructed nostril, we found a significant negative correlation between score and resistance and a significant positive correlation between score and volume for the total group at baseline. There were no clear differences in the correlation coefficients found in patients and controls. The correlation coefficients did not change after induction of nasal obstruction. Objective assessment of nasal obstruction did not correlate significantly with subjective evaluation for the nasal cavity as a whole, but there was a correlation for unilateral assessments. There was correlation between the objective evaluations. Allergic rhinitis and acute induction of nasal obstruction did not affect the correlation between objective and subjective assessments of nasal obstruction. Addition of an objective method for evaluation of nasal obstruction could be useful in the research setting; if no such method can be used, each nostril should be evaluated separately.

Nasal dysfunction induced by chlorinate water in competitive swimmers

Swimmers commonly complain of nasal symptoms probably due to mucosal irritation caused by chlorinated water. The aim of the present prospective study was to investigate changes in nasal function and cytology in a cohort of 15 volunteer competitive swimmers, as compared with a control group of 15 competitive athletes practicing other sports. Olfactory threshold for n-butanol was measured in a population of competitive swimmers. Changes in nasal function and cytology were compared between the two groups of volunteer competitive athletes. There were no significant differences between the two groups in terms of mean 20-Item Sino-Nasal Outcome Test scores, peak nasal inspiratory flow, pulmonary peak expiratory flow, or total nasal resistance on anterior active rhinomanometry. Nasal mucociliary transport time (MCTt) was significantly shorter for the non-swimmers than for the swimmers. The mean olfactory threshold for n-butanol in the swimmers was significantly lower than in the other group of athletes. Data seem to confirm the utility of MCTt in studying nasal mucosa damage caused by chlorinated water. The present results also support the hypothesis of a role for the olfactory threshold in evaluating damage to the olfactory mucosa exposed to chlorinated water.

Modeling Nasal Physiology Changes due to Septal Perforations

Objective: Some surgical procedures intentionally create asymptomatic septal perforations or inadvertently produce problematic ones. The purpose of this study is to use computational fluid dynamics (CFD) technology to help providers understand 1) how septal perforations alter nasal physiology, and 2) how this is influenced by perforation size and location. Method: Septal perforations of 1 and 2 cm were virtually created in a nasal cavity digital model in anterior, posterior, and superior (similar to a modified Lothrop procedure) locations. CFD technology was used to analyze airflow, conditioning, and wall shear stress. Results: Total nasal resistance was not significantly altered by septal perforations. Airflow allocation changed, with more airflow through the lower-resistance nasal cavity. This effect was less in the superior perforations compared to the other locations. There was less localized heat and moisture fluand wall shear stress in superior perforations compared to those in anterior or posterior locations. For anterior perforations, larger size (2 cm) correlated with 59% higher velocity and 22% greater wall shear, while the reverse relationship was seen in posterior perforations, with 5% higher velocity and 29% greater wall shear in the smaller perforation (1 cm). Conclusion: Septal perforations may alter nasal physiology. Airflow allocation is changed as air is shunted through the perforation to the lower-resistance nasal cavity. Superior perforations cause less alteration in nasal physiology than those in other locations. Larger anterior and smaller posterior perforations cause greater alterations in velocity and wall shear.

Daytime Sleepiness and Sleep in Allergic Rhinitis

Objective: Over 20 million people in Japan suffer from hay fever caused by cedar pollen, and every year, they are disturbed with severe symptoms during a season of just 2 to 3 months. Clinically, there is a big problem with quality of life, including daytime sleepiness and sleep problems. Method: To clarify the influence of hay fever on sleep and daytime sleepiness subjectively, 22 patients with hay fever caused by cedar pollen were enrolled. We evaluated sleep architecture and objective sleepiness before the season and during the season using PSG and MSLT. Results: Wake time after onset (WASO) showed significant increase during the season compared to before the season: from 16.4 to 29.7 min. AHI does not change for the worse during the season. In 11 patients with nasal obstruction, total nasal resistance was &gt;0.3pa/cm/sec, out of 22, rate of REM-sleep decreased (from 24.2 to 20.8%), and mean MSLT decreased (from 12.4 to 8.5 min) significantly. Especially 4 out of 11 showed severe sleepiness that was recognized as disease (MSLT &lt;5 min) during the season. Conclusion: There are strong associations between nasal symptoms, especially nasal obstruction, sleep quality, and daytime sleepiness.

Rinomanometria ed espansione palatale: studio clinico prospettico. Dati preliminari

ObjectivesTo evaluate the effect of palatal expansion on nasal airway resistance in patients with maxillary transversal constriction using rhinomanometry. Materials and methodsTwenty patients (12 females and 8 males) aged 7–11 years with monolateral or bilateral crossbite or with transversal maxillary constriction without crossbite, underwent rhinomanometric examination before (T0) and 9 months after rapid palatal expansion (T1). Total airway flow and nasal resistance were assessed during inspiration and expiration. ResultsNasal airway resistance decreased significantly after rapid maxillary expansion (P<.05). ConclusionsRhinomanometric examination detects an improvement in nasal resistance after rapid palatal expansion.