Nasal obstruction during development leads to defective synapse elimination, hypersynchrony, and impaired cerebellar function.

Nasal respiratory disorders are linked to craniofacial anomalies and systemic dysfunctions. However, the implications of nasal respiratory disorders on brain development and their subsequent impact on brain functionalization remain largely unknown. Here, we describe that nasal obstruction from postnatal developmental stages in mice precipitates deficits in cerebellum-associated behaviors and compromised refinement and maturation of neural circuits in the cerebellum. We show that mice with nasal obstruction during developmental phases exhibit marked impairments in motor function and exhibit increased immobility time in forced swimming test. Additionally, we identified critical periods during which nasal respiration is essential for optimizing motor function and preserving mental health. Our study also reveals that nasal obstruction in mice disrupts the typical developmental process of synapse elimination in the cerebellum and hinders the normal transition of activity patterns in cerebellar Purkinje cell populations during development. Through comparing activity patterns in mouse models subjected to nasal obstruction at various stages, we suggest that the maturation of specific activity pattern among Purkinje cell populations is fundamental to the functional integrity of the cerebellum. Our findings highlight the indispensable role of adequate nasal respiration during development for the establishment and functional integrity of neural circuits, thereby significantly affecting brain function.

Effects of unilateral nasal obstruction on mandibular condyle in mice of different ages: An exploration based on H-type angiogenesis coupling osteogenesis.

Nasal obstruction leads to a hypoxia condition throughout the entire body. In this study, the unilateral nasal obstruction (UNO) mouse model was established by blocking the left nostril of mice. The aim of this study was to investigate the effects of UNO-induced hypoxia on mandibular condyle in juvenile (3-week-old), adolescent (6-week-old) and adult (12-week-old) male C57BL/6J mice from the perspective of H-type angiogenesis coupling osteogenesis. Firstly, UNO exerted a significant inhibitory effect on weight gain in mice of all ages. However, only in adolescent mice did UNO have an obvious detrimental effect on femoral bone mass accrual. Subsequently, micro-computed tomography (CT) analysis of mandibular condylar bone mass revealed that UNO significantly retarded condylar head volume gain but increased condylar head trabecular number (Tb.N) in juvenile and adolescent mice. Furthermore, UNO promoted the ratio of proliferative layer to cartilage layer in condylar cartilage and facilitated the chondrocyte-to-osteoblast transformation in juvenile and adolescent mice. Moreover, although UNO enhanced the positive expression of hypoxia-inducible factor (HIF)-1α in the condylar subchondral bone of mice in all ages, an increase in H-type vessels and Osterix+ cells was only detected in juvenile and adolescent mice. In summary, on the one hand, in terms of condylar morphology, UNO has a negative effect on condylar growth, hindering the increase in condylar head volume in juvenile and adolescent mice. However, on the other hand, in terms of condylar microstructure, UNO has a positive effect on condylar osteogenesis, promoting the increase of condylar Tb.N, chondrocyte-to-osteoblast transformation, HIF-1α expression, H-type angiogenesis and Osterix+ cells in juvenile and adolescent mice. Although the changes in condylar morphology and microstructure caused by UNO have not yet been fully elucidated, these findings improve our current understanding of the effects of UNO on condylar bone homeostasis.

Changes in Craniofacial Morphology Induced by Unilateral Nasal Obstruction in Mice of Different Ages.

BACKGROUND: Nasal obstruction in humans leads to mouth breathing and subsequent hypoxia in the entire body. Furthermore, nasal obstruction in growing children affects craniofacial growth and development. OBJECTIVE: To investigate the effects of unilateral nasal obstruction (UNO) on craniofacial growth in mice of different ages, particularly on the morphology of the nasomaxillary complex and mandible. METHODS: Mice aged 3, 6 and 12 weeks were selected as representatives of juvenile, adolescent and adult stages, respectively. A total of 30 male C57BL/6J mice (10 mice each at the ages of 3, 6 and 12 weeks) were used in this study for a 3-week experiment. The mice in each age stage were randomly and evenly assigned to either the control group (C3+3, C6+3 and C12+3) or the experimental group (E3+3, E6+3 and E12+3). The UNO model in experimental group was constructed by plugging the mouse's left nostril, thereby disrupting its normal nasal breathing pattern and inducing hypoxia. The control group underwent the sham procedure. After 3 weeks, the length, width and height of the cranium, nasomaxillary complex and mandible of each group were measured on two-dimensional images constructed by micro-computed tomography. Furthermore, the impact of UNO on mouse growth was evaluated through the measurement of femoral length. RESULTS: In juvenile mice, UNO inhibited the growth of cranial width, cranial height and mandibular length. In adolescent mice, UNO impeded the growth of the femoral length, cranial length, nasomaxillary length and mandibular length. In adult mice, no significant negative effects of UNO on craniofacial growth were found. CONCLUSION: Referring to the experimental results, in addition to actively treating nasal obstruction in patients, it is important to monitor the growth of the mandible in juveniles, as well as the nasomaxillary and mandibular growth in adolescents during orthodontic clinical practice.

Retrospective evaluation of radiofrequency volumetric tissue reduction for hypertrophic turbinates in dogs with brachycephalic obstructive airway syndrome.

OBJECTIVE: The objective of this study was to retrospectively assess the effect of Radiofrequency Volumetric Tissue Reduction (RFVTR) on hypertrophic turbinates and clinical outcome in brachycephalic dogs when included in multi-level surgery (MLS). STUDY DESIGN: Clinical retrospective multicenter study. ANIMALS: 132 client-owned brachycephalic dogs. METHODS: 132 brachycephalic dogs with high-grade Brachycephalic Obstructive Airway Ayndrome (BOAS) and hypertrophic turbinates were treated with RFVTR as part of MLS of the upper airways. Intranasal obstruction was evaluated by computer tomography (CT) and antero-/retrograde rhinoscopy before and 6 months after RFVTR. The clinical records, the CT images and the rhinoscopy videos were reviewed and clinical evolution was evaluated using a standardized questionnaire. The data was scored semi-quantitatively. RESULTS: In this study, 132 patients were included for a follow-up period of 120 weeks. RFVTR resulted in minor complications, including serous nasal discharge within the first postoperative week in all dogs, and intermittent nasal congestion between 3-8 weeks after treatment in 24.3% of the patients. Rhinoscopy and CT follow-ups were available for 33 patients. Six months after treatment intranasal airspace was increased (p = 0.002) and the presence and overall amount of mucosal contact points was reduced (p = 0.039). CONCLUSION: MLS with RFVTR led to a significant reduction in turbinate volume at the 6-month follow-up examination and significant clinical improvement over a long-term period of 120 weeks. This suggests the viability of RFVTR as a turbinate-preserving treatment for intranasal obstruction in dogs with BOAS. CLINICAL SIGNIFICANCE: RFVTR is a minimally invasive turbinoplasty technique for intranasal obstruction in dogs with BOAS and can be included in MLS without increasing complication rates.

Biochemical Variability of Nasal Cartilages: Implications in Functional Rhinoplasty.

INTRODUCTION: Nasal valve compromise is a common issue for patients presenting to an otolaryngologist. Anatomically, the dorsal septal cartilage (DSA) articulates with the upper lateral nasal cartilage (ULC). When the ULC weakens, it is prone to collapse and may result in nasal obstruction. Our objectives were to analyze histological differences between quadrangular and DSA nasal cartilages and compare histological composition of these tissues among patients with diagnosis of nasal valve compromise (NVC) versus those without NVC (no NVC). METHODS: Prospective cross-sectional study of nasal cartilages from seventy-three (73) live donors. Quadrangular cartilage (QC), and DSA from patients undergoing septorhinoplasty were collected. Safranin O histochemical staining was used to observe glycosaminoglycans (GAGs) content and cell count. Masson's Trichrome staining was used to assess collagen content in these nasal cartilages. RESULTS: Mean GAG content was lower in DSA compared with QUAD cartilage (68.18% vs. 87.22%, p < 0.0001), and was lowest in DSA of patients with NVC (59.07%). Mean collagen content was higher in DSA compared with QUAD cartilage, (65.43% vs. 46.65%, p = 0.0002), and was highest in DSA of patients with NVC (74.86%). CONCLUSION: The DSA showed decreased GAG and increased collagen content compared with quadrangular cartilage. Within the DSA subsite, patients with presurgical NVC had the lowest GAG and highest collagen levels. This observation suggests that the biochemical composition of the DSA may contribute to its weakening, potentially resulting in its inability to withstand minor trauma and/or the effects of aging, ultimately leading to NVC. LEVEL OF EVIDENCE: N/A Laryngoscope, 134:4252-4258, 2024.

Juvenile trabecular ossifying fibroma of the inferior turbinate.

Nasal obstruction is a commonly reported issue in the Otorhinolaryngology Outpatient Department. In this case, an early adolescent boy with a long-standing problem of right-sided nasal obstruction since childhood sought consultation. Diagnostic nasal endoscopy revealed a deviation of the nasal septum to the left, coupled with right inferior turbinate hypertrophy, all overlying healthy mucosa. A CT scan of the nose and paranasal sinuses further identified a bony hyperdense lesion with ground glass attenuation, confined to the right inferior turbinate. Subsequent biopsy confirmed juvenile trabecular ossifying fibroma (JTOF). The patient underwent endoscopic right medial maxillectomy, and the final histology affirmed the diagnosis of JTOF.

Nasal chondromesenchymal hamartoma (NCMH): a rare DICER1-associated tumour in an adult male.

An adult male presented to the ENT clinic with a 1-year history of unilateral nasal blockage. He had presented to another institution 5 years previously with the same issue, undergoing resection of what was reported to be a benign inflammatory polyp with osseous metaplasia. Detailed examination revealed a large mass filling the left nasal cavity. Excisional biopsy and secondary specialist review of pathology revealed nasal chondromesenchymal hamartoma (NCMH) with associated DICER1 mutations. NCMH is a rare, benign tumour of the sinonasal tract, presenting more often in the early childhood, with symptoms related to the site and extent of the tumour. As highlighted in this case, complete excision is mandatory for definitive diagnosis and treatment of NCMH, and an awareness of the association with DICER1 mutation, which can predispose individuals to a range of neoplasia, is key to providing appropriate genetic counselling.

Exploring the influence of nasal vestibule structure on nasal obstruction using CFD and Machine Learning method.

Motivated by clinical findings about the nasal vestibule, this study analyzes the aerodynamic characteristics of the nasal vestibule and attempt to determine anatomical features which have a large influence on airflow through a combination of Computational Fluid Dynamics (CFD) and machine learning method. Firstly, the aerodynamic characteristics of the nasal vestibule are detailedly analyzed using the CFD method. Based on CFD simulation results, we divide the nasal vestibule into two types with distinctly different airflow patterns, which is consistent with clinical findings. Secondly, we explore the relationship between anatomical features and aerodynamic characteristics by developing a novel machine learning model which could predict airflow patterns based on several anatomical features. Feature mining is performed to determine the anatomical feature which has the greatest impact on respiratory function. The method is developed and validated on 41 unilateral nasal vestibules from 26 patients with nasal obstruction. The correctness of the CFD analysis and the developed model is verified by comparing them with clinical findings.

Sphenochoanal polyps.

Nasal polyps are a common aetiology for persistent nasal obstruction. While antrochoanal polyps predominate the literature, the lesser known sphenochoanal polyp is equally as bothersome. To our knowledge, no prior dedicated review exists that characterises the patient population affected by this disease. We present a case and associated literature review over the past 30 years on the patient demographics and treatment of sphenochoanal polyps. A total of 88 cases were identified. Of the published cases, 77 were included in our search as patient characteristics were available. The age ranged from 2 to 80 years old. There were 35 female and 42 male patients. Only 58 studies established laterality, with the polyps originating from the left in 32 cases, right in 25 and bilateral in 1 case. Sphenochoanal polyps occur in all ages, nearly even distribution across sex. Endoscopic removal is safe with favourable outcomes.

Cirugía de cornetes inferiores en población pediátrica: ¿Cómo, cuándo y por qué? / Inferior turbinate surgery in pediatric population: How, when and why?

La hipertrofia de cornetes inferiores representa una de las principales causas de obstrucción nasal en pacientes pediátricos. En estudios recientes se ha observado un aumento significativo de esta patología en niños que no responden a terapia médica. La evidencia disponible recomienda la cirugía como tratamiento de elección en la obstrucción nasal refractaria en niños con cornetes hipertróficos. Sin embargo, hasta la fecha no existen criterios formales de derivación a cirugía en la población pediátrica y los estudios en infantes son limitados. Al mismo tiempo, la falta de consenso no ha permitido recomendar una técnica quirúrgica en estos pacientes por sobre otras. Por lo tanto, se hace necesario profundizar las diferentes alternativas disponibles, considerando y optando por aquellas que presenten mayores beneficios y menor riesgo de complicaciones. En la presente revisión se estudió la evidencia disponible hasta el momento sobre este tema en la población pediátrica y además se realizó un análisis de la efectividad y complicaciones de las diferentes técnicas disponibles.

Inferior turbinate hypertrophy represents one of the leading causes of nasal obstruction in pediatric patients. Recent studies have observed a significant increase in turbinate hypertrophy in children that does not respond to medical treatment. The latest evidence recommends inferior turbinoplasty for treating nasal obstruction in children with hypertrophic turbinates. However, until today there are no formal criteria for referral to surgery in the pediatric population, and studies in children are limited. At the same time, the absence of consensus has not allowed the recommendation of one surgical technique over others in these patients. This is why it is necessary to deepen the available alternatives and choose those with more significant benefits and a lower risk of complications. In this review, we study available evidence about this topic in the pediatric population and analyze the effectiveness and complications of different known techniques.

Primary Aneurysmal Bone Cyst of Nasal Cavity and Sinuses in a Child: Case Report and Literature Review.

INTRODUCTION: Aneurysmal bone cysts (ABCs) are a rare benign bone lesion, which are divided into primary and secondary categories, and occur mainly in the vertebra and the long tubular bones. Primary ABCs in the nasal cavity and the sinuses are rare. CASE PRESENTATION: We reported on a one-year-old boy who suffered from progressive nasal obstruction and intermittent nosebleeds over a period of approximately 1 month. The patient had no history of trauma or surgery. Physical examination showed a red tumor in his right nasal cavity. A magnetic resonance imaging scan showed a multicystic lesion arising from the ethmoid sinus. The lesion was resected under a nasal endoscope without any complications. Histological evaluation confirmed that the lesion was an aneurysmal bone cyst. Because an osteoma was found during the surgery on the cyst, the lesion was considered secondary clinically. However, fluorescence in situ hybridization testing showed a rearrangement of the USP6 (ubiquitin-specific protease 6) oncogene on chromosome 17. No recurrence was observed after 1 year. CONCLUSION: An ABC of the nasal cavity and sinuses in such a young child is very rare and needs to be further analyzed according to postoperative pathology and combined with a genetic examination to make a diagnosis. Endoscopic sinus surgery is an effective method of treatment for this kind of disease.

Eosinophilic angiocentric fibrosis of the sinonasal tract: a case report and review of the literature.

Eosinophilic angiocentric fibrosis (EAF) is a rare chronic benign disorder of unknown etiology and is characterized by submucosal thickening and fibrosis in the upper respiratory tract. In this report, we describe a case of EAF in the nasal cavity of a woman who underwent elective surgery for division of adhesions and has had no recurrence during 2 years of postoperative follow-up. A review of the literature on the clinical manifestations of EAF, sites of lesions, management, and outcomes identified 48 articles that included 72 cases. A summary of these reports is presented, including our present case. The most common anatomic site involved was the nose (77.8%), the most common manifestation was nasal obstruction (66.7%), and the most common treatment modality was surgical resection (83.3%). After surgery, 36% of patients remained free of EAF. The most common pharmacologic agent used was a corticosteroid (38.9%).

Eosinophilic Angiocentric Fibrosis of the Nasal Cavities: A Report of an Uncommon Lesion with Emphasis on the Etiology and Differential Diagnosis.

Background and Objectives: Eosinophilic angiocentric fibrosis (EAF) is an indolent but sometimes locally destructive lesion with a predilection for the sinonasal tract. Although it was first described in 1983, its etiology remains unknown. Some authors initially attributed EAF to trauma, hypersensitivity, and/or surgical manipulation, while it has been recently suggested to include EAF within the spectrum of IgG4-related systemic diseases. Materials and Methods: We report an uncommon case of idiopathic EAF in a 76-year-old male who developed two bilateral tumefactive masses in the nasal cavities. Results: As the histological examination showed a subepithelial proliferation of fibroblasts along with sclero-hyaline fibrosis around small-sized vessels (an "onion skin-like" pattern) and an eosinophils-rich inflammatory infiltrate, a diagnosis of EAF was rendered. The differential diagnosis included granuloma faciale, Wegener's granulomatosis, and Churg-Strauss syndrome. Conclusions: Pathologists should be aware of the possibility that this lesion can be part of the wide spectrum of IgG4-related systemic diseases by performing IgG4 investigations to assess adherence to IgG4-related systemic disease criteria.

Cirugía asistida por radiofrecuencia en hipertrofia de cornete inferior / Radiofrequency-Assisted Surgery in Inferior Turbinate Hypertrophy

CONTEXTO CLÍNICO: La obstrucción nasal crónica es uno de los motivos más frecuentes de consulta en otorrinolaringología, la cual se manifiesta como sensación de flujo aéreo insuficiente por la nariz.1 Entre las causas más frecuentes se encuentran las deformaciones del tabique nasal y la enfermedad de la mucosa nasal asociada a hipertrofia de cornetes.2 La estructura interna de la nariz está formada por el tabique nasal, la válvula nasal interna y externa, y la pared nasal lateral. Esta última consta de los cornetes superior, medio e inferior. Estos son estructuras compuestas por mucosa y hueso esponjoso las cuales se encuentran recubiertas a su vez por una membrana mucosa. Su función es calentar, humidificar y filtrar el aire inspirado previo a su ingreso a los pulmones. Ante los cambios de temperatura, humedad y/o exposición a alérgenos, los cornetes modifican su tamaño expandiéndose o contrayéndose.3 Los extremos anteriores de los cornetes inferiores frecuentemente se hipertrofian como resultado de esta exposición produciendo obstrucción nasal debido a la invasión de la valva nasal. Existen diferentes métodos para evaluar el grado de obstrucción nasal. Un instrumento objetivo es el uso de rinomanometría anterior la cual mide la presión diferencial entre las porciones anterior y posterior de la nariz.4 Esta evaluación puede identificar cualquier aumento en la impedancia de la mucosa nasal causada por la obstrucción nasal, pero no puede localizar el sitio de la obstrucción intranasal. Para una mayor precisión, debe aplicarse simultáneamente con la rinomanometría acústica lo que permite identificar una obstrucción topográfica. Es un método rápido y no invasivo y se ha convertido en el método de primera línea para confirmar la ubicación y el nivel de la obstrucción nasal.4 El objetivo del tratamiento es reducir la obstrucción nasal y restaurar una respiración nasal confortable. El tratamiento inicial incluye antihistamínicos orales, descongestivos tópicos y/o corticoesteroides intranasales tópicos.5 Cuando el manejo conservador falla luego de un período adecuado de tratamiento (como regla general se consensuó en tres meses), está indicado el tratamiento quirúrgico. Abdullah y col. plantean dos tipos de técnicas quirúrgicas como tratamiento de la hipertrofia de cornete inferior: sin o con preservación de la mucosa.3 Aquella cirugía que no preserva la mucosa es la turbinectomía convencional (parcial o total). La técnica que preserva la mucosa es la turbinoplastía. La turbinectomía implica la remoción completa o parcial del cornete inferior según el grado de hipertrofia e incluye la remoción de la mucosa del cornete y el hueso. El abordaje se realiza mediante visualización directa o a través de un endoscopio y utiliza una tijera en ángulo a lo largo de su inserción en la pared nasal lateral. La turbinoplastía, también denominada resección submucosa, implica la remoción de la porción obstructiva no funcional del cornete mientras que preserva la mucosa medial funcional, la cual juega un rol clave en el calentamiento y humidificación del aire en su pasaje por las fosas nasales. Las complicaciones asociadas a estos procedimientos pueden ser desde formación de costras, goteo post nasal y sangrado hasta rinitis atrófica y síndrome de nariz vacía en el caso de tubinectomías totales. El síndrome de nariz vacía se caracteriza por obstrucción nasal paradojal en la presencia de una cavidad nasal amplia y permeable. Tanto la turbinectomía como la turbinoplastía pueden realizarse asistidas por diferentes métodos.3 En la turbinectomía asistida con láser se utilizan láseres de diodo y CO2 para realizar la reducción del cornete inferior.8 Esta técnica permite un corte preciso y una adecuada hemostasia durante el procedimiento. En la turbinectomía con electro cauterización se utiliza una corriente eléctrica para cauterizar la mucosa del cornete.9,10 La crioturbinectomía utiliza nitrógeno líquido u óxido nitroso como agente de enfriamiento e induce necrosis por congelamiento del cornete. La turbinectomía asistida por radiofrecuencia (RF) realiza la escisión del cornete inferior mediante una sonda de radiofrecuencia. TECNOLOGÍA: La radiofrecuencia utiliza un sistema bipolar para destruir el tejido submucoso y consecuente fibrosis, lo que produce reducción del volumen del cornete.10,12,13 Esto se realiza a temperaturas más bajas que la electro cauterización (40°C a 70°C) logrando una menor disipación del calor y menor daño de la mucosa funcional subyacente, preservándose la función mucociliar de la misma. La corriente alterna del electrodo, sin embargo, induce agitación iónica a nivel celular con la consiguiente vaporización de parte del tejido y crea una lesión térmica. Se aplica mediante una sonda la cual se introduce en la porción superior del cornete inferior, paralelo al hueso. Se repite el procedimiento en la parte medial del cornete y si está indicado, en el tercio posterior de los cornetes nasales. Si se requiere, se pueden indicar analgésicos comunes luego de la intervención y se debe informar a los pacientes que en los días inmediatamente posteriores se puede producir un aumento de la obstrucción, la cual habitualmente cede espontáneamente. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de cirugía asistida por radiofrecuencia para pacientes con hipertrofia de cornete inferior. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: Se incluyeron dos ECAs, dos RS, dos GPC, y seis informes de políticas de cobertura de cirugía asistida por radiofrecuencia en pacientes con hipertrofia de cornete inferior. CONCLUSIONES: Evidencia de moderada calidad muestra que la cirugía asistida por radiofrecuencia en pacientes con hipertrofia de cornete inferior probablemente produce un beneficio neto menor dada su mejoría leve en la eficacia y seguridad en comparación con otras cirugías convencionales. Evidencia de moderada calidad muestra que la cirugía asistida por radiofrecuencia en pacientes con hipertrofia de cornete inferior probablemente sea inferior que la cirugía asistida por microdebridación, con menor eficacia en resultados objetivos y subjetivos (beneficio neto "negativo"). En términos de seguridad, la cirugía asistida por radiofrecuencia presentaría una menor tasa de eventos adversos. Actualmente en Argentina la microdebridación no es un procedimiento de uso rutinario. Se encontró una única guía de práctica clínica, de Turquía, que menciona a la cirugía de cornetes asistida por radiofrecuencia como posible opción terapéutica en pacientes con hipertrofia de cornetes y rinitis alérgica. El financiador público del Reino Unido, Australia y un financiador privado de Estados Unidos de Norteamérica, brindan cobertura a la cirugía de cornetes asistida por radiofrecuencia. El resto de los financiadores públicos o privados relevados, así como otras guías de práctica clínica relevadas, no mencionan la tecnología. No se encontraron evaluaciones económicas locales ni internacionales acerca de la costo-efectividad o impacto presupuestario de la cirugía de cornetes asistida por radiofrecuencia en esta indicación.

The Virtual Nose: Assessment of Static Nasal Airway Obstruction Using Computational Simulations and 3D-Printed Models.

Background: The use of virtual noses to predict the outcome of surgery is of increasing interests, particularly, as detailed and objective pre- and postoperative assessments of nasal airway obstruction (NAO) are difficult to perform. The objective of this article is to validate predictions using virtual noses against their experimentally measured counterpart in rigid 3D-printed models. Methods: Virtual nose models, with and without NAO, were reconstructed from patients' cone beam computed tomography scans, and used to evaluate airflow characteristics through computational fluid dynamics simulations. Prototypes of the reconstructed models were 3D printed and instrumented experimentally for pressure measurements. Results: Correlation between the numerical predictions and experimental measurements was shown. Analysis of the flow field indicated that the NAO in the nasal valve increases significantly the wall pressure, shear stress, and incremental nasal resistance behind the obstruction. Conclusions: Airflow predictions in static virtual noses correlate well with detailed experimental measurements on 3D-printed replicas of patient airways.

Congenital Nasal Pyriform Aperture Stenosis: Successful Management of Restenosis After Primary Surgery by Stent Placement.

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare anomaly causing respiratory distress in newborns. While the primary surgical technique is well established, the timing of the removal of the stents and the management of restenosis remain a matter of debate. We report a case of a female newborn affected by CNPAS with the recurrence of respiratory distress after primary surgery due to the early removal of nasal stents, causing an overgrowth of granulation tissue. This report notes that restenosis was successfully managed by repeating the procedure over a 14-day period, with soft polyvinyl chloride uncuffed tracheal tubes acting as nasal stents.

Primary Heterotopic Meningioma of Nasal Cavity: Case Report and Literature Review.

Primary heterotopic meningiomas are lesions that are not associated with a cranial nerve foramen, vertebral canal, or intracranial structure. The most common histopathological subtype is meningeal epithelioma. In clinical practice, primary heterotopic nasal meningioma occurs relatively rarely, and its most common pathological type is psammomatous meningioma, whereas nasal fibrous meningioma is infrequent. In our case, a 31-year-old male patient was admitted to the hospital with "progressive nasal obstruction on the right side for half a year." Computed tomography examination of the paranasal sinuses revealed a polyploid mass in the right nasal cavity. The patient underwent surgical resection of the mass under nasal endoscopy. Histopathological examination confirmed that the mass was an ectopic meningioma of the nasal cavity. The patient was regularly followed up for 2 years without recurrence of the tumor. Primary heterotopic fibrous meningioma of the nasal cavity is clinically rare but should be considered as a differential diagnosis for hemangioma of the nasal cavity, inverted papilloma, and nasal polyp. The final diagnosis is based on pathology and immunohistochemistry analysis results.

Using thermal effect of 970 nm diode laser to reduce nasal swell body.

In recent decades, semiconductor lasers have been successfully used in rhinology. However, their usage in the reduction of the nasal swell body (NSB) is barely studied. Our research aimed to conduct an experimental selection of the laser exposure mode in the NSB zone using a 970 nm diode laser for safe and effective NSB reduction. The thermometric parameters of a diode laser with a wavelength of 970 nm were evaluated in a continuous contact mode of exposure at the power from 2 W to 10 W with 2 W step. The laser was targeted at the liver of cattle, given its similar optical properties to the NSB region. After a series of experiments with every power rate and the analysis of temperature data, we estimated an optimal exposure mode at a power of 4 W. The collected thermometric data demonstrate the safety of this mode in a clinical setting for NSB reduction due to causing no thermal damage to the adjacent tissue. Based on the experiment, a technique for laser reduction of the NSB was developed to improve nasal breathing in patients with severe hypertrophy of this area. The proposed technique was applied to 39 patients with chronic vasomotor rhinitis and the NSB. All patients were divided into 2 groups. Group 1 consisted of 20 patients who underwent surface contact laser-turbinectomy and the NSB reduction using a 970 nm diode laser. Group 2 included 19 patients with the same pathology who underwent laser-turbinectomy, without reduction of the NSB. No statistically significant difference was observed during the dynamic observation with an objective assessment of nasal respiration according to active anterior rhinomanometry when comparing these subgroups with each other according to the t-criterion for independent samples (p > 0.05). As a result of comparing the data obtained on the NOSE scale using the Student's t-test, a statistically significant difference is observed (p < 0.001). Thus, patients who did not perform the reduction of the NSB subjectively noted the insufficiency of nasal breathing. This fact indicates that the NSB is involved in the regulation of airflow.

Laterality and severity of nasal obstruction does not correlate between physicians and patients, nor among physicians.

BACKGROUND: Nasal obstruction is a common patient complaint and has a variety of etiologies, and a specific anatomical abnormality can often be found within the nasal cavity on physical examination. In practice, this observed pathology does not always correlate with the laterality, severity, and exact intranasal site of the patients' perceived obstruction. OBJECTIVES: We seek to answer the following questions: 1) Does a physician's evaluation of nasal obstruction correlate with subjective patient complaints? 2) Is there reasonable correlation between physicians of similar training in the routine evaluation of nasal obstruction? METHODS: First, we asked patients presenting to the otolaryngology clinic with a primary complaint of nasal obstruction to fill out a modified NOSE survey. Nasal endoscopy was performed on all subjects to assess all potential sites of obstruction. We then determined whether there is an association between patient complaints and findings on physical examination. Second, we determined if there is correlation between similarly trained physicians in their interpretation of a basic nasal examination. Otolaryngologists were shown a series of standardized videos of an endoscopic nasal examination that were recorded with a primary complaint of nasal obstruction. Findings were reported in an anonymous online survey focusing on laterality, severity, and specific site of perceived obstruction. RESULTS: A total of 38 patients were included in the first part of the study. The Cohen's kappa coefficient was used to determine the interrater agreement between the patient and physician in the degree of nasal obstruction. The kappa coefficient was 0.03 (p value 0.372) for the comparison of the left-sided scores (fair agreement), and 0.16 (p value 0.014) for the right-sided scores (slight agreement). A comparison was also done between the side of the nose the patient felt was most obstructed to the most obstructed side found on physical exam by the otolaryngologist. Thirteen of the 38 patients (34%) had perceived nasal obstruction on the opposite side of that noted to be most obstructed on physical exam. Despite this, the kappa coefficient in this comparison was 0.43 (p value <0.001) revealing moderate agreement between the two groups. Seventeen otolaryngologists participated in the second part of the study. Data extrapolated revealed very little agreement among the physicians in reporting which side of the nose was most obstructed, what anatomical structure contributed to the obstruction the most, and what percentage obstruction was present. DISCUSSION: Based on our findings, patients can reasonably determine based on their symptoms which side is most obstructed, but symptoms do not correlate with severity of obstruction when compared to physical exam. There is also very little consistency between otolaryngologists in their assessment of the degree of nasal obstruction on exam. The results of this study may have far-reaching implications for patient management, surgical intervention, and medicolegal documentation as it relates to the current surgical treatment of nasal obstruction.