Is There a Relationship Between Snoring Sound Intensity and Frequency and OSAS Severity?

OBJECTIVES: We investigated the relationship between snoring sounds and severity of obstructive sleep apnea syndrome (OSAS). METHODS: A total number of 103 snoring patients (60 males and 43 females) were evaluated by means of polysomnographic findings and snoring sound recordings. Snoring sound intensity was assessed using fast Fourier transform (FFT) method by measuring maximal frequency (Fmax) and average snoring sound intensity level (SSIL). RESULTS: Maximal frequency and SSIL are correlated with apnea-hypopnea index (AHI), REM AHI, and severity of the OSAS. So, as the severity of the OSAS increased, so did the Fmax and SSIL of the snoring recordings, meaning patients started snoring louder with more frequency. In older patients, in females, in severe OSAS group, and in patients with higher body mass index (BMI), AHI and AHI REM values and SSIL and Fmax values increased. As mean oxygen (O2) saturation and lowest O2 saturation decreased, SSIL and Fmax values increased. CONCLUSION: Maximal frequency and SSIL analysis of the snoring sound increased in severe OSAS patients. People should be aware of the importance of snoring sounds. In particular, patients with snoring sounds increasing in intensity and of higher frequency should discuss with their physicians the possibility of OSAS.

Telephonic analysis of the snoring sound spectrum.

OBJECTIVE: Snoring is a sound caused by vibration of collapsed and/or unsteady airway walls of the pharynx and soft palate. We compared stored spectra of snoring sounds recorded via cell phone (CP) and a microphone placed over the head (head phone [HP]). METHODS: Thirty-four snoring patients were included in this prospective study. Groups were identified by reference to body mass index (BMI) values: group 1, BMI < 25 kg/m² (n = 8); group 2, BMI 25 to 29 kg/m² (n = 10); and group 3, BMI ≥ 30 kg/m² (n = 16). Snoring sounds were recorded using CPs and HPs and digitally analyzed. We identified the frequencies with the highest snoring powers (F(max) values) and snoring sound intensity levels (SSILs). RESULTS: F(max) ranged from 520 to 985 Hz in HP recordings and from 845 to 1645 Hz in CP recordings. Snoring sound intensity level values increased in proportion to BMI and were 6 to 24 dB in HP recordings and 19 to 52 dB in CP recordings. Thus, the CP values of F(max) and SSIL were higher than the HP values. In obese patients of group 3, almost all F(max) and SSIL values were higher than those of groups 1 and 2. In particular, the CP F(max) values were elevated in such patients. The advanced technologies used in modern CPs may allow some snoring sounds in susceptible individuals to be defined as oronasal. CONCLUSION: Cell phone technology allows snoring to be evaluated in patients located in areas remote from a hospital. To explore the intensity of snoring and to postoperatively monitor the efficacy of surgery used to treat snoring, telephonic sound analysis is both new and effective and reduces the need for patient attendance at a hospital. Those experiencing severe snoring and/or who are obese should be told of what can be done to solve such problems.

Nasal expiratory sound analysis for evaluation of nasal patency in perennial allergic rhinitis patients treated with nasal corticosteroids.

PURPOSE: To assess the efficacy of nasal expiratory sound analysis in determining the degree of nasal obstruction. MATERIALS AND METHODS: We have analyzed and recorded the expiratory nasal sounds in 18 healthy controls and in 30 patients with inferior turbinate hypertrophy before and after the administration of nasal corticosteroid treatment. Analysis consisted of the time-expanded waveform, spectral analysis with time-averaged fast Fourier transform and waveform analysis of nasal sound. RESULTS: Before treatment, an increase in sound intensity at high frequency was observed in the sound analyses of the patients, whereas after treatment, a decrease in sound intensity at high frequency was noted in the sound analyses of the patients. The differences between the patients and the control group were statistically significant. Data obtained with the Odiosoft-Rhino method were correlated with symptom scores and endoscopic examination. CONCLUSION: Expiratory nasal sound is a practical and objective tool, which can be reliably used not only for the assessment of the degree of nasal blockage but also for the comparison of different treatment alternatives.

Effects of lateral osteotomy on nasal sound intensity levels in patients who underwent rhinoplasty.

We investigated the effects of lateral osteotomy on nasal sound intensity levels in 34 patients who underwent rhinoplasty. Four groups were evaluated: group 1, preoperative rhinoplasty with lateral osteotomy (Preop-RPwithLO); group 2, postoperative rhinoplasty with lateral osteotomy (Postop-RPwithLO); group 3, preoperative rhinoplasty without lateral osteotomy (Preop-RPwithoutLO); and group 4, postoperative rhinoplasty without lateral osteotomy (Postop-RPwithoutLO). By sound analysis, low-frequency (Lf; 500-1000 Hz), medium-frequency (Mf; 1-2 kHz), and high-frequency (Hf; 2-4 and 4-6 kHz) nasal sound intensities were defined. Mf-left values of Postop-RPwithLO were significantly lower than those of Preop-RPwithLO, and Mf-left values of Postop-RPwithoutLO were significantly higher than those of Postop-RPwithLO and Preop-RPwithoutLO. Hf-right values of Preop-RPwithoutLO were significantly higher than those of Postop-RPwithLO and Postop-RPwithoutLO. Hf-total values of Postop-RPwithoutLO were significantly lower than those of Preop-RPwithoutLO. Nasal airway width decreased and nasal sounds, especially Mf sound intensities, increased in the nonlateral osteotomy group (group 4). When lateral osteotomy is performed, the nasal air passage may be adjusted as required by the surgeon, the air passage in the nasal valve region may not be narrowed, and nasal sound intensities may decrease. During postoperative follow-ups, increased Mf and Lf nasal sound intensities should be considered for the narrowness of the nasal passage and lower patency of the nasal cavities. Nasal sound analysis is a noninvasive technique and can also be used to evaluate nasal patency in septoplasty and rhinoplasty patients and children and for cases in which official reports are needed in addition to acoustic rhinometry measurements.

Evaluation of nasal airway alterations associated with septorhinoplasty by both objective and subjective methods.

The aim of functional septorhinoplasty is to create an esthetically elegant nose and harmony in the face by preserving nasal function as well as maintaining or restoring adequate airway. Since nasal complaints are usually subjective, it may be difficult to evaluate the functions objectively. In the present study, we aimed to investigate the alterations in nasal function associated with septorhinoplasty by using both objective and subjective methods. The study population consisted of 40 patients who underwent septorhinoplasty and 40 healthy controls. Before and after the operation, visual analog scale, acoustic rhinometry, rhinomanometry, and Odiosoft-Rhino test were applied to all patients and controls. There were significant differences in all parameters both before and after the operation. While a significant difference was obtained between the patient and control groups in terms of preoperative values, no significant difference was found between postoperative values of these groups. Both objective and subjective methods are important in evaluations.

Assessment of the impact of altitude on nasal airflow via expiratory nasal sound spectral analysis.

The aim of the study was to evaluate the effects of high altitude (HA) on the expiratory nasal sound spectra. The design consisted of a prospective analysis. The study group consisted of 24 otorhinolaryngologists and a student (2 females, 23 males) climber of the mountain of Kackar in Rize, a city located in northeastern Turkey. The elevation of the highest peak of the Kackar Mountain is 3,937 m (12,920 ft) and that of mountain plateaus at about 3,000 m (9,800 ft). Nasal sound spectral analysis was performed on 25 subjects at 700 and 3,937 m, respectively. We found that sound intensity (dB) at high frequency (Hf) was below 18.6 dB in the subjects at low altitude, while the results were found to be above 25.1 dB in the subjects at HA during expiration. A correlation was observed between the degree of HA and 'Odiosoft-rhino' findings at Hf intervals of the subjects. At the top of the mountain, the sound intensities at low and medium frequency were observed to be significantly lower than at low altitude (p < 0.05). We concluded that Hf values of HA were significantly higher than at low altitude because of nasal congestion and also narrowing of the cross-sectional area of the nasal airway. Nasal conchal and mucosal congestion affects airflow through the nasal cavity at HA, transforming it from a laminar pattern to turbulent flow. We found significant increases in the sound intensity level at Hf in the sound spectra at HA. Awareness of the impact of HA in nasal airflow is important in the diagnosis and treatment of nasal obstruction symptoms.

Morphological adaptation of the nasal valve area to climate.

Ecogeographic variation in nasal valve angles stands as one of the best examples of human morphological adaptation to climate. A major physiological function of the nasal cavity is to condition the inhaled air to body core temperature and saturated with vapour to prevent damage to the alveolar epithelium in the lungs. The air conditioning capability of the nose is dependent on the nasal mucosal temperature and the airflow dynamics caused by the airway geometry. Morphological variation of the human nose has been attributed to the ecogeographic adaptation to climate where nasal cavities have been broadly categorised as tall and narrow (leptorrhines) or short and broad (platyrrhines) according to their morphology. We believe that there is a relationship between nasal valve angles and climate adaptation.

Web-based hearing screening test.

This article describes a Web-based hearing screening system developed for real-time application via Internet and compares efficacy with conventional screening. The present prospective study used 36 adult participants in a double-blind study of two different systems: a conventional audiometer and a Web-based hearing screening test. The audiometric thresholds assessed by these two systems varied by no more than 1.78 dB for air conduction. The results demonstrated the feasibility of this Web-based hearing screening system. This Web-based system can be used effectively and easily in many locations that have Internet access but no local audiologists. The system makes audiometric measurements easily accessible for the public by providing a cost-effective solution based on the software for testing hearing installed in local personal computers or in network servers.

Effect of nasal valve area on inspirator nasal sound spectra.

OBJECTIVE: We have researched the effects of nasal valve area on the inspiratory nasal sound spectra in this study. STUDY DESIGN AND SETTING: We have spectral analyzed and recorded the inspiratory nasal sound in 22 healthy people with and without the Cottle maneuver. RESULTS: We have found an increase in sound intensity at high frequency in the sound analyses of the subjects without the Cottle maneuver; whereas, a decrease in sound intensity at high frequency was found in subjects with the Cottle maneuver. CONCLUSIONS: The nasal valve area plays an important role in the transformation of the nasal airflow from a laminar pattern to a more turbulent one. This condition affects nasal sound spectra and produces a marked shift upward in frequencies in the spectra. This method may be a new way of evaluating the nasal valve area. EBM RATING: C-4.

Effects of body mass index and adenotonsillar size on snoring sound intensity levels at highest power.

OBJECTIVES: Snoring during sleep is a major clinical symptom of adenoid and tonsil hypertrophy in paediatric patients. The aim of this study was to determine the effects of adenoid and tonsil size on snoring sound frequency and intensity in children. METHODS: Twenty-seven patients with adenotonsillar hypertrophy were included the study. Adenoid size was graded from 1+ to 4+ by rigid endoscopy. Patients were staged (I-III) according to body mass index (BMI) and tonsil and adenoid size. Snoring was recorded and analysed. The analysis focused on the highest power frequency (Fmax) and snoring sound intensity levels (SSILs). RESULTS: SSIL and Fmax values for Stage III were significantly higher than those for Stages I and II. BMI for Stage III was higher than for Stages I and II, and that for Stage II was higher than for Stage I. The BMI, SSIL, and Fmax values increased at each stage and tonsil/adenoid grade. CONCLUSIONS: SSIL seems to be related to Adenoid and Tonsils size and BMI. As stage increased, both Fmax and SSILs increased proportionally. Also, Fmax values shifted to higher frequencies. Physicians and parents should be aware of snoring, and be informed that a higher frequency and intensity may be related to obesity and/or adenotonsillar hypertrophy. Snoring analysis may be a useful tool for detecting cases of Adenoid and Tonsils hypertrophy and/or upper airway obstruction during sleep.

The effect of an adhesive external nasal dilator strip on the inspiratory nasal airflow.

BACKGROUND: We studied the affect of an adhesive external nasal dilator strip (ENDS) on the inspiratory nasal airflow. A prospective study was performed. METHODS: Twenty-two healthy volunteers were enrolled in the study. All volunteers analyzed the inspiratory nasal sound samples before and while wearing a commercially available ENDS. This nasal sound analysis includes the spectral analysis and average sound intensities in low frequency (Lf), medium frequency (Mf), and high frequency (Hf). RESULTS: In the sound analyses, an increase was found in sound intensity at Hf when the nasal strips were not worn whereas a decrease was found in sound intensity at Hf when the nasal strips were on. CONCLUSION: Changes in the nasal geometry of the anterior part of the nose by wearing nasal strips affects the pattern of nasal airflow and transforms it into a laminar pattern.

A new surgical method of dynamic nasal valve collapse.

OBJECTIVE: To describe a technique for internal nasal valve collapse using radiofrequency-induced thermotherapy (RFITT). DESIGN: Prospective study. SETTING: Academic research center. PATIENTS: A total of 28 patients with nasal obstruction due to inspiratory nasal valve collapse were included in this study. INTERVENTION: Radiofrequency-induced thermotherapy. MAIN OUTCOME MEASURES: Visual analog scale score. RESULTS: Severity of obstruction scores improved in all patients, with the mean score improving at the left nostril from 8.2 before treatment to 3.4 after treatment and at the right nostril from 8.9 before treatment to 4.1 after treatment. The outcomes were measured using visual analog scale score before treatment and at 16 weeks after treatment. Improvement was shown in severity of obstruction (P < .001). CONCLUSIONS: This new method appears to be safe, quick, bloodless, and painless. These good, encouraging preliminary results must be confirmed by further study and long-term follow-up.

Effect of the radiofrequency volumetric tissue reduction of inferior turbinate on expiratory nasal sound frequency.

BACKGROUND: We sought to evaluate the short-term efficacy of radiofrequency volumetric tissue reduction (RFVTR) in treatment of inferior turbinate hypertrophy (TH) as measured by expiratory nasal sound spectra. In our study, we aimed to investigate the Odiosoft-rhino (OR) as a new diagnostic method to evaluate the nasal airflow of patients before and after RFVTR. METHODS: In this study, we have analyzed and recorded the expiratory nasal sound in patients with inferior TH before and after RFVTR. This analysis includes the time expanded waveform, the spectral analysis with time averaged fast Fourier transform (FFT), and the waveform analysis of nasal sound. RESULTS: We found an increase in sound intensity at high frequency (Hf) in the sound analyses of the patients before RFVTR and a decrease in sound intensity at Hf was found in patients after RFVTR. CONCLUSION: This study indicates that RFVTR is an effective procedure to improve nasal airflow in the patients with nasal obstruction with inferior TH. We found significant decreases in the sound intensity level at Hf in the sound spectra after RFVTR. The OR results from the 2000- to 4000-Hz frequency (Hf) interval may be more useful in assessing patients with nasal obstruction than other frequency intervals. OR may be used as a noninvasive diagnostic tool to evaluate the nasal airflow.

Frequency spectra of normal expiratory nasal sound.

BACKGROUND: The computerized analysis of the nasal sound reflects the nasal airflow. We have developed a new software program that analyzes the nasal sound to use in the research area and clinical applications. We aimed to analyze automatically the spectral parameters of nasal sound in healthy people by our new versatile PC-based nasal sound analyzer software. METHODS: In this study, we analyzed and recorded the expiratory nasal sound in 30 healthy people. This analysis includes the time-expanded waveform, the spectral analysis with time-averaged fast Fourier transform, the automatic detection, and the waveform analysis of nasal sound. RESULTS: We calculated the mean frequency of low-intensity sound (LIS) and high-intensity sound (HIS). The mean frequency of LIS was found as 1254 +/- 10.23 Hz at the right nose and 1375 +/- 18.45 Hz at the left nose. The mean frequency of HIS was found as 2453 +/- 22.23 Hz at the right nose and as 2234 +/- 21.12 Hz at the left nose. These results showed that the values between LIS and HIS are statistically significant (p < 0.005) and different from each other. We found that the nasal sound of the similar nasal airflow was the same type and amplitude in the analysis of the nasal sound recordings. CONCLUSION: The frequency of the nasal sound is an indicator of the intensity of the nasal airflow. The method that provides the analysis of the nasal sound may lead to a new diagnostic method. The method, which is noninvasive, rapid, of low cost, and even applicable for small children, requires little cooperation of the subjects. In addition, it will be possible to record and save the analysis of the nasal airflow as digital data.

Web-based analysis of nasal sound spectra.

The spectral analysis of the nasal sound is an indicator of the nasal airflow pattern. We investigated a new technique for nasal sound analysis via Internet. This study includes 27 patients and 22 healthy people. Patients were treated by septoplasty operation for septal deviation. Postoperation 10(th) day, this technique was applied to follow nasal airflow course. The patients recorded the nasal sound by microphone into the computer as a .wav file and sent us via internet, all those records were evaluated by us. The results were sent back to themselves. The 11 patients who had nasal obstruction symptoms (group A) were called to the hospital to check. In the nasal sound analyses e-mails of those patients, the sound intensity was at high frequencies (2-4 kHz, 4-6 kHz) above 30 dB, but low (500-1000 Hz) and medium frequencies (1-2 kHz), are below then 10 dB. In the patients without nasal obstruction symptom (group B), the sound intensity was at high frequencies below 10 dB, but low and medium frequencies are above 20 dB. There was a statistically significant difference in sound intensity between group A and group B. In the endoscopical examination of those obstructions, which decreases the nasal airway, crusting formation in the nasal cavity was found. Web-based nasal sound analysis is an important method to follow the postoperative course and the nasal airflow evaluation. The new method will save time and money, avoiding a return visit to the hospital unnecessarily.