Nasal spirometery.

Nasal obstruction is a common symptom which is difficult to quantify clinically. Rhinomanometry, Acoustic Rhinometry and Forced Oscillation methods are available for estimating nasal resistance but, these require sophisticated machines. Because of limited availability of these techniques, this potential physiological measure has not been tapped fully for research and clinical purposes. Here, we describe the use of pulmonary spirometer with little modification for quantification of nasal flow. Nasal inspiratory and expiratory flow rates along with oral inspiratory and expiratory flow rates are used to derive different nasal resistance indices. This way of reporting nasal resistance is not new but, the data for these variables is currently not available in published literature. The reproducibility of nasal flow rates were tested as variation after one day and the interclass coefficient for inspiratory and expiratory nasal flow rates were found to be with in acceptable limits. Thus, nasal spirometery is able to describe the nasal resistance in a reliable manner and may be used to quantify nasal obstruction in pathological condition and also to study the physiological phenomenon like nasal cycle.

A reprodutibilidade do espelho de Glatzel modificado na aferição da permeabilidade nasal / Modified Glatzel mirror test reproducibility in the evaluation of nasal patency

O espelho de Glatzel (EG) é utilizado para a avaliação da permeabilidade nasal. Estudos de validação inexistem na literatura. Este estudo teve por objetivos verificar a reprodutibilidade do EG e a correlação intra-sujeito entre área de condensação e percepção subjetiva de permeabilidade nasal. MÉTODOS: Estudo prospectivo onde 25 sujeitos foram avaliados com o EG por cinco minutos consecutivos; cada meia hora por quatro horas; cada dia no início da tarde, por cinco dias e toda a quinta-feira por cinco semanas consecutivas. Utilizou-se uma escala analógica visual para avaliar a percepção de respiração nos períodos. RESULTADOS: O coeficiente de correlação total (área direita mais esquerda) encontrado entre área de condensação e percepção subjetiva foi de r=0,04 (p=0,37). No lado esquerdo foi de r=0,08 (p=0,09) e no lado direito de r=0,05 (p=0,28). Os coeficientes de variação unilaterais medianos foram menores que 15 por cento e os totais menores que 12 por cento, independente do intervalo de tempo entre teste e re-teste. CONCLUSÃO: Não se evidenciou correlação significativa entre a percepção subjetiva e a área de condensação. A variabilidade unilateral foi maior do que quando considerados os valores totais (direito mais esquerdo) e não houve diferença na variabilidade das medidas de área de condensação nasal nos diferentes momentos do tempo.

The Glatzel Mirror (GM) is used to evaluate nasal patency. Validation studies are not available in the literature. This paper aims to verify the GM test reproducibility and the correlation between the intra-subject condensation area and nasal patency subjective perception. METHODS: This is a prospective study. 25 subjects were evaluated with the GM for five consecutive minutes, every half an hour for 4 hours; every day, beginning in the early afternoon, every Thursday for five consecutive weeks. A visual analogue scale was used to evaluate nasal patency perception in all periods. RESULTS: The total correlation coefficient (right + left areas) found between the condensation area and the subjective perception was r = 0.04 (p = 0.37). On the left side it was r = 0.08 (p = 0.09) and on the right side r = 0.05 (p = 0.28). The mean unilateral variation coefficient was less than 15 percent and the total was less than 12 percent, regardless of the time period interval between test and re-test. CONCLUSION: We did not observe any significant correlation between the subjective perception of breathing and the condensation area. Unilateral variability was higher than the total (right + left area) and the test variability was the same between the different time periods of measurements.

Correlation between Nasal Obstruction Symptoms and Objective Parameters of Peak Nasal Inspiratory Flow Metry and Acoustic Rhinometry

BACKGROUND AND OBJECTIVES: Measurement of the peak nasal inspiratory flow rate (PNIFR) is a useful technique for obtaining a quick measure of nasal obstruction and changes in PNIFR, reflecting changes in symptoms. The aim of the present study was to correlate changes in nasal obstruction symptoms with changes in several parameters of acoustic rhinometry (AR) and peak nasal inspiratory flow metry (PNIFM) before and after decongestion and to examine whether changes in PNIFR correlate with changes in nasal cross-sectional areas and volume. MATERIALS AND METHODS: The subjects of the current study were 30 patients with nasal obstruction symptoms and 20 normal subjects. Subjective nasal patency was assessed by visual analogue scale (VAS). We measured PNIFR and minimal cross-sectional area (MCA), cross-sectional area at distances of 3.3 (CA3.3), 4.0 (CA4.0), and 6.4 (CA6.4) cm from the nostril and volume from the nostril 6.4 cm (V6.4) towards the choanae, in each nasal cavity before and after decongestion. RESULTS: The VAS had no significant correlation with PNIFR, each cross-sectional area and volume in bilateral nasal cavities before decongestion. There was a significant correlation between the changes in VAS and PNIFR and MCA before and after decongestion. There was a significant correlation between changes in PNIFR and MCA and CA3.3 in one side and both sides of nasal cavity before and after decongestion. CONCLUSIONS: These results suggest that PNIFM and AR may have no sensitive diagnostic values in estimating the severity of nasal obstruction symptoms in the nondecongested state of the bilateral nasal cavities, but PNIFM and AR can be recommended especially in provocation studies because PNIFR and MCA reflect changes in subjective symptoms by mucosal changes.

Correlation between Nasal Obstruction Symptoms and Objective Parameters of Peak Nasal Inspiratory Flow Metry and Acoustic Rhinometry

BACKGROUND AND OBJECTIVES: Measurement of the peak nasal inspiratory flow rate (PNIFR) is a useful technique for obtaining a quick measure of nasal obstruction and changes in PNIFR, reflecting changes in symptoms. The aim of the present study was to correlate changes in nasal obstruction symptoms with changes in several parameters of acoustic rhinometry (AR) and peak nasal inspiratory flow metry (PNIFM) before and after decongestion and to examine whether changes in PNIFR correlate with changes in nasal cross-sectional areas and volume. MATERIALS AND METHODS: The subjects of the current study were 30 patients with nasal obstruction symptoms and 20 normal subjects. Subjective nasal patency was assessed by visual analogue scale (VAS). We measured PNIFR and minimal cross-sectional area (MCA), cross-sectional area at distances of 3.3 (CA3.3), 4.0 (CA4.0), and 6.4 (CA6.4) cm from the nostril and volume from the nostril 6.4 cm (V6.4) towards the choanae, in each nasal cavity before and after decongestion. RESULTS: The VAS had no significant correlation with PNIFR, each cross-sectional area and volume in bilateral nasal cavities before decongestion. There was a significant correlation between the changes in VAS and PNIFR and MCA before and after decongestion. There was a significant correlation between changes in PNIFR and MCA and CA3.3 in one side and both sides of nasal cavity before and after decongestion. CONCLUSIONS: These results suggest that PNIFM and AR may have no sensitive diagnostic values in estimating the severity of nasal obstruction symptoms in the nondecongested state of the bilateral nasal cavities, but PNIFM and AR can be recommended especially in provocation studies because PNIFR and MCA reflect changes in subjective symptoms by mucosal changes.

Effects of External Nasal Dilators on Nasal Respiration and Patency in Patients with Deformity of the Nasal Septum by Mladina ClaSSIFICATION: An Acoustic Rhinometric Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The external nasal dilator (END) was designed to improve nasal respiration by expanding the nasal valve area and authors have proven in previous reports that the END improves nasal respiration and patency in patient with DSN. The present study attempts to assess the different effects of the END on nasal respiration and patency in DSN patients with dysfunction of the nasal valve area and in those with dysfunction of some other areas. MATERIALS AND METHODS: Fourty-six male patients (ages 18-49, average age 31.5) without any other nasal or sinus disease and who are not classified as Mladina types 1, 4 or 7 were used as subjects. The type of DSN was determined by Mladina classification. Those with dysfunction of the nasal valve area (Type 2) were classited as Group A and those with dysfunction of some other anatomical area as Group B (Type 3, 5, 6). The subjective sensation of nasal respiration, average minimum cross-sectional area (MCA) and nasal volume (V5: nasal volume from 0-5 cm) of all subjects were assessed and compared before and after the application of an END. RESULTS: Subjective sensation of nasal respiration, MCA and V, improved sign ificantly in both groups after the application of an END, but there were no significant differences between the two groups. CONCLUSION: Although an F,ND significantly improves nasal respiration and patency, this effect does not show any significant differences between patients with dysfunction of the nasal valve area and those with dysfunction of some other anatomical areas. This is because ENDs equally affect all Types of septal deformity.

The Effects of Alcohol on Nasal Patency and Mucociliary Clearance

MATERIALS AND METHODS: Fifteen healthy volunteers were studied to evaluate the effects of alcohol ingestion on nasal mucosa over time and changes in mucociliary function after alcohol ingestion. Nasal patency was evaluated with acoustic rhinometry, and mucociliary clearance was measured with a saccharine test. RESULTS: The cross-sectional area of the I-notch and the Cnotch did not change after alcohol ingestion. The cross-sectional area of the posterior part of the nasal cavity (CA 6.4) indicated changes more prominently than that of the anterior part (CA 3.3). A significant reduction in total nasal volume was first noted at 1.5 hours after alcohol ingestion and lasted for 1.5 hours. The saccharine transit time did not change significantly. CONCLUSION: There was no acute impairment of mucociliary function at moderate concentrations of alcohol.

Effects of External Nasal Dilators on Nasal Respiration and Patency in Patients with Deformity of the Nasal Septum: An Acoustic Rhinometric Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Some types of deformities of the nasal septum (DNSs) interfere with the nasal valve function. External nasal dilators (ENDs) were developed to improve the nasal airway by mechanically dilating the nasal valve. The aim of this study is to evaluate the effects of ENDs on nasal respiration and patency in patients with DNS. MATERIALS AND METHODS: Fifty-four patients with DNS (37 males and 17 females, aged 18 to 46 years) without other sinonasal diseases were included in this study. All subjects were required to assess their own sensation of nasal respiration on a 100 mm visual analog scale. Minimal cross-sectional areas (MCAs) and volumes of 0 to 5 cm from the nostril (V 5s) of both nasal cavities were measured by acoustic rhinometry, respectively. All measurements before application of an END were compared with those 5 minutes after application. RESULTS: The subjective sensation of nasal respiration improved significantly after application of an END in both male and female. The END increased MCA and V5 significantly in both sexes. However, there were no significant correlations between changes in the subjective and objective parameters. CONCLUSION: ENDs offer an effective, nonsurgical therapeutic approach in the management of DNS by improving nasal respiration and by increasing MCA and nasal cavity volume. However, it should be kept in mind that this improvement in nasal patency does not always coincide with the improvement in subjective sensation of nasal respiration.

The Effects of Topically Administered Methacholine on the Nasal Patency as Assessed by Acoustic Rhinometry

The aim of this study was to evaluate the effect of topical methacholine on the nasal mucosa in allergic rhinitis and nonallergic control group, particularly in terms of nasal patency. The study population consisted of 32 adults with no nasal disorders and 22 patients with nasal allergy, and their age ranged from 18 to 42. Increasing concentrations of methacholine ranging from 0.125% to 25% were sprayed on both nasal cavities of the study subjects. The minimal cross sectional area and the nasal cavity volume at each concentration were measured using acoustic rhinometry. The overall incidence of methacholine responsiveness was 56%. The allergic group did not show a significantly higher incidence of methacholine responsiveness compared to the control group. The incidence and the pattern of methacholine responsiveness was not bilaterally symmetric on both sides of the nasal cavities. The results of this study indicate that, both in allergic and control group, topical methacholine stimulation resulted in decreased nasal patency only in a subset of the population.

Effects of External Nasal Dilators on Nasal Respiration and Patency in HealthyKorean Adults: An Acoustic Rhinometric Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although physiological effects of external nasal dilators (ENDs) were recently reported on white and black people, there are no available data on Asians. Nasal geometry is affected by many factors such as race, age, or sex. The aim of this study is to evaluate the effects of ENDs on nasal respiration and patency in healthy Korean adults. MATERIALS AND METHODS: One hundred healthy Korean adults (50 females and 50 males, aged 20 to 39 years) without nasal complaints, history of sinonasal surgery, nor major structural abnormalities of the nose were recruited. All subjects were required to assess their own sensation of nasal respiration on a 100 mm visual analog scale. Minimal cross-sectional areas (MCAs) and volumes from 0 cm to 5 cm from the nostril (V5s) of both nasal cavities were measured by acoustic rhinometry and added together to obtain the total MCA and V5, respectively. All measurements before application of an END were compared with those 5 minutes after application. RESULTS: The sensation of nasal respiration improved significantly after application of an END in both female and male. The END increased MCA and V5 significantly in both sexes. These acoustic rhinometric changes resulted in 21.1% (male) and 20.5% (female) increment in MCA and 10.0% (male) and 12.5% (female) increment in V5, respectively. However, there were no significant correlations between changes in the subjective and objective parameters. CONCLUSION: ENDs significantly improve the subjective sensation of nasal respiration and increase MCA and nasal cavity volume in healthy Korean adults. However, this improvement in nasal patency does not always coincide with the improvement in the subjective feeling of nasal respiration.

Correlation between Nasal Obstruction and Parameters in Acoustic Rhinometry

Several attempts have been made to correlate nasal obstruction and acoustic rhinometric parameters, so far failed to find any significant correlation. We evaluated the correlation between the sense of nasal obstruction and parameters measured with acoustic rhinometry, and searched any secondary variables calculated from primary parameters, to explain the sense of nasal obstruction objectively on 114 patients (72 men and 42 women) with nasal obstruction. The sense of nasal obstruction was measured with visual analogue scale. Nasal volume, minimal cross-sectional area, and equivalent resistance were measured by acoustic rhinometry. As secondary variables, we introduced the concept of decongestion rate which representing the amount of change in the parameters after application of nasal decongestant. Weak correlations were found between the sense of nasal obstruction and total minimal cross-sectional area. Significant correlations were found between the sense of nasal obstruction and decongestion rate of total nasal volume, and particularly in the wider cavity. Stronger correlations than in total population were found in male patients. The decongestion rate may have potential implication in explaining the sense of nasal obstruction.

Change in the Nasal Patency and Mucociliary Clearance after Phenylephrine Spray / 대한이비인후과학회지

Mucociliary clearance of nasal cavity is one of the most important defense mechanism of the respiratory tract. Abnormalities in the mucociliary clearance may cause pathologic condition of nose and paranasal sinus. Fifty healthy volunteers with no rhinologic disorders were studied to determine the effect of phenylephrine spray on mucociliary clearance and nasal patency. Nasal patency was evaluated using acoustic rhinometry and mucociliary clearance was measured using saccharine method. The result shows that cross sectional area of C-notch increased after phenylephrine spray but mucociliary transit time was prolonged from 476 seconds to 624 seconds, which was statistically significant(p < 0.05). These data demonstrate that phenylephrine should be used judiciously in order to minimize the negative effect of mucociliary dysfunction.