Change in the nose areas in children with mouth breathing after nasal cleansing and massage. / Mudança nas áreas nasais em crianças com respiração oral após a limpeza e massagem nasal.

PURPOSE: To analyze the changes occurred in the nasal cavity geometry, before and after nasal cleansing, through nasal aeration and acoustic rhinometry in children with oral breathing. METHODS: Twenty children aged four to 12 years were included in the study. The gathering of participants was conducted at the Multifunctional Laboratory of the Speech Pathology Department of the Federal University of Pernambuco - UFPE. The following procedures were conducted: Identification Index of Signs and Symptoms of Oral Breathing; marking of nasal expiratory airflow using the graded mirror of Altmann, and examination of the Nasal Geometry by Acoustic Rhinometry. The same procedures were performed after nasal massage and cleansing with saline solution. RESULTS: Significant change was observed in the areas with respect to the nasal airflow on both sides after nasal cleansing and massage. As for nasal geometry, measured by acoustic rhinometry, comparison between the nostrils showed that the effect of cleansing and massage was discrete. CONCLUSION: Nasal aeration measures showed sensitivity to the cleansing and massage technique and measures of nasal geometry confirmed its effect on respiratory physiology.

Mudança nas áreas nasais em crianças com respiração oral após a limpeza e massagem nasal / Change in the nose areas in children with mouth breathing after nasal cleansing and massage

RESUMO A avaliação e quantificação das possíveis alterações da cavidade nasal são necessárias para o auxílio diagnóstico e tratamento de crianças que respiram predominantemente pela boca. O modo respiratório oral pode desencadear distúrbios da fala, deformidades da face, mau posicionamento dos dentes, postura corporal inadequada e alterações no sistema respiratório. Objetivo analisar as mudanças ocorridas na geometria das cavidades nasais, antes e depois da limpeza nasal por meio da aeração nasal e da rinometria acústica em crianças com respiração oral. Método Foram selecionadas 20 crianças com idade entre quatro e 12 anos. A coleta foi realizada no Laboratório Multifuncional do Departamento de Fonoaudiologia da Universidade Federal de Pernambuco. Foi aplicado o Índice de Identificação dos Sinais e Sintomas da Respiração Oral; marcação da aeração nasal por meio do espelho milimetrado de Altmann e o exame da geometria nasal por Rinometria Acústica. Depois da limpeza e massagem nasal com o soro fisiológico, foram realizados os mesmos procedimentos. Resultados Observaram-se mudanças significantes nas áreas relativas ao fluxo aéreo nasal em ambos os lados, após limpeza e massagem nasais. Quanto à geometria nasal, aferida por meio da rinometria acústica, o efeito da limpeza e massagem nasal mostrou-se discreto, quando feita a comparação entre as narinas. Conclusão As medidas de aeração nasal mostraram sensibilidade à técnica de limpeza e massagem e as medidas da geometria nasal confirmaram seu efeito sobre a fisiologia respiratória.

ABSTRACT The evaluation and quantification of possible changes in the nasal cavity can assist in the diagnostics and treatment in children who breathe predominantly through the mouth. The oral breathing mode can initiate speech disorders, facial deformities, poor positioning of the teeth, improper body posture, and changes in the respiratory system. Purpose To analyze the changes occurred in the nasal cavity geometry, before and after nasal cleansing, through nasal aeration and acoustic rhinometry in children with oral breathing. Methods Twenty children aged four to 12 years were included in the study. The gathering of participants was conducted at the Multifunctional Laboratory of the Speech Pathology Department of the Federal University of Pernambuco - UFPE. The following procedures were conducted: Identification Index of Signs and Symptoms of Oral Breathing; marking of nasal expiratory airflow using the graded mirror of Altmann, and examination of the Nasal Geometry by Acoustic Rhinometry. The same procedures were performed after nasal massage and cleansing with saline solution. Results Significant change was observed in the areas with respect to the nasal airflow on both sides after nasal cleansing and massage. As for nasal geometry, measured by acoustic rhinometry, comparison between the nostrils showed that the effect of cleansing and massage was discrete. Conclusion Nasal aeration measures showed sensitivity to the cleansing and massage technique and measures of nasal geometry confirmed its effect on respiratory physiology.

An Experimental and Numerical Investigation of CO2 Distribution in the Upper Airways During Nasal High Flow Therapy.

Nasal high flow (NHF) therapy is used to treat a variety of respiratory disorders to improve patient oxygenation. A CO2 washout mechanism is believed to be responsible for the observed increase in oxygenation. In this study, experimentally validated Computational Fluid Dynamics simulations of the CO2 concentration within the upper airway during unassisted and NHF assisted breathing were undertaken with the aim of exploring the existence of this washout mechanism. An anatomically accurate nasal cavity model was generated from a CT scan and breathing was reproduced using a Fourier decomposition of a physiologically measured breath waveform. Time dependent CO2 profiles were obtained at the entrance of the trachea in the experimental model, and were used as simulation boundary conditions. Flow recirculation features were observed in the anterior portion of the nasal cavity upon application of the therapy. This causes the CO2 rich gas to vent from the nostrils reducing the CO2 concentration in the dead space and lowering the inspired CO2 volume. Increasing therapy flow rate increases the penetration depth within the nasal cavity of the low CO2 concentration gas. A 65% decrease in inspired CO2 was observed for therapy flow rates ranging from 0 to 60 L min(-1) supporting the washout mechanism theory.

Effect of the nasal cycle on congestive response during bilateral nasal allergen provocation.

BACKGROUND: Bilateral nasal allergen provocation usually produces more pronounced obstruction of one nasal passage. It was found that this could be related to the stage of the nasal cycle before the provocation. OBJECTIVE: To discover whether the stage of the nasal cycle is decisive for asymmetry in congestive response observed during bilateral allergen nasal provocation. methods. Two bilateral nasal allergen provocations were performed in a group of 26 pollen-sensitive volunteers. Acoustic rhinometry measurements were taken during the nasal cycle, and then after the provocation. A cross-sectional area at the level of the inferior turbinate (CSA-2) was measured. Consecutive challenges were performed in the opposite phase of the nasal cycle: the side which had been wide just before the first challenge, was narrow before the second provocation. RESULTS: Asymmetry in CSA-2 reduction between the nasal passages was observed in most cases. Significant difference was observed between mean CSA-2 reduction rate (reactivity) of the side that responded with greater congestion, and the opposite side. No significant difference was found in mean CSA-2 reduction rate between the side which was narrow, and the side which was wide before provocation. CONCLUSIONS: Asymmetry of congestive response during bilateral nasal allergen provocation is not dependent on the stage of the nasal cycle preceding the challenge.

Valoración de la inflamación nasal / Evaluation of nasal inflammation

En la reacción de hipersensibilidad inmediata, el alérgenose une a su anticuerpo específico tipo IgE, unido a su vez a los receptores de alta afinidad para la IgE (FccRI) de las células efectoras, fundamentalmente mastocitos y basófilos. El entrecruzamiento de estas moléculas de F ccRI tras la unión de antígenos polivalentes a la IgE, activa a estas células produciéndóse tres respuestas biológicas: exocitosis del contenido preformado de sus gránulos, sintetización de mediadores lipídicos y secreción de citoquinas. Los mediadores de la inflamación son en último termino, las sustancias responsables de la sintomatología clínica. Pueden dividirse en general en mediadores preformados (aminas biógenas y macromoléculas de los gránulos) y mediadores de nueva síntesis (mediadores lípidicos y citoquinas)

In the reaction of immediate hypersensibility to alergene is joined to itsspecific type IgE antibody, also united to the high afflnity receptors for IgE (FccI) of the effecters cells fundamentally mastocites and basophiles. The interbreeding of these molecules Fcc to RI, after the union ofpolyvalent antigenes to IgE, active these cells, producing three biologic responses: excitosis of the preformed content of its granules, synthesization of lipidic mediators and citoquine secretion. The inflammation mediators are in last term, substances responsible of the clinic symptomatology. They can be divided generally in preformed mediators (biogene amines and macromolecules ofthe granules) and ofnew synthese mediators (lipidic and citoquine mediators)

Alar anaesthesia: A kinder method.

SUMMARY Local infiltration of anaesthetic in the ala of the nose is very uncomfortable for most patients. This is an area frequently operated on by dermatosurgeons under local anaesthesia as it is a common site for non-melanoma cutaneous malignancies. A simple method is described of providing more pleasant local anaesthesia for patients undergoing alar surgery by using nerve blocks prior to local infiltration.

The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms.

OBJECTIVE: To assess quality of life (QOL) in patients with sinonasal symptoms in response to hypertonic saline nasal irrigation (HSNI), and to assess HSNI use patterns. STUDY DESIGN AND SETTING: The study was an uncontrolled 12-month follow-up to a randomized controlled trial (RCT) and used HSNI in a community setting. We included 54 participants with recurrent or chronic sinonasal symptoms. Forty participants had been in the intervention group of a previous study; 14 had been control participants. Primary outcome measures were the Rhinosinusitis Disability Index (RSDI), a sinus-symptom severity assessment (SIA), and the Sino-Nasal Outcomes Test (SNOT-20). Secondary outcome measures were frequency and pattern of HSNI use, side effects and satisfaction. RESULTS: Among participants using HSNI in the prior RCT, RSDI scores continued to improve, from 73.2 +/- 2.6 points to 80.6 +/- 2.4 points (P < 0.001). SIA and SNOT-20 scores remained stable. Former control participants reported QOL improvement similar to that of HSNI users in the prior RCT. RSDI scores improved from 62.0 +/- 3.9 points to 79.7 +/- 3.7 points (P < 0.05), SNOT-20 scores improved from 43.5 +/- 5.7 points to 28.4 +/- 4.8 points, and SIA scores improved from 4.2 +/- 0.3 points to 2.6 +/- 0.3 points (P < 0.01). Mean HSNI use for all participants was 2.4 irrigations per week; 33% of participants used HSNI regularly, 55% when symptomatic. Side effects were minor; satisfaction was high. CONCLUSIONS: Participants with chronic sinonasal symptoms reported improved QOL and frequent, satisfying use of HSNI. SIGNIFICANCE: HSNI is an effective adjunctive treatment of chronic sinonasal symptoms.

Olfactory impairments in patients with unilateral cerebellar lesions are selective to inputs from the contralesional nostril.

Functional imaging studies of olfaction have consistently reported odorant-induced activation of the cerebellum. However, the cerebellar role in olfaction remains unknown. We examined the olfactory and olfactomotor abilities of patients with unilateral cerebellar lesions, comparing performance within subjects across nostrils, as well as between subjects with age-matched and young controls. Regarding olfactory performance, initial testing revealed that patients had a contralesional impairment in olfactory identification but not olfactory detection threshold. However, when tested under conditions that prevented compensatory sniffing strategies, the patients also exhibited a contralesional olfactory detection impairment. Regarding olfactomotor function, a healthy olfactomotor system generates sniffs that are (1) sufficiently vigorous and (2) inversely proportional to odorant concentration in sniff mean airflow velocity, maximum airflow velocity, volume, and duration. Patients' sniffs were lower in overall airflow velocity and volume in comparison with control participants. Furthermore, reduced sniff velocity predicted poorer detection thresholds in patients. Finally, whereas young controls used concentration-dependent sniffs, there was a trend in that direction only for age-matched controls. Patients used sniffs that were concentration invariant. In conclusion, cerebellar lesions impacted olfactory and olfactomotor performance. These findings strongly implicate an olfactocerebellar pathway prominent in odor identification and detection that functionally connects each nostril primarily to the contralateral cerebellum.

Possible new assessment of patulous Eustachian tube function: audiometry for tones presented in the nasal cavity.

OBJECTIVE: To assess the acoustic transfer function of the Eustachian tube by means of audiometric measurements in order to evaluate the severity of the patulous condition. MATERIAL AND METHODS: Detection thresholds for tones presented in the nasal cavity (at the nostril) were measured in subjects with a patulous Eustachian tube (PET) and in normal subjects. RESULTS: In typical cases, these thresholds were lower in the subjects with PET and were markedly elevated to the same level as those of normal subjects by the insufflation of Lugol's solution (iodine solution). The pre- versus post-insufflation threshold differences seemed to reflect the effects of a patulous tube on the acoustic characteristics via the Eustachian tube. Based on the obtained results, sound patency via a patulous tube appeared to be dominant in lower frequency tones. CONCLUSION: The present method seems to be another easy way to assess PET.

Comparison of the effects of desloratadine 5-mg daily and placebo on nasal airflow and seasonal allergic rhinitis symptoms induced by grass pollen exposure.

BACKGROUND: Nasal congestion is a chronic symptom of seasonal allergic rhinitis (SAR) that is often difficult to treat with antihistamines. Desloratadine, a new, potent, H1-receptor antagonist has been shown to decrease nasal congestion in clinical trials and to maintain nasal airflow in response to grass pollen exposure. We compared the effects of desloratadine 5 mg and placebo on nasal airflow, nasal secretion weights and SAR symptoms, including nasal congestion, in patients exposed to grass pollen in an environmental exposure unit. METHODS: Forty-six grass pollen allergic SAR patients received desloratadine or placebo for 7 days, followed by a 10-day washout, and then crossed over to the other treatment for 7 days. A 6-h allergen exposure was performed at the end of each treatment period. RESULTS: Desloratadine was significantly superior to placebo in maintaining nasal airflow (P

Acquired nasal hyperresponsiveness aggravates antigen-induced rhinitis in the guinea pig.

Whether a state of nasal hyperresponsiveness influences antigen-induced biphasic nasal blockage and sneezing were examined using a guinea pig model of allergic rhinitis. Sensitized animals were challenged with an antigen, Japanese cedar pollen, once every week. Before the 13th challenge, the animals were randomly divided into 2 groups, and then the 13th challenge was performed (Groups A-0 and B-0). The 14th challenge was done on day 2 (Group A-2) and on day 7 (Group B-7) after the 13th challenge, on which nasal hyperresponsiveness was present and absent, respectively. Biphasic nasal blockage and sneezing after the challenge in Group A-2 were more severe than those in Group A-0, while those of Group B-7 were almost the same as those of Group B-0. An anti-histaminic, mepyramine, inhibited sneezing but not the biphasic nasal blockage in Group B-7. A cysteinyl leukotriene (CysLT) antagonist, pranlukast, suppressed the late nasal blockage but not the early blockage and sneezing in Group B-7. In contrast, in Group A-2, mepyramine significantly attenuated not only sneezing but also the early nasal blockage. Pranlukast significantly inhibited both nasal blockage and sneezing in Group A-2. In conclusion, nasal hyperresponsiveness aggravated the antigen-induced nasal responses, to which histamine and CysLTs considerably contributed.

A comparison of once daily fexofenadine versus the combination of montelukast plus loratadine on domiciliary nasal peak flow and symptoms in seasonal allergic rhinitis.

BACKGROUND: The combination of montelukast (ML) and loratadine (LT) has previously been shown to be superior to either drug alone in managing seasonal allergic rhinitis (SAR), whilst fexofenadine (FEX) has been shown to be better than LT as monotherapy. OBJECTIVES: We wished to compare ML + LT vs. FEX alone for effects on daily measurements (am/pm) of peak inspiratory flow (PIF) and symptoms. METHODS: Thirty-seven patients with SAR (skin prick positive to grass pollen) were randomised into a single-blind, double-dummy placebo (PL)-controlled cross-over study during the grass pollen season, comparing 2 weeks of once daily treatment with (a) 120mg FEX or (b) 10mg ML + 10mg LT. There was a 7-10 day placebo run-in and washout prior to each randomised treatment. The average of am/pm PIF (the primary outcome variable) was analysed. Patients recorded their symptom scores (from 0 to 3) twice daily, for nasal blockage, discharge, itching and sneezing with; total eye symptoms, ocular cromoglycate use, and daily activity. The total nasal symptom score was calculated as a composite (out of 24). RESULTS: There were no significant differences between baselines after the run-in and washout placebos for any variables. There were significant (P < 0.05, Bonferroni) improvements in all symptoms and PIF compared to pooled placebo with both treatments for all end-points, but no differences between the two treatment regimes (as means and within-treatment 95% confidence intervals): PIF: PL 102 (98-107), FEX 111 (107-116), ML+LT 113 (109-118); total nasal symptoms: PL 7.4 (6.7-2.0), FEX 5.0 (4.3-5.7), ML + LT 4.0 (3.3-4.7). CONCLUSIONS: Once daily FEX as monotherapy was equally effective as the combination of once daily ML + LT in improving nasal peak flow and controlling symptoms in SAR. Further studies are indicated to assess whether ML confers additional benefits to FEX in SAR.

Seasonal variations of nasal resistance in allergic rhinitis and environmental pollen counts.

We made measurements of nasal airway resistance in a patient with Japanese cedar pollinosis and also measured the environmental pollen counts under different exposure conditions. In the season of high Japanese cedar pollen counts in Japan values of mean nasal airway resistance were significantly increased, remained elevated for 2 months after the season, and eventually decreased. In the season of low pollen counts, the mean values of nasal airway resistance measurements were increased during the season but decreased more rapidly after the season. In a year with no exposure to the environmental allergen because the subject lived out of Japan, the mean nasal airway resistances were relatively increased closely in phase with the Japanese cedar pollen season.

Seasonal variations of nasal resistance in allergic rhinitis and environmental pollen counts. II: Efficacy of preseasonal therapy.

We gave Mao-bushi-saishin-to, a Chinese blended medicine, and azelastine to an adult patient with hay fever due to Japanese cedar pollen and measured nasal resistance and ambient floating pollen counts throughout the time of Japanese cedar pollination in separated years. In the patient Mao-bushi-saishin-to was effective against preseasonal increases in nasal airway resistance but could not control severe episodes of allergic rhinitis caused by high dose exposure to Japanese cedar pollen and also perhaps caused by a priming effect. Azelastine inhibited both pre- and post-seasonal increases in nasal airway resistance but not only on high pollen counts days.

[Variations in mucociliary drainage of the nasal fossae after sulfoarsenical thermal therapy]. / Variations du drainage mucociliaire des fosses nasales après cure thermale sulfoarsenicale.

The saccharine test described by Andersen appears as a simple, harmless and reproducible means to measure the rate of the mucociliary clearance mainly in children. The sweet taste is so strong that the answer is always clear cut. This measured clearance is a good estimate of the efficiency of the first line of defence that builds up the mucus ciliary complex against most of the inhaled noxious agents. In measuring the rate of the clearance in 83 children before and after the Spa treatment (Saint Honoré les Bains), each subject being its own control, the Authors demonstrate a slowing of the clearance speed in 62,1% of the patients, immediately after the end of the Spa period. This percentage is almost reversed 19 days later at the end of the post Spa period. At this time, in 52.2%, an accelerated clearance is measured. This study demonstrates both the efficiency of the Spa treatment, and the necessity, too often overlooked, of 20 days of post Spa medical care.