Nasal Peak Inspiratory Flow in Healthy and Obstructed Patients: Systematic Review and Meta-Analysis.

OBJECTIVES: Nasal peak inspiratory flow (NPIF) is a practical and affordable tool that measures maximum inspiratory flow rate through both nostrils. Although NPIF values for healthy controls and patients appear to differ considerably, a generally expected value for populations with and without nasal obstruction has yet to be established. The aim of this systematic review and meta-analysis was to determine the mean NPIF value in populations with and without nasal obstruction. METHODS: Medline (1946-) and Embase (1947-) were searched until July 1, 2017. A search strategy was used to identify studies that reported NPIF values for defined healthy or disease states. All studies providing original data were included. The study population was defined as having either normal nasal breathing or nasal obstruction. A meta-analysis of the mean data was presented in forest plots, and data were presented as mean (95% confidence interval [CI]). RESULTS: The search yielded 1,526 studies, of which 29 were included. The included studies involved 1,634 subjects with normal nasal breathing and 817 subjects with nasal obstruction. The mean NPIF value for populations with normal nasal breathing was 138.4 (95% CI: 127.9-148.8) L/min. The mean value for populations with nasal obstruction was 97.5 (95% CI: 86.1-108.8) L/min. CONCLUSIONS: Current evidence confirms a difference between mean NPIF values of populations with and without nasal obstruction. The mean value of subjects with no nasal obstruction is 138.4 L/min, and the mean value of nasally obstructed populations is 97.5 L/min. Prospective studies adopting a standardized procedure are required to further assess normative NPIF values. Laryngoscope, 131:260-267, 2021.

Correlation Between Peak Nasal Flow Reversibility and Mucociliary Clearance in Allergic Rhinitis.

OBJECTIVES/HYPOTHESIS: Reversibility of nasal airflow after decongestion measured by rhinomanometry is associated with the severity of allergic inflammation. Peak nasal flow is a simpler alternative method for assessing nasal patency. The aim of this study was to evaluate the correlation between changes in peak nasal expiratory and inspiratory flows (PNEFs and PNIFs) after decongestion and nasal mucociliary clearance times (NMCCTs). STUDY DESIGN: Single-center, prospective cross-sectional study. METHODS: One hundred one allergic rhinitis patients were enrolled. Nasal symptoms and NMCCTs were assessed. PNEF and PNIF were performed before and after decongestion. Correlations between changes in PNEF and PNIF after decongestion and NMCCTs were analyzed. One-half the standard deviation of baseline peak nasal flows was used to estimate the minimal clinically important differences (MCIDs) and discriminate between patients with reversible mucosa and with irreversible mucosa. RESULTS: PNEF showed more peak flow improvements after decongestion compared to PNIF. Changes in PNEF had better negative correlations with NMCCTs than PNIF (ρ = -0.49, P < .001 and ρ = -0.34, P < .001, respectively). The MCID values of the PNEF and PNIF were 27.93 and 19.74, respectively. In comparisons of NMCCTs between patients with or without MCID of peak nasal flow after decongestion, PNEF had better discrimination ability compared to PNIF (P = .003 and P = .026, respectively). CONCLUSIONS: The limitation of reversibility as measured by peak nasal flows could indirectly point to the affection of mucosal inflammation as indicated by NMCCTs. PNEF is more sensitive to assess peak flow changes after decongestion than PNIF. LEVEL OF EVIDENCE: 2 Laryngoscope, 130:1372-1376, 2020.

Patient experience of nasal obstruction and its clinical assessment.

BACKGROUND: The correlation between objective and subjective nasal obstruction is poor, and dissatisfaction rates after surgery for nasal obstruction are high. Accordingly, novel assessment techniques may be required. This survey aimed to determine patient experience and preferences for the measurement of nasal obstruction. METHOD: Prospective survey of rhinology patients. RESULTS: Of 72 questionnaires distributed, 60 were completed (response rate of 83 per cent). Obstruction duration (more than one year) (χ2 = 13.5, p = 0.00024), but not obstruction severity, affected willingness to spend more time being assessed. Questionnaires (48 per cent) and nasal inspiratory peak flow measurement (53 per cent) are the most commonly used assessment techniques. Forty-nine per cent of participants found their assessment unhelpful in understanding their obstruction. Eighty-two per cent agreed or strongly agreed that a visual and numerical aid would help them understand their blockage. CONCLUSION: Many patients are dissatisfied with current assessment techniques; a novel device with visual or numerical results may help. Obstruction duration determines willingness to undergo longer assessment.

Assessment of upper airway obstruction by measuring peak oral and nasal inspiratory flow.

OBJECTIVE: We wanted to access upper airway obstruction in patients undergoing tonsillectomy by measuring peak oral and nasal inspiratory airflow. METHODS: We recruited study participants from a cohort of patients on the waiting list for tonsillectomy, with or without adenoidectomy, at University Hospital of Wales, Cardiff, UK. Fifty patients enrolled on phase I of the study and underwent pre-operative measurement of the rate of peak oral and nasal inspiratory flow; 25 of these patients returned after one month for phase II of the study and underwent post-operative measurement of the rate of both peak oral and nasal inspiratory flow. RESULTS: Of the 25 participants who completed phase II of the study, 17 (68 per cent) showed an increase in post-operative peak oral inspiratory flow rate by an average of 45 per cent, while 18 (72 per cent) showed an increase in post-operative peak nasal inspiratory flow rate by an average of 22 per cent. CONCLUSION: Both peak oral and nasal inspiratory flow rate measurements may be useful measures of oral and nasal obstruction. Further larger studies are needed to develop these measurements as screening and efficacy measures for adenotonsillectomy to relieve upper airway obstruction.

The pull-up spreader high (PUSH) technique for nasal tip support.

BACKGROUND: Nasal tip depression is associated with nasal valve collapse. The pull-up spreader high (PUSH) technique was developed to enlarge the nasal dorsum and upwardly rotate and define the nasal tip by lifting the domes. OBJECTIVES: The authors reviewed a case series to assess the long-term effectiveness of the PUSH technique in improving nasal airflow and aesthetic outcomes. METHODS: This retrospective study included 50 consecutive cases of PUSH rhinoplasty. Objective (acoustic rhinomanometry) and subjective (patient questionnaire) evaluations of the stability of the aesthetic result and improvement of airflow were conducted before and 3 years after PUSH rhinoplasty. RESULTS: PUSH rhinoplasty resulted in long-term stability of the aesthetic effect. All patients had pleasing aesthetic results and a general improvement in the nasal airway. When the degree of nasal obstruction was scored from 1 (greatest obstruction) to 10 (least obstruction), 22 patients rated their nasal function improved to a score of 10 and 28 patients to a score of 8. Rhinomanometry indicated that only 1 patient had worsened nasal airflow. CONCLUSIONS: The PUSH technique enables stable upward rotation and improved definition of the severely depressed nasal tip through an open approach. LEVEL OF EVIDENCE: 4.

Normal nasal patency: problems in obtaining standard reference values for the surgeon.

This review examines why there is no normal range of nasal patency available to the surgeon when assessing nasal obstruction, and discusses the factors that influence nasal patency. Current normal ranges are examined and criticised because of the variability of normal values and the poor sampling methods used. Instability of physiological nasal patency is related to factors such as the nasal cycle and the nose's direct exposure to the external environment. Decongestion of the nose is proposed as a way of stabilising anatomical nasal patency, and measurements of patency in this state may be more useful to the surgeon. Population studies are needed to establish a normal range, but these studies must control for factors such as age, height, sex, and nasal shape and size related to climatic adaptation. Rather than classify populations according to unscientific categories such as race, anthropometric measures such as the nasal index are proposed.

Correlación entre la rinomanometría anterior activa y la endoscopia nasal / Correlation between active anterior rhinomanometry and nasal endoscopy

Objetivo: La permeabilidad nasal se correlaciona con unos parámetros funcionales y anatómicos, que se objetivan mediante la rinomanometría anterior activa (RNMAA). Objetivo: Se pretende comparar las alteraciones visualizadas mediante endoscopia nasal (EN) con los parámetros de la RNMAA. Material y métodos: Se realiza un estudio observacional prospectivo de 45 pacientes afectos de obstrucción nasal y desviación septal. Se exploran mediante RNMAA y EN, clasificando las desviaciones en cuadrantes anterosuperior y anteroinferior. Se analiza el grado de concordancia interobservador y la validez de la prueba diagnóstica. Resultados: Se obtiene una sensibilidad y especificidad del 74,6% y 60,5% respectivamente, comparando globalmente la RNMAA con la EN. Conclusión: La disminución del flujo en fase espiratoria se correlaciona con las obstrucciones inferiores objetivadas en la EN. En el estrecho vestíbulo fosal, esta correlación no es predictiva (AU)

Objective: Nasal permeability is related to functional and anatomical parameters, which are objectified by active anterior rhinomanometry (AARNM). The study aims to compare alterations visualized through Nasal Endoscopy (NE) with nasal flow parameters in AARNM. Material and methods: We carried out a prospective observational study of 45 patients suffering from nasal obstruction and septal deviation. They were explored through AARNM and NE, and the deviations were classified into anterosuperior and anteroinferior quadrants. The degree of agreement between observers and the validity of the diagnostic test was then analyzed. Results: A sensitivity of 74.6% and a specificity of 60.5% were obtained comparing AARNM and EN globally. Conclusion: A reduced flow of the expiratory phase is correlated to inferior obstructions observed through NE. In the narrow nasal vestibule this correlation is not predictive (AU)

[Correlation between active anterior rhinomanometry and nasal endoscopy]. / Correlación entre la rinomanometría anterior activa y la endoscopia nasal.

OBJECTIVE: Nasal permeability is related to functional and anatomical parameters, which are objectified by active anterior rhinomanometry (AARNM). The study aims to compare alterations visualized through Nasal Endoscopy (NE) with nasal flow parameters in AARNM. MATERIAL AND METHODS: We carried out a prospective observational study of 45 patients suffering from nasal obstruction and septal deviation. They were explored through AARNM and NE, and the deviations were classified into anterosuperior and anteroinferior quadrants. The degree of agreement between observers and the validity of the diagnostic test was then analyzed. RESULTS: A sensitivity of 74.6% and a specificity of 60.5% were obtained comparing AARNM and EN globally. CONCLUSION: A reduced flow of the expiratory phase is correlated to inferior obstructions observed through NE. In the narrow nasal vestibule this correlation is not predictive.

Assessment of Cottle's areas through the application of a mathematical model deriving from acoustic rhinometry and rhinomanometric data.

OBJECTIVES: Each nasal area, as defined by Cottle, has a different influence on the nasal airflow. The longitudinal distribution of resistances in nasal cavities was calculated by the anterior rhinomanometry and acoustic rhinometry data. DESIGN: Dynamic study of Cottle's areas in normal subjects was carried out by rhinomanometry and acoustic rhinometry. SETTING: Study by the Department of Otolaryngology of the University of Rome-La Sapienza. PARTICIPANTS: Twenty-seven Caucasian adults in local and general healthy conditions took part and completed this study, with a total of 54 nasal cavities included because of negativity at ENT-examination and clinical history, with normal respiratory parameters at the rhinomanometry and acoustic rhinometry. MAIN OUTCOME MEASURES: We determined nasal and acoustic resistances, nasal volumes and cross-sectional surface areas, as defined by Cottle, using nasal endoscopy. The longitudinal distribution of nasal resistances was obtained by integrating experimental surface areas using a novel mathematical model. The estimation of the longitudinal nasal resistance variations as a result of a theoretical reduction of the surface areas. RESULTS: The reduction of the 2-3-1 areas (in this order of importance) showed the greatest influence on the nasal resistances with coefficients of determinations greater than 0.98, this being quite different from that of the areas 4 and 5 for quite smaller area reduction percentages. CONCLUSIONS: The areas 2-3-1 control the overall nasal resistance so the surgical procedures on these areas greatly influence the dynamics of nasal airflow. The mathematical model developed here gives useful information to nasal functional surgery and may be applied to other schemes of nasal cavity.

[The influence of desloratadine on course of intermittens allergic rhinitis]. / Wplyw desloratadyny na przebieg przerywanego alergicznego niezytu nosa.

Influence of desloratadine (DL) therapy on intermittens allergic rhinitis was presented. Investigated group consisted of 60 patients, aged average 29, among them 23 women and 37 men. Score of nasal symptoms as discharge congestion, itching, sneezing and eye symptoms was evaluated. All measurements of nose airways resistance were performed by means of rhinomanometer Rhinotest 1000 (MES). The result was a significant statistic improvement both of separate nasal or eye symptoms, total nasal symptom score and global therapeutic assessments of response to DL therapy. At the beginning the investigation a statistically significant improvement after DL therapy was shown by rhinomanometry among patients with severe or moderate nasal resistance in contrast to low nasal resistance group.