Analysis of conductive olfactory dysfunction using computational fluid dynamics.

Conductive olfactory dysfunction (COD) is caused by an obstruction in the nasal cavity and is characterized by changeable olfaction. COD can occur even when the olfactory cleft is anatomically normal, and therefore, the cause in these cases remains unclear. Herein, we used computational fluid dynamics to examine olfactory cleft airflow with a retrospective cohort study utilizing the cone beam computed tomography scan data of COD patients. By measuring nasal-nasopharynx pressure at maximum flow, we established a cut-off value at which nasal breathing can be differentiated from combined mouth breathing in COD patients. We found that increased nasal resistance led to mouth breathing and that the velocity and flow rate in the olfactory cleft at maximum flow were significantly reduced in COD patients with nasal breathing only compared to healthy olfactory subjects. In addition, we performed a detailed analysis of common morphological abnormalities associated with concha bullosa. Our study provides novel insights into the causes of COD, and therefore, it has important implications for surgical planning of COD, sleep apnea research, assessment of adenoid hyperplasia in children, and sports respiratory physiology.

Quick septoplasty in children: Long-term effects on nasal breathing and dentofacial morphology. A prospective cephalometric study.

OBJECTIVE: Many authors have investigated the most appropriate surgical approach to the deviated septum in childhood, considering the obligate mouth-breathing habit a possible cause of malocclusion and disharmonious development of the facial skeleton in growing kids. Nevertheless, controversies still remain about the long-term functional/esthetic results of such procedures, mainly due to the duration of the follow-up and possible confounding factors. METHODS: 111 Caucasian children (age range: 6-13 years) were submitted to a personal "Quick" septoplasty surgical technique between 2005 and 2010. Preoperative otorhinolaryngological examination using flexible nasal endoscopy, anterior active rhinomanometry (AAR), Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire, and dentofacial evaluation (including cephalometry) were performed. Postoperative AAR, NOSE questionnaire and cephalometric assessment were carried out in all patients at the age of 18 years. Informed consent was obtained from children's parents as appropriate. RESULTS: No surgical complication was recorded. Among our patients, a significant (p <0.001) improvement of nasal breathing resistances at AAR and NOSE questionnaire scores was found after surgery. A significant improvement in cephalometric/dental parameters (gonial angle values, anterior facial height, prevalence of class I occlusion, maxillary intermolar width, and cross-bite frequency) was noticed after the follow-up with respect to preoperative conditions. CONCLUSION: The "Quick" septoplasty technique described is a practical and conservative procedure with a low complication rate that offers long-term favourable results for the correction of nasal septum deviations in children. Nasal-breathing restoration may favor a physiological and harmonious development of craniofacial and dental structures in offspring.

Health outcomes associated with improvement in mouth breathing in children with OSA.

PURPOSE: Children with mouth breathing (MB) report poor quality of life. It is unknown whether improvement in MB is associated with improvement in behavior or quality of life. We hypothesized that in children with MB and obstructive sleep apnea (OSA), improvement in MB is associated with improvement in behavior and quality of life, independent of improvement in OSA. METHODS: This is a retrospective post hoc analysis utilizing Childhood Adenotonsillectomy Trial (CHAT) dataset, a multicenter controlled study evaluating outcomes in children with OSA randomized into early adenotonsillectomy or watchful waiting. Children with OSA and MB at baseline (determined by reporting 2 or greater to OSA-18 questionnaire on mouth breathing) were divided into 2 groups: improved mouth breathing (IMB, determined by a lower score compared to baseline at follow up) and persistent mouth breathing (PMB, determined by an unchanged or higher score). Baseline characteristics, behavior (Conners GI score), sleepiness (Epworth Sleepiness Scale), and quality of life (PedsQL) were compared between the groups using appropriate statistical tests. ANCOVA models were used to analyze change in outcomes, adjusting for treatment arm and change in AHI. RESULTS: Of 273 children with OSA and MB at baseline, IMB (N = 195) had significantly improved score between visits for Conner's GI Total T score, Epworth Sleepiness Scale, and PedsQL compared to PMB (N = 78), after adjusting for treatment arm and change in AHI. CONCLUSION: Our study suggests an interesting association between mouth breathing and quality of life, independent of polysomnographic evidence. Future studies should explore the effect of mouth breathing on quality of life, in absence of OSA.

Comparison between rhinometric variables and nasal airing in children with mouth breathing

ABSTRACT Purpose: to analyze the correlation between the values of nasal aeration and geometry of the nasal cavities, before and after nasal cleansing in children with mouth breathing. Methods: 20 children aged 4 to 12 years old were chosen. The questionnaire Identification Index of Signs and Symptoms of Oral breathing was applied and nasal patency was assessed by nasal aeration, through the Altmann graded mirror, and the nasal geometry measured by acoustic rhinometry. After nasal cleansing and massage, the same aeration measurements and nasal geometry procedures were performed. Group normality was analyzed using the Shapiro-Wilk test considering the hypothesis of normal distribution whenever p>0.05. The Spearman's test was applied to analyze the correlation between variables (p<0.05). Results: there was a strong and significant correlation between nasal aeration and the corresponding cross-sectional area of the front of the inferior turbinate (CSA2) in the left cavity before cleansing. There were no correlations between the nasal aeration and other rhinometric variables. Conclusion: there was a correlation between nasal aeration values and the anterior portion of the turbinates, before the massage and nasal cleansing technique, in mouth breathing children. There were no significant differences when the nasal aeration was correlated with other rhinometric variables.

EEG signals during mouth breathing in a working memory task.

Background: Continuous mouth breathing results not only morphological deformations but also poor learning outcomes. However, there were few studies that observed correlations between mouth breathing and cognition. This study aimed at investigating the changes in brain activity during mouth breathing while the participant simultaneously performed a cognitive task using electroencephalography (EEG).Methods: Twenty subjects participated in this study, and EEG electrodes (32 channels, 250-Hz sampling rate) were placed on their scalp. Brain waves during a resting state and n-back tasks (0-back and 2-back) and physiological parameters such as SpO2, ETCO2, and the airway respiratory rate were measured. The pre-processed EEG signals were analyzed based on their frequencies as delta waves (0.5 ∼ 4 Hz), theta waves (4 ∼ 8 Hz), alpha waves (8 ∼ 13 Hz), beta waves (13 ∼ 30 Hz) and gamma waves (30 ∼ 50 Hz) using fast Fourier transform (FFT).Results: When compared with nose breathing, theta and alpha powers were lower during mouth breathing at rest and alpha wave presented low power at 0-back and 2-back tasks. Furthermore, beta and gamma waves exhibited low powers at 2-back task. However, the behavioral results (accuracy and response time) have no significant difference between two breathing methods (mouth and nose). Mouth breathing showed different brain activity patterns, compared to nose breathing, and these changes are related to cognitive regions.Conclusion: The reason for this change seems to relate to the decreased oxygen saturation during mouth breathing, suggesting that when cognitive abilities are required, mouth breathing can act as one of the variables that cause different outcomes in brain activities.

Impact of adenotonsilectomy on nasal airflow and pulmonary blood pressure in mouth breathing children.

INTRODUCTION: Adenotonsillar hyperplasia (ATH) causing upper airway obstruction (UAO) may increase pulmonary artery systolic pressure (PASP). Early diagnosis and mouth breathing (MB) management may help in cases of high PASP. Total inspiratory nasal airflow (TINAF) obtained by active anterior rhinomanometry (AARM) is a means to quantify nasal patency. This study aimed to correlate TINAF with high PASP. METHODS: This is a prospective study involving 30 children between two and twelve years of age, with indication for adenotonsillectomy due to ATH, evaluated before and six months after surgery; and 29 nasal breathing (NB) children in the same age group. We obtained the PASP, calculated for tricuspid regurgitation, by means of a transthoracic echocardiography. We assessed nasal patency using the AARM to estimate the TINAF. RESULTS: The mean PASP among mouth breathing children was 25.99 mmHg, with a Standard Deviation of (±) 3.27, p = 0.01 in the preoperative period; and 21.79 mmHg (±2.48; p = 0.01) in the postoperative period. Among nasal breathers, this mean value was 21.64 mmHg (±3.87, p = 0.01). The mean pre-operative TINAF was 266.76 cm3/s (±112.21, p = 0.01); and 498.93 cm3/s (±137.80, p = 0.01) after surgery. Among nasal breathers it was 609.37 cm3/s (±109.16; p = 0.01). The mean nasal patency in the preoperative period was 42.85% (±17.83; p = 0.01); and 79.33% (±21.35; p = 0.01) in the post-op. Among nasal breathers it was 112.94% (±15.88, p = 0.01). There was a significant Spearman correlation value between TINAF and PASP (r = -0.459; p = 0.01) when we analyzed all the groups. CONCLUSION: PASP and TINAF values improved postoperatively and had an inverse correlation. This study suggests that by improving TINAF there was a decrease in PASP.

Sleep Quality and Congestion with Breathe Right Nasal Strips: Two Randomized Controlled Trials.

INTRODUCTION: Two multicenter, double-blind, randomized controlled trials assessed the effect of Breathe Right Nasal Strips (BRNS) on sleep-related quality of life in otherwise healthy subjects with chronic nocturnal nasal congestion who reported trouble sleeping. METHODS: Subjects were randomized to BRNS or a placebo strip for approximately 8 h each night for 14 days. Efficacy was assessed in the clinic using the Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ). RESULTS: A total of 140 subjects were randomized in Study 1, and 130 in Study 2. There was no significant difference between BRNS and placebo on either the NRQLQ "Sleep Problems" domain or the "Feel Tired and Unrefreshed" item of the "Symptoms on Waking in the Morning" domain at day 7 or 14. There was, however, a significant change in the least squares mean difference from baseline to days 7 and 14 in both the BRNS and placebo arms for each of these endpoints. BRNS were well tolerated. CONCLUSIONS: BRNS did not significantly improve subjective measures of sleep quality and nasal congestion compared with placebo strips in this population of chronic nocturnal congestion sufferers with self-reported sleep impairment, possibly due to a strong placebo effect. FUNDING: GlaxoSmithKline Consumer Healthcare. CLINICALTRIALS. GOV REGISTRATION NUMBERS: Study 1: NCT03549117; Study 2: NCT03549130.

Relationship between mouth breathing etiology and maximum tongue pressure. / Relação entre a etiologia da respiração oral e a pressão máxima da língua.

PURPOSE: To verify the relationship between maximum tongue pressure and the etiology of oral breathing in oral breathing children attended at the Oral Respiratory Outpatient Clinic. METHODS: A descriptive and analytical cross-sectional study was accomplished with 59 mouth breathing children aged 3 to 12 years (mean age 6.5 years and SD: standard deviation= 2.4). To collect tongue pressure, the Iowa Oral Performance Instrument (IOPI) was used and data regarding the etiology of oral breathing and dental occlusion were collected in the records of these patients for analysis. The associations between the maximum tongue pressure and the etiology of oral breathing, age, gender and dental occlusion were verified by the T test, ANOVA, Spearman's coefficient and Tuckey's test, using a significance level of 5%. RESULTS: There was a moderate and positive correlation between age and maximum pressure, it was verified that there was a statistically significant difference between the maximum tongue pressure and the variables pharyngeal tonsil hypertrophy and palatine tonsil hypertrophy. There were no statistical differences between the other variables. CONCLUSION: It was concluded that mechanical obstructions, among them the pharyngeal and palatine tonsil hypertrophy alter the maximum tongue pressure in oral breathing children.

OBJETIVO: Verificar a existência de relação entre pressão máxima da língua e a etiologia da respiração oral em crianças respiradoras orais atendidas em um Ambulatório do Respirador Oral. MÉTODO: Foi conduzido um estudo transversal observacional descritivo e analítico com 59 crianças respiradoras orais com idades entre três e 12 anos (média de 6,5 anos e DP=2,4). Para a coleta da pressão de língua, foi utilizado o Iowa Oral Performance Instrument ­ (IOPI) e dados sobre a etiologia da respiração oral e oclusão dentária foram coletados nos prontuários desses pacientes para análise. As associações entre a pressão máxima da língua e a etiologia da respiração oral, idade, gênero e oclusão dentária foram verificadas pelo teste T, ANOVA, coeficiente de Spearman e Teste de Tuckey, utilizando-se nível de significância de 5%. RESULTADOS: Houve correlação moderada e positiva entre idade e pressão máxima, verificou-se que houve diferença estatisticamente significativa entre a pressão máxima da língua e as variáveis hipertrofia da tonsila faríngea e hipertrofia das tonsilas palatinas. Não foram verificadas diferenças estatísticas entre as outras variáveis. CONCLUSÃO: Conclui-se que as obstruções mecânicas, dentre elas a hipertrofia das tonsilas faríngea e palatinas alteram a pressão máxima de língua em crianças respiradoras orais.

Nasal patency and otorhinolaryngologic-orofacial features in children / Patência nasal e características otorrinolaringológicas e orofaciais em crianças

Abstract Introduction: Nasal obstruction is a common symptom in childhood, related to rhinitis and pharyngeal tonsil hypertrophy. In the presence of nasal obstruction, nasal patency may be reduced, and nasal breathing is replaced by mouth breathing. Orofacial and otorhinolaryngologic changes are related to this breathing mode. Objective evaluation of upper airways may be obtained through nasal patency measurement. Objective: To compare nasal patency and otorhinolaryngologic-orofacial features in children. Methods: One hundred and twenty three children, 6-12 year-old, and of both sexes underwent speech therapy evaluation, according to Orofacial Myofunctional Evaluation protocol, clinical and endoscopic otorhinolaryngologic examination and nasal patency measurement, using the absolute and predicted (%) peak nasal inspiratory flow values. Results: Lower values of absolute and estimated peak nasal inspiratory flow values were found in children with restless sleep (p = 0.006 and p = 0.002), nasal obstruction report (p = 0.027 and p = 0.023), runny nose (p = 0.004 and p = 0.012), unsystematic lip closure during mastication (p = 0.040 and p = 0.026), masticatory speed reduced (p = 0.006 and p = 0.008) and altered solid food swallowing (p = 0.006 and p = 0.001). Absolute peak nasal inspiratory flow was lower in children with pale inferior turbinate (p = 0.040), reduced hard palate width (p = 0.037) and altered speech (p = 0.004). Higher absolute values were found in children with increased tongue width (p = 0.027) and, higher absolute and predicted (%) in children with mild everted lip (p = 0.008 and p = 0.000). Conclusions: Nasal patency was lower in children with restless sleep, rhinitis signs and symptoms, hard palate width reduced and with changes in mastication, deglutition and speech functions. It is also emphasized that most of the children presented signs and symptom of allergic rhinitis.

Resumo Introdução: A obstrução nasal é um sintoma comum na infância relacionado a rinite e hipertrofia das tonsilas faríngeas. Na presença de obstrução nasal, a patência nasal pode estar reduzida e a respiração nasal ser substituída por respiração oral. Alterações orofaciais e otorrinolaringológicas estão relacionadas a esse modo de respiração. A avaliação objetiva das vias aéreas superiores pode ser obtida através da medida da patência nasal. Objetivo: Comparar a patência nasal e características otorrinolaringológicas e orofaciais em crianças. Método: Foram submetidas 123 crianças de seis a 12 anos, de ambos os sexos, a avaliação fonoaudiológica, de acordo com o protocolo de avaliação Miofuncional Orofacial, exame clínico e endoscópico otorrinolaringológico e medição da patência nasal, com o uso do pico de fluxo inspiratório nasal em valores absolutos e valores estimados (% pico de fluxo inspiratório nasal). Resultados: Valores mais baixos de pico de fluxo inspiratório nasal e % pico de fluxo inspiratório nasal foram encontrados em crianças com sono agitado (p = 0,006 e p = 0,002), relato de obstrução nasal (p = 0,027 e p = 0,023), rinorreia (p = 0,004 e p = 0,012), fechamento não sistemático dos lábios durante a mastigação (p = 0,040 e p = 0,026), velocidade mastigatória reduzida (p = 0,006 e p = 0,008) e alteração da ingestão de alimentos sólidos (p = 0,006 e p = 0,001). O pico de fluxo inspiratório nasal foi menor em crianças com conchas inferiores pálidas (p = 0,040), redução da largura do palato duro (p = 0,037) e alterações da fala (p = 0,004). Valores maiores foram encontrados em crianças com largura da língua aumentada (p = 0,027). Valores maiores de pico de fluxo inspiratório nasal e % de pico de fluxo inspiratório nasal foram observados em crianças com lábio levemente evertido (p = 0,008 e p = 0,000). Conclusões: A patência nasal foi menor em crianças com sono agitado, sinais e sintomas de rinite, redução da largura do palato duro e alterações nas funções de mastigação, deglutição e fala. Enfatiza-se também que a maioria das crianças apresentava sinais e sintomas de rinite alérgica.

Growth and mouth breathers.

OBJECTIVE: To assess the relationship between mouth breathing and growth disorders among children and teenagers. DATA SOURCE: Search on MEDLINE database, over the last 10 years, by using the following terms: "mouth breathing", "adenotonsilar hypertrophy", "allergic rhinitis", "sleep disturbance" AND "growth impairment", "growth hormone", "failure to thrive", "short stature", or "failure to thrive". DATA SUMMARY: A total of 247 articles were identified and, after reading the headings, this number was reduced to 45 articles, whose abstracts were read and, of these, 20 were deemed important and were included in the review. In addition of these articles, references mentioned in them and specific books on mouth breathing deemed important were included. Hypertrophy of palatine and/or pharyngeal tonsils, whether associated with allergic rhinitis, as well as poorly controlled allergic rhinitis, are the main causes of mouth breathing in children. Respiratory sleep disorders are frequent among these patients. Several studies associate mouth breathing with reduced growth, as well as with reduced growth hormone release, which are reestablished after effective treatment of mouth breathing (clinical and/or surgical). CONCLUSIONS: Mouth breathing should be considered as a potential cause of growth retardation in children; pediatricians should assess these patients in a broad manner.

Alterações sensoriais em respiradores orais: revisão sistemática baseada no método prisma / Sensory changes in mouth breathers: systematic review based on the prisma method

RESUMO Objetivo: Revisar, na literatura, estudos que abordem alterações nos sistemas sensoriais apresentadas por respiradores orais. Fonte de dados: A busca foi realizada nas bases de dados PubMed, BIREME, LILACS, Web of Science e Scopus. A busca foi realizada independentemente por dois pesquisadores, seguindo os critérios de seleção. Foram selecionados artigos originais que abordaram a respiração oral e as alterações nos sistemas sensoriais publicados nos idiomas português, inglês e espanhol. Os artigos de revisão da literatura, as dissertações, os capítulos de livros, os estudos de caso e os editoriais foram excluídos. Síntese dos dados: Foram encontrados 719 artigos, dos quais 663 foram excluídos pelo título e 22 pelo resumo. Trinta e quatro manuscritos foram analisados, dos quais 23 estavam repetidos e 8 foram excluídos pelo texto lido na íntegra. Assim, três artigos foram selecionados para esta revisão. Conclusões: A maioria dos estudos apresenta a ocorrência de alterações dos sistemas sensoriais em crianças respiradoras orais. Contudo, observa-se maior preocupação na avaliação da recepção sensorial. Além disso, a avaliação dos sistemas sensoriais foi realizada de forma não padronizada, o que pode ter acarretado resultados menos precisos na população estudada.

ABSTRACT Objective: To review, in the literature, information regarding changes in the sensory systems of mouth breathers. Data sources: The search was conducted in the following databases PubMed, BIREME, LILACS, Web of Science and Scopus. The search was independently carried out by two researchers, following the selection criteria. Original articles that approached mouth breathing and changes in sensory systems published in Portuguese, English and Spanish were published. Literature review of articles, dissertations, book chapters, case studies and editorials were excluded. Data synthesis: We found 719 articles. Among them, 663 were excluded by the title and 22 by the summary. Among the 34 analyzed manuscripts, 23 were repeated and 8 were excluded by reading the full text. Thus, 3 articles were selected for this review. Conclusions: Most studies presents the occurrence of changes in sensory systems in mouth breathing children. However, sensory reception is a matter of more concern. Besides, the evaluation of sensory systems was not standardized, which may have led to less precise results in the studied population.

Unilateral nasal obstruction alters sweet taste preference and sweet taste receptors in rat circumvallate papillae.

Nasal obstruction causes mouth breathing, and affects the growth and development of craniofacial structures, muscle function in the stomatognathic system, and the taste perceptive system. However, the detailed mechanism underlying the effects of nasal obstruction on taste perception has not been fully elucidated. In this study, we investigated this mechanism using the two-bottle taste preference test, immunohistological analysis, and quantification of the mRNA expression of taste-related molecules in the circumvallate papillae. Neonatal male Wistar rats were divided randomly into control and experimental groups. Rats in the experimental group underwent unilateral nasal obstruction by cauterization of the external nostril at the age of 8 days. Arterial oxygen saturation (SpO2) was recorded in awake rats using collar clip sensors. Taste preference for five basic taste solutions was evaluated. Immunohistochemical analysis and quantitative real-time polymerase chain reaction (RT-PCR) were conducted to evaluate the expressions of taste-related molecules in the taste cells of the circumvallate papillae. Body weights were similar between the two groups throughout the experimental period. The SpO2 in the 7- to 12-week-old rats in the experimental group was significantly lower than that in the age-matched rats in the control group. In the two-bottle taste preference test, the sensitivities to sweet taste decreased in the experimental group. The mRNA expression of T1R2, T1R3, α-gustducin, and PLCß2 was significantly lower in the experimental group than in the control group as determined by quantitative RT-PCR, and the immunohistochemical staining for α-gustducin and PLCß2 was less prominent. These findings suggest that nasal obstruction may affect sweet taste perception via the reduced expression of taste-related molecules in the taste cells in rat circumvallate papillae.

SENSORY CHANGES IN MOUTH BREATHERS: SYSTEMATIC REVIEW BASED ON THE PRISMA METHOD. / ALTERAÇÕES SENSORIAIS EM RESPIRADORES ORAIS: REVISÃO SISTEMÁTICA BASEADA NO MÉTODO PRISMA.

OBJECTIVE: To review, in the literature, information regarding changes in the sensory systems of mouth breathers. DATA SOURCES: The search was conducted in the following databases PubMed, BIREME, LILACS, Web of Science and Scopus. The search was independently carried out by two researchers, following the selection criteria. Original articles that approached mouth breathing and changes in sensory systems published in Portuguese, English and Spanish were published. Literature review of articles, dissertations, book chapters, case studies and editorials were excluded. DATA SYNTHESIS: We found 719 articles. Among them, 663 were excluded by the title and 22 by the summary. Among the 34 analyzed manuscripts, 23 were repeated and 8 were excluded by reading the full text. Thus, 3 articles were selected for this review. CONCLUSIONS: Most studies presents the occurrence of changes in sensory systems in mouth breathing children. However, sensory reception is a matter of more concern. Besides, the evaluation of sensory systems was not standardized, which may have led to less precise results in the studied population.

OBJETIVO: Revisar, na literatura, estudos que abordem alterações nos sistemas sensoriais apresentadas por respiradores orais. FONTE DE DADOS: A busca foi realizada nas bases de dados PubMed, BIREME, LILACS, Web of Science e Scopus. A busca foi realizada independentemente por dois pesquisadores, seguindo os critérios de seleção. Foram selecionados artigos originais que abordaram a respiração oral e as alterações nos sistemas sensoriais publicados nos idiomas português, inglês e espanhol. Os artigos de revisão da literatura, as dissertações, os capítulos de livros, os estudos de caso e os editoriais foram excluídos. SÍNTESE DOS DADOS: Foram encontrados 719 artigos, dos quais 663 foram excluídos pelo título e 22 pelo resumo. Trinta e quatro manuscritos foram analisados, dos quais 23 estavam repetidos e 8 foram excluídos pelo texto lido na íntegra. Assim, três artigos foram selecionados para esta revisão. CONCLUSÕES: A maioria dos estudos apresenta a ocorrência de alterações dos sistemas sensoriais em crianças respiradoras orais. Contudo, observa-se maior preocupação na avaliação da recepção sensorial. Além disso, a avaliação dos sistemas sensoriais foi realizada de forma não padronizada, o que pode ter acarretado resultados menos precisos na população estudada.

Nasal patency and otorhinolaryngologic-orofacial features in children.

INTRODUCTION: Nasal obstruction is a common symptom in childhood, related to rhinitis and pharyngeal tonsil hypertrophy. In the presence of nasal obstruction, nasal patency may be reduced, and nasal breathing is replaced by mouth breathing. Orofacial and otorhinolaryngologic changes are related to this breathing mode. Objective evaluation of upper airways may be obtained through nasal patency measurement. OBJECTIVE: To compare nasal patency and otorhinolaryngologic-orofacial features in children. METHODS: One hundred and twenty three children, 6-12 year-old, and of both sexes underwent speech therapy evaluation, according to Orofacial Myofunctional Evaluation protocol, clinical and endoscopic otorhinolaryngologic examination and nasal patency measurement, using the absolute and predicted (%) peak nasal inspiratory flow values. RESULTS: Lower values of absolute and estimated peak nasal inspiratory flow values were found in children with restless sleep (p=0.006 and p=0.002), nasal obstruction report (p=0.027 and p=0.023), runny nose (p=0.004 and p=0.012), unsystematic lip closure during mastication (p=0.040 and p=0.026), masticatory speed reduced (p=0.006 and p=0.008) and altered solid food swallowing (p=0.006 and p=0.001). Absolute peak nasal inspiratory flow was lower in children with pale inferior turbinate (p=0.040), reduced hard palate width (p=0.037) and altered speech (p=0.004). Higher absolute values were found in children with increased tongue width (p=0.027) and, higher absolute and predicted (%) in children with mild everted lip (p=0.008 and p=0.000). CONCLUSIONS: Nasal patency was lower in children with restless sleep, rhinitis signs and symptoms, hard palate width reduced and with changes in mastication, deglutition and speech functions. It is also emphasized that most of the children presented signs and symptom of allergic rhinitis.

Growth and mouth breathers / Crescimento e respiradores orais

Abstract Objective: To assess the relationship between mouth breathing and growth disorders among children and teenagers. Data source: Search on MEDLINE database, over the last 10 years, by using the following terms: "mouth breathing", "adenotonsilar hypertrophy", "allergic rhinitis", "sleep disturbance" AND "growth impairment", "growth hormone", "failure to thrive", "short stature", or "failure to thrive". Data summary: A total of 247 articles were identified and, after reading the headings, this number was reduced to 45 articles, whose abstracts were read and, of these, 20 were deemed important and were included in the review. In addition of these articles, references mentioned in them and specific books on mouth breathing deemed important were included. Hypertrophy of palatine and/or pharyngeal tonsils, whether associated with allergic rhinitis, as well as poorly controlled allergic rhinitis, are the main causes of mouth breathing in children. Respiratory sleep disorders are frequent among these patients. Several studies associate mouth breathing with reduced growth, as well as with reduced growth hormone release, which are reestablished after effective treatment of mouth breathing (clinical and/or surgical). Conclusions: Mouth breathing should be considered as a potential cause of growth retardation in children; pediatricians should assess these patients in a broad manner.

Resumo Objetivo: Avaliar a relação entre respiração oral e distúrbios do crescimento entre crianças e adolescentes. Fonte de dados: Busca na base de dados do MEDLINE, nos últimos 10 anos, com o emprego dos seguintes termos: "mouth breathing" ou "adenotonsilar hypertrophy", ou "allergic rhinitis" ou sleep disturbance" AND "growth impairment" ou "growth hormone" ou "failure to thrive" ou "short stature" ou "failure to thrive". Síntese dos dados: Foram identificados 247 artigos, que após a leitura dos títulos foram reduzidos a 45, cujos resumos foram lidos e desses 20 foram considerados de importância e integraram a revisão. Além desses, referências por eles citadas e livros-texto específicos sobre respiração oral considerados importantes foram incluídos. A hipertrofia de tonsilas palatinas e/ou faríngeas, associada ou não à rinite alérgica, assim como a rinite alérgica mal controlada, é a principal causa de respiração oral na criança. Distúrbios respiratórios do sono são frequentes entre esses pacientes. Vários estudos associam a respiração oral à redução do crescimento, bem como à redução de liberação de hormônio do crescimento, que são restabelecidos após o tratamento efetivo da respiração oral (clínico e/ou cirúrgico). Conclusões: A respiração oral deve ser cogitada como possível causa de retardo de crescimento em crianças e cabe ao pediatra a tarefa de investigar esses pacientes de forma mais abrangente.

Relação entre a etiologia da respiração oral e a pressão máxima da língua / Relationship between mouth breathing etiology and maximum tongue pressure

RESUMO Objetivo Verificar a existência de relação entre pressão máxima da língua e a etiologia da respiração oral em crianças respiradoras orais atendidas em um Ambulatório do Respirador Oral. Método Foi conduzido um estudo transversal observacional descritivo e analítico com 59 crianças respiradoras orais com idades entre três e 12 anos (média de 6,5 anos e DP=2,4). Para a coleta da pressão de língua, foi utilizado o Iowa Oral Performance Instrument - (IOPI) e dados sobre a etiologia da respiração oral e oclusão dentária foram coletados nos prontuários desses pacientes para análise. As associações entre a pressão máxima da língua e a etiologia da respiração oral, idade, gênero e oclusão dentária foram verificadas pelo teste T, ANOVA, coeficiente de Spearman e Teste de Tuckey, utilizando-se nível de significância de 5%. Resultados Houve correlação moderada e positiva entre idade e pressão máxima, verificou-se que houve diferença estatisticamente significativa entre a pressão máxima da língua e as variáveis hipertrofia da tonsila faríngea e hipertrofia das tonsilas palatinas. Não foram verificadas diferenças estatísticas entre as outras variáveis. Conclusão Conclui-se que as obstruções mecânicas, dentre elas a hipertrofia das tonsilas faríngea e palatinas alteram a pressão máxima de língua em crianças respiradoras orais.

ABSTRACT Purpose To verify the relationship between maximum tongue pressure and the etiology of oral breathing in oral breathing children attended at the Oral Respiratory Outpatient Clinic. Methods A descriptive and analytical cross-sectional study was accomplished with 59 mouth breathing children aged 3 to 12 years (mean age 6.5 years and SD: standard deviation= 2.4). To collect tongue pressure, the Iowa Oral Performance Instrument (IOPI) was used and data regarding the etiology of oral breathing and dental occlusion were collected in the records of these patients for analysis. The associations between the maximum tongue pressure and the etiology of oral breathing, age, gender and dental occlusion were verified by the T test, ANOVA, Spearman's coefficient and Tuckey's test, using a significance level of 5%. Results There was a moderate and positive correlation between age and maximum pressure, it was verified that there was a statistically significant difference between the maximum tongue pressure and the variables pharyngeal tonsil hypertrophy and palatine tonsil hypertrophy. There were no statistical differences between the other variables. Conclusion It was concluded that mechanical obstructions, among them the pharyngeal and palatine tonsil hypertrophy alter the maximum tongue pressure in oral breathing children.

Effect of Nasal Valve Shape on Downstream Volume, Airflow, and Pressure Drop: Importance of the Nasal Valve Revisited.

OBJECTIVES: The relative importance of the nasal valve relative to the remainder of the nasal airway remains unknown. The goal of this article was to objectively measure the shape of the nasal inlet and its effect on downstream airflow and nasal cavity volume using a physical model and a physiologic flow model. METHODS: A patient who had isolated nasal valve surgery and had pre- and postoperative computed tomography scans available for analysis was studied. Nasal inlet shape measurements, computational fluid dynamics, and nasal volume analysis were performed using the computed tomography data. In addition, a physical model was used to determine the effect of nasal obstruction on downstream soft tissue. RESULTS: The postoperative shape of the nasal inlet was improved in terms of length and degree of tortuosity. Whereas the operated-on region at the nasal inlet showed an only 25% increase in cross-sectional area postoperatively, downstream nonoperated sites in the nasal cavity revealed increases in area ranging from 33% to 51%. Computational fluid dynamics analysis showed that airway resistance decreased by 42%, and pressure drop was reduced by 43%. Intraluminal mucosal expansion was found with nasal obstruction in the physical model. CONCLUSION: By decreasing the degree of bending and length at the nasal valve, inspiratory downstream nonoperated sites of the nasal cavity showed improvement in volume and airflow, suggesting that the nasal valve could play an oversized role in modulating the aerodynamics of the airway. This was confirmed with the physical model of nasal obstruction on downstream mucosa.

Short-term evaluation of tegumentary changes of the nose in oral breathers undergoing rapid maxillary expansion / Avaliação em curto prazo das alterações tegumentares do nariz em respiradores orais submetidos à expansão rápida da maxila

Abstract Introduction Rapid maxillary expansion is an orthodontic and orthopedic procedure that can change the form and function of the nose. The soft tissue of the nose and its changes can influence the esthetics and the stability of the results obtained by this procedure. Objective The objective of this study was to assess the changes in nose dimensions after rapid maxillary expansion in oral breathers with maxillary atresia, using a reliable and reproducible methodology through computed tomography. Methods A total of 30 mouth-breathing patients with maxillary atresia were analyzed and divided into a treatment group who underwent rapid maxillary expansion (20 patients, 10 of which were male and 10 female, with a MA of 8.9 years and a SD of 2.16, ranging from 6.5 to 12.5 years) and a Control Group (10 patients, 5 of which were male and 5 female, with a MA of 9.2 years, SD of 2.17, ranging from 6.11 to 13.7 years). In the treatment group, multislice computed tomography scans were obtained at the start of the treatment (T1) and 3 months after expansion (T2). The patients of the control group were submitted to the same exams at the same intervals of time. Four variables related to soft tissue structures of the nose were analyzed (alar base width, alar width, height of soft tissue of the nose and length of soft tissue of the nose), and the outcomes between T1 and T2 were compared using Osirix MD software. Results In the TG, the soft tissues of the nose exhibited significant increases in all variables studied (p < 0.05), whereas, changes did not occur in the control group (p > 0.05). In the treatment group, mean alar base width increased by 4.87% (p = 0.004), mean alar width increased by 4.04% (p = 0.004), mean height of the soft tissues of the nose increased by 4.84% (p = 0.003) and mean length of the soft tissues of the nose increased by 4.29% (p = 0.012). Conclusion In short-term, rapid maxillary expansion provided a statistically significant increase in the dimensions of the soft tissues of the nose.

Resumo Introdução A expansão rápida da maxila é um procedimento ortodôntico e ortopédico que pode alterar a forma e a função do nariz. Os tecidos moles do nariz e suas alterações podem influenciar na estética e na estabilidade dos resultados obtidos por esse procedimento. Objetivo O objetivo desse estudo foi avaliar as alterações nas dimensões do nariz após expansão rápida da maxila em respiradores orais com atresia maxilar, usando uma metodologia confiável e reprodutível com o auxílio de tomografia computadorizada. Método Um total de 30 pacientes respiradores orais com atresia maxilar foram avaliados e divididos em um grupo de tratamento, submetidos à expansão rápida da maxila (20 pacientes, 10 dos quais do sexo masculino e 10 do sexo feminino, com média de idade de 8,9 anos e DP de 2,16, variando de 6,5 a 12,5 anos) e um grupo controle (10 pacientes, sendo 5 do sexo masculino e 5 do sexo feminino, com média de idade de 9,2 anos, DP de 2,17, variando de 6,11 a 13,7 anos). No grupo tratado, foram realizados exames de tomografia computadorizada multislice no início do tratamento (T1) e 3 meses após a expansão (T2). Os pacientes do grupo controle foram submetidos aos mesmos exames nos mesmos intervalos de tempo. Foram analisadas quatro variáveis relacionadas às estruturas dos tecidos moles do nariz (largura da base alar, largura alar, altura do tecido mole do nariz e comprimento do tecido mole do nariz) e os resultados entre T1 e T2 foram comparados, utilizando-se o software Osirix MD. Resultados No grupo tratado (GT), os tecidos moles do nariz apresentaram aumentos significativos em todas as variáveis estudadas (p < 0,05), enquanto isso não ocorreu no GC (p > 0,05). No GT, a largura média da base alar aumentou 4,87% (p = 0,004), a largura média alar aumentou 4,04% (p = 0,004), a altura média dos tecidos moles do nariz aumentou 4,84% (p = 0,003) e o comprimento médio dos tecidos moles do nariz aumentou 4,29% (p = 0,012). Conclusão A curto prazo, a expansão rápida da maxila proporcionou um aumento estatisticamente significativo nas dimensões dos tecidos moles do nariz.

Tongue pressure measurement in children with mouth-breathing behaviour.

The tongue plays an important role in oral functions. Reduced tongue strength is often noted among children with mouth-breathing behaviour. The purposes of this study were to measure the tongue pressure in children with mouth-breathing behaviour, to compare these values to those of children with nasal-breathing behaviour and to analyse the relationship between age and tongue pressure in children with a mouth-breathing pattern and in children with a nasal-breathing pattern. In this cross-sectional analytical observational study, we enroled 40 children aged 5-12 years who either exhibited mouth-breathing behaviour (n = 20) or nasal-breathing behaviour (gender- and age-matched [±2 years] controls; n = 20). Tongue pressure was evaluated using the Iowa Oral Performance Instrument; 3 measurements were recorded for each participant, with a 30-seconds rest interval. The average tongue pressure in the mouth-breathing group was lower than that in the nasal-breathing group. There was no difference in tongue pressure between genders. There was a strong and direct correlation between tongue pressure and age in the nasal-breathing group. The breathing pattern impacts tongue pressure development.