Comparing the effectiveness of nasal dilator strips: does race play a role?

BACKGROUND: Nasal dilator strips are thought to widen and stiffen the anterior nasal cavity, and thus improve symptoms of nasal obstruction. It is postulated that anthropomorphic differences in external nasal proportions between races may influence the effectiveness of such dilator strips. METHODS: Caucasian and Asian subjects were compared. Nasal peak inspiratory flow, nasal airway resistance, minimum cross-sectional area and visual analogue scale measurements of nasal obstruction were recorded at baseline and following the application of two different dilator strips. RESULTS: Nine Caucasian and six Asian subjects were recruited (n = 15). There was a significant difference between races in terms of nasal peak inspiratory flow improvements following nasal strip application (mean of 29.4 litres per minute in Caucasians vs 14.6 litres per minute in Asians; p = 0.04). Only Caucasians experienced a significant decrease in nasal airway resistance (median of 0.12 Pa/cm3/s; p < 0.01). CONCLUSION: Nasal peak inspiratory flow, minimum cross-sectional area and visual analogue scale values improved from baseline with strip application in both populations. Only Caucasians experienced significant nasal airway resistance improvement with strip application. Both cohorts experienced nasal peak inspiratory flow improvement, with Caucasians experiencing a significantly larger improvement.

Evaluation of the psychological status in seasonal allergic rhinitis patients.

OBJECTIVE: To investigate the psychological status of Chinese adults with seasonal allergic rhinitis (SAR) in the allergic season, and evaluate the effects of nasal symptoms on their psychological status. METHODS: The Symptom Checklist 90 (SCL-90) or Self-Reporting Inventory was employed to analyze the psychological status of 337 SAR patients. RESULTS: The SCL-90 scores of the SAR patients were statistically higher than those of nonallergic adults in terms of somatization, depression, anxiety, hostility and psychosis. No statistical discrepancies existed in gender or age, the impact of disease course was limited to somatization, compulsion and phobic disorders and the impact of the educational level was that the lower the level of education, the more obvious the hostility. The behavior of somatization, compulsion, depression and anxiety in patients with a history of eczema or asthma was much more obvious than in patients without such a history. Nasal obstruction had a conspicuous impact on somatization, compulsion, interpersonal sensitivity, depression, anxiety and psychosis, while nasal itching contributed to somatization, depression and anxiety. CONCLUSION: The psychological status of SAR patients is evidently worse than that of nonallergic adults. Symptoms such as nasal obstruction and nasal itching had an obvious impact on the psychological status of the patients.

Association of self-reported nasal blockage with sleep-disordered breathing and excessive daytime sleepiness in Pakistani employed adults.

PURPOSE: To assess prevalence of self-reported nasal congestion and its association with sleep-disordered breathing (SDB) and excessive daytime sleepiness (EDS) in Pakistani adults employed at a medical university. METHODS: All full-time employees of a medical university (n=3,470) were delivered a questionnaire that elicited demographic data, symptoms of nasal blockage and SDB and Epworth Sleepiness Scale score. Overnight pulse oximetry was performed on self-reported snorers and a random sample of non-snorers. Supervised polysomnography was performed on subjects with oxygen desaturation index >5/h. Logistic regression analysis was used to assess the association of nasal blockage with SDB and EDS. RESULTS: Of 2,497 (72%) responders, 45.2% reported nasal congestion. Self-reported nasal blockage was significantly associated with an increased risk of SDB symptoms: snoring (odds ratio [OR] 1.9), witnessed apnoea (OR, 2.2) and unrefreshing sleep (OR, 1.7). Those with nasal blockage had higher Epworth Sleepiness Scale score (5.5 ± 3.6 vs. 3.9 ± 3.3, p<0.001) compared with those without nasal blockage. Nasal blockage was associated with increased risk of doziness in seven out of eight items of Epworth Sleepiness Scale score. Oxygen desaturation index and apnoea-hypopnoea index were similar between subjects with and without self-reported nasal blockage. CONCLUSION: Self-reported nasal blockage is a common symptom in employed Pakistani adults. Self-reported nasal blockage is significantly associated with symptoms of SDB and EDS but not with respiratory variables on overnight sleep monitoring.

Measurement of nasal patency by acoustic rhinometry in Japanese school children.

OBJECTIVE: The present study was planned in order to evaluate: (1) the reference value of Japanese school children at a certain grade, (2) the relationship between subjective sensation of nasal obstruction and acoustic rhinometry, and (3) relationship of acoustic rhinometry with gender and body status. METHODS: Seventy-five school children in the second grade, which include 39 girls (52%) and 36 boys (48%), ranging in age from 7 to 8 were studied in July 2006. RESULTS: The normal mean values of the minimal cross-sectional area and nasal volume were 0.389 and 2.63cm(3) in this group, respectively. In those with nasal obstruction sensation, the cross-sectional areas at the third and the fourth notches were significantly smaller than those without nasal obstruction sensation (p<0.05). Nasal volume weakly correlated to body weight and body mass index. The distance from the nostril to the i-notch was significantly higher in the girls than in the boys (p<0.01). The area at the i-notch was significantly higher in the boys than in the girls. Height, weight, body mass were significantly higher in the boys than in the girls (p<0.01). CONCLUSION: Acoustic rhinometry is a useful method for evaluation of nasal patency in school children.

Influence of ethnicity on the frequency of nasal surgery.

OBJECTIVE: To determine whether surgery for nasal obstruction differs in frequency between ethnic groups. METHOD: Ethnicity data was collected from all patients attending otolaryngology clinic appointments and compared to census data. Odds ratios with confidence intervals were calculated for attendance at otolaryngology clinics, rhinology clinics, undergoing septoplasty, septorhinoplasty and/ or turbinate surgery for each ethnic group over a 3-year period. RESULTS: The ethnic groups of the 39493 outpatient attendees closely mirrored demographic data from the 2001 Census. Non-Chinese Asian ethnic groups were more likely to undergo septal surgery than the general (mainly white) population (odds ratio 1.44, 95% CI 1.25 to 1.66, p < 0.00001), whereas Black groups (odds ratio 0.31 [0.23 - 0.41], p < 0.00001) and Chinese (odds ratio 0.28 [0.11 - 0.70], p = 0.00311) were much less likely. Similar results were found for rhinoplasty and turbinate surgery. CONCLUSIONS: There is strong statistical evidence for large differences in the frequency of surgery for nasal obstruction between ethnic groups. Asian groups were more likely to undergo surgery, whereas Chinese and Blacks were less likely than the general population, which was predominantly white in this study. This may be due to anatomical variations, differences cultural views towards surgery, or inequalities in clinician's attitudes.

Effect of the external nasal dilator on nasal minimal cross-sectional area in orientals as assessed by acoustic rhinometry.

OBJECTIVE: This study aimed to evaluate the effect of the external nasal dilator on the dimension of the nasal valve in Orientals. DESIGN: A cohort study of normal subjects. SETTING: Academic institution. METHODS: The nasal fossae of normal subjects were assessed by acoustic rhinometry before and after application of the external nasal dilator. MAIN OUTCOME MEASURES: The minimal cross-sectional area of the nasal fossae and the total cross-sectional area of the nose. RESULTS: Nasal fossae of 25 normal subjects were evaluated. There was a significant increase of 0.10 cm2 (SD = 0.16) or a 17% increase in the minimal cross-sectional area of the 50 nasal cavities after application of the external nasal dilator (Wilcoxon's matched-pairs signed rank test, p = .0001). A significant increase in the total minimal cross-sectional area for the whole nose after application was also present (0.19 cm2, SD = .27, or 16%; Wilcoxon's matched-pairs signed rank test, p = .0032). CONCLUSIONS: The external nasal dilator results in an increase in the minimal cross-sectional area of the nasal airway in Orientals.

An international comparison of characteristics of the sensation of nasal obstruction between Canadian and Japanese patients.

To determine differences in perception of nasal obstruction in Canadians and Japanese, we assessed subjective and objective nasal patency of 48 patients in Canada and 43 patients in Japan. Mean severity of the sensation of nasal obstruction in Canadian patients was significantly higher than in Japanese patients, while no significant differences in nasal resistances were found. Complaints of nasal obstruction in Canadian patients were directly concerned with nasal breathing, while Japanese patients complained of indirect matters, such as "unable to concentrate on job or study" or "nasal obstruction or nasal speech pointed out by other persons." The differences might be due to national characteristics.

A study of nasal respiratory resistance and craniofacial dimensions in white and West Indian black children.

Two studies have shown that there are morphologic differences in the nasopharynx between the major racial groups. This investigation was conducted to see whether these morphologic differences affected nasal respiration. Twenty-two West Indian and 24 white children (mean age of 13 years 11 months) were studied to examine the relationship between nasorespiratory function and nasopharyngeal and dentofacial structure. The nasorespiratory function was measured in terms of nasal respiratory resistance, NRR, (Pascals/cm3 per second), both by anterior and posterior methods, with a computerized rhinomanometer. Nasopharyngeal structure was described in terms of cephalometric variables. The West Indian cephalometric profile generally conformed to its existing description in the literature including prognathic jaws and bimaxillary proclination; in addition, the West Indians were found to have a greater bony nasopharyngeal width (posterior nasal spine-basion) and shallower nasopharyngeal roof angle (posterior nasal spine-hormion-basion). All rhinomanometric measurements were significantly lower in the West Indian group, especially when posterior rhinomanometry was used. The correlation coefficients between the cephalometric and the rhinomanometric measurements were statistically significant but low. In addition, the measure of mandibular prognathism (angle SNB) was also found to be significantly correlated with the nasorespiratory resistance.

A study of nasal respiratory resistance and craniofacial dimensions in white and West Indian black children

Two studies have shown that there are morphologic differences in the nasopharynx between the major racial groups. This investigation was conducted to see whether these morphologic differences affected nasal respiration. Twenty-two West Indian and 24 white children (mean age of 13 years 11 months) were studied to examine the relationship between nasorespiratory function and nasopharyngeal and dentofacial structure. The nasorespiratory function was measured in terms of nasal respiratory resistance, NRR, (Pascals/cm3 per second), both by anterior and posterior methods, with a computerized rhinomanometer. Nasopharyngeal structure described in terms of cephalometric variables. The West Indian cephalometric profile generally conformed to its existing description in the literature including prognathic jaws and bimaxillary proclination; in addition, the West Indians were found to have a greater bony nasopharyngeal width (posterior nasal spine-basion) and shallower nasopharyngeal roof angle (posterior nasal spine-hormion-basion). All rhinomanometry were significantly lower in the West Indian group, especially when posterior rhinomanometry was used. The correlation coefficients between the cephalometric and the rhinomanometric measurements were statistically significant but low. In addition, the measure of mandibular prognathism (angle SNB) was also found to be significantly correlated with the nasorespiratory resistance (AU)