The limitations of peak nasal flow measurement

The Youlten Peak Nasal Flow Meter is a convenient device for obtaining objective measurements of nasal patency and gives static values which correlate well—though inversely—with resistance measured by rhinomanometry. In this study peak nasal flow and nasal resistance are compared before and after intranasal challenge using histamine. The comparatively small change in nasal resistance induced by low-dose histamine is not reliably detected by the peak flow meter. Large changes in nasal resistance with a higher dose of histamine are reflected by significant but small changes in peak nasal inspiratory flow. It is concluded that changes in nasal patency as measured by the Youlten meter are an insensitive measure of nasal patency compared with rhinomanometrically measured resistance changes. Continued use of the latter is recommended for physiological research.     

Congenital nasal masses: diagnosis and management

One hundred and nine congenital nasal masses which presented to two children's hospitals over a 20 year period are reviewed. The diagnosis of the nasal mass is discussed with respect to age, mode of presentation, and site of the lesion, and a management protocol is advocated.     

Can snoring relief after nasal septal surgery be predicted?

Patients with nasal obstruction often have associated snoring. This study aims to find out if there are reliable predictors for the success or failure of septal surgery in relieving snoring in patients with symptomatic nasal obstruction secondary to a deviated nasal septum and who have associated snoring. Thirty patients were studied pre-operatively and at 4–12 months (mean 6 months) post-operatively. The intensity of snoring was measured on a visual analogue scale. Nasal patency was measured with a peak nasal inspiratory flow meter. The collapsibility of the soft palate was gauged by the degree of velopharyngeal closure on the Muller manoeuvre. Fifteen patients (50%) achieved snoring relief after septal surgery. The severity of nasal obstruction and intensity of snoring pre-operatively, the magnitude of nasal obstruction relief post-operatively and the degree of collapsibility of the soft palate were found not to influence the outcome of septal surgery on snoring. The relationship between nasal obstruction and snoring is complex and the alteration of airflow patterns after septal surgery is postulated to be important in influencing snoring relief.     

Nasal Mucosal Temperature after Exposure to Cold,Dry Air and Hot,Humid Air

Objective - To determine the influence of variations in the temperature and humidity of inhaled air on the nasal mucosal temperature at various sites int he nasal airways.

Materials and Methods - Fifteen volunteers were enrolled int he study. The temperature was measured on the mucosal surface of the nasal septum at the level of the nasal vestibule, in the nasal valve area, anterior turbinate area and choanae. Temperature measurements were made using a miniaturized thermocouple. Continuous temperature readings were performed before and after 10 min of exposure to either cold, dry air, ambient air or hot, humid air.

Results - Inhilation of cold, dry air significantly reduced the temperatyre of the septal mucosa at each location of measurement compared to the breathing of ambient air. Inhalation of hot, humid air significantly increased the septal mucosal temperature at all detection sites.

Conclusions - The climatic condition of inhaled air can lead to significant changes in nasal mucosal temperature. As the nasal mucosa is important for nasal air conditioning, short term exposure to air of extreme temperature and humidity can rapidly compromise nasal air conditioning.     

鼻瓣区的鼻中隔偏曲矫正术

2003-2010年我们对单纯鼻瓣区的鼻中隔偏曲及鼻腔并鼻瓣区鼻中隔偏曲患者进行了鼻瓣区鼻中隔偏曲矫正术,效果良好,报告如下。     

The role of the temperature of the nasal lining in the sensation of nasal patency

The receptors and neural pathways involved in the common symptom of nasal blockage are of great interest. Studies to date suggest that the sensation of nasal patency may be related to the temperature of the nasal passages. Sixty-two subjects were asked to assess their own nasal patency subjectively and indicate this on a visual analogue scale. The temperature of the nasal lining was continuously recorded during quiet nasal repiration using a non-contact infrared themometer. The cooler the nasal lining, the clearer the nose felt, and the greater the drop in temperature on inspiration again the clearer the nose felt. The study supports the previously proposed hypothesis that the sensation of nasal airflow is derived from a cooling of the nasal lining on inspiration, and this is probably detected by cold thermoreceptors in the mucosa.     

The effect of nasal mucosal vasoconstriction on nasal airflow sensation

The correlation between the objective measurement of nasal resistance and nasal airflow sensation is usually regarded as poor. To investigate the relationship between these two parameters 20 healthy volunteers had nasal resistance to airflow measured by rhinomanometry compared with nasal sensation by visual analogue scoring before and after nasal mucosal vasoconstriction using topical 0.1% xylometazoline. The median change in nasal resistance was 0.2 kPal^-1s (95% CI 0.08–0.28 kPal^-1s) and in nasal sensation 24 mm (95% CI 17 mm-35 mm). A significant relationship between nasal sensation and nasal resistance to airflow was found (Kendall's Rank correlation (P < 0.05). This function can be described by the linear regression equation: dS = 13.2 + 70.dNR where dS = change in nasal sensation and dNR = change in nasal resistance. There may be a much closer relationship between subjective and objective measures of nasal patency than has previously been thought.     

Correlation of subjective sensation of nasal patency with nasal inspiratory peak flow rate*

To determine the relationship between subjective sensation of nasal patency and objective measurement of nasal inspiratory peak flow rate, a longitudinal study was conducted using healthy volunteers. Five healthy medical practitioners, one woman and 4 men, aged 24–34 years, made daily subjective estimations of their sensation of nasal patency on a 10cm visual analogue scale. This was followed immediately by measurements of nasal inspiratory peak flow rate using a Youlten meter, repeated on at least 25 days per subject. Correlation coefficient and regression lines for subjective nasal patency on nasal inspiratory peak flow rate were calculated. One hundred and sixty nine sets of observations were made, range 25–44 per subject. Each subject showed strong evidence (P < 0.01) of positive correlation between subjective nasal patency score and nasal inspiratory peak flow rate. There was strong evidence (P < 0.001) that different regression lines are needed for different subjects, but no evidence that the lines are not parallel. Subjective sensation of nasal patency is strongly correlated with objective nasal patency, as measured by peak inspiratory flow rate. This relationship varies between individuals. Measurement of nasal inspiratory peak flow rate may be a valuable objective test of nasal patency, and is quick and simple to perform.     

Late results of nasal septum injury in children

In the period 1973-1982 241 children with nasal injuries were treated in ORL Clinics in Prague-Motol. The pathological septal findings were confirmed at the time by rhinoscopy in 98 cases (40%). In these cases, deviation, subluxation, or fracture were found 73 times, subperichondrial abscess 12 times, and hematoma 13 times. At the time of control examination 2-10 years after the injury, the unfavourable effects of the injury on the septum or the nasal passage were confirmed. Deviation of the septum was found in 55% of children; bad or insufficient rhinomanometric values in 62%. The septal deviation was associated with snoring in 52%, with colds in 56%, and in 37% with bronchitis and sinusitis. It was found necessary to carry out surgical correction of the nasal septum in several children of the 10-12 year age group; rhinotomy was not deemed necessary in any case.     

The relief of snoring by nasal surgery

Patients with nasal obstruction may also complain of snoring. It is uncertain whether surgery which relieves the nasal obstruction will also relieve the snoring. We have reviewed 126 patients who complained of both nasal obstruction and snoring and who underwent nasal surgery. Snoring was completely relieved in 39 patients (31%), was less loud in a further 72 patients (57%), unchanged in 11 and louder in 4. It occurred on fewer nights post-operatively in 61, on the same number in 24 and more frequently in 2. Patients who had nasal polypectomy as part of their nasal surgery obtained the greatest snoring relief. This study suggests that when snoring and nasal obstruction coexist nasal surgery should be considered as the first line of surgical treatment.     

A randomized study to compare calcium sodium alginate fibre with two commonly used materials for packing after nasal surgery

A prospective randomized study was undertaken to compare the qualities of calcium sodium alginate (Kaltostat), trousered paraffin gauze, and glove finger packs as nasal packing material following the operation of partial inferior turbinectomy. All three types of packing material were found to be similarly effective in preventing bleeding whilst the packs were in situ. Calcium sodium alginate (Kaltostat) was associated with significantly less bleeding on pack removal than the other two packing materials. Further, irrespective of the material used, leaving the packs in situ for 48 hours produced significantly less bleeding than when they were removed after 24 hours.     

内镜鼻窦手术一期行鼻中隔黏膜下切除182例临床分析

目的 探讨内镜鼻窦手术一期行鼻中隔黏膜下切除术的方法及疗效。方法 对222例内镜鼻窦手术中182例伴鼻中隔偏曲患者一期行鼻中隔黏膜下切除术。结果 经随访6个月～2年，全部病例经门诊内镜检查，无如鼻中隔穿孔、鼻中隔血肿、脓肿和鼻腔粘连等严重并发症；总有效率100％。结论 临床实践证明：内镜鼻窦手术一期行鼻中隔黏膜下切除容易操作，对治疗鼻窦疾病疗效显著。     

Internal nasal dimensions of adults with nasal obstruction

Nasal septum deviation (SD) and turbinate hypertrophy (TH) increase the resistance to respiratory airflow and may impair nasal patency.ObjectiveTo characterize the nasal geometry of individuals with nasal obstruction secondary to SD and/or TH by means of acoustic rhinometry.MethodThis prospective study included 30 adults with complaints of nasal obstruction (NO) and SD + TH (n = 24), SD (n = 5) or TH (n = 1) seen by clinical examination. The cross-sectional areas of the three main dips of the rhinogram (CSA₁, CSA₂, CSA₃), the distance between them and the nostrils (dCSA₁, dCSA₂, dCSA₃), and the volumes of segments 1.0-3.2 cm (V₁), 3.3-6.4 cm (V₂), and 7.0-12.0 cm (V₃) were measured before and after nasal decongestion (DN). For analysis, right and left cross-sectional areas and volumes were added and mean dCSA was calculated.ResultsMean values (± standard deviation) before ND were: 0.83 ± 0.23 (CSA₁), 1.66 ± 0.52 (CSA₂), and 2.36 ± 0.77 (CSA₃) cm²; 2.19 ± 0.20 (dCSA₁), 4.01 ± 0.33 (dCSA₂), and 5.85 ± 0.37 (dCSA₃) cm; 2.77 ± 0.51 (V₁), 6.52 ± 1.99 (V₂), and 26.00 ± 9.62 (V₃) cm³; all values were lower than laboratory reference values (p < 0.05). ND led to proportionally greater increases of sectional areas and volumes in the NO group, suggesting an associated functional component. Individual analysis revealed 12 cases with normal results despite nasal obstruction.ConclusionMost patients with structural nasal obstruction had results suggestive of nasal patency impairment in acoustic rhinometry.     

A new audio processor for combined electric and acoustic stimulation for the treatment of partial deafness

Abstract

Conclusions. Modified vidian neurectomy combined with inferior turbinoplasty provided an optimal surgical outcome as a treatment for intractable chronic rhinitis as evidenced by a relatively long-term follow-up. Objective. The study was designed to determine the efficacy of submucosal reduction of the inferior turbinate and resection of the posterior nasal nerve for the treatment of resistant chronic rhinitis. Patients and methods. Fifty-six consecutive patients (37 males and 19 females; mean ± SD age, 26 ± 11 years) with resistant allergic rhinitis or nonallergic rhinitis with eosinophilia syndrome despite medical treatment. Symptomatic improvement including nasal obstruction, nasal discharge, sneezing, smell perception, and quality of life and objective evaluation of nasal airway resistance and nasal provocation test before and after surgery were investigated. Results. The patients showed a remarkable improvement of ≥80%, with the exception of two patients who had an approximately 50% reduction of the total symptomatic scores. Four of eight patients with anosmia subjectively improved whereas the other four patients felt unchanged. All patients who underwent rhinomanometry (n = 15) and nasal provocation testing (n = 15) both before and after surgery showed a significant improvement. There were no intraoperative complications. Postoperative epistaxis occurred in one patient. One patient complained of a transient hypesthesia of the soft palate and dry eye. Nasal mucosal tears were observed in approximately 30% of the patients who otherwise showed no severe synechia or persistent crusting.     

经鼻中隔凹侧径路的鼻中隔矫正术

鼻中隔偏曲是耳鼻咽喉科的常见病,故鼻中隔矫正术也是耳鼻咽喉科常用手术之一。为了提高手术质量,减少术后鼻中隔穿孔等并发症的发生,我科于2009-06-2011-06对收住院的224例鼻中隔偏曲患者,采用计算机掷骰随机分组的方法分为     

The effect of histamine challenge on nasal airflow sensation

Objective nasal airflow resistance, as measured by the rhinomanometer, and the subjective sensation of nasal patency are usually regarded as showing poor correlation. However, previous population studies comparing nasal resistance and subjective nasal airflow sensation have failed to takee into account the great individual variation in resting nasal resistance. To investigate the potential relationship between the two parameters, 20 healthy volunteers underwent histamine nasal challenge tests. Nasal resistance prior to the intra-nasal administration of histamine (‘resting’ nasal resistance, NR_R) was compared with nasal resistance when the subject reported a subjective sensation of nasal blockage (‘obstructed’ nasal resistance, NR₀) and the two were found to be significantly correlated using the Spearman rank correlation method (r_s= 0.648, P = 0.002). Linear regression analysis using the method of least squares demonstrated an association between the two variables (P = 0.029), conforming to the formula NR₀= 1.26NR + 0.478, (resistance units kPa.s.1^?1). Subjective and objective measurements of nasal patency may be much more closely related than has previously been reported.