成年人鼻声反射测量的面积-距离曲线分析

目的 分析正常成年人面积-距离曲线,得到大多数人面积-距离曲线上前两个最小横截面积(the first minimum cross-sectional area,MCA1;the second minimum cross-sectional area,MCA2)和整个鼻腔的最小截面积(total minimum cross-sectional area,MCA)的常见位置.方法 正常成年人103例,年龄18～60岁,平均(35.6±12.6)岁,其中男性49例(98侧鼻腔),年龄18～60岁,平均(35.7±13.3)岁;女性54例(108侧),年龄18～60岁,平均(35.6±11.9)岁.利用Eccovision鼻声反射仪测量得到面积-距离曲线及MCA1,MCA2,MCA及其距前鼻孔的距离.结果 多数受试者的MCA1位于前鼻孔附近,多数受试者的MCA2位于距前鼻孔2 cm的距离附近,与下鼻甲前端出现的位置基本一致,多数受试者MCA多位于鼻阈至下鼻甲前端出现的位置之间.结论 MCA能客观地反映鼻腔的通畅程度,特别是将分析片断定于1 cm以后则更有意义.     

鼻声反射和CT对正常鼻腔截面积测定的比较

目的探讨鼻声反射(AR)用于鼻腔截面积测量的准确性。方法对10例(20侧)成人正常鼻腔行螺旋CT和鼻声反射检测,CT重建层面与鼻腔声波传导弧线垂直。比较两种检测方法的面积-距离曲线,并进行统计学分析。结果 CT和鼻声反射对鼻瓣区检测结果直线相关和回归分析r=0.885(P<0.01,CT=0.17+0.82AR)。距前鼻孔6.0 cm内的相关性(r=0.827,P<0.01)比6.0 cm以后(r=0.352,P<0.01)高。距前鼻孔6.0 cm以后至鼻咽部,鼻声反射对截面积评测过高。结论鼻声反射测量能准确提供距前鼻孔6.0 cm内的距离-面积信息,对距前鼻孔6.0 cm以后评测过高,更适用于距前鼻孔6.0 cm内的测量。     

Modified Method of Acoustic Rhinometry

Acoustic rhinometry is a well-known method for evaluating nasal cavity patency using sound waves. The method produces graphical information on cross-sectional areas, the distances between these areas and the nostril and the nasal volume. We used this method to evaluate 40 children aged between 7 and 13 years old with complaints of nasal obstruction. All patients underwent endoscopic examination of the nasal cavity, and only children presenting with hypertrophic inferior nasal turbinates and with no history or clinical evidence of infectious rhinitis were included in the study. Using a modified method we obtained four distinct and constant cross-sectional areas along the nasal cavity and four corresponding distances from these areas to the nostril.     

Acoustic rhinometric assessment of nasal obstruction after treatment with fluticasone propionate in patients with perennial rhinitis

Objective: To investigate the effect of fluticasone propionate (FP) on the symptom of nasal obstruction and to assess the correlation between the subjective visual analogue score (VAS) and the objective acoustic rhinometry (AR) measurements. Methods: A prospective study of 45 consecutive patients, 30 males and 15 females with a mean age of 27 years (range: 16–59 years), with moderate/severe symptoms of perennial rhinitis who were treated by FP nasal spray for 4 weeks. AR and VAS were used to evaluate, compare and correlate the efficacy of FP nasal sprays. Results: There was a significant improvement in the VAS post-treatment (3.9) compared with pre-treatment (6.3). There was also a significant increase in the nasal volume (V) and minimum cross-sectional area (MCA) after intranasal FP. Good correlation between the total MCA and total V was noted. Subjective improvements in symptoms did not correlate well with objective measurements as the correlation between VAS and AR was poor. Conclusion: Our study provides subjective and objective evidence on the efficacy of intranasal FP in improving nasal obstruction in perennial rhinitis. AR also proved to be a useful instrument in monitoring the effectiveness of medical therapy for perennial rhinitis.     

Does maxillary superior repositioning affect nasal airway function?

This study aimed to assess nasal airflow, nasal resistance, and the cross-sectional area of the nasal cavity in patients who have had maxillary superior repositioning (MSR). This is a cross-sectional study, and nasal airflow, nasal resistance, and the cross-sectional area of the nasal cavity were evaluated by rhinometry and acoustic rhinometry techniques in patients who had had MSR. Thirty-two patients were studied, and the mean (SD) MSR was 5.03 (1.61) (range 3-8) mm. There was a significant correlation between the mean MSR and the mean change in nasal airflow and nasal resistance (p = 0.001 and p = 0.005, respectively). There was also a correlation between MSR and the change in the cross-sectional area of the inferior concha (p = 0.001), but there was no correlation between the mean MSR and the change in cross-sectional area of the isthmus (p = 0.07). Nasal airflow increases when the mean MSR is less than 6.5 mm, and when maxillary impaction is 6.5 mm or more, nasal airflow decreases. It seems, therefore, that MSR of less than 6.5 mm was associated with an improvement in nasal airflow. When maxillary impaction was more than 6.5 mm, nasal airflow and the cross-sectional area of the nasal cavity decreased, and nasal resistance increased.     

轻中度阻塞性睡眠呼吸暂停低通气综合征患者单纯行鼻腔扩容术疗效分析

目的　探讨单纯行鼻腔扩容术对轻中度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的疗效。方法  ①应用声反射鼻腔测量（acoustic rhinometry,AR）、鼻阻力（rhinomanometer,RM）测量检测30例OSAHS患者术前、术后0～5 cm鼻腔容积（nasal cavity in 0-5cmvolume,NCV0-5）、鼻腔最小横截面积（nasal minimal cross-sectional area,NMCA）、鼻气道阻力（nasal airway resistance,NAR）,鼻堵塞程度使用视觉模拟量表（visual analogue scale,VAS）评分进行评价;②应用多道睡眠图（PSG）监测对30例OSAHS患者进行术前和术后3～5个月监测,使用呼吸暂停低通气指数（AHI）、最低动脉血氧饱和度（lowest SaO2,LSaO2）进行评价,嗜睡程度使用Epworth嗜睡量表（Epworth sleepiness score,ESS）评分进行评价。结果　术前NCV0-5、NMCA、NAR、VAS评分、AHI、LSaO2、ESS评分分别为（4.83±0.08）cm3、（0.37±0.03）cm2、（0.437±0.012）kPa·s/L、7.5±1.4、（10.2±3.0）次/h,（77.3±7.2）%和11.2±2.6,与术后[（8.05±0.42）cm3、（0.58±0.04）cm2、（0.202±0.014）kPa.s/L、4.0±1.0、（5.4±1.9）次/h,（81.3±5.9）%和7.9±1.4]比较差异有统计学意义（P 均＜0.01）。结论　①鼻腔结构异常为主要阻塞平面的OSAHS患者,手术处理鼻腔阻塞平面,矫正鼻腔结构,是去除鼻腔阻塞平面治疗OSAHS的有效方法;②通过术前、术后AR、RM、PSG监测,将有助于统一规范手术适应证和术后疗效评价标准,在术前、术后评估中有助于患者治疗方案的制订,可减少不必要的手术创伤。     

麻黄碱试验在鼻声反射中的临床应用

目的：探讨麻黄碱试验在鼻声反射（AR）中的临床应用，研究定量评价鼻腔黏膜状态的方法和鉴别单纯性鼻炎与肥厚性鼻炎的客观指标。方法：利用AR测试单纯和肥厚性鼻炎患者，并设正常对照，通过麻黄碱试验深入分析试验前后鼻气道通气阻力（NAR）、鼻腔容积（NCV）、鼻腔最小截面积（NMCA）和NMCA所处的位置相对于鼻腔入口处的距离（DCAN）以及上述参数的变化量和变化率，定量分析3类受试者的鼻黏膜舒缩状态。结果：麻黄碱试验前后成对资料比较，各基本参数均差异有统计学意义（均P〈0．01），麻黄碱试验后NAR减小，NCV增加，并伴有NMCA扩大和DCAN的“前移”。麻黄碱试验前后各组各参数的均数多组间的均差异有统计学意义（均P〈0．01）。2个患者组之间相比，麻黄碱试验前只有NCV有统计学意义（P〈0．05），而麻黄碱试验后所有参数（包括变化量和变化率）的均差异有统计学意义（P〈0．05或P〈0．01）。与正常对照，单纯性鼻炎所有参数（包括变化量和变化率）的均差异有统计学意义（P〈0．05或P〈0．01），而肥厚性鼻炎的某些参数的变化量和变化率的差异则无统计学意义。结论：AR能客观的判断鼻黏膜的状态，结合麻黄碱试验能提供更多的信息，扩大了AR的临床应用，建议作为常规配套检查。     

Acoustic Rhinometry Assessment of the Nasal Cycle in Neonates

In this study the nasal cycle in newborns was assessed using acoustic rhinometry with miniprobe (RHIN 2100). Enrolled in the study were 67 newborns aged 2 to 4 days. Each subject was assessed for 3 h, examinations taking place every 30 min. At least six measurements, three from each nostril, were taken at each examination. The miniprobe RHIN 2100 (SR Electronics ApS) was used for evaluation of nasal geometry. The minimal cross-sectional area (MCA) and the total volume of the anterior 45 mm (VOL₄₅) were calculated and used for statistical analysis. The mean volume of MCA and VOL₄₅ in the examined group of children was 0.08 cm3 and 1.19 cm3 respectively. Nasal cycle was assessed by constructing the plots of acoustic rhinometry parameters MCA or VOL₄₅ for time and statistically using Pearson's correlation coefficients. Most of the examined infants (70?85%) showed no significant fluctuations in nasal patency.     

Nasal Obstruction and Sleep-disordered Breathing: The Effect of Supine Body Position on Nasal Measurements in Snorers

Objective --Nasal obstruction is considered to be a potential etiological factor in sleep-disordered breathing. However, a significant correlation between nasal measurements and obstructive sleep apnea has not been demonstrated so far. The aim of this study was to investigate the relationships between nasal resistance, nasal volumes and selected sleep parameters using nasal measurements performed in both seated and supine positions. We also investigated whether snoring patients in our clinical sample showed increased positional or decongestive nasal mucosal changes. Material and Methods --Forty-one snoring men on a waiting list for correction of nasal obstruction underwent polysomnography, anterior rhinomanometry and acoustic rhinometry. Nineteen non-snoring control subjects were also recruited. Nasal measurements were performed in a seated position, after lying down in a supine position and, after decongestion of nasal mucosa, in a seated position again. Results --In the overall patient group, nasal volume at a distance 2-4 cm from the nares in the supine position correlated inversely with apnea-hypopnea index (AHI) ( r = &#109 0.32, p <0.05) and oxygen desaturation index (ODI) ( r = &#109 0.49, p <0.05). In the non-obese patients, total nasal resistance measured in a supine position correlated with AHI ( r =0.50, p <0.05) and ODI ( r =0.58, p <0.05) and supine nasal volumes were also inversely correlated with ODI. No significant correlations were found between baseline nasal measurements performed in a seated position and sleep parameters. Postural or decongestive changes in nasal measurements were not increased in snoring patients compared with control subjects. Conclusion --The relationship found between nasal measurements and sleep parameters suggests that nasal obstruction does augment airway collapse.     

结构性鼻炎患者鼻通气功能的主客观评估

目的对结构性鼻炎患者进行术前鼻通气的主客观评估,为手术提供临床依据。方法结构性鼻炎患者56例,收缩鼻腔前后分别进行鼻堵视觉模拟量表(visualanalogue scale,VAS)评分并分为两组:组1,30例,VAS评分>7;组2,26例,VAS评分<7。组3,正常对照组,24例,VAS评分=0。3组分别进行鼻声反射和鼻阻力测量。记录两侧鼻腔前2个最小截面积(minimum cross-sectional area of nasal cavity,MCA1)、MCA2及其距离前鼻孔距离(the distance between the nostril to minimumcross-sectional area,MD1)、MD2,并分别记算两侧的比值;测量距离前鼻孔5 cm、2～5 cm、5～7 cm的两侧鼻腔容积(nasal volume,V5)、V2-5、V5-7并分别记算两侧的比值;测量双侧鼻腔总阻力(nasal resistance total,RT),计算双侧鼻腔阻力差异比(Rlr)。取收缩鼻腔后数值进行统计学检验。结果 3组MCA1、MD1、MCA2、MD2和RT值均无统计学差异;3组间各比值,除MD1、V5-7差异无统计学意义外,其余比值差异均存在统计学意义;组1测量结果较组2或组3有明显差异,结构异常也更加明显。结论鼻堵严重程度与两侧鼻腔结构异常程度有一定关联;鼻堵VAS评分、鼻声反射和鼻阻力测量应作为结构性鼻炎术前评估的常规手段。