个性化设计3D打印鼻前庭支撑器用于鼻前庭区狭窄治疗的临床研究

目的 分析个性化设计3D打印鼻前庭器支撑扩张与常规支撑扩张对鼻前庭区狭窄治疗后鼻腔通气功能和前鼻孔形态上恢复疗效的评价。方法 73例单侧外伤性鼻前庭区狭窄的患者,随机分为两组,35例对照组采用常规支撑扩张,38例试验组采用3D打印鼻前庭器支撑扩张,分别从主观评价指标、客观的局部形态结构参数和数值模拟鼻腔气流动力学参数等方面来评价两组患者术前和支撑扩张治疗后鼻腔局部形态和功能恢复情况。结果 两组患者支撑治疗后鼻塞主观感觉和鼻孔对称性满意度视觉模拟评分(VAS)均较术前有明显改善(P<0.05),在鼻孔对称性满意度方面试验组评分高于对照组(P＜0.05);支撑扩张治疗后两组的鼻瓣区截面积[对照组(0.86±0.29)cm²和试验组(0.71±0.26)cm²]均较手术前明显增加(P<0.05), 其中对照组鼻瓣区截面积均值大于试验组(P<0.05),但鼻孔形态学参数显示支撑扩张治疗后试验组Δ_长轴比值和Δ_短轴比值的值均小于对照组(P<0.05),在恢复鼻孔形态上个性化设计3D打印的鼻前庭支撑器支撑扩张治疗更优;支撑扩张治疗后两组的狭窄侧鼻腔阻力均分别低于术前(P<0.05),并且试验组[(0.022±0.008)Pa.s.mL^-1]比对照组[(0.028±0.012)Pa.s.mL^-1]有更小的狭窄侧鼻腔阻力值(P<0.05),但两组的总鼻腔阻力值差别不明显(P=0.64);鼻腔气流温度与湿度调节功能参数结果显示,支撑扩张治疗后对照组(94.55±2.54)%和试验组(95.26±3.21)%患者的鼻腔气流的加温效率较手术前[对照组(95.45±2.93)%和试验组(96.14±2.63)%]均有明显减小(P<0.05),但两组之间患者总鼻腔加温效率和加湿效率无明显差异(P均＞0.05)。结论 个性化设计3D打印鼻前庭支撑器用于前鼻孔狭窄患者的术后支撑扩张治疗使前鼻孔外形、鼻腔正常的通气功能和鼻腔气流的温湿度调节作用均有较好的恢复,能够体现个性化治疗的优势并让患者获得更为满意的疗效,可作为临床上鼻前庭局部支撑扩张治疗的补充,其临床应用前景较好。     

主观感觉评估与解剖结构及鼻功能测量在慢性鼻窦炎中的相关性研究

目的 探讨主观感觉测量与解剖结构及鼻功能测量在慢性鼻窦炎疾病中的相关性。方法 选择2019年9月-2020年10月在山西医科大学附属汾阳医院耳鼻咽喉科就诊的慢性鼻窦炎患者43例。分别应用视觉模拟量表评估患者鼻塞主观症状;Lund-Mackay评分和Lund-Kennedy评分系统评估鼻窦CT及鼻内镜检查结果;鼻声反射、鼻阻力测量评估鼻腔通气情况,采用SPSS 19.0软件对其相关性进行统计学分析。结果 Spearman相关性显示,慢性鼻窦炎患者鼻塞视觉模拟评分量表（VAS）评分与最小横截面积2（MCA2）、最小横截面积距离前鼻孔的距离2（MD2）、距鼻孔2~5 cm鼻腔容积（Vol2~5）呈负相关（P<0.05）,与鼻腔有效阻力、Lund-Mackay评分、Lund-Kennedy评分呈正相关（P<0.05）;Lund-Mackay评分、Lund-Kennedy评分与鼻声反射、鼻阻力呈相关性（P<0.05）。结论 主观感觉测量、解剖结构测量及鼻功能测量相联合能综合评估慢性鼻窦炎患者鼻塞病情的严重程度,有利于治疗方案的选择。     

鼻声反射在射频治疗鼻阻塞中的价值

目的：探讨鼻声反射在射频治疗鼻阻塞中的价值。方法：根据鼻声反射测试结果定位,应用射频治疗46例鼻阻塞患者。结果：射频治疗前,鼻腔最小横截面积、下鼻甲前端截面积、鼻腔容积和鼻阻力分别为（0．37±0．16）cm^2、（1．10±0．17）cm^2、（5、76±2．81）cm^3和（5．96±2．24）kPa·s／L;射频治疗后分别为（0．68±0．18）cm^2、（1．76±0．19）cm^2、（9．10±2．10）cm^3和（2．42±0．86）kPa·s／L。射频治疗前后对比差异有统计学意义（P〈0．05）。46例患者中,治愈27例,好转19例,有效率为100％。结论：鼻声反射指导射频治疗鼻阻塞有助于鼻阻塞的定位及提高疗效。     

泡性中鼻甲相关性头痛的临床分析

目的 探讨泡性中鼻甲相关性头痛的临床诊疗方法及效果。方法 回顾性分析2017年7月-2019年10月首都医科大学宣武医院耳鼻咽喉头颈外科经筛选考虑为泡性中鼻甲相关性头痛17例患者的临床资料,其中男6例,女11例;年龄34~58岁,平均47岁。术前常规行鼻内镜检查和鼻窦CT检查以明确诊断。所有患者于全麻鼻内镜下行泡性中鼻甲修正手术,术后定期清理术腔,并进行必要的药物治疗。采用视觉模拟量表（VAS）及偏头痛残疾量表（MIDAS）评估患者手术前后头痛及生活质量改善情况。结果 17例泡性中鼻甲相关性头痛患者术后定期随访12个月。术前VAS的平均值（7.47±1.23）分明显高于术后VAS的平均值（2.18±0.95）分;术前MIDAS评分平均值（17.24±2.14）分也明显高于术后的平均值（2.53±1.23）分。术后患者头痛及生活质量明显改善,术后患者未出现严重并发症及头痛复发。结论 泡性中鼻甲相关性头痛术前鼻内镜检查结合鼻窦CT检查可明确诊断,经鼻内镜下行泡性中鼻甲修正手术,是一种经济、安全、简便易行的有效治疗手段。     

鼻中隔矫正术后鼻腔微创支架与膨胀海绵填塞的临床对照研究

目的 通过对比观察鼻腔支架与膨胀海绵应用于鼻中隔矫正术后填塞的临床效果及舒适度,分析鼻腔支架临床应用的安全性及有效性。方法 选择因鼻中隔偏曲行鼻中隔偏曲矫正术患者56例,按填塞方式随机分为鼻腔支架组（实验组26例）和膨胀海绵组（对照组30例）,比较两组填塞期止血效果、舒适度及并发症情况。结果 实验组有效率69%,对照组有效率60%,差异无统计学意义（χ²=0.517,P=0.472）,术后视觉模拟量表（VAS）评分均值显示实验组鼻塞、鼻痛、头痛、溢泪、面部胀痛、吞咽困难、睡眠障碍、口干及总体不适均小于对照组,差异具有统计学意义（P<0.05）。实验组及对照组患者均未出现鼻中隔穿孔、鼻中隔血肿及感染等并发症。结论 鼻腔支架作为鼻中隔矫正术后新型填塞方式安全有效,舒适度优于膨胀海绵填塞,可进一步应用于临床。     

鼻声反射和鼻阻力对结构性鼻通气障碍患者的评估价值[论著]

目的　鼻声反射和鼻阻力对结构性鼻通气障碍患者的评估价值及与鼻腔结构指标的相关性研究。方法　选择2018年3月～2020年1月空军特色医学中心耳鼻咽喉头颈外科收治的结构性鼻通气障碍患者131例作为对象，采用视觉模拟量表评分对患者的鼻堵情况进行评分，根据结果将其分为轻度鼻堵组36例、中度鼻堵组57例、重度鼻堵组38例，另选同期体检者42名作为对照组。各组均进行鼻声反射测量和鼻阻力测量。对各组间鼻声反射和鼻阻力测量情况进行比较，并采用Pearson相关性分析对鼻呼气相总阻力、鼻吸气相总阻力与鼻腔结构测量指标的相关性进行分析。结果　重度鼻堵组鼻声反射指标与其他各组差异更为明显（P <0.05）；鼻腔总阻力在对照组与轻度鼻堵组和中度鼻堵组间无统计学差异，与重度鼻堵组间有统计学差异；轻度鼻堵组、中度鼻堵组、重度鼻堵组的鼻腔阻力差异比均高于对照组（P <0.05），其中重度鼻堵组鼻腔阻力差异比与其他三组均有统计学差异（P <0.05）。鼻吸气相总阻力、鼻呼气相总阻力与下鼻甲前缘黏膜至鼻中隔之间距离、双侧下鼻甲软组织内侧缘之间最小距离（和双侧下鼻甲骨之间最小距离）呈负相关，数据差异具有统计学意义（P <0.05）。结论　鼻声反射和鼻阻力检测对结构性鼻通气障碍患者的鼻通气功能具有一定的评估价值，鼻腔扩容手术可以显著改善结构性鼻通气障碍患者的鼻通气功能。     

鼻腔扩容术在OSAHS治疗中的应用及临床疗效评估

随着人们对OSAHS存在多平面狭窄的认识,鼻腔扩容术在OSAHS治疗中的作用越来越受到重视,现就鼻阻塞与OSAHS的病理生理、鼻腔扩容术在OSAHS患者治疗中的意义及对鼻功能的影响、鼻腔扩容术前上气道检查和评估、鼻腔扩容手术适应症的选择、鼻腔扩容手术时机选择及鼻腔扩容手术疗效评价几个方面做一述评。     

中重度阻塞性睡眠呼吸暂停低通气综合征患儿二氧化碳的监测与分析

目的 探讨中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患儿睡眠期CO₂波动趋势特点,分析其变化与多导睡眠监测（PSG）指标的相关性。方法 选取经PSG同时联合经皮二氧化碳分压（TcpCO₂）监测确诊的中重度OSAHS患儿21例（OSAHS组）,同期选取健康体检儿童25例作为对照组。比较两组儿童的一般情况、呼吸事件及睡眠期TcpCO₂趋势的特点,并将TcpCO₂平均值及最高值与各变量进行相关性分析。结果 OSAHS组患儿与对照组的体重指数（BMI）分别为（27.9±6.8）、（16.8±2.9） kg/m²;呼吸暂停低通气指数（AHI）分别为（21.6±17.2）、（1.3±1.0）次/h;阻塞型呼吸暂停指数（OAI）中位数分别为1.1、0.0次/h;阻塞型呼吸暂停低通气指数（OAHI）中位数分别为19.2、0.2次/h;氧减指数（ODI）分别为（19.5±16.9）、（1.1±1.0）次/h;TcpCO₂平均值分别（46.8±3.8）、（44.7±2.5） mmHg;TcpCO₂最高值分别为（54.8±5.3）、（48.9±3.3） mmHg;非快速眼动（NREM） TcpCO₂分别为（47.0±3.8）、（45.1±2.4） mmHg;快速眼动（REM） TcpCO₂分别为（48.0±5.2）、（44.4±2.8） mmHg;OSAHS组患儿与对照组中BMI、AHI、OAI、OAHI、ODI、TcpCO₂平均值及最高值、NREM TcpCO₂、REM TcpCO₂均高于对照组。OSAHS组患儿与对照组的平均SaO₂分别为（96.5±1.2）%、（97.6±0.9）%;最低SaO₂分别为（82.6±8.7）%、（92.2±2.9）%。OSAHS组患儿平均SaO₂、最低SaO₂均低于对照组。两组间BMI、AHI、OAI、OAHI、ODI、平均SaO₂、最低SaO₂、TcpCO₂平均值及最高值、NREM TcpCO₂、REM TcpCO₂比较,差异具有统计学意义（P均<0.05）。两组间TcpCO₂平均值和最高值均与BMI、OAHI、ODI无相关性。结论 TcpCO₂监测可以反映整夜CO₂动态变化,OSAHS患儿睡眠期CO₂有升高趋势,且REM睡眠CO₂水平较NREM睡眠亦有升高。CO₂水平不能根据PSG指数判断,需要进行客观检查进行评估。     

CD4+ Treg细胞对变应性鼻炎患者外周血单个核细胞的作用

目的 探讨CD4⁺ Treg细胞对变应性鼻炎（AR）患者外周血单个核细胞（PBMCs）的作用。方法 招募正常人（对照组）和AR患者（AR组）各15例,分别从两组志愿者外周血中获取PBMCs,接着从PBMCs中分离、提纯CD4⁺ Treg细胞,检测该细胞在总CD4⁺ T细胞中所占的百分比,并将其进行体外培养,然后检测CD4⁺ Treg细胞培养基中白介素（IL）-10和转化生长因子（TGF）-β及其mRNA的含量,最后,将体外培养的CD4⁺ Treg细胞加入到AR患者的PBMCs培养基中进行干预,并检测培养基中IL-4和IL-5的浓度。结果 AR患者CD4⁺Treg细胞（2.523±0.260）在总CD4⁺ T细胞中所占的百分比较对照组（4.716±0.390）减少,但AR组患者CD4⁺ Treg细胞培养基中IL-10（96.19±6.96 vs 33.69±3.88）和TGF-β（77.73±7.96 vs 31.39±3.15）及其mRNA（3.30±0.27 vs 0.26±0.05;3.29±0.26 vs 0.26±0.03）的含量却显著增多,AR组PBMCs培养基中IL-4（260.40±12.49）和IL-5（287.10±18.52）的浓度较对照组（23.07±3.26;19.62±2.46）为高,径AR患者的CD4⁺ Treg细胞干预后,AR患者PBMCs培养基中IL-4（120.60±9.58）和IL-5（137.60±12.33）的浓度显著降低,但对照组CD4⁺ Treg细胞的干预没有改变培养基中这些细胞因子（241.70±12.44;262.40±18.88）的含量。结论 CD4⁺ Treg细胞在变应性炎症状态下可以激活并起到抑制炎症的作用。     

鼻内镜下鼻后神经丛解剖研究

目的 探讨鼻内镜下鼻后神经丛(PNNP)的构成及分布特点,为后续行鼻内镜下高选择性PNNP切断术提供解剖学参考。方法 利用5具(10侧)冰鲜尸头灌注标本,经内镜下中鼻道入路,解剖蝶腭孔周围区域内结构;利用5具人体标本解剖前接受的鼻窦CT扫描结果,经影像学工具测量相应结构间距离。利用内镜系统采集解剖图像,影像测量软件获取影像学数据,并由资深放射科医师盲法测量。在解剖过程中,寻找蝶腭孔周围区域重要解剖标志及各结构间的毗邻关系。去除腭骨蝶突及蝶骨鞘突骨质,开放骨性腭鞘管,暴露PNNP咽支,在腭鞘管前口外侧探查定位翼管神经。结果 PNNP出蝶腭孔后均存在3个主要分支与蝶腭动脉分支血管伴行,前下方有与蝶腭鼻后外侧支伴行的鼻腔外侧壁支,后上方有与上鼻甲动脉伴行的上鼻甲支,后内侧有与鼻后中隔动脉伴行的鼻中隔支,蝶腭神经节在翼腭窝内即发出咽支,未穿出蝶腭孔,通过腭鞘管进入鼻咽部,且翼管前口均位于腭鞘管前口的外侧。腭鞘管前口外侧壁至翼管前口内侧壁间距,内镜下测量值(5.90±1.12)mm,影像学测量值(6.30±1.06)mm。结论 通过解剖定位腭鞘管,开放骨性腭鞘管,暴露其中的PNNP咽支,探讨腭鞘管前口与翼管前口之间的位置关系及术中规避翼管神经及蝶腭神经节的安全操作范围,为变应性鼻炎精准手术治疗提供解剖依据。     

鼻腔扩容术的临床疗效观察

目的评价鼻腔扩容术治疗OSAHS患者主客观症状的改善情况。方法观察30例行鼻腔扩容术的成年OSAHS患者,所有患者于术前进行多道睡眠图（PSG）描记,鼻声反射和鼻阻力测试等鼻功能检查,填写白天嗜睡主观评分Epworth嗜睡量表（Epworth sleepiness score,ESS）、鼻塞主观视觉模拟量表（visual analogue scale,VAS）评分、鼾声评分量表,以上主客观检查于鼻腔手术后3个月重复记录。所有患者接受鼻腔扩容术（鼻中隔三线减张成形术、双侧下鼻甲外移、双侧中鼻甲内移和双侧中鼻道鼻窦对称性开放）。结果鼻腔扩容术后患者鼻腔总阻力显著降低[（0.89±0.23）kPa·s/L vs（0.29±0.12）kPa·s/L,P〈0.01],鼻塞VAS评分显著降低[8.2±1.1 vs 2.1±0.73,P〈0.01],白天嗜睡ESS评分显著降低（12.7±1.2 vs 8.6±2.9,P〈0.01）,打鼾程度减轻（62.2±25.6 vs 45.6±18.6,P〈0.01）。轻度OSAHS患者呼吸暂停低通气指数（apnea and hypopnea index,AHI）较术前显著下降（P〈0.05）,觉醒指数较术前显著下降（P〈0.01）,最低动脉血氧饱和度（lowest SaO2,LSaO2）较术前显著升高（P〈0.01）。中度和重度OSAHS患者的AHI指数、觉醒指数、LSaO2均较术前无显著改变（P〉0.05）。LSaO2、睡眠结构各阶段的比例、快动眼睡眠阶段的长度在所有OSAHS患者均没有显著变化（P〉0.05）。30例OSAHS患者鼻腔扩容术的总体有效率为26.7%。结论鼻腔扩容手术可以改善OSAHS患者鼻塞及白天嗜睡、睡眠打鼾等相关睡眠主观症状,并在一定程度上改善OSAHS患者的阻塞性睡眠呼吸暂停的严重程度,应适当选择其手术适应证。     

A validation study of nasal spectroscopy: Rhinolux

This study is the first to validate the Rhinolux against acoustic rhinometry in detecting nasal mucosal swelling when changing body position from sitting to supine. The Rhinolux (Rhios GmbH, Germany) is a new device using a light-absorption technique called nasal spectroscopy and to measure changes in nasal blood volume as a sign of nasal mucosal swelling in real time. The relationship between the changes in nasal blood volume measured with the Rhinolux and changes in nasal mucosal swelling has however, not previously been validated objectively. To evaluate this relationship we compared the Rhinolux to acoustic rhinometry following the change in body position from sitting to supine. The study population consisted of 20 healthy subjects (7 women, 13 men, mean age 34.7 ± 9.3 years). The Rhinolux was applied sitting in the upright position followed by 5 min in the supine position. Acoustic rhinometry was measured sitting in the upright position and after 5 min in the supine position. In seven subjects the measurements were repeated on three different days to assess the repeatability. The mean change from baseline in minimal cross sectional area ΔMCA measured with acoustic rhinometry was −0.12(±0.19) cm² (right + left side), P = 0.013 but ΔE (change in light extinction from baseline) measured with the Rhinolux was unchanged 0.02(±0.18) optical densities (OD), P = 0.56. There was no correlation between ΔE and ΔMCA r = 0.028, P = 0.9. The mean ΔE result from repeated measurements on different days was 0.05(±0.08) OD, P = 0.09 and the ΔMCA was −0.1(±0.11) cm², P = 0.02. This study showed that the changes in nasal blood volume measured with the Rhinolux did not reflect changes in nasal mucosal swelling measured with acoustic rhinometry when changing body position from sitting to supine. The results indicate that the utility of the Rhinolux in assessing nasal mucosal reactions has to be evaluated further.     

Acoustic rhinometry in nasal provocation test in perennial allergic rhinitis

Acoustic rhinometry is one method to evaluate nasal geometry by an acoustic reflection technique. The aim of this study was to investigate the changes in acoustic rhinometry after nasal provocation in patients with exclusively perennial allergic rhinitis. In 19 patients, acoustic rhinometry and active anterior rhinomanometry were performed before and after nasal provocation test. There was a statistically significant nasal flow reduction measured by active anterior rhinomanometry after nasal provocation (p < 0.05) and a median symptom score of four points, both indicating a positive response to nasal provocation. On the other hand, there was no statistically significant change in the values of acoustic rhinometry after nasal provocation (p > 0.05). In patients with exclusively perennial allergic rhinitis, acoustic rhinometry does not seem to significantly change after nasal provocation. In contrast, active anterior rhinomanometry values decreased significantly after nasal provocation. The presented results indicate that acoustic rhinometry does not seem to be a diagnostic method superior to active anterior rhinomanometry in this context.     

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。     

Objective evidence for the efficacy of surgical management of the deviated septum as a treatment for chronic nasal obstruction: a systematic review

Clin. Otolaryngol. 2011, 36 , 106–113 Background: Nasal septal surgery is a common procedure, but there are concerns that the benefits of this surgery are mainly cosmetic. Objective of review: The primary aim is to identify any functional benefits of septal surgery and provide any evidence of a change in patency of the nasal airway, as assessed by objective methods such as rhinomanometry, acoustic rhinometry and peak nasal inspiratory flow. Type of review: Systematic review. Search strategy: A systematic search of the available literature was performed, using Pubmed, Medline (1950–November 2010), Embase (1947–November 2010) and the Cochrane Controlled Trials Register. Papers written in English that objectively compared pre‐ and post‐surgical treatment of nasal obstruction in adults because of septal deviation were reviewed. Objective measurements of rhinomanometry, acoustic rhinometry and nasal peak inspiratory flow were specified within the search. Searches were restricted to surgery on the nasal septum, which included septoplasty, submucous resection and septal (deviation) corrective surgery. Results: Seven studies (460 participants) involving rhinomanometry, six studies (182 participants) with acoustic rhinometry and one study (22 participants) using nasal peak inspiratory flow were included in the review. All the studies reported an objective improvement in nasal patency after septal surgery. Mean unilateral nasal resistance (data from six studies) decreased from preoperative 1.19 Pa/cm³/s to postoperative 0.39 Pa/cm³/s, mean minimum cross‐sectional area (data from five studies) increased from preoperative 0.45 cm² to postoperative 0.61 cm², median peak nasal inspiratory flow (data from one study) increased by 35 L/min after surgery. Conclusions: There is sufficient evidence in the literature to conclude that septal surgery improves objective measures of nasal patency and that improved nasal airflow may have beneficial effects for the patient.     

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.     

Acoustic rhinometry in the evaluation of nasal obstruction

Acoustic rhinometry (AR) is a recently developed objective technique for assessment of geometry of the nasal cavity. The technique is based on the analysis of sound waves reflected from the nasal cavities. It measures cross-sectional areas and nasal volume (NV). To obtain dependable assessments of nasal resistance by rhinomanometry or cross-sectional area measurements by AR, it is essential that the structural relations of the compliant vestibular region remain undisturbed by the measuring apparatus. The use of nozzles in making these measurements carries a great risk of direct distortion of the nasal valve. We used a nasal adapter that does not invade the nasal cavity and a chin support that stabilizes the head. In 51 healthy nasal cavities, the average minimum cross-sectional area (MCA) was 0.62 cm² at 2.35 cm from the nostril and 0.67 cm² at 2 cm from the nostril, respectively, before and after topical decongestion of the nasal mucosa. The MCA and NV findings in this group were significantly higher than MCA and NV (P<0.001) in people with structural or mucosal abnormalities before mucosal decongestion. After mucosal decongestion, the MCA and NV were significantly higher in healthy nasal cavities than in nasal cavities with structural abnormalities (P<0.001) but were not higher than nasal cavities with mucosal abnormalities (MCA, P = 0.05; NV, P = 0.06). A nozzle was applied in 20 healthy nasal cavities after mucosal decongestion, and a significantly higher MCA was found compared to measurements made with the nasal adapter (P = 0.02). We conclude that the nasal adapter, which does not invade the nasal cavities, avoids the distortion of the nasal valve and gives more accurate results.     

Altered positional regulation of nasal patency in patients with obstructive sleep apnoea syndrome

We assessed the regulation of nasal patency supine in subjects with obstructive sleep apnoea syndrome (OSAS) compared to healthy controls. Healthy subjects increase nasal obstruction when changing body position from sitting to supine, possibly due to increased hydrostatic pressure in the head supine. Limited data indicate that this response is altered in patients with OSAS, suggesting that supine nasal patency is actively regulated. This study examined the nasal response to recumbent body position using acoustic rhinometry in OSAS patients and healthy controls. Twenty subjects (16 men and 4 women, mean age 55 ± 16 years), with diagnosed OSAS [mean apnoea hypopnoea index (AHI) 46 ± 22 events/h] without nasal obstruction and continuous positive airway pressure (CPAP)-naive, underwent measurement of intra-nasal cross sectional area by acoustic rhinometry at sitting and after 5 min supine. Twenty healthy controls (13 men, 7 women, mean age 35 ± 9 years) were also included in the study. In the patients with OSAS, the mean minimal cross sectional area (MCA, left + right nasal cavity) was unchanged between sitting (1.18 ± 0.41 cm²) and supine (1.21 ± 0.35 cm², P = 0.5). In the healthy controls, the mean MCA decreased from 1.06 ± 0.18 to 0.94 ± 0.21 cm² supine, P = 0.01. This study showed that the normal decrease in nasal patency following a change in body position from sitting to supine is absent in patients with OSAS. The results indicate that there is an active regulation of supine nasal patency.     

鼻阻塞的主观评价与客观鼻测量的相关性研究

目的 探讨鼻阻塞时检查者和患者的主观评价与客观鼻测量之间是否有相关性.方法 检查者和患者均采用视觉模拟量表(visual analog scale,VAS)对鼻阻塞程度进行评价.客观鼻测量采用主动后鼻测压仪和鼻声反射测量仪进行.以配对t检验分析检查者的临床评价和患者VAS均数的差异,以Spearman等级相关分析评价客观鼻测量结果单侧鼻气流阻力与单侧鼻道容积、单侧鼻腔最小横截面积的关系,以及检查者的临床评价、患者VAS与上述客观鼻测最结果的相关性.结果 本组病例经统计学分析,316例患者中,减充血前后单侧鼻气流阻力与单侧鼻道容积、单侧鼻腔最小横截面积间呈负相关(r值分别为-0.430、-0.554、-0.373、-0.600,P值均＜0.001).减充血前后,检查者的临床评价与患者VAS均数呈正相关,差异均有统计学意义(r值分别为0.630、0.526,P值均＜0.001),二者均与鼻气流阻力有一定的正相关关系(减充血前:检查者的临床评价与鼻气流阻力r=0.530,P=0.000,患者VAS与鼻气流阻力r=0.351,P=0.000;减充血后:检查者的临床评价与鼻气流阻力r=0.452,P=0.000,患者VAS与鼻气流阻力r=0.216,P=0.000),与鼻道容积和鼻腔最小横截面积均有一定的负相关关系(减充血前:检查者的临床评价与鼻道容积r=-0.411,P=0.000,患者VAS与鼻道容积r=-0.325,P=0.000,检查者的临床评价与鼻腔最小横截面积r=-0.507,P=0.000,患者VAS与鼻腔最小横截面积r=-0.384,P=0.000;减充血后:检查者的临床评价与鼻道容积r=-0.391,P=0.000,患者VAS与鼻道容积r=-0.209,P=0.000,检查者的临床评价与鼻腔最小横截面积r=-0.471,P=0.000,患者VAS与鼻腔最小横截面积r=-0.286,P=0.000).检查者的临床评价与客观鼻测量参数的相关系数大于患者VAS与客观鼻测最参数的相关系数.结论 鼻阻力测压与鼻声反射测量的结果有一定的相关性.检查者的临床评价与患者VAS存在一定的正相关关系.两者均与客观鼻测量参数存在一定的直线相关关系.     

鼻腔扩容术治疗OSAHS疗效分析

目的 探讨鼻腔扩容技术在治疗OSAHS中的意义。方法 以韩德民提出的鼻腔扩容技术理论为基础,对伴鼻腔结构异常的OSAHS患者施行鼻腔扩容手术,观察OSAHS患者术后主客观症状改善情况。结果 鼻腔扩容术可以有效减轻OSAHS患者的鼻堵和嗜睡症状,并提高了最低血氧饱和度。部分患者虽然手术前后AHI存在边缘性统计学差异,但术后AHI仍然较高,没有下降到正常水平。结论 鼻腔扩容术治疗OSAHS的疗效是肯定的,但还需要大样本量的研究来确定其适用条件。