Physiologic Effects of an External Nasal Dilator

An external nasal dilator (Breathe Right, CNS, Inc., Bloomington, MN) has become popular with athletes. The dilator is an adhesive band with a central elastic strip. When applied across the nasal valve, the device theoretically increases nasal valve area. We used acoustic rhinometry (Hood Laboratories, Pembroke, MA) to measure the cross-sectional area at the nasal valve with and without the device in 53 athletes. Thirty athletes were exercised on a cycle ergometer with and without the device while measuring physiologic parameters, including oxygen consumption (VO₂), heart rate, and respiratory rate. The study was conducted in a randomized, double-blind, placebo-controlled manner. At rest, the external nasal dilator was found to significantly increase nasal valve area in all demographic groups measured. The device was also found to significantly decrease submaximal exercise perceived exertion, heart rate, ventilation, and VO₂ when compared with placebo.     

Mast过敏原检测系统在阻塞性鼻病中的应用

目的 探讨Mast过敏原检测系统应用于阻塞性鼻病中的意义,其检测出的特异性IgE(sIgE)、总IgE(tlgE)与血清学酶联免疫吸附方法检测的总IgE(tlgE)间的相关性.方法 利用Mast系统对215例住院患者进行slgE、tIgE的检测,并利用酶联免疫吸附方法对其中102例患者进行血清tIgE检测.结果 215例患者中,Mast系统测出的slgEFR性率为43.3%,其中慢性鼻窦炎(伴或不伴鼻息肉)患者的sIgE性率为47.6%.Mast系统测出的slgE升高的患者中,以粉尘螨(24.2%)、屋尘螨(20%)最多见.Mast系统测出的sIgE与酶联免疫吸附方法检测的tIgE关联系数r=0.29,Mast系统检测的tIgE与酶联免疫吸附方法检测的tIgE关联系数r=0.34,Mast系统检测的sIgE与Mast系统检测的tlgE关联系数r=0.22.结论 Mast过敏原检测系统可应用于阻塞性鼻病的过敏原检测;酶联免疫吸附方法总IgE检测可不作为常规的变应性鼻炎检测方法;对于慢性鼻窦炎(伴或不伴鼻息肉)患者应常规行Mast过敏原检测,并根据结果使用抗过敏药物;无法进行过敏原检测的医疗机构,可对就诊的无过敏症状的慢性鼻窦炎患者在进行过敏原检测之前酌情给予抗过敏药物治疗.     

Nasal Obstruction and Palate-Tongue Position on Sleep-Disordered Breathing

Objectives

We wanted to evaluate whether the presence of nasal obstruction makes a change on the association between the modified Mallampati score and the severity of sleep-disordered breathing (SDB) and the sleep quality.

Methods

Polysomnography (PSG), the modified Mallampati score (MMS), the body-mass index, and a questionnaire about nasal obstruction were acquired from 275 suspected SDB patients. The subjects were divided into two groups according to the presence of nasal obstruction. The clinical differences between the two groups were evaluated and the associations between the MMS and PSG variables in each group were also assessed.

Results

Significant correlations were found between the MMS and many PSG variables, including the apnea-hypopnea index, the arousal index and the proportion of deep sleep, for the patients with nasal obstruction, although this was not valid for the total patients or the patients without nasal obstruction.

Conclusion

The severity of SDB and the quality of sleep are well correlated with the MMS, and especially for the patients with nasal obstruction. The MMS can give more valuable information about the severity of SDB when combined with simple questions about nasal obstruction.     

Role of Vascular Reflex in Nasal Mucosal Swelling in Nasal Allergy

Objective: In patients with nasal allergy, antigen challenge on the unilateral nasal mucosa results in nasal secretion not only in the ipsilateral but also in the contralateral nasal cavities that can be inhibited almost completely by premedication with atropine sulfate. The present study was performed to elucidate if centrally mediated vascular reflex induced by antigen challenge plays a role in nasal mucosal swelling in subjects with nasal allergy. Methods: Variations of mucosal swelling and mucosal blood flow in the ipsilateral and the contralateral nasal cavities after unilateral antigen challenge were evaluated by acoustic rhinometry and laser Doppler flowmetry in 20 patients with perennial nasal allergy. Results: Unilateral antigen challenge caused ipsilateral and contralateral nasal mucosal swelling in 17 and 13 patients, respectively. Incidence of contralateral nasal mucosal swelling after unilateral antigen challenge was significantly higher compared with that after control disc challenge (P < .001). In 10 patients in whom unilateral antigen challenge caused bilateral nasal mucosal swelling, significant swelling of the nasal mucosa lasted for more than 30 minutes in the ipsilateral nasal cavity after antigen challenge compared with only 15 minutes in the contralateral nasal cavity. Peak values of contralateral mucosal swelling were 45.3% of those of ipsilateral nasal mucosa. Conclusions: Centrally mediated vascular reflex is partially involved in the onset of nasal mucosal swelling observed after antigen challenge in subjects with nasal allergy. However, nasal mucosal swelling that persists and proceeds even 20 minutes after antigen challenge is caused by the direct effects of chemical mediators on the nasal vasculature.