Correlation between nasal obstruction symptoms and objective parameters of acoustic rhinometry and rhinomanometry

Acoustic rhinometry and rhinomanometry have been used to assess nasal airway patency objectively. We compared nasal obstruction symptoms before and after decongestion with several parameters of these objective tests. The patients assessed their nasal obstruction using a visual analogue scale (VAS). Cross-sectional areas and nasal resistance were measured by acoustic rhinometry and rhinomanometry before and after topical application of 1% phenylephrine solution in 32 patients with nasal obstruction symptoms. There was no significant correlation between the difference in the VAS and the difference in nasal resistance. There was also no significant correlation between the difference in the VAS and minimal cross-sectional area and cross-sectional areas at 3.3 cm (CA3.3), CA4.0 and CA6.4 from the nosepiece both in the wide and narrow sides and in both nasal cavities before and after nasal decongestion. It is concluded that rhinomanometry and acoustic rhinometry may have no diagnostic value in estimating the severity of nasal obstruction symptoms.     

Proposed diagnostic standard using visual analogue scale and acoustic rhinometry in nasal provocation test in allergic patients

Objective

The authors aimed to analyze symptom change after nasal provocation and acoustic rhinometry results of a larger number of allergic rhinitis patients and also aimed to propose a new diagnostic threshold by investigating the difference between patients with allergic and non-allergic perennial rhinitis.

Methods

The authors checked symptom change and performed acoustic rhinometry before and after nasal provocation in 208 patients (114 males and 94 females, 19-58 years old) with allergic rhinitis and 222 patients (116 males and 106 females, 20-74 years old) clinically diagnosed with non-allergic perennial rhinitis (control group). Then the authors compared VAS (visual analogue scale), TNV (total nasal volume), MCA (minimal cross-sectional area), length of MCA and change of these values between allergic patients group and control group, to propose the new diagnostic standard.

Results

The change of symptom score and number of sneezing after nasal provocation were significantly different between allergic patient and control group. The basal TNV, MCA, length of MCA, and changes of these values were also significantly different. By drawing the ROC (receiver operator characteristic) curve and evaluating the sensitivity and specificity for each criteria, we could set the diagnostic criteria as follows: (1) symptom change: more than 2 points in the case of nasal obstruction and more than 1 point for the case of rhinorrhea or itching, (2) more than 24.5% change of the TNV, and (3) more than 20% change of the MCA.

Conclusion

VAS change and acoustic rhinometry in nasal provocation test could be a valuable tool in diagnosing allergic rhinitis with high sensitivity and specificity.     

Correlation between acoustic rhinometry and subjective nasal patency during nasal challenge test in subjects with suspected occupational rhinitis; a prospective controlled study

Clin. Otolaryngol. 2010, 35 , 462–467 Objectives: To assess the correlation between acoustic rhinometry and visual analogue scale endpoints in the context of nasal challenge with occupational agents. Design: Prospective controlled study. Setting: University teaching hospital. Participants: Sixty-seven subjects with a history of work-related rhinitis and asthma symptoms. Main outcomes measures: Subjects underwent nasal challenge with control and specific agent on consecutive days. Nasal congestive response to challenge was monitored by acoustic rhinometry and visual analogue scale. Results: Results showed no correlation between visual analogue scale and acoustic rhinometry measurements at baseline on the control (r = −0.13, P = 0.3) and active (r = 0.14, P = 0.2) challenge days. No correlation was found between acoustic rhinometry and visual analogue scale when analysing all measurements obtained at all times after challenge with the control and active agent (control: r = 0.09, P = 0.04; active: r = 0.001, P = 0.9). The correlation between acoustic rhinometry and visual analogue scale was good and significant (r = −0.62, P = <0.01) when the analysis was restricted to cases showing a decrease in nasal volume >40% from baseline values. Conclusions: We showed that the correlation between acoustic rhinometry and subjective nasal patency was poor on steady conditions. However, a significant correlation was observed in those cases showing a greater nasal congestive response after challenge measured by acoustic rhinometry.     

鼻声反射测量对鼻塞主客观相关性的研究

目的:探讨鼻声反射技术(acoustic rhinometry,AR)客观测量指标与鼻塞患者主观感受的相关性及相关程度.方法:将365例因鼻部病变就诊的患者分为鼻塞组220例和无鼻塞组145例,另征集健康志愿者(对照组)70例.3组均行AR,测试内容为鼻腔最小横截面积(NMCA),鼻腔容积(NV),鼻气道阻力(NAR),鼻腔最小横截面积到前鼻孔的距离(DCAN);鼻塞主观测试采取VAS评分测量,进行统计学分析.结果:鼻塞组与对照组在NAR、NV、DCAN中显示差异均有统计学意义(均P<0.05);VAS评分与NMCA、NV、NAR、DCAN存在直线相关关系,RNAR=0.7385;RNV=-0.8532;RNMCA=-0.7454;RDCAN=0.3697.结论:AR测量指标中NAR及NV的结果与患者的主观感受高度一致,可以作为评价患者主观是否具有鼻塞症状的客观评价测量工具.     

Correlation between nasal resistance and different acoustic rhinometry parameters in children and adolescents with and without allergic rhinitis

Acoustic rhinometry and rhinomanometry are important tests used to assess nasal function. The degree to which the parameters of these tests are correlated is yet to be established.ObjectiveThis paper aimed to study the correlations between nasal resistance (NR) and acoustic rhinometry parameters in children and adolescents with allergic rhinitis and controls.MethodTwenty patients with allergic rhinitis and 20 controls were enrolled. NR, volumes (V4, V5, V2-5), and minimal cross-sectional areas (MC1, MC2) were measured in three moments: baseline, after induction of nasal obstruction and after topical decongestant administration.ResultsPatients with allergic rhinitis had significant correlation between NR and all volumes (V5: r = -0.60) and with MC2. Among controls, MC1 was the parameter with the strongest correlation with NR at baseline (r = -0.53) and after decongestant administration. In the combined analysis, V5 had the highest correlation coefficients at baseline (r = -0.53), after obstruction (r = -0.58) and after decongestant (r = -0.46).ConclusionsOur data showed that NR and acoustic rhinometry parameters have negative and significant correlations. Nasal volumes are, in general, better correlated than minimal cross-sectional areas. V5 was the parameter with the highest correlation in the rhinitis group and in the combined analysis.     

鼻阻力测压与鼻声反射测量的相关性研究

目的探讨主动后鼻阻力测压仪的参数——鼻阻力(nasal resistance,NR)与鼻声反射测量仪的参数——鼻腔容积(nasal cavity volume,NV)、鼻腔最小横截面积(minimal cross sectional area,MCSA)间是否具有相关性。方法应用主动后鼻阻力测压法和鼻声反射测量法对316例有鼻阻塞的患者进行前瞻性研究。根据减充血前双侧鼻阻力(bilateral NR,BNR)将患者分为2组,组1:BNR减充血前≤0.25 Pa/cm~3·s,组2:BNR减充血前>0.25 Pa/cm~3·s。Spearman等级相关分析研究上述两种客观测量法的参数在全体研究对象及各组中的相关性。结果在使用减充血剂前、后,316例患者单侧鼻阻力(unilateral NR,UNR)与单侧鼻腔容积(unilateral NV,UNV)、单侧鼻腔最小横截面积(unilateral MCSA,UMCSA)间均存在显著性负相关(P值均=0.000);组1(104例)和组2(212例)在减充血前、后的UNR与UNV、UMCSA间均存在显著性负相关(P值均=0.000)。鼻阻力与鼻腔最小横截面积的相关系数均大于鼻阻力与鼻气道容积的相关系数。结论在有鼻阻塞的患者中,NR、NV及MCSA存在负相关,MCSA是影响NR的主要因素。     

四相鼻阻力测量法评估健康成人鼻腔通气状况的初步研究

目的 研究四相鼻阻力测量(four-phase rhinomanometry)法对评估健康成人鼻腔通气状况的临床应用价值.方法 健康成人85名,采用四相鼻阻力计测量吸气、呼气及整个呼吸过程中的有效阻力(effective resistance in inspiration,expiration and total breathing process,分别简称为Reffin、Reffex、Refft),以及吸气和呼气过程的顶点阻力(vertex resistance in inspiration and expiration process,分别简称为Vrin、Vrex).同时,应用鼻声反射仪测量鼻腔的最小横截面积(minimum cross-sectional area of nasal cavity,MCA)和0～5 cm的鼻腔容积(nasal volume from 0-5 cm,V5).对四项鼻阻力和鼻声反射测量结果 进行相关性分析.结果 健康成人男性和女性Reffin(x-±s)分别为(1.28±1.02)Pa/(cm3·s)和(1.55±1.03)Pa/(cm3·s);Reffex(x-±s)分别为(1.43±1.07)Pa/(cm3·s)和(1.75±1.14)Pa/(cm3·s);Refft(x-±s)分别为(1.34±0.99)Pa/(cm3·s)和(1.62±1.03)Pa/(cm3·s);Vrin(x-±s)分别为(1.31±1.03)Pa/,(cm3·s)和(1.60±1.03 Pa/(cm3·s);Vrex(x-±s)分别为(1.46±1.04)Pa/(cm3·s)和(1.82±1.17)Pa/(cm3·s),男性和女性的各观察值比较差异均无统计学意义(r值分别为:0.661、-0.397、0.127、0.649、-0.684,P值均>0.05).Reffin,Reffex,Refft,Vrin和Vrex,与年龄、身高、体重、头围、体表面积、体重指数之间均无显著的相关性(P值均>0.05).Reffin,Reffex,Refft,Vrin,Vrex与MCA、V5之间均有显著的相关性(r值为-0.18～-0.20,P值均<0.05).结论 四相鼻阻力测量的结果 与鼻声反射的测量结果 相关性良好,可作为评估成人鼻腔通气功能的临床检测手段.     

Study of nasal cycles in children by acoustic rhinometry

BACKGROUND: Studies concerning nasal cycle physiology in children are still rare, and controversies exist about its existence. This study was ascertained to evaluate the dynamic behavior of inferior turbinates in children by acoustic rhinometry. METHODS: Sixteen volunteer patients, aged 2-11 years old (mean, 6.25 years), were evaluated between April and July 2003. The patients submitted to periodic acoustic rhinometry, with triplicate measurements (each 30 minutes) for 3 hours. RESULTS: All evaluated children presented nasal cycles, with five children presenting a classic pattern (31.25%), three children presenting a concert pattern (18.75%), and eight children presenting an irregular pattern (50%). CONCLUSION: This study suggests that children present nasal cycles, as well as adults. Nevertheless, the most prevalent pattern in children was the irregular pattern, whereas in adults the most frequently detected is the classic pattern.     

应用声反射鼻腔测量腺样体肥大患儿的鼻及鼻咽气道

目的:研究声反射鼻腔测量对腺样体肥大患儿的诊断与手术疗效评价方面的临床应用价值。方法:对23例正常儿童(正常儿童组)及27例腺样体肥大患儿(腺样体肥大组)进行坐位声反射鼻腔测量。结果:腺样体肥大组术前总鼻气道阻力(NAR)为[(0.44±0.17)kPa.L-1.min-1],较正常儿童组[(0.33±0.17)kPa.L-1.min-1]增大,差异有统计学意义(P<0.05),双侧鼻咽部容积(NPV)为[(14.74±5.01)cm3],较正常儿童组[(19.77±5.77)cm3]减小,差异有统计学意义(P<0.01);腺样体肥大组术后总NAR为[(0.36±0.21)kPa.L-1.min-1],较术前减小,差异有统计学意义(P<0.05),双侧NPV为[(17.93±4.56)cm3],较术前增大,差异有统计学意义(P<0.05)。结论:声反射鼻腔测量在腺样体肥大的诊断和疗效判定方面具有重要意义。     

Correlation between nasal anatomy and subjective patency: a prospective MRI study

Background: Variations in the thickness of the nasal septum are well documented¹ Objective: To determine if septal mucosal thickness and other parameters derived from MRI imaging correlate significantly with subjective sensation of nasal resistance. Methods: Forty patients undergoing MRI head scans for non-nasal disease were asked to complete a questionnaire immediately prior to the scan being taken. Subjective patency was scored for each nasal airway, patients were also asked about hayfever, URTIs, medication and history of nasal surgery or trauma. Scans were assessed using image analysis software. The following parameters were assessed at the level of the nasal valve: cross-sectional area of airway, horizontal thickness of inferior turbinate and maximum septal mucosal thickness. In addition, the presence of septal deviation (lateral to the vertical plane of the middle turbinate), and sinus mucosal thickening of 4 mm or more was assessed. Repeatability and inter-observer error was calculated. Data was analysed using non-parametric tests and multiple stepwise regression. Results: Overall correlation between anatomical parameters and subjective patency was low. Patients with sinus mucosal thickness greater than 4 mm on MRI scanning had subjectively poorer nasal airways (left P = 0.003, right P = 0.029). Multiple regression confirmed sinus mucosal thickening as the most significant predictor of patency but also negative correlation between ipsilateral mucosal thickness and patency (P < 0.002) and positive correlation between contralateral turbinate thickness (P < 0.01) and patency. Conclusions: Anatomical factors in both ipsilateral and contralateral nasal airways are of importance in subjective nasal patency. Sinus mucosal thickening correlates strongly with subjective nasal obstruction although the mechanism of this relationship is unclear. Non-anatomical and psychological factors are likely to be of considerable importance.     

Relationship between subjective nasal stuffiness and nasal patency measured by acoustic rhinometry.

Nasal geometry measured by acoustic rhinometry was compared with the subjective sensation of nasal stuffiness in healthy subjects before and after provocation with histamine. The correlation was poor at rest, but it was significant after histamine provocation in children and adults. It is easier to find a relationship between subjective and objective nasal obstruction afer inducing congestion. (American Journal of     

Two-year follow-up with acoustic rhinometry in children

BACKGROUND: This is an explorative study of growth-related nasal geometry in healthy children. METHODS: A total of 88 girls and boys between the ages of 4 and 16 years were followed over a period of 2 years by acoustic rhinometry. The registrations were correlated to height at each occasion. RESULTS: Although both the minimal cross-sectional area and the nasal volume increased in all age groups over 7 years, large individual variations in nasal geometry led to a weak relationship with growth. CONCLUSION: In the undecongested nasal cavity in children, correlation of nasal geometry makes sense for height but not for age.     

鼻声反射在学龄前儿童鼻腔容积测定中的应用

目的:使用鼻声反射技术检测学龄前儿童鼻腔容积,提出检测方法、结果分析方法以及相关正常参考值。方法:①在最小横截面积相同但容积不同的模拟鼻腔,通过鼻声反射仪和通气阻力检测仪测量管腔容积和通气阻力,比较最小横截面积和管腔容积在反映通气阻力变化时的敏感性。②使用鼻声反射仪测量97例4岁儿童和137例5岁儿童的鼻腔容积。结果:①在模拟鼻腔最小横截面积不变的情况下,通气阻力随鼻腔容积增加而减小。②学龄前儿童平均双侧鼻腔容积为(2.03±0.4)ml。不同年龄和不同性别学龄前儿童鼻腔容积差异均无统计学意义(均P>0.05)。结论:分析鼻声反射检测结果时,鼻腔容积变化比最小横截面积更能反映鼻腔通气阻力变化。本次研究提出鼻声反射检测结果评估方法和学龄前儿童鼻腔容积正常参考值。     

Measurement of nasal geometry by acoustic rhinometry in normal-breathing Asian children.

OBJECTIVE: The purpose of this study was to obtain normal values of nasal geometry in Asian children with no nasal problems using the acoustic rhinometry method. METHOD: Acoustic rhinometric measurement of the nasal fossae was performed in pediatric patients coming for general surgical operations with no nasal problem. RESULTS: A cohort study of 183 children in an acute care hospital with full elective and emergency surgical services was undertaken. The mean minimal cross-sectional area (MCA), which was functionally important for nasal breathing, was found to be 0.32 cm2 (SD = 0.13) and situated at 1.40 cm (SD = 0.26) from the anterior nare. Normal values for area, length, and volume of the nose in these children as a group and at different ages from 1 to 11 years old were obtained. CONCLUSIONS: Acoustic rhinometry was found to be well tolerated by the children. The MCA was confirmed to be situated at the anterior part of the nose and had a positive correlation with an increase in age.     

Effects of anatomical variations of the nasal cavity on acoustic rhinometry measurements: a model study

BACKGROUND: The goal of this study was to assess how anatomic variations of the nasal cavity affect the accuracy of acoustic rhinometry (AR) measurements. METHODS: A cast model of a human nasal cavity was used to investigate the effects of the nasal valve and paranasal sinuses on AR measurements. A luminal impression of a cadaver nasal cavity was made, and a cast model was created from this impression. To simulate the nasal valve, inserts of varying inner diameter were placed in the model nasal passage. To simulate the paranasal sinuses, side branches with varying neck diameters and cavity volumes were attached to the model. RESULTS: The AR measurements of the anterior nasal passage were reasonably precise when the passage area of the insert was within the normal range. When the passage area of the insert was reduced, AR measurements significantly underestimated the cross-sectional areas beyond the insert. The volume of the paranasal sinus had limited effect on AR measurements when the sinus ostium was small. However, when the ostium size was large, increasing the volume of the sinus led to significant overestimation of AR-derived areas beyond the ostium. CONCLUSION: The pathologies that narrow the anterior nasal passage result in the most significant AR error by causing area underestimation beyond the constriction. It also appears that increased paranasal sinus volume causes overestimation of areas posterior to the sinus ostium when the ostium size is large. If these physical effects are not considered, the results obtained during clinical examination with AR may be misinterpreted.     

鼻声反射和鼻阻力检查在气道炎症应用中的评价

目的探讨在上下气道炎症研究中鼻声反射、鼻阻力检查的参数选择及临床应用价值。方法应用鼻声反射仪及鼻阻力计对变应性鼻炎、哮喘患者及正常人鼻激发试验前后鼻腔通气功能进行测量,比较两种检查方法的差异,分析上下气道炎症的关系。结果①与正常对照组比较,鼻激发试验前后变应性鼻炎组、哮喘组鼻腔容积（nasal volume,NV）变化有显著性差异（P〈0．05）,鼻腔阻力（nasal airway resistance,NAR）变化也有显著性差异（P〈0．05）。②变应性鼻炎组、哮喘组NV与NAR变化率均呈负相关（r鼻炎=-0．673;r哮喘=-0．497,P〈0．01）,但NAR变异系数（coefficient of variation,CV）较大。正常组NV与NAR变化率无明显相关（r正常组=0．120,P〉0．05）。③以鼻声反射NV减少20％或NAR增加20％作为阳性标准,变应性鼻炎组、哮喘组与正常对照组NV阳性率的差异有统计学意义（X^2=23．03,P〈0．01）,NAR阳性率差异也有统计学意义（X^2=28．06,P〈0．01）。结论①AR、NAR检查均可作为评价鼻激发试验（nasal provocation testing,NPT）前后鼻腔通气功能的客观检查,但是,AR比NAR检查更为简便、迅速,精确度更高,重复性更好。②上、下气道炎症存在密切相关性。