Nasal mucosal blood flow at rest and during exercise

Nasal airway resistance increases at rest in the supine position and decreases during exercise due to changes of the thickness of the nasal mucosa regulated by the capacitance vessels. The resistance vessels regulating blood flow have not not been evaluated in these conditions before. In 15 healthy subjects the nasal mucosal blood flow was measured in rest and exercise with the 133Xe washout method. No change in blood flow was registered during exercise, which demonstrates that the blood flow and the blood content of the human nasal mucosa are not affected in the same way by exercise.     

Simulated septal deviations

Effects of simulated septal deviations on nasal airflow resistance were measured in two healthy young adults by computer-assisted rhinomanometry. Within the decongested bony cavum, simulated deviations, 30 x 5 x 5 mm perpendicular to the maxillary crest, elevated resistance only slightly, but severely when the mucosa was not decongested. Caval resistance was unaffected by simulated maxillary crest spurs, 30 x 5 x 5 mm, in either vascular state. Between inferior turbinate and anterior naris, 5-mm septal protrusions from floor to roof increased resistance severely, but when shortened by one third, their resistive effects were markedly decreased, especially when positioned near the roof. The cavum can accommodate large septal spurs, deviations, and congested mucosa with little effect on airflow resistance. By contrast, resistance of the anterior nasal airway beyond the inferior turbinate bone is acutely responsive to changes in mucosal congestion and to septal protrusions, especially when they are situated near the floor of the nose.     

Nasal resistance and nasal blood flow in postural changes

Posture greatly influences nasal resistance. To investigate whether nasal blood flow synchronizes with nasal resistance during changes in posture, correlation coefficients were calculated based on findings from both nasal cavities in 14 normal subjects. There was no correlation between nasal resistance and nasal blood flow, except in the left nasal cavity of one subject. Nasal blood flow was measured by a laser Doppler flowmeter, which detects the blood flow in the superficial part of the nasal mucosa. Nasal resistance is regulated mainly by capacitance vessels located in the deeper part of the nasal mucosa. Therefore, the dissociation in nasal resistance and blood flow responses to postural changes noted in our study suggests that vessels in different parts of the nasal mucosa respond differently to this same stimulus.     

Reflex activation in allergen-induced nasal mucosal vascular reactions

Subjects with allergic rhinitis were challenged unilaterally with diluent and increasing doses of allergen. Challenge with the highest dose of allergen was also carried out after topical anesthesia of the nasal cavity using lidocaine. In the contralateral, unprovoked nasal cavity the mucosal blood flow was determined using the 133Xenon wash-out technique and the nasal airway resistance was determined by rhinomanometry before and after challenge. Nasal symptom scores were estimated 15 min after each challenge. Blood flow in the nasal mucosa in the unprovoked right nasal cavity decreased in a dose-dependent manner for th two highest doses of allergen where a reduction of 21% (p less than 0.05) and 26% (p less than 0.01) was obtained. Nasal airway resistance increased somewhat after the highest dose (p greater than 0.05). Topical anesthesia in the provoked nasal cavity inhibited the decrease in blood flow in the unchallenged nasal cavity. These findings suggest that the changes in the tone of the resistance vessels, but not the capacitance vessels, which are induced by allergen, are largely reflex-mediated.     

A computed tomographic study of nasal mucosa: effects of vasoactive substances

Computed tomographic studies of mucosal responses to vasoactive substances (xylometazoline and histamine) in healthy nasal cavities of adult subjects demonstrate the distribution of erectile mucosa. Following artificial congestion of the mucosa by local application of histamine: (1) the middle turbinate and the body of the inferior turbinate limit the main nasal airway as it passes through the middle meatus; (2) an expanded mass of localized erectile tissue in the anterior septal region bars the entrance to middle meatus and intrudes medially into the narrow airway of the piriform aperture and nasal valve; (3) this critical segment of the airway is further limited by forward extension of the anterior tip of the inferior turbinate.     

鼻中隔偏曲伴下鼻甲肥大患者的鼻窦CT分析

目的　通过对鼻中隔偏曲患者鼻窦CT的测量分析,初步评价鼻中隔偏曲程度与下鼻甲肥大的相关性。方法　分析98例鼻中隔偏曲患者鼻窦冠状位CT,将与鼻中隔偏曲方向一致的鼻腔设为对照组,与鼻中隔偏曲方向相反的鼻腔设为实验组。测量并记录鼻中隔偏曲角度,双侧下鼻甲骨、内侧黏膜、外侧黏膜厚度。结果　实验组和对照组下鼻甲内侧黏膜、骨、外侧黏膜厚度差异有统计学意义（P <0.05）。实验组下鼻甲内侧黏膜、骨、外侧黏膜厚度差异有统计学意义（P <0.05）。实验组下鼻甲内侧黏膜、骨、外侧黏膜厚度与鼻中隔偏曲角度的相关性无统计学意义,但相关系数r 提示三者与鼻中隔偏曲角度的相关性：骨＞内侧黏膜＞外侧黏膜。结论　鼻中隔偏曲伴代偿性下鼻甲肥大,不仅由下鼻甲黏膜增厚引起,也可由下鼻甲骨本身增生引起,鼻中隔矫正术术前行鼻窦CT检查,对鼻中隔偏曲伴下鼻甲肥大患者手术方式的选择有一定帮助。     

Measurement of the blood flow of the nasal mucosa by the hydrogen clearance method

The tissue blood flow of the nasal mucosa in normal subjects and patients with nasal allergy was studied by the hydrogen clearance method. The flow in the inferior turbinate in normal subjects and patients with nasal allergy did not differ. The test results were highly reproducible and were almost the same in different anterior parts of the inferior turbinate. The effects of nasal spray with vasoconstrictor and nasal provocation by an allergen-containing paper disc on the blood flow of the inferior turbinate were examined in normal subjects and patients with nasal allergy. The flow decreased remarkably after spray with vasoconstrictor. The flow also decreased remarkably in the mucosal membrane close to the area of contact of the allergen disc, whereas it increased at the area 10 mm away from the disc. The hydrogen clearance method is useful for clinical studies of nasal circulation.     

Why we should avoid using inferior turbinate tissue as control to Nasal Polyposis studies

Conclusion: The authors are aware that inferior turbinate mucosa presents different properties from middle turbinate mucosa and any data generated using inferior turbinate as control in Nasal Polyposis (NP) should be analysed very carefully. Objective: This study aims to compare the mechanical properties of inferior turbinate mucosa vs middle turbinate mucosa. Materials and methods: The interstitial hydrostatic pressure behaviour was compared during a saline solution infusion between healthy nasal mucosa from inferior turbinate with middle turbinate (four patients). Results: A significant difference, p?=?0.02, was found in the response of interstitial hydrostatic pressure during the saline injection when the inferior turbinate vs middle turbinate was compared.     

The septal mucosa decongests with naphazoline: a study of mucosal dynamics with sonography

A new method using B-mode and power-Doppler-mode (pD) sonography for the investigation of changes in nasal mucosa swelling and perfusion was developed. The effect of naphazoline (0.25 mg/mL) on the nasal mucosa was visualized and recorded in 1-minute intervals in 40 patients. The effect of normal saline solution was studied in 27 healthy volunteers. The decongestant and normal saline were applied by flooding the anterior nasal cavity. A computer program automatically quantified pD color information. Normal saline solution induced a 4.8 +/- 2.4% increase in perfusion (+/- SEM, n.s.) after 5 minutes. In the naphazoline group, changes in stereometry were measured on B-mode-sequences in 24 (60%) and perfusion changes in 24 participants (60%). In 16 of 40 patients (40%), both stereometry and perfusion were analyzed. After 10 minutes, the septum and inferior turbinate mucosa thickness were reduced by 17 +/- 2.8% (p < 0.001) and 25 +/- 2.6% (p < 0.001). Perfusion of the septum and inferior turbinate mucosa as visualized with pD-sonography decreased by 33 +/- 3.3% (p < 0.001). The reduction of bloodflow induced by naphazoline as visualized with pD-sonography is within the range of perfusion changes found in LDF and Xenon clearance studies. Decongestion of the septum mucosa demonstrates erectile properties of the septum, which may contribute to the increase of nasal patency after nasal decongestion.     

Effects of amphetamine on human nasal mucosa

The present study was devised to determine the effects of amphetamine on the sympathetic function of human nasal mucosa. A tissue bath method was employed on the vitro preparations of nasal turbinate mucosa from adult patients with nasal allergies or hypertrophic rhinitis. The effects of amphetamine on the contractile response of isolated human nasal mucosal blood vessels were investigated following electrical field stimulation and methoxamine. The results showed that amphetamine inhibited field stimulation and antagonized the effects on mucosal contraction induced by methoxamine. Likewise, the drug increased mucosal basal tension but had local drug toxicity when a 10^–4 M solution was used. Amphetamine could potentiate mucosal contraction induced by norepinephrine or epinephrine. The study indicated that amphetamine may increase sympathetic function by potentiating the effect of norepinephrine and that high concentrations of amphetamine may actually antagonize a-adrenoceptors.     

Endoscopic, assisted, modified turbinoplasty with mucosal flap

A variety of surgical methods have been developed to reduce the volume of the inferior turbinates, in order to create a more patent nasal airway. We describe a technique used in our department since February 2002 for all patients undergoing inferior turbinectomy. We resect with endoscopic assistance the lateral mucosa and bony inferior turbinate. This technique can reduce a large volume of the turbinate while preserving the mucosal continuity and the submucosa by covering the raw surface with a mucosal flap. We believe our method minimises post-operative side effects and complications such as dryness, infection, bleeding and pain.     

The effects of saline-induced edema in the human nasal mucosa on laser Doppler flowmetry

The nasal mucosa on the anteromedial surface of the inferior turbinate was studied with laser Doppler flowmetry in ten patients who were under general anaesthesia. A specially designed adapter was used, which held an injection needle with a diameter of 0.4 mm in a fixed position to the tip of the probe. The tip of the needle was inserted to a depth of 0.7 mm below the surface of the mucosa, while the tip of the probe was held at a distance of 0.3 mm from the mucosa. The laser Doppler parameters of perfusion, concentration of moving blood cells (CMBC) and velocity were recorded before and after the injection of 0.8 ml saline, thus inducing an experimental edema. After the injection no change in perfusion was detected but CMBC decreased and velocity increased. The findings agreed with the view that an increase in mucosal edema would reduce CMBC. When studying unanaesthesised subjects we normally use both rhinostereometry and laser Doppler flowmetry. It is then possible to measure the degree of mucosal congestion and micro circulation simultaneously, thus permitting study of the effects of a change in interstitial fluid content on mucosal congestion.     

鼻中隔偏曲患者双侧下鼻甲的影像学和病理学观察

目的：观察鼻中隔偏曲患者双侧下鼻甲的形态结构及其黏膜的病理改变。方法：为住院行手术治疗鼻中隔偏曲患者30例行术前鼻窦冠状位CT扫描，在CT片上直接测量下鼻甲的宽度和高度，将测量数值根据CT片上的标尺换算成实际值。手术全麻后、鼻腔表麻前，在鼻内镜下，于鼻中隔明显偏曲处对称切取下鼻甲组织，在光镜、透射电镜下观察下鼻甲的黏膜上皮层及固有层组织结构的改变。结果：从30例鼻中隔偏曲患者的鼻窦CT中观察到，偏曲对侧下鼻甲的高度和宽度均大于同侧，差别有统计学意义。光镜结果：偏曲对侧下鼻甲较同侧黏膜上皮、基底膜增厚，血管增生，纤维组织增生，腺体密度同侧较对侧减小。电镜结果：偏曲对侧较同侧的下鼻甲黏膜固有层的结缔组织胶原纤维增生明显；黏膜固有层毛细血管及腺体周围毛细血管的内膜具有窗格样空隙，小静脉内皮基底膜变透明，间隙增大，肿胀样，结构疏松。结论：在鼻中隔偏曲患者中，偏曲两侧的下鼻甲在宽度和高度上差异有统计学意义。偏曲对侧下鼻甲的肥大，既有骨质增生的成分，也有黏膜及黏膜下层组织增生的因素。     

A comparison of the effects of xylometazoline on nasal airflow, and on blood flux as measured by laser Doppler flowmetry

The purpose of this study was to examine whether changes in mucosal blood flow measured directly by laser Doppler flowmetry corresponded to changes in turbinate blood volume measured indirectly as changes in nasal airflow. Fifteen healthy subjects underwent active anterior rhinomanometry and laser Doppler flowmetry prior to and following the topical application of 100 micrograms of xylometazoline to each nostril. A significant decrease in nasal resistance occurred in the probe nostril (p less than 0.001) and the non probe nostril (p less than 0.005) following xylometazoline. A significant fall in blood flux occurred with xylometazoline (p less than 0.05). There was no correlation between the percentage change in airflow (rhinomanometry) and the percentage change in blood flux (laser Doppler) following xylometazoline. These results suggest that laser flowmetry and rhinomanometry measure different parts of the inferior turbinate vascular bed.     

Nasal mucosal temperature and the effect of acute infective rhinitis

Nasal mucosal temperature was measured in 71 healthy subjects with an electronic thermometer. No correlation was found between the nasal mucosal temperature and age or sex. An increased mucosal temperature was found in patients with acute rhinitis, an effect which is supposed to assist in the defence system against microorganisms. When measuring nasal mucosal temperature over a 7-h period at the same time as nasal airway resistance, there was no correlation between these factors, indicating that the temperature is independent of the state of the capacitance vessels.     

Submucous electrocautery following submucous resection of turbinate bone--a rationale of surgical treatment for allergic rhinitis

OBJECTIVE: Since the majority of the key elements such as trigeminal nerves, parasympathetic nerves, nasal glands, and blood vessels targeted by histamine and leukotrienes are found in the lamina propria of the nasal mucosa, its selective electrocautery has a rationale to improve the symptoms of allergic rhinitis with preservation of epithelial layer. To achieve the above goal, we performed the submucous electrocautery of the lamina propria (SECLP) following the submucous resection of the inferior turbinate bone (submucous turbinectomy: SMT). This paper discusses the efficacy of this procedure for the patients with persistent perennial allergic rhinitis. METHODS: An intranasal initial incision was made along the piriform aperture. The mucoperiosteum was elevated from the inferior turbinate bone followed by its complete resection. The SECLP was performed by applying a high-frequency coagulation current with a ball tip electrode, which was inserted into the mucoperiosteal sack after the completion of the SMT and was drawn forward on the medial surface of the mucoperiosteum with drawing a wavy line. We performed this surgery in 43 patients with perennial allergic rhinitis who were refractory to pharmacotherapy or were reluctant to take medicine. Symptoms, macroscopic intranasal findings, the results of allergic tests, nasal resistance, mucociliary function with saccharin, and the number of mast cells were compared pre- and postoperatively. RESULTS: The patients exhibited satisfactory improvement in symptoms only with a few crust formations. The macroscopic intranasal findings and allergic tests improved after surgery. Saccharin transport time remained normal. The number of anti-tryptase positive mast cells significantly decreased in the epithelial layer and in the superficial layer of the lamina propria of the postoperative inferior turbinate mucosa. CONCLUSION: The SECLP following the SMT is evaluated to be a useful surgical modality for allergic rhinitis with preservation of the nasal mucosal function.     

The effect of ice packs upon nasal mucosal blood flow.

The effect on nasal mucosal blood flow of ice packs on the forehead and ice packs within the mouth was investigated in 16 healthy subjects. The laser Doppler flowmeter was used to record changes in blood flow to the inferior turbinate, as measured by change in the flux. Ice packs within the mouth produced a significant decrease in nasal mucosal blood flow (p less than 0.05). The average fall was 23% (SEM 5.9) compared with the control measurements. No significant change was recorded following the application of ice packs to the forehead. The results of this study question the scientific rationale behind the use of forehead ice packs in clinical practice.     

水通道蛋白-4在人鼻息肉组织中的表达及意义

目的 研究水通道蛋白-4(aquaporin4, AQP-4)在鼻息肉组织中的分布并探讨其在鼻息肉形成过程中的机制和作用。方法 采用免疫组织化学方法检测60例新鲜鼻息肉标本和30例肥大下鼻甲黏膜中AQP-4的表达及分布水平,应用两独立样本t检验对检测结果进行对比分析。结果 鼻息肉和下鼻甲黏膜的上皮细胞、固有层腺体细胞、血管及血窦内皮中均可检测到AQP-4分布;鼻息肉上皮细胞、血管及血窦内皮中阳性细胞数均高于下鼻甲黏膜,且差异有统计学意义。结论 AQP-4在鼻息肉上皮细胞和血管及血窦内皮细胞中表达水平明显增高,提示AQP-4在鼻息肉组织中的异常分布可能是鼻黏膜水肿的形成机制之一。     

2种手术方法治疗伴鼻中隔偏曲的变应性鼻炎的疗效分析

目的：观察2种手术方法治疗伴鼻中隔偏曲的变应性鼻炎的疗效及应用价值。方法：将87例伴鼻中隔偏曲的变应性鼻炎患者根据下鼻甲黏膜肥厚及骨增生情况分为2组,分别行鼻中隔偏曲矫正联合双下鼻甲低温等离子射频消融并骨折外移术、鼻中隔偏曲矫正联合双下鼻甲骨黏膜下部分切除术,疗效采用2004兰州标准和鼻阻力测量值进行评价。结果：术后随访1年,患者鼻阻力较术前明显改善,2组症状改善的总有效率均大于88%。结论：2种手术方法均显著降低了患者的鼻阻力,改善了过敏性症状,效果良好。     

The autonomic innervation of the nasal capacitance and resistance vessels in the cat

In the present study reflex manners in capacitance and resistance vessels of the nasal mucosa have been observed respectively and simultaneously by stimulating the a) Cervical sympathetic nerve trunk, b) Vagal nerve, c) Vidian nerve, d) sympathectomized Vidian nerve electrically. Capacitance change in the nasal mucosa was measured by plethysmographic balloons inserted into the nasal cavity. Resistance change was measured as the pressure change in the terminal branch of the maxillary artery by using the constant flow perfusion method. a) Stimulation of the cervical sympathetic nerve trunk evoked a decrease change in the volume of the nasal mucosa and an increase change in the resistance of the maxillary artery. b) Stimulation of the Vagal nerve evoked an increase change in the volume of the nasal mucosa and a decrease change in the resistance of the maxillary artery. c) Stimulation of the Vidian nerve there were observed an increase change in the volume of the nasal mucosa and a decrease change in the resistance of the maxillary artery at the low stimulation intensity, from 0.2 to 0.8 volts. Further increasing the stimulation intensity, from 1.0 to 6.0 volts a decrease change in the volume of the nasal mucosa was observed. In spite of the reverse change in the capacitance vessel, pressure in the maxillary artery still maintained low pressure level. d) Stimulation of the sympathectomized Vidian nerve evoked an increase change in the volume of the nasal mucosa and a decrease change in the maxillary artery. Manner of these reflex was very similar to that of the Vagal nerve stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)