The lateralization percentage as a measure of nasal flow asymmetry in active anterior rhinomanometry

The lateralization percentage as a measure of nasal flow asymmetry in active anterior rhinomanometry A new parameter is introduced in active anterior rhinomanometry: the lateralization percentage, calculated as (right flow-left flow)/(right flow+ left (low)x 100%. The flow-was measured at 15 mm H₂O pressure difference after induced shrinkage of the nasal mucosa. Two groups of subjects were studied. One group consisting of 28 male and 40 female volunteers was used to establish normal values in both sexes for flow, absolute flow difference and lateralization percentage. The second group consisting of 20 men who were to undergo submucous septal reconstruction for nasal obstruction was used to test the detection of abnormal cases when applying the normal values derived from the control group. It appeared that the absolute flow difference is a less effective measure than either the total flow or the lateralization percentage. Optimum detection (75–85% of the abnormal cases) was achieved by applying a criterion combining total flow and lateralization percentage.     

Numerical simulation of normal nasal cavity airflow in Chinese adult: a computational flow dynamics model

Our purpose is to simulate the airflow inside the healthy Chinese nose with normal nasal structure and function by computational fluid dynamics (CFD) method and to analyze the relationship between the airflow and physiological function. In this study, we used the software MIMICS 13.0 to construct 20 3-dimensional (3-D) models based on the computer tomography scans of Chinese adults’ nose with normal nasal structure and function. Thereafter, numerical simulations were carried out using the software FLUENT 6.3. Then the characteristics of airflow inside the airway and sinuses were demonstrated qualitatively and quantitatively in steady state. We found that during the inhalation phase, the vortices and turbulences were located at anterior part and bottom of the nasal cavity. But there is no vortex in the whole nasal cavity during the expiratory phase. The distributions of pressure and wall shear stress are different in two phases. The maximum airflow velocity occurs around the plane of palatine velum during both inspiratory and expiratory phases. After the airflow passed the nasal valve, the peak velocity of inhaled airflow decreases and it increases again at the postnaris. Vice versa, the exhaled airflow decelerates after it passed the postnaris and it accelerates again at nasal valve. The data collected in this presentation validates the effectiveness of CFD simulation in the study of airflow in the nasal cavity. Nasal airflow is closely related to the structure and physiological functions of the nasal cavity. CFD may thus also be used to study nasal airflow changes resulting from abnormal nasal structure and nasal diseases.     

Diagnostic accuracy of peak nasal inspiratory flow and rhinomanometry in functional rhinosurgery

OBJECTIVES: Sensitivity and specificity of active anterior rhinomanometry (RMM) and peak nasal inspiratory flow (PNIF) in the diagnosis of functionally relevant structural nasal deformities should be assessed. The reference standard was clinical judgment based on all clinical data available. STUDY DESIGN: Prospective study of diagnostic accuracy at a tertiary rhinologic referral center. METHODS: RMM and PNIF were performed on 53 patients with symptomatic nasal stenosis and 40 healthy volunteers. Cut-offs for RMM and PNIF were defined by receiver operating characteristic analysis. RESULTS: A cut-off between normal and pathological of 700 mL/second for RMM at a transnasal pressure difference of 150 Pa, and of 2,000 mL/second (120 l per minute) for PNIF was calculated. No significant differences in terms of sensitivity of RMM and PNIF (0.77 vs. 0.66), specificity (0.8 vs. 0.8) and diagnostic accuracy (0,79 vs. 0.72) were found. CONCLUSION: RMM and PNIF provide valuable information to support clinical decision making. However, with both methods, approximately 25% of symptomatic patients with functionally relevant nasal structural deformity were not detected. A negative test outcome of RMM or PNIF does not exclude a functionally relevant nasal stenosis.     

基因重排检测在原发性鼻腔非霍奇金淋巴瘤诊断和分型中的应用

目的探讨免疫球蛋白重链（immunoglobulin heavy chain, IgH） 和T细胞受体（ non-Hodgkin lymphoma, NHL）基因重排在鼻腔非霍奇金淋巴瘤（polymerse chain reaction, PCR）诊断和分型中的价值。方法采用两对引物进行半巢式聚合酶链反应（polymerse chain reaction，PCR）检测11例B细胞淋巴瘤组织DNA的单克隆性IgH基因重排；采用两对引物进行一步法PCR检测23例NK／T细胞淋巴瘤和20例T细胞淋巴瘤组织DNA的单克隆性TCR基因重排。以10例鼻息肉组织标本作为对照。结果11例B细胞淋巴瘤中IgH基因单克隆性重排10例阳性（90．9％），20例T细胞淋巴瘤中TCR基因单克隆性重排17例阳性（85.0％），23例NK／T细胞淋巴瘤中TCR基因单克隆性重排10例阳性（43.5％）。10例鼻息肉标本采用相应引物扩增结果均为阴性。结论在鼻腔NHL中，基因重排检测是一种有效的辅助诊断和分型方法，采用两对引物进行PCR可提高基因重排检测的阳性率。     

Diagnostic accuracy of the nasal obstruction index in detecting adenoid hypertrophy in children without allergy

Objective

We have previously compared the capacity of the nasal obstruction index (NOI) and nasal fiberoptic endoscopy (NFE) to detect adenoid hypertrophy (AH) in children and found no agreement between them. However, the prevalence of false positive results was significantly higher in children with allergic rhinitis (AR), thus suggesting that AR may be a possible causative factor. The aim of this study was to verify the diagnostic accuracy of the NOI in detecting AH by comparing NOI scores with NFE findings in a selected series of non-allergic children affected by nasal obstruction.

Methods

This prospective study was carried out at the Outpatient Clinics of the Departments of Specialist Surgical Sciences and Maternal and Pediatric Sciences of the University of Milan, Italy, and involved 154 non-allergic children aged 3-12 years in whom otological diseases and/or perceived nasal obstruction led to the suspicion of adenoid obstruction. The diagnostic accuracy of NOI was tested at all of the thresholds obtained by combining all of the cut-off points of NFE and NOI.

Results

Sixty-two percent of the children had otological diseases. The choanal opening was completely blocked by the adenoids in 40% of the children, whereas NOI indicated severe clinical obstruction in only 16%. The analysis of diagnostic accuracy showed that sensitivity and specificity were respectively 17-96% and 15-91% depending on the threshold, with no simultaneously acceptable sensitivity and specificity values at any threshold and AUC values of ≤0.7 at all thresholds.

Conclusions

In comparison with NFE, the NOI seems to be inaccurate in detecting AH in non-allergic children with nasal obstruction.     

鼻腔流体力学分析模型的构建及分析

目的通过建立用于流体力学分析的鼻腔三维模型,探讨建立三维模型的方法,为研究鼻腔内结构对气流场的影响提供基础。方法螺旋CT薄层扫描获取DICOM格式数据文件,导入三维重建软件Mimics,并应用流体力学分析软件重建鼻腔三维模型,计算分析后获得鼻腔气流场相关信息。结果所建鼻腔三维模型与实体鼻腔结构有较好的相似性,并且操作误差小,建模分辨率高,流体力学分析并模拟鼻腔不同层面的压力等值图、速度矢量图和鼻腔气流流动迹线图,能客观直接的反映出鼻腔气流场特性。结论应用DICOM数据计算机辅助建模法是一种快捷、准确、高效的建模方法,该实验所建鼻腔三维模型精确度高,操作的可重复性好,计算分析后获得的鼻腔气流场相关数据,处理转换成直观图形,不仅能客观直接的反映出鼻腔气流场特性,同时还能为临床上研究鼻腔结构对鼻腔功能的影响提供了一种新型的研究方法。     

鼻腔鼻窦神经纤维瘤一例

患者女,78岁,因渐进性鼻塞10余年于2009年1月入院.患者10年前自觉双侧鼻塞、流涕,无明显鼻出血、头痛及耳鸣,无发热.自行药物治疗,疗效不佳.鼻塞呈渐进性加重,左侧著,间或有脓性分泌物流出,伴轻度头痛,上呼吸道感染或劳累后明显加重.为进一步诊治,收入院.人院查体:外鼻宽大畸形,呈蛙状,左侧鼻腔内灰白色肿物,质软,表面附着少许胶冻样物,触之无明显出血,鼻中隔重度右偏,鼻腔内其他结构不可见,双侧上颌窦区轻压痛,耳及咽喉检查大致正常.     

鼻腔鼻窦神经纤维瘤一例

患者女,78岁,因渐进性鼻塞10余年于2009年1月入院.患者10年前自觉双侧鼻塞、流涕,无明显鼻出血、头痛及耳鸣,无发热.自行药物治疗,疗效不佳.鼻塞呈渐进性加重,左侧著,间或有脓性分泌物流出,伴轻度头痛,上呼吸道感染或劳累后明显加重.为进一步诊治,收入院.人院查体:外鼻宽大畸形,呈蛙状,左侧鼻腔内灰白色肿物,质软,表面附着少许胶冻样物,触之无明显出血,鼻中隔重度右偏,鼻腔内其他结构不可见,双侧上颌窦区轻压痛,耳及咽喉检查大致正常.     

鼻腔结构不良综合征及其对策

目的提出鼻腔结构不良的基本概念。探讨鼻腔结构不良的诊断和治疗问题。方法通过对2000~2002年55例鼻腔结构不良的病例分析,介绍各种鼻腔结构不良的诊断和治疗方法。结果55例鼻腔结构不良中,鼻中隔偏曲合并下鼻甲骨性肥大或内移32例,鼻中隔偏曲合并中鼻甲骨下垂、下鼻甲内移12例,鼻中隔偏曲合并鼻前庭狭窄6例,筛骨垂直板及筛泡过度气化5例,均经鼻窦内镜行鼻腔成形术治疗,随访6个月至1年,疗效满意。结论鼻腔结构不良应引起临床的充分重视。只有通过鼻内镜行鼻腔成形手术治疗,才能取得满意疗效。     

正常和病理状态下鼻气道阻力在鼻腔中的分布

目的探讨正常和病理状态下鼻瓣区的确切位置。方法研究正常成人鼻黏膜减充血前、后以及慢性鼻炎和鼻中隔偏曲手术前、后鼻气道阻力（nasal airway resistance,NAR）在鼻腔中的分布。结果正常成人鼻黏膜减充血前,NAR最大部位位于梨状孔,而在减充血后,则位于内孔区。慢性鼻炎患者手术前、后NAR最大部位分别位于梨状孔和内孔区。鼻中隔偏曲矫正术前、后则分别位于偏曲部位和梨状孔。结论鼻瓣区在正常情况下位于梨状孔和下鼻甲前端,当鼻腔存在阻塞性病变时则位于病变部位。鼻瓣区的部位不是固定不变的,而是和鼻黏膜舒缩状态以及鼻腔的开放程度密切相关。     

The distribution of thermoreceptors within the nasal cavity

The distribution of thermoreceptors within the nasal vestibule (that part of the nasal cavities lined with skin) and nasal cavum (that part of the nasal cavities lined with respiratory epithelium) was studied in 20 subjects. The distribution was compared with that of the malar skin adjacent to the nose. No thermoreceptors were located in the nasal cavum but the nasal vestibule contained a dense distribution of cold receptors (3.5 receptors per cm2) and warm receptors (3.2 receptors per cm2). The corresponding density of receptors in the malar skin was 2.7 receptors per cm2 and 2.6 receptors per cm2. The difference in distribution density between the nasal vestibule and the malar skin was significant (P less than 0.05). The implications of these findings are discussed.     

Assessing the reproducibility of nasal spirometry parameters in the measurement of nasal patency

The reproducibility of nasal spirometry was assessed in ten subjects at two visits. Topical nasal decongestion was applied to minimise mucosal variation. Eleven parameters of flow volume were measured. Data analysis using Spearman's rank correlation coefficients revealed peak inspiratory flow rate (PIFR) followed by forced expiratory volume in first one second (FEV1) to be the most reproducible measures, yielding significance values of < 0.05. For all other spirometric parameters significance was not reached. Analysis revealed that using a naso-pulmonary index (a ratio of nasal to pulmonary flow) was detrimental to reproducibility. We conclude that future nasal spirometric studies should use PIFR and FEV1 as their derived variables of flow-volume loops in the assessment of nasal patency, and the naso-pulmonary index is of no value.     

鼻腔扩容技术的临床意义

随着对睡眠上气道通气功能障碍认识的不断深入,解决上气道通气障碍或通气功能不全的问题逐渐被同道们所重视.作为呼吸系统的门户,鼻腔在上气道通气障碍中发挥着源头性作用,引起关注[1].近年来,在该领域开展的相关基础和临床研究,取得了一定的成果.研究发现,鼻腔扩容术可以通过增加鼻腔有效通气容积和降低患者鼻阻力,进而降低咽腔塌陷压,减轻咽腔黏膜肿胀,缓解咽腔塌陷,降低咽腔顺应性,改善患者睡眠状态下上气道通气障碍,不仅可以提高患者夜间睡眠质量,减轻白天嗜睡程度,提高生活质量;还能使潮气量增加,促进机体代谢……总之,成功的鼻腔扩容可以有效缓解上气道通气功能障碍,对于伴有鼻腔结构异常的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)可以取得理想的治疗效果.     

Plasmacytoma in nasal cavity and maxillary sinus

Summary The interrelationship of extramedullary plasmacytoma (EMP), solitary myeloma of bone (SMB), and multiple myeloma (MM) is unknown. Some authors think that they represent no more than a spectrum of plasma cell tumors; others think that they are completely different entities.We have encountered three cases of plasmacytoma in the head and neck region in the past 5 years. One was present in the nasal cavity and the other two in the maxillary sinus. The former seemed to be secondary to an EMP of 10 years' duration and the latter two, secondary to a MM of 1 or 2 years' duration.We compared these cases clinically and concluded that the plasmacytoma in the nasal cavity was a transitional form of EMP to MM and was responsive to radiation and surgery just as ordinary EMPs occurring in the head and neck region were. The other plasmacytomas in the maxillary sinus appeared secondary to the MM and were not responsive to any treatment.From these facts, the plasmacytoma occurring in the head and neck region secondary to an EMP elsewhere should be treated locally and differently from those originating from MM for which systemic treatment should be started from the beginning.     

鼻窦内窥镜下鼻腔鼻窦手术

目的探讨鼻窦内窥镜技术在外科治疗鼻腔鼻窦疾病上的可行性.方法经由鼻窦镜治疗鼻窦炎,鼻息肉,鼻中隔偏曲,肥厚型鼻炎,上颌窦囊肿,上颌窦出血坏死性息肉,鼻腔鼻窦内翻性乳头状瘤,顽固性鼻出血,早期鼻中隔鳞癌等236例.结果236例均顺利完成手术.鼻窦炎、鼻息肉130例中随访97例 ,治愈好转86例;鼻中隔偏曲72例次,治愈率达97%;肥厚型鼻炎52例次,1次治愈率达95% ;鼻腔鼻窦内翻性乳头状瘤及出血坏死性息肉8例,上颌窦囊肿5例,顽固性鼻出血3例,早期鼻中隔鳞癌1例,均顺利完成手术,随访2～3年均未见复发.结论鼻窦内窥镜下鼻腔鼻窦手术可用于包括早期局限性鼻腔恶性肿瘤在内的各种鼻腔鼻窦疾病.