The nasal valve: a physiological and clinical study

Fifteen subjects underwent nasal pressure gradient studies to determine the resistance profile of the nose. Seventy-nine per cent of nasal resistance to airflow occurred in the segment 0 cm.-2.8 cm. from the posterior margin of the anterior nares. The greater part of this resistance (43 per cent) occurred in the segment 1.5 cm.-2.8 cm. within the nose, and this area approximated to the site of the pyriform aperture. Eighteen patients underwent a trial of radical trimming of the inferior turbinates (12 patients) versus anterior trimming of the inferior turbinates (6 patients). Both operations produced a similar fall in nasal resistance to airflow, confirming that the region of the pyriform aperture was the site of maximum nasal resistance. Whereas the radical operation significantly reduced the sensation of nasal obstruction, the anterior operation did not. The results of the study are discussed with reference to previous work on the subject.     

The human respiratory nasal mucosa in nasal syphilis. An ultra-microscopic study

The fine structure of the human tertiary syphilitic nasal mucosa was studied in 5 patients. The epithelium showed variations in thickness, loss of cilia, irregular cell contours, widened intercellular spaces, rare goblet cells. The seromucinous glands were in three forms. The arterioles and capillaries varied in relation to the pathology of the surrounding tissue. The venules were least affected. The stroma was infiltrated by macrophages, plasma cells with some areas having excessive fibrosis and others partially necrotic. These findings were correlated to the histochemical reactions. Scattered Treponema pallidum were seen, demonstrating the blood-borne dissemination and the infective nasal secretions.     

A study of nasal airway function in the postoperative period of nasal surgery

One hundred fifty-seven consecutive nasal surgery cases were followed for a minimum of one year or more. Ten cases were considered to have unsatisfactory mechanical airways, caused either by return of the original pathology (alar collapse or atrophic rhinitis) or by inadequate mechanical results. Nineteen cases in which the mechanical airways were satisfactory had soft tissue obstruction secondary to chronic inferior turbinate congestion. The effects of nasal allergy and the trauma of postnasal packing on chronic congestion of the turbinates are tabulated according to the type of surgery performed and results discussed.     

Activation of the impaired nasal mucociliary function. A preliminary clinical study

The effect of HR-6 solution containing adenosine triphosphate 10 mg/ml on the impaired nasal mucocililary function in 13 patients was studied. The nasal mucociliary function measured with the radioisotopic method using 99Tc-labelled human serum albumin as a tracer substance was markedly impaired in all patients. The patients had had symptoms of upper and/or lower respiratory tract infections for 8 1/2 years, on the average. The nasal mucociliary function ranged from 0 to 5.0 mm/minute, mean 2.0 mm/minute. In this single dose study the test drug improved nasal mucociliary function by at least 1.4 mm/minute in 77% of the patients and by at least 2.8 mm/minute in 54% of the patients. This preliminary study indicates the need for further examinations with the HR-6 in patients with impaired mucociliary function.     

Effects of nasal obstruction on Eustachian tube function and middle ear pressure.

To evaluate the relationship between nasal obstruction and otitis media, 10 ferrets were studied before and after either unilateral (E = 5) or bilateral (n = 5) nasal obstruction. Observations included otomicroscopic assessments of middle ear status, tympanometric recordings of middle ear pressure and forced-response, inflation-deflation and continuous monitoring tests of Eustachian tube function. During the 6 8 week post-obstruction follow-up period no animal developed evidence of otitis media. Abnormal positive middle ear pressures lasting for the period of follow-up occurred only in the animals with bilateral nasal obstruction. Eustachian tube function test results showed these pressures to be generated during swallowing. No changes in the passive function of the tube were documented in either group, but changes in active function consistent with alterations in the pressure gradient between the middle ear and the nasopharynx were observed in both groups.     

Factors affecting ciliary function in vitro: a preliminary study.

Nasal ciliary function forms an important defence mechanism within the upper respiratory tract which has largely been ignored in recent years. The effects of various drugs used extensively in the treatment of diseases of the nose have not been fully established. Furthermore, the physiological control of ciliary activity is unclear. The aim of this study was therefore to investigate the effects of drugs on ciliary beat frequency in vitro using a photometric technique. A dose-dependent response to alpha and beta receptor drugs was found, cocaine hydrochloride achieved ciliostasis even at 40-fold dilution, and potassium ions, except at the limits of tolerance for excitable tissue, did not affect ciliary function. In conclusion, we suggest that alpha and beta receptors may be present on ciliated epithelium and be involved in the control of ciliary function in vivo. Ion fluxes across the ciliary cell membrane may also be important in ciliary activity akin to nervous tissue.     

Effects of female hormones on the muscarinic and alpha 1-adrenergic receptors of the nasal mucosa. An experimental study in guinea pigs

During pregnancy aggravation of nasal allergic symptoms is occasionally observed in subjects with nasal allergy. To evaluate the effect of female hormones on the muscarinic receptor and the alpha 1-adrenergic receptor of the nasal mucosa, receptor binding assay was performed using the nasal mucosa of pregnant guinea pigs and of male guinea pigs; the latter were treated either with estrogen or with progesterone. Pregnancy induced a significant decrease of the density of the alpha 1-adrenergic receptor of the nasal mucosa (p less than 0.05). Estrogen induced a significant increase of the density of the muscarinic receptor (p less than 0.05), while progesterone induced a significant decrease of the density of the alpha 1-adrenergic receptor of the nasal mucosa of guinea pigs. When similar changes of the receptor can be induced by female hormones in the nasal mucosa of the human subjects, this may facilitate secondary development of hyperreactive nasal symptoms in subjects who have been sensitized before without apparent nasal symptoms.     

Vascular corrosion casts of the nasal mucosa. An experimental study in the rabbit

Ten-rabbits of either sex, weighing between 1.8 and 2.7 kg were used for studies on the angioarchitecture of the nasal mucosa of the septum and the anterior concha. Via the common carotid artery, Batson's corrosion compound No. 17 was introduced into the vascular system of the nose after rinsing with Ringer's solution. After digesting the connective tissue between the vessels, vascular corrosion casts were obtained. The replica of the endonasal angioarchitecture offers a unique opportunity to examine the various vascular layers of the nasal mucosa as well as the junction and relationships between different vessels in the different levels of the tunica propria. Our results can be regarded as a useful extension of earlier investigations in this field.     

Fenestrated endothelia in vessels of the nasal mucosa. An electron-microscopic study in the rabbit

The ultrastructure of the vessels in the normal respiratory and olfactory mucosa of the nasal septum was studied in 15 adult rabbits. Capillaries with continuous and fenestrated endothelia could be observed in both tissues. In the respiratory part, many of the fenestrated capillaries were located subepithelially with their fenestrations facing the adjacent epithelium. Fenestrated capillaries of the olfactory mucosa were found mainly in the deeper parts of the tunica propria and usually revealed only a small number of fenestrations in their endothelial lining. It was also demonstrated that muscularized veins sometimes displayed fenestrated areas in their attenuated endothelia. These results are discussed and compared with the appropriate literature. Our results confirm that there is a link between the morphological peculiarities of the vascular wall and the functional behaviour of the nasal mucosa. These findings also emphasize that endothelial fenestrations seem to be characteristic for a certain segment of the microcirculatory system rather than for a distinct type of capillary vessel.     

Effects of the nasal muscles on the nasal airway

BACKGROUND: The nasal muscles and their function are not clearly defined. The nasal muscles generally are thought to act synergistically to produce mimetic motion and affect the nasal airway. We proposed direct examination of the effects of the nasal muscles on the nasal airway. METHODS: Rhinomanometry was performed on volunteers. After paralysis of the nasal muscles with lidocaine, rhinomanometry was performed again to measure nasal airway function with the patient at rest and attempting to flare his/her nostrils. Each patient's rhinomanometric results (at rest and attempting to flare the nostrils) taken before injection of lidocaine served as the control for comparison of his/her results postinjection. The structural tension of the ala at rest and with active flaring of the nostril was measured also, and the results pre- and postparalysis with lidocaine were compared. RESULTS: The data from both the stiffness (structural tension) and the airflow portions, taken together, support the following conclusions. First, the paralysis was significant, although not complete. Clinical and stiffness data supported complete paralysis. Airflow data, which we think most sensitive, support a statistically significant affect of the injection, although incomplete paralysis. CONCLUSION: All of the evidence supports an important role for the nasal muscles when actively used to increase nasal airflow. Second, the majority of the evidence supports an important resting nasal muscle tension that opens the nasal airway.     

The effect of oestrogen on the nasal respiratory mucosa. An experimental histopathological and histochemical study.

An experimental histopathological and histochemical work carried out in thirty guinea-pigs of an average weight of 475 gm. receiving oestrogen in the form of ethynyl oestradiol in a dose of 10 microgram/animal/day and aiming at a study of the effects of oestrogen on the respiratory nasal mucosa. The histopathalogical lesions of the respiratory nasal mucosa were in the form of squamous metaplasia and spongiosis of the lining epithelium, with oedema of the underlying corium, glandular hyperplasia submucosal cellular infiltration, increased vascularity and some vascular changes in the form of endothelial proliferation with intimal thickening. Histochemical enzymatic alterations were in the form of increased succinic dehydrogenase activity in the epithelium as well as in the hyperplastic submucous glands, intensified reaction of the acid phosphatase in the cells of the corium, and the appearance of alkaline phosphatase activity in the apical parts of the cells lining the glands, indicating increased secretory activity. All the changes obtained in the histopathological and histochemical studies can be attributed to hormonal stimulation of the nasal mucosa.     

Delayed irradiation effects on nasal epithelium in patients with nasopharyngeal carcinoma. An ultrastructural study.

The ostiomeatal complex is responsible for the clearance of most sinus secretions. To evaluate the delayed effects of irradiation. this study examined the infundibulum mucosa of 10 patients who developed sinusitis after receiving radiotherapy for nasopharyngeal carcinoma (NPC). Pathologic findings under the light microscope revealed an increased deposition of dense collagenous fibers in the lamina propria. The epithelial cells also transformed into a stratified arrangement and showed gradual reduction of cytoplasmic volume. Ultrastructural observations detected areas of ciliary loss, intercellular and intracellular vacuolation, and ciliary dysmorphism. Most of these pathologic findings were observed even in a patient 23 years after irradiation. The results presented herein suggest that radiotherapy may cause long-term damage to the nasal epithelium that may be responsible for the prolonged sinusitis of irradiated NPC patients.     

Effects of topical nasal steroids and diclofenac on the nasal mucosa during hyperbaric oxygen therapy: a double-blind experimental study

We aimed to evaluate nasal mucosal changes and efficiency of nasal steroids and diclofenac on nasal mucosa during hyperbaric oxygen (HBO) treatment. Forty adult Albino–Wistar rats were randomized into four groups. Group 1 (control group) (n = 10) not exposed to hyperbaric or enhanced oxygen concentrations; group 2 (HBO group) (n = 10) underwent only HBO treatment; group 3 (n = 10) received HBO and intranasal mometasone furoate (10 μl/day); group 4 (n = 10) treated with HBO and diclofenac sodium (10 mg/kg/day ip). Specimens of nasal mucosa were collected after sacrificing and dissection of animals. The specimens were processed for light microscopic evaluation, and then evaluated histopathologically for fibroblastic proliferation and inflammation. Regarding the scores of inflammation, the level of inflammation in the control group was significantly less severe than the other groups (p < 0.05). Evaluation of the fibrosis scores showed that the scores of both groups 2 and 4 were significantly increased (p < 0.05). There were no statistically significant differences between groups 2, 3, and 4 as for fibrosis and inflammation (p > 0.05). Chronic HBO treatment induced mild inflammation of the nasal mucosa. These effects cannot be prevented adequately by administration of nasal steroids and diclofenac.     

In vitro study on the influence of N-chlorotaurine on the ciliary beat frequency of nasal mucosa

BACKGROUND: The aim of this study was to investigate the in vitro effects of N-chlorotaurine (NCT), a new endogenous antimicrobial agent, on the nasal ciliary beat frequency (CBF) in nasal mucosa samples of 10 adult patients who underwent conchotomy. METHODS: CBF was measured by a photometric technique, combining a light microscope, a photometer, a photograph multiplier, and a computed analyzing unit. RESULTS: CBF decreased approximately 10% after 20 minutes of incubation in aqueous 1% NCT solution compared with 3% in 0.9% saline, and 0.1 and 0.01% NCT had no effect. However, a solution of 7% cocaine, which is used routinely for shrinking the nasal mucosa before rhinoscopy lowered the CBF to 50% after the same incubation time. CONCLUSION: These results confirm the very low toxic potential of NCT, and they are fundamental for clinical investigations regarding its topical application in the nasal and paranasal sinuses.     

An experimental study on the physiological significance of the mode of cupular movement

Isolated frog posterior semicircular canals were used. The ampullary nerve action potentials were recorded under three kinds of cupular movement, i.e., swing-door deflection, "cupula fixation-1" and "cupula fixation-2". Cupula fixation-1 was achieved by immobilizing the central top portion of the cupula, while cupula fixation-2 was achieved by immobilizing the entire top of the cupula. Cupula fixation-1 resulted in action potentials which were comparable to those of the swing-door deflection in terms of the maximum spike count and the stimulus-response curve. Cupula fixation-2 resulted in potentials with the maximum spike count comparable to the swing-door deflection; however, the response increase rate was very low. The time courses of the potentials in those cases of cupula fixation-1 and -2 were extremely short (about 2-3s) when compared to that of the swing-door deflection. These findings suggest that the swing-door deflection is physiologically more relevant in giving the optimum increase in response rate, as well as maintaining the time course of the tonic response.