鼻瓣区的鼻中隔偏曲矫正术

2003-2010年我们对单纯鼻瓣区的鼻中隔偏曲及鼻腔并鼻瓣区鼻中隔偏曲患者进行了鼻瓣区鼻中隔偏曲矫正术,效果良好,报告如下。     

The effect on nasal resistance of an external nasal splint during isometric and isotonic exercise

The now commonplace wearing of external nasal splints by sportsmen and athletes has never been scientifically evaluated. The present study looks into the effect of both isometric and isotonic exercise on nasal resistance and examines if this is altered by the wearing of an external nasal splint. Twenty subjects who did not suffer from rhinitis were tested. Nasal resistance measurements were recorded using an anterior rhinomanometer before and after exercise, with and without an external nasal splint. Pulse and blood pressure were measured using a Criticare Inc. model 508 physiological monitor before and after exercise. Significant changes were observed in pulse (P < 0.001) and both systolic (P < 0.002) and diastolic (P < 0.001) blood pressure in response to isotonic exercise and pulse (P < 0.0001) and diastolic blood pressure (P < 0.0006) in isometric exercise. Significant differences were seen in nasal resistance when the splint was applied before (P < 0.001) and after exercise in both groups (P < 0.003). No significant difference was observed between the post-isotonic exercise groups with and without the splint (P= 0.167) but significant differences were seen in the isometric group (P < 0.0001). External nasal splints decrease nasal resistance at rest but are of little proven value when performing isotonic exercise however significantly reduce nasal resistance during isometric exercise.     

Nasal valve suspension revisited

OBJECTIVES: Nasal valve suspension (NVS) is a simple technique to correct nasal valve obstruction or collapse by providing a lateral vector of pull on the nasal sidewall. The purpose of this research was to review our experience with NVS in a cohort of patients with nasal valve collapse, including a subset of patients with facial paralysis. The objectives were to determine patient satisfaction and complication rates after NVS. STUDY DESIGN: A retrospective review of patients 18 years and older who had NVS from 2003 to 2006 with a follow-up of at least 1 month was performed. METHODS: Data were collected on diagnosis, surgical outcomes, complications, and treatments required. Complications included adverse outcomes, infections, and the need for repeat surgery or treatments. RESULTS: In 17 charts reviewed, 9 patients (53%) had nasal valve collapse as a result of facial paralysis, and 8 (47%) had previous nasal surgery. Follow-up ranged from 1 to 30 months, with a mean of 16.5. Moderate to complete resolution of obstruction was reported by 82% of patients, or for 88% of procedures. Sustained relief was observed in two of eight patients who had previous nasal surgery and six of nine who had no previous nasal surgery (P = .1). Infection occurred in four (24%) patients and five (21%) total suspensions and ranged from 1.5 to 7 months. Six (35%) patients experienced a loss of suspension at 6 to 22 months. CONCLUSIONS: NVS is a technically straightforward, relatively reversible procedure particularly useful in the patient with facial paralysis. The efficacy is excellent in the short term yet appears to diminish with time.     

Analysis of rhinomanometric data based upon a model of nasal airflow and logarithmic transformation of the data

Estimation of nasal airflow, flow asymmetry and nasal valve stiffness was performed using anterior rhinomanometry in a group of 12 normal subjects and a group of 12 patients suffering from nasal obstruction. The method, based upon a simplified mathematical model of nasal airflow and utilizing logarithmic transformation of inspiratory pressure and flow data, improved the sensitivity and specificity of rhinomanometry and gave a more comprehensive index of nasal function.     

Accuracy of Acoustic Rhinometry Measurements

Objectives To identify the factors that influence the accuracy of acoustic rhinometry measurements recorded with commercially available equipment. Study Design A simple model was used which consisted of a metal pipe and cylindrical inserts. These inserts comprised various lengths, and aperture dimensions were comparable to, or smaller than, the nasal valve areas of both adults and children. Methods Accuracy of the acoustic rhinometry technique was evaluated by comparing the measured and actual cross‐sectional areas. The results were discussed in terms of the calculated acoustic transmission, reflection, and attenuation coefficients of the pipe model variations. Results Reducing the inner diameter of the insert increased the degree of measurement error. As the length of the insert was increased, the measured cross‐sectional area gradually decreased, approaching the actual area of the experimental passageway. For larger inserts, level of error was not highly dependent on passageway length compared with the narrower inserts. Conclusion Our results show that both the cross‐sectional area and passageway length of the narrow segment are the most significant factors that influence the accuracy in acoustic rhinometry measurements.     

Breath actuated device improves delivery to target sites beyond the nasal valve

OBJECTIVES: The objective was to compare nasal deposition patterns achieved with a conventional hand actuated spray pump and a novel breath actuated bidirectional prototype device housing the same spray pump (OptiMist, OptiNose AS, Oslo, Norway). STUDY DESIGN AND METHODS: The bidirectional delivery device exploits the posterior connection between the nasal passages persisting when the velum automatically closes during oral exhalation. The deposition and clearance patterns achieved with the two devices were compared in nine healthy subjects by scintigraphy after administration of Tc-aerosols. RESULTS: Compared with traditional spray pump delivery, the OptiMist device provided significantly (P < .004) larger initial and cumulative deposition (area under the deposition vs. time curve) in the upper posterior segment of the nasal passage, housing the sinus ostia and the olfactory region, and significantly lower deposition (P < .004) in the anterior segment, lined by nonciliated squamous epithelium. Furthermore, intersubject reproducibility of the initial and cumulative deposition was higher for the OptiMist device both in the upper posterior segment and the entire nose. CONCLUSIONS: Compared with a spray pump, the novel breath actuated bidirectional device provides significantly larger deposition in the clinically important regions beyond the nasal valve and reduced anterior deposition. These striking differences provide new opportunities for improved therapy of chronic rhinosinusitis and polyposis as well as extended use of the nose for delivery of drugs from the nose into the brain.     

Nasal valve surgery improves disease-specific quality of life

OBJECTIVES/HYPOTHESIS: Disease-specific quality-of-life (QOL) assessment of patients with nasal valve compromise and symptomatic nasal obstruction has not been studied previously. The objectives of the study were to determine whether surgical treatment of the nasal valve improves disease-specific QOL and to identify clinical or demographic variables predictive of patients' baseline QOL or change in QOL. STUDY DESIGN: Prospective, multi-institutional outcomes study of 20 patients with nasal obstruction and a surgically treatable diagnosis of nasal valve compromise. METHODS: Disease-specific QOL assessment was performed using the Nasal Obstruction Symptom Evaluation (NOSE) scale preoperatively (n = 20) and at 3 (n = 14) and 6 months (n = 20) after surgery. Clinical and demographic data were collected, along with physician-reported assessments of degree of nasal obstruction. RESULTS: Mean NOSE scores significantly improved from baseline to 3 months after surgery (68.9 vs. 20.7 [P < .0001]), from baseline to 6 months after surgery (68.9 vs. 15.8 [P < .0001]), and from 3 to 6 months after surgery (20.7 vs. 15.8 [P = .0077]). Physician assessment of degree of nasal obstruction using a visual analogue scale was significantly correlated with baseline NOSE scores (P = .013) and change in NOSE scores at 6 months (P = .0015). No other clinical or demographic factors were found to be predictive. CONCLUSION: In patients with symptomatic nasal obstruction and nasal valve compromise, surgical repair of the nasal valve improves disease-specific QOL. Physician rating of degree of nasal obstruction was found to be significantly correlated with patient-reported QOL.     

Piriform aperture surgery for alar collapse

The region of maximum resistance in the respiratory tract is in the anterior part of the nose, and this area has been termed the nasal valve.¹ Inspiratory narrowing of this area, known as alar or nasal valve collapse can produce the symptom of obstruction, and may be very difficult to correct. The anatomy and physiology of the nasal valve are discussed followed by the author's technique for correction of a common problem leading to alar collapse; a narrow piriform aperture, which is often associated with a prominent web at the muco-cutaneous junction.     

Otological Wegener's granulomatosis at the time of initial presentation: a potential diagnostic dilemma

Conclusions. The internal nasal valve (INV) angle in Asians is 21.6°±4.5° and it is significantly larger than that of Caucasians. The reconstructed CT method has better reproducibility than the endoscopic method in measuring the INV angle. Objectives. The INV is an area of interest for nasal surgeons due to its functional significance in rhinoplasty and septoplasty. This study was designed to evaluate the size of the INV angle in an Asian population by measuring the angle through reconstructed CT scans and nasal endoscopy. Patients and methods. Thirty-eight ostiomeatal unit CTs and 24 endoscopic photos of patients who had minimal or no sinonasal problems were analyzed. CT images that had been reconstructed perpendicular to the acoustic axis and endoscopic photos were used to measure the INV angle. Each method was verified as to reproducibility and the angles measured by the two methods were compared. Results. The INV angle of the Asians measured by CT scan was 21.6°±4.5°. This value was significantly larger than that of the Caucasians, which has been reported to be 11.4°±2.6° (p<0.001). The INV angle measured endoscopically was 19.3°±3.6°. Reproducibility of the reconstructed CT method was good (p<0.001), while the reproducibility of the endoscopic method was poor (p=0.093). The correlation between the two methods was also poor (p=0.107).     

Value of acoustic rhinometry for measuring nasal valve area

OBJECTIVE: To assess the validity of acoustic rhinometry for measuring nasal valve area in human subjects. STUDY DESIGN: A comprehensive study that compared acoustic rhinometry data with computed tomography findings from scans obtained perpendicular to the acoustic axis and perpendicular to the floor of the nose. METHODS: Fifty nasal passages of 25 healthy adults with no nasal disease were examined by acoustic rhinometry and computed tomography. In each case, the area of the nasal valve as measured by acoustic rhinometry was compared with the area calculations from computed tomography sections taken in two different coronal planes, one perpendicular to the acoustic axis and one perpendicular to the floor of the nose. Computed tomography slices perpendicular to the floor of the nose were obtained at two different locations, a specific distance from the tip of the nose and a specific distance from the anterior nasal spine. RESULTS: There was a significant correlation between the nasal valve areas determined by acoustic rhinometry and computed tomography when imaging was obtained perpendicular to the acoustic axis. In contrast, when scanning was obtained perpendicular to the straight axis of the floor of the nose, the correlations between the acoustic rhinometry and computed tomography data were weak. CONCLUSIONS: When any type of imaging is used for comparison with nasal valve areas determined by acoustic rhinometry, the cross-sections should be perpendicular to the acoustic pathway. The results of the study show that acoustic rhinometry is a valuable method for measuring nasal valve area.     

Alar batten grafting for management of the collapsed nasal valve

OBJECTIVE: The purpose of the study is to describe a commonly overlooked etiology of nasal airway obstruction. Collapse of the nasal valve can be corrected with precise placement of cartilage grafts. This study demonstrates the surgical technique, rarely described in the literature, of placing a contoured cartilage graft in the nasal valve region for the improvement of the nasal airway. STUDY DESIGN: Retrospective review of surgical results of the 21 patients who underwent alar batten grafting performed over a 3-year period at the Geisinger Medical Center (Danville, PA). METHODS: A retrospective review was conducted of 21 patients surgically treated with alar batten grafts for nasal valvular collapse between the 1997 and 1999. The surgical technique is described, and our results are analyzed including for both functional and aesthetic outcome. RESULTS: All patients treated with alar batten grafting at the nasal valve improved with regard to their airway obstruction. There were no complications, and there was only minor aesthetic fullness in six cases. CONCLUSIONS: Alar batten cartilage grafting is an easy, highly effective therapeutic measure in the treatment of nasal valve collapse. The surgical technique is demonstrated.