The nasal response to axillary pressure in non-eosinophilic intrinsic rhinitis

The exact pathophysiology of intrinsic rhinitis is not fully understood. The generally held belief is that it is due to an imbalance between the outflow of the sympathetic and parasympathetic nervous systems to the nose, perhaps due to excessive parasympathetic or reduced sympathetic activity. In this study the nasal airway response to a predominantly sympathetic stimulus, axillary pressure, was studied in 19 patients with intrinsic rhinitis and compared with 16 normal patients. Axillary pressure was applied using a crutch. Following sustained pressure, a significant fall in nasal resistance in the normal group (0.823 kPas/l) and an insignificant fall in the patients with rhinitis (0.0725 kPas/l) was found. Pulse and blood pressure changes were similar in both groups with a significant rise in pulse rate and diastolic blood pressure. The study shows that there is an abnormal response to axillary pressure in intrinsic rhinitis, perhaps due to relative nasal sympathetic hyposensitivity.     

The nasal response to isometric exercise

The cardiovascular response to isometric exercise is well understood. However, the response of the nasal mucosa is less well known. We have attempted to document this response in normal individuals. Ten individuals with no history of nasal disease or allergy were studied. All subjects were asked to perform sustained handgrip on the side of the obstructed nostril for a period of 5 min at 30% of maximum voluntary effort. Nasal cross-sectional area was measured on both sides of the nose using an acoustic rhinometer. The individuals were then rested for at least 30 min and the test repeated with pressure applied by the opposite hand. Statistical analysis was performed by non-parametric methods. There was a significant fall in nasal cross-sectional area on the side of exercise median change = 0.09 cm², P < 0.01) while cross-sectional area in the contralateral nasal passage increased (median change = 0.35 cm², p= 0.01). There was no significant differences between these results and those obtained by handgrip on the opposite side. The results indicate that isometric exercise produces nasal obstruction (isotonic exercise) and both afferent and efferent arms of this reflex are side-specific.     

The effect of cold water immersion on the nasal mucosa

The response of the nasal mucosa to cold water immersion is not well known. We have attempted to document this response in normal individuals. Seventeen individuals with no history of nasal disease or allergy were studied. All subjects were asked to perform sustained cold water (15°C) immersion of their hand and forearm on the side of the obstructed nostril for a period of 5 min. The nasal cross-sectional area was measured on both sides of the nose using an acoustic rhinometer. The individuals were then rested for at least 30 min and the test repeated with immersion of the opposite hand. There was a significant fall in nasal cross-sectional area on the side of immersion (median change = 0.32 cm², P= 0.0003) with a significant rise in nasal cross-sectional area on the none test side (median change = 0.35 cm², P= 0.0003). There were no significant differences between these results and those obtained by immersion on the opposite side. The results indicate that cold water immersion produces nasal obstruction and that both afferent and efferent arms of this reflex are side-specific.     

The nasal response to isometric exercise in non-eosinophilic intrinsic rhinitis

The exact pathophysiology of intrinsic rhinitis is not fully understood. The generally held belief is that it is due to an imbalance between the outflow of the nasal sympathetic and parasympathetic nervous systems, perhaps due to excessive parasympathetic or reduced sympathetic activity. In this study the nasal airway response to a predominantly sympathetic stimulus, isometric exercise, was studied in 19 patients with intrinsic rhinitis and compared with 16 normal patients. Isometric exercise took the form of a handgrip stimulus using a hand dynomometer. Following sustained handgrip, a small fall of nasal resistance in the normal group (0.058 kPas/1) and a moderate rise in nasal resistance in the rhinitis group (0.242 kPas/1) was found. Pulse and blood pressure changes were the same in both groups with a significant rise in pulse rate and diastolic blood pressure. The study shows that there is an abnormal response to isometric exercise in intrinsic rhinitis, perhaps due to relative nasal sympathetic hyposensitivity.     

The relationship between middle ear pressure and deviated nasal septum

The deviated nasal septum may be associated with middle ear problems, particularly on the side of nasal obstruction. This study aims to find out whether middle ear pressure (MEP) correlates with the degree of nasal obstruction secondary to a deviated nasal septum, and to examine changes in MEP following septal surgery. Patencies of the nasal passages (measured with a peak nasal inspiratory flowmeter) and MEP (measured with tympanometer) of 55 patients were obtained prior to surgery and 7.5 (6–10) months post-operatively [median (range)]. Forty patients completed the study. Results were analysed by linear regression. In the ear on the side of nasal blockage, MEP was -25.7±28.4 mm water pre-operatively, and following surgery increased significantly to -2.9±30.4 mm water (mean±sd ) (P < 0.001). Pre-operatively, it was inversely related to the difference in patencies between the two nasal passages (r = -0.32, P < 0.02). Post-operatively, its improvement correlated with the degree of reduction of asymmetry of airway patency (r = 0.56, P < 0.001).     

Changes in nasal airway resistance in response to controlled external respiratory obstruction

Summary A high degree of external nasal obstruction will by itself decrease nasal airway resistance. However, a controlled series of experiments in normal volunteers has shown that this lessened resistance is still not able to balance the level of the external obstruction present. The implications of this finding are discussed.     

The relief of snoring by nasal surgery

Patients with nasal obstruction may also complain of snoring. It is uncertain whether surgery which relieves the nasal obstruction will also relieve the snoring. We have reviewed 126 patients who complained of both nasal obstruction and snoring and who underwent nasal surgery. Snoring was completely relieved in 39 patients (31%), was less loud in a further 72 patients (57%), unchanged in 11 and louder in 4. It occurred on fewer nights post-operatively in 61, on the same number in 24 and more frequently in 2. Patients who had nasal polypectomy as part of their nasal surgery obtained the greatest snoring relief. This study suggests that when snoring and nasal obstruction coexist nasal surgery should be considered as the first line of surgical treatment.     

An in vitro model for measuring tryptase release from nasal mucosa in response to allergen challenge

A simple in vitro nasal mucosal culture model has been developed to measure release of the mast cell specific enzyme tryptase in response to allergen challenge. Patients who were undergoing inferior turbinectomy were skin-tested for commonly inhaled allergens. The mucosa from the inferior turbinates was kept viable using Minimal Essential Medium. Tryptase release into the medium was measured using the Pharmacia Riact Assay. There was a significant increase in tryptase release in response to allergen challenge from the mucosa harvested from skin-test positive patients. Mucosa from skin-test negative patients failed to demonstrate an increase in tryptase release. This could prove to be a useful research model for the study of nasal type I hypersensitivity and drugs that affect it.     

The role of the temperature of the nasal lining in the sensation of nasal patency

The receptors and neural pathways involved in the common symptom of nasal blockage are of great interest. Studies to date suggest that the sensation of nasal patency may be related to the temperature of the nasal passages. Sixty-two subjects were asked to assess their own nasal patency subjectively and indicate this on a visual analogue scale. The temperature of the nasal lining was continuously recorded during quiet nasal repiration using a non-contact infrared themometer. The cooler the nasal lining, the clearer the nose felt, and the greater the drop in temperature on inspiration again the clearer the nose felt. The study supports the previously proposed hypothesis that the sensation of nasal airflow is derived from a cooling of the nasal lining on inspiration, and this is probably detected by cold thermoreceptors in the mucosa.     

Internal nasal dimensions of adults with nasal obstruction

Nasal septum deviation (SD) and turbinate hypertrophy (TH) increase the resistance to respiratory airflow and may impair nasal patency.ObjectiveTo characterize the nasal geometry of individuals with nasal obstruction secondary to SD and/or TH by means of acoustic rhinometry.MethodThis prospective study included 30 adults with complaints of nasal obstruction (NO) and SD + TH (n = 24), SD (n = 5) or TH (n = 1) seen by clinical examination. The cross-sectional areas of the three main dips of the rhinogram (CSA₁, CSA₂, CSA₃), the distance between them and the nostrils (dCSA₁, dCSA₂, dCSA₃), and the volumes of segments 1.0-3.2 cm (V₁), 3.3-6.4 cm (V₂), and 7.0-12.0 cm (V₃) were measured before and after nasal decongestion (DN). For analysis, right and left cross-sectional areas and volumes were added and mean dCSA was calculated.ResultsMean values (± standard deviation) before ND were: 0.83 ± 0.23 (CSA₁), 1.66 ± 0.52 (CSA₂), and 2.36 ± 0.77 (CSA₃) cm²; 2.19 ± 0.20 (dCSA₁), 4.01 ± 0.33 (dCSA₂), and 5.85 ± 0.37 (dCSA₃) cm; 2.77 ± 0.51 (V₁), 6.52 ± 1.99 (V₂), and 26.00 ± 9.62 (V₃) cm³; all values were lower than laboratory reference values (p < 0.05). ND led to proportionally greater increases of sectional areas and volumes in the NO group, suggesting an associated functional component. Individual analysis revealed 12 cases with normal results despite nasal obstruction.ConclusionMost patients with structural nasal obstruction had results suggestive of nasal patency impairment in acoustic rhinometry.     

Correlation of subjective sensation of nasal patency with nasal inspiratory peak flow rate*

To determine the relationship between subjective sensation of nasal patency and objective measurement of nasal inspiratory peak flow rate, a longitudinal study was conducted using healthy volunteers. Five healthy medical practitioners, one woman and 4 men, aged 24–34 years, made daily subjective estimations of their sensation of nasal patency on a 10cm visual analogue scale. This was followed immediately by measurements of nasal inspiratory peak flow rate using a Youlten meter, repeated on at least 25 days per subject. Correlation coefficient and regression lines for subjective nasal patency on nasal inspiratory peak flow rate were calculated. One hundred and sixty nine sets of observations were made, range 25–44 per subject. Each subject showed strong evidence (P < 0.01) of positive correlation between subjective nasal patency score and nasal inspiratory peak flow rate. There was strong evidence (P < 0.001) that different regression lines are needed for different subjects, but no evidence that the lines are not parallel. Subjective sensation of nasal patency is strongly correlated with objective nasal patency, as measured by peak inspiratory flow rate. This relationship varies between individuals. Measurement of nasal inspiratory peak flow rate may be a valuable objective test of nasal patency, and is quick and simple to perform.     

The effectiveness of nasal surgery on psychological symptoms in patients with obstructive sleep apnea and nasal obstruction

Conclusion Nasal obstruction can aggravate the psychological status of OSA patients, and nasal surgery should reduce this aggravation. Nasal surgery significantly improved sleep latency and ameliorated several polysomnographic characteristics.

Background The aim of this study was to investigate the psychological status of patients with obstructive sleep apnea (OSA) and nasal obstruction and to evaluate the effects of nasal surgery on the psychological symptoms and polysomnographic (PSG) parameters of these patients.

Methods The study was designed as a prospective comparative study. This study compared 30 patients (all male) with nasal obstruction and 30 matched patients without nasal obstruction using the Pittsburgh Sleep Quality Index (PSQI) and the Symptom Check List 90 (SCL-90). All of the patients had been previously diagnosed with OSA (apnea hypopnea index [AHI]?≥ 5 events/h) via a whole-night polysomnographic examination. Nasal obstruction was assessed using a visual analogue scale (VAS). The patients with nasal obstruction underwent nasal surgery, and their weight, VAS, nocturnal PSG characteristics, and psychological symptoms at baseline and 3 months after surgery were compared.

Results The OSA patients with nasal obstruction suffered from significantly longer sleep latency on the PSQI and higher somatization and anxiety scores on the SCL-90 than the subjects without nasal obstruction (p?p?p?p?2, from 73.83?±?8.49% to 75.97?±?9.86%, p?p?r?>?0.3, p?相似文献   

The expression of vimentin in epithelial cells from human nasal mucosa

Summary The results of an immunohistological study of the normal human nasal mucosa show that there are frequently vimentin-positive cells detectable in addition to cytokeratins in the respiratory epithelium. The vimentin cells are probably ciliated and/or goblet type in origin. Furthermore, some co-expressing cells were found in basal parts of the submucous glands.     

Can snoring relief after nasal septal surgery be predicted?

Patients with nasal obstruction often have associated snoring. This study aims to find out if there are reliable predictors for the success or failure of septal surgery in relieving snoring in patients with symptomatic nasal obstruction secondary to a deviated nasal septum and who have associated snoring. Thirty patients were studied pre-operatively and at 4–12 months (mean 6 months) post-operatively. The intensity of snoring was measured on a visual analogue scale. Nasal patency was measured with a peak nasal inspiratory flow meter. The collapsibility of the soft palate was gauged by the degree of velopharyngeal closure on the Muller manoeuvre. Fifteen patients (50%) achieved snoring relief after septal surgery. The severity of nasal obstruction and intensity of snoring pre-operatively, the magnitude of nasal obstruction relief post-operatively and the degree of collapsibility of the soft palate were found not to influence the outcome of septal surgery on snoring. The relationship between nasal obstruction and snoring is complex and the alteration of airflow patterns after septal surgery is postulated to be important in influencing snoring relief.     

Malignant melanoma of the nasal cavity and paranasal sinuses*

Malignant melanoma affecting the nasal cavity and paranasal sinuses is a rare condition with a poor prognosis. The Head and Neck Oncology Clinic at the University Hospital Nottingham has treated 16 patients in an 8-year-period. Twelve patients were treated with primary radical surgery and salvage radiotherapy was used for 7 patients with local recurrence. This resulted in tumour shrinkage in 4 patients. Eight patients treated surgically, have died of systemic spread. Four are currently alive, although 2 have local disease.     

Variations in congestion of the nasal mucosa in man

Congestion of one side of the nose is accompanied by decongestion of the other side. This is called the nasal cycle. The nasal cycle does not seem to be present in all subjects and it has not been shown with rhinostereometry. There are very few studies showing whether there are spontaneous day-to-day variations in nasal mucosal congestion and no studies showing differences in nasal mucosal congestion between morning and afternoon. This, however, may be very important in studies covering a longer period. In the present study, data from four healthy volunteers were recorded 18 or 19 times in the mornings and afternoons on different days. Measurements were made with rhinostereometry, a peak flow meter (PNIF) and by symptom scores. A nasal cycle was found in some subjects. There was no difference in total nasal mucosal swelling in the mornings and in the afternoons and no day-to-day variation in the total nasal mucosal swelling.