Work of nasal breathing: measurement of each nostril independently using a split mask.

The work of nasal breathing was determined in human subjects as a measure of impedance to respiratory airflow. The nasal cavities were examined separately and simultaneously with a split mask; flow and pressure signals were fed to a microprocessor for on-line computation and printout of respired volumes and work of nasal breathing. An alternating resistive nasal cycle of 3--4 hours' duration was demonstrated in the majority of normal, resting subjects. Reciprocity of the resistive changes in each nasal cavity maintained a constant total nasal respiratory work load of about 0.2 Joules/litre. Moderate changes in breathing rate and tidal volume had little influence on work. Inspiratory work was 1.6 times that of expiration. Increases in resistance of the dependent nostril were seen when the lateral decubitus position was adopted. Increase in cephalic venous pressure and pathological nasal obstruction increased the work of nasal breathing.     

Particle deposition in the nose related to nasal cavity geometry

A number of studies have been made to characterise the deposition-pattern of inhaled airborne particles in the nose. Common to all results has been considerable differences in deposition fractions between normal human subjects. It was the aim of the current study to improve our understanding of individual differences in nasal deposition of inhaled particles. Depositions were measured in ten adult normal subjects and were related to dimensional measurements by acoustic rhinometry. Five litres of a polydisperse aerosol (MMAD = 0.7 micron, sigma g = 1.7) were inhaled through one nostril only during 5 inspirations with flows of 10, 20, and 30 L/min with decongested mucosa. Increasing flow was found to increase the fraction deposited in the nose, while there was an inverse correlation between nasal deposition fraction and minimum cross-sectional area of the nasal cavity (Amin). Information based on acoustic rhinometry measurements significantly reduced the amount of unexplained variation between subjects in nasal deposition fraction. We conclude that an estimate of maximum linear air velocity, calculated as airflow divided by Amin, was the best single predictor of nasal deposition fraction, which was found to increase with increasing air velocity raised to a power of approximately 4/3.     

周期性呼吸与稳态呼吸状态下正常鼻腔气流的数值模拟比较

目的 比较周期性呼吸状态与稳态呼吸状态下正常鼻腔气流的流场特点.方法 根据正常成人鼻腔的CT扫描,利用计算流体力学软件Fluent建立正常的鼻腔模型,模拟周期性呼吸下鼻腔的气流状况,选取其中某些时刻(呼气加速区第15.600秒、呼气减速区第16.495秒)的气流状态与相同流量下稳态呼气状态下的气流状态进行比较.结果 周期性呼吸时第15.600秒与入口流量为697.25ml/s稳态呼气情况下鼻腔气流参数如下:两种呼吸状态下,左鼻腔主要通道气流的平均速度、最大速度和压强相近,各鼻窦内气流的平均速度相近;气流分布均以总鼻道和中鼻道为主,两者分别占气流总流量的50%和30%以上;两种呼吸状态下,下鼻道和总鼻道下部的气流流线均以直线为主,中鼻道、上鼻道和总鼻道中上部的气流流线呈抛物线形.周期性呼吸第16.495秒(距离交界点0.005 s)时鼻腔气流平均速度为0.0706 m/s,气流在鼻咽和鼻阈等宽阔区域形成大范围的涡旋运动;而入口流量为7.62 ml/s稳态呼气时左鼻腔气流的平均速度为0.0415 m/s,鼻腔气体的流动与高流量时相似.结论 在相同流量时,除在呼气和吸气交界点附近外,周期性呼吸和稳态呼吸状态下鼻腔气流流动的各参数相似.     

Presence and characterization of sensitization to staphylococcal enterotoxins in patients with allergic rhinitis.

Exotoxins derived from Staphylococcus aureus appear to be involved in the pathogenesis of allergic diseases, especially atopic dermatitis (AD). However, little is known about sensitization to enterotoxins in cases of respiratory allergies. Because the nasal cavity is a primary site of colonization by S. aureus, we sought to determine the prevalence and role of serum immunoglobulin E (IgE) antibodies against staphylococcal enterotoxin A (SEA) and SEB in patients with allergic rhinitis (AR). The presence of SEA- and SEB-specific IgE was determined in 40 patients with AR and 16 healthy control subjects. In the rhinitis group, nasal symptom score, total serum IgE, sensitization to other inhaled allergens and the presence of sinusitis were determined. Twenty-five percent of patients with AR were sensitized to SEA/SEB whereas 6.3% of controls were sensitized to the toxins. Sensitization to SEB was predominant relative to SEA. There were no significant differences in the severity of nasal symptoms and complications of other allergic diseases including AD and bronchial asthma, between patients with or without sensitization to SEA/SEB. However, patients sensitized to these toxins were likely to show increased total serum IgE and polyvalent sensitization, suggesting that exposure and subsequent sensitization to SEA/SEB may be involved in polyvalent sensitization.     

重组人表皮生长因子对鼻-鼻窦炎患者鼻内镜术后创面上皮化的影响

目的　探讨重组人表皮生长因子（recombinant human epidermal growth factor,rhEGF）对慢性鼻-鼻窦炎（CRS）患者鼻内镜术后创面上皮化的影响。方法　选择110例CRS行双侧鼻内镜手术患者,对照组（右侧鼻腔）行鼻腔冲洗以及类固醇激素喷鼻,实验组（左侧鼻腔）加用rhEGF喷鼻,在术后2周、4周、3个月、6个月鼻内镜检查评估鼻腔黏膜情况及主观症状的视觉模拟量表（visual analogue scale,VAS）评分,比较鼻腔黏膜情况、完全上皮化比例、主观症状的VAS评分。结果　术后2周实验组鼻腔黏膜情况优于对照组（P＜0.05）,但主观症状VAS评分无明显差异（P >0.05）;术后4周及3个月时实验组鼻腔黏膜情况、上皮化比例以及主观症状VAS评分均优于对照组（P＜0.05）;术后6个月时则无差异（P >0.05）。结论　CRS患者鼻内镜术后用rhEGF喷鼻,可缩短术后上皮化时间、改善鼻腔黏膜情况及患者主观症状,值得临床应用。     

儿童慢性鼻窦炎治疗方案与手术时机的选择

目的:探讨儿童慢性鼻窦炎(CRS)疗效及其相关因素,以选择最佳治疗方案与最佳手术时机.方法:根据是否伴有腺样体肥大与鼻腔结构异常,220例CRS患儿被分成4组,A组单纯鼻窦炎;B组伴腺样体肥大,其中B1组无鼻腔结构异常,B2组有鼻腔结构异常;C组仅伴鼻腔结构异常.参照文献,所有患儿均给予规范、系统的3阶段治疗.统计分析每个阶段各组鼻窦炎的疗效.结果:经第1阶段治疗后A组与B1、B2、C组比较,疗效均差异有统计学意义(均P＜0.01).而B1与B2组、B1与C组、B2与C组比较,疗效均差异无统计学意义(均P＞0.01).B组经第1阶段未治愈者94例进行第2阶段治疗后,B1与B2组比较,疗效差异有统计学意义(P＜0.01).经前述2阶段治疗后,无效者行鼻内镜手术,总有效率达89.65%.结论:①3阶段阶梯性治疗方案对儿童CRS的治疗具有一定的参考价值;②是否伴有腺样体肥大和(或)鼻腔结构异常是影响儿童CRS药物疗效的重要因素;③对伴有腺样体肥大和(或)鼻腔结构异常患儿宜在进行规范、系统的保守治疗的同时,切除腺样体和进行功能性鼻内镜手术,以缩短疗程,节约费用.     

Filtration of Particulates in the Human Nose

This report reviews the current theories on the deposition of inhaled particulates in the human nose. The inhalation of particulates represents a challenge to the upper respiratory tract. The concentration of airborne particulates and pollutants varies between occupational and nonoccupational exposure. Regional deposition of potentially hazardous inhaled material determines the local and systemic toxicity. In vitro experiments using casting and molding techniques with water dye models or laser Doppler anemometry indicate that nasal airflow is determined by the size of the nasal valve and the turbinates. The main airstream during inspiration passes through the lower nasal passage. Filtration capacity of the human nose can be expressed mathematically or experimentally. In vivo experiments applying monodisperse or polydisperse aerosols during single or multiple respiratory cycles have shown by using microscopic or laser-optic identification that particles larger than 3µm have a maximum deposition in the anterior part of the nose (nasal valve). Particles smaller than 3 µm and larger than 0.5 µm are filtered by the nasal mucosa and transported by cilia propulsion to the nasopharynx. The filtration for particles smaller than 0.5 µm is low. They seem to pass easily into the lower respiratory tract. This knowledge has an impact on nasal septal surgery and rhinoplasty. By influencing the structure of the nasal valve and the lower turbinates, the filtration capacity of the nose can be significantly decreased.     

变应性因素及变应性鼻炎与慢性鼻-鼻窦炎鼻息肉的相关性探讨

目的：探讨变应性因素及变应性鼻炎（AR）与慢性鼻-鼻窦炎鼻息肉的临床相关性。方法：将200例研究对象分为A、B组,A组诊断为AR（110例）,B组诊断为慢性鼻-鼻窦炎鼻息肉（90例）,通过欧蒙印迹法定量检测血清sIgE浓度并观察慢性鼻-鼻窦炎鼻息肉手术治疗后的复发率、AR并发慢性鼻-鼻窦炎鼻息肉的发生率。结果：A组sIgE总阳性率为89.09%,B组sIgE总阳性率为74.44%。B组中sIgE阳性者术后复发率为58.21%,sIgE阴性者术后复发率为8.70%。A组41例（37.27%）并发慢性鼻-鼻窦炎鼻息肉,血清sIgE阳性率为97.56%;69例（62.73%）未并发慢性鼻-鼻窦炎鼻息肉,血清sIgE阳性率为79.71%;组内slgE阳性率比较差异有统计学意义（χ2=6.96,P〈0.01）。结论：变应性因素及AR与慢性鼻-鼻窦炎鼻息肉的发生有一定的相关性,提示避免接触变应原、合理治疗AR能够有效控制慢性鼻-鼻窦炎鼻息肉的复发率。     

两性霉素B鼻腔冲洗在非侵袭性真菌性鼻窦炎术后的应用

目的观察在鼻内镜手术治疗非侵袭性真菌性鼻窦炎后，应用0．05％两性霉素B冲洗鼻腔的临床效果。方法鼻内镜手术治疗的非侵袭性真菌性鼻窦炎患者16例，术后常规生理盐水冲洗鼻腔，临床症状改善不满意，术腔黏膜恢复不良，后改用0．05％两性霉素B冲洗鼻腔。结果随访6个月～2年，14例术腔上皮化，症状缓解或消失，2例术腔未上皮化，症状不能缓解，有效率87．5％。结论对于非侵袭性真菌性鼻窦炎术后恢复不良的患者给与两性霉素B冲洗鼻腔，能促进术腔黏膜上皮化，可作为降低患者术后复发率的一种治疗方法。     

探讨鼻腔、鼻窦解剖异常与慢性鼻窦炎的相关性

目的 探讨鼻腔、鼻窦解剖异常与慢性鼻窦炎的关系。 方法 分析450例患者的CT片,从中分出鼻窦炎组和对照组（无鼻窦炎组）,对450例患者存在的鼻腔、鼻窦解剖异常, 如中鼻甲气化及反向歪曲、鼻丘气房、鼻中隔高位偏曲、Haller’s气房、钩突肥大及钩突移位等进行统计分析。 结果 鼻腔、鼻窦解剖异常在鼻窦炎组与对照组的发生率差异有统计学意义（P<0.01）。结论 鼻腔、鼻窦解剖异常与慢性鼻窦炎有相关关系。     

Quantitative Study of Nasal Secretory Cells in Normal Subjects and Patients With Chronic Sinusitis

The contribution of nasal secretory cells to mucus hypersecretion in chronic sinusitis was investigated. The mucosae of the inferior turbinate were obtained from 18 normal control subjects and 65 patients with chronic sinusitis. Histochemical quantitation showed that there was no significant difference in the number of goblet cells between normal controls and chronic sinusitis. On the other hand, the number of submucosal acinar cells in chronic sinusitis was significantly higher than that in normal controls ( P < 0.01). The area occupied by the acini in lamina propria was also increased in chronic sinusitis ( P < 0.01). There was no significant difference in the distribution of the intra-acinar glycoproteins between normal control subjects and patients with chronic sinusitis. Results suggest that hyperplasia and hypertrophy of nasal acinar cells may have an important role in mucus hypersecretion in chronic sinusitis.     

Increased net water loss by oral compared to nasal expiration in healthy subjects

AIM OF THE STUDY: To compare the difference in respiratory water loss during expiration through the nose and through the mouth, in healthy subjects. METHODS: The study included 19 healthy, non-smoking volunteers without any present history of non-infectious rhinitis, presenting with symptoms of rhinitis, asthma or previous nasal surgery. Nasal and oral expiratory breath condensates were collected using a breath condenser during tidal respiration at indoor resting conditions. During the nasal breath condensate sampling, the subjects were breathing into a transparent face mask covering the nose and the mouth with the mouth closed. During the oral breath condensate sampling, the subjects inhaled through the nose and exhaled through a mouthpiece connected to the condenser. The airflow during the sampling was assessed with a dry-spirometer connected to the condenser. Sampling was stopped after 100 litres of expired air for each breathing mode. Nasal sampling was done before and after decongestion of the nasal mucosa with oxymetazoline, 0.5 mg/ml. The effect on the nasal mucosa was assessed with acoustic rhinometry. RESULTS: The mean loss of expired water was 42% less by nasal expiration before decongestion than by oral expiration (1.9 x 10(-3) g/L min compared to 2.7 x 10(-3) g/L min, p < 0.001). The mean expiratory minute ventilation was 9.0 L/min by nasal respiration and 9.8 L/min by oral respiration. Decongestion of the nasal mucosa showed a mean increase of the cross-sectional area at 4 cm from the nostril (1.44 to 1.67 cm2, p = 0.0024), but there was no effect on the net water loss (1.9 x 10(-3) g/Lmin vs 1.9 x 10(-3) g/Lmin). CONCLUSION: This study showed that the net water loss increased by 42% when the breathing mode was switched from nasal to oral expiration during tidal breathing in healthy subjects. Increased water and energy loss by oral breathing could be a contributing factor to the symptoms seen in patients suffering from nasal obstruction.     

Pressures generated during nose blowing in patients with nasal complaints and normal test subjects

The authors compared nasal resistance and pressures generated during breathing and nose blowing in patients with chronic sinusitis, septal deviations and a control group consisting of normal test subjects. The chronic sinusitis group generated pressures during nose blowing that were significantly higher (898 daPa for the left side and 913 daPa for the right side) than in the other two groups. The decongestion didn't change the generated pressures very much. Pressures generated during nose blowing with both nostrils closed are much higher than pressures generated during nose blowing with one nostril open. These very high pressures could have an important role in the pathophysiology of chronic sinusitis.     

婴幼儿变应性鼻炎的治疗

目的探讨婴幼儿变应性鼻炎的治疗方法。方法将267例婴幼儿变应性鼻炎患儿分成3组,第1组为有鼻腔分泌物蓄积,在治疗前先以吸痰管吸除鼻腔分泌物,共76例;第2组为有鼻腔分泌物蓄积,在治疗前未以吸痰管吸除鼻腔分泌物,共75例;第3组为无鼻腔分泌物蓄积者116例。3组均以泵式雾化器经鼻腔雾化吸入布地奈德,1岁以下0.25mg/次,1岁以上0.5mg/次,隔日1次,共6次。观察疗效和治疗前后体重、身高的变化。结果第1组、第3组与第2组疗效比较均有统计学意义。低剂量布地奈德雾化吸入能够改善婴幼儿变应性鼻炎的临床症状和鼻腔炎症,但鼻腔分泌物会妨碍布地奈德的吸收,而影响其疗效。病例组治疗前后体重、身高增长与健康体检组比较无统计学意义（P〉0.05）。结论低剂量布地奈德经鼻腔雾化吸入治疗婴幼儿变应性鼻炎疗效显著。当有鼻腔分泌物蓄积时,应先将分泌物吸除才能获得满意疗效,且未对婴幼儿生长发育产生不良影响。     

The impact of expiration on particle deposition within the nasal cavity

One of the most important functions of the nose is cleansing the inspired air. The aim of this study was to compare the intranasal deposition of particles during inspiration and expiration, applying different breathing manoeuvres. In nine subjects, the non-deposited particles during inhalation of an aerosol of starch particles were laser-optically detected by placing a suction probe transnasally in the anterior nasal segment. The particle deposition was measured during cyclical nose-in/nose-out (nose-only) and nose-in/mouth-out breathing. The deposited fraction was calculated in percentages. Active anterior rhinomanometry and acoustic rhinometry were performed. The mean deposited fraction in the anterior nasal segment was statistically significantly higher (P < 0.02) during nose-only breathing (46.0%) compared with nose-in/mouth-out breathing (33.0%). Our results suggest that intranasal particle deposition takes place during inspiration as well as during expiration. The period of expiration does not only seem to be important for water and heat recovery, but also for cleansing of the respiratory air.     

Pressure measurements in the normal and occluded rabbit maxillary sinus

Occlusion of the maxillary ostium is considered to be a key factor in the pathogenesis of maxillary sinusitis. In this study, the authors determined the effect of ostial occlusion on pressure in the rabbit maxillary sinus which, like most humans, has only one ostium. We compared pressures in the normal and occluded maxillary sinus and the nasal cavity during spontaneous breathing in anesthetized adult animals. Serial pressure measurements were obtained from sinuses with patent ostia in nasal-breathing rabbits and with occluded ostia in both nasal-breathing and tracheotomized animals. Sinuses with patent ostia showed pressure curves synchronous with the respiratory cycle. Inspiratory and expiratory pressures in the nasal cavity and the sinus were isobaric. Sinuses with occluded ostia initially developed a positive pressure followed by a negative pressure that reached a subatmospheric plateau of-28.2 ± 7.3 mm H₂O (mean ± standard deviation [SD]) within 20 to 50 minutes. This is the first quantitative study of sinus pressures using the rabbit as an animal model. The findings may contribute to a better understanding of the role of ostial occlusion in the pathogenesis of maxillary sinusitis in humans.     

鼻腔嗅裂区呼吸道上皮腺瘤样错构瘤的CT影像表现

目的 探讨鼻腔嗅裂区呼吸道上皮腺瘤样错构瘤的特征性CT影像表现及其与慢性鼻窦炎鼻息肉在CT表现上的区别。 方法 (1) 回顾性分析17例经组织病理学证实的双侧嗅裂区呼吸道上皮腺瘤样错构瘤的CT资料,探讨其影像学特点。(2) 分别测量17例错构瘤患者、36例鼻息肉患者和41例正常人在轴位和冠状位CT上的嗅裂区的宽度和鼻腔总宽度,计算嗅裂宽度和鼻腔宽度的比值,并进行统计学分析。 结果 错构瘤患者的CT层面上显示嗅裂区有与脑灰质呈等密度的软组织影,嗅裂宽度增大。嗅裂宽度的中位数,在轴位和冠状位CT上分别是,错构瘤组11.5 mm和11.8 mm,鼻息肉组7.5 mm和7.8 mm,对照组5.4 mm和5.4 mm。各组间差异均有统计学意义(所有P< 0.001)。鼻腔的总宽度在各组中及两个扫描方位上均没有显著差异。嗅裂宽度和鼻腔宽度比值的中位数,在轴位和冠状位CT上分别是,错构瘤组45.5%和43.5%,鼻息肉组30.0%和30.0%,对照组为22.0%和21.0%。各组间差异均有统计学意义(所有P< 0.001)。 结论 错构瘤组CT扫描下的嗅裂宽度及嗅裂宽度和鼻腔总宽度的比值较正常组和鼻息肉组显著增加。嗅裂膨胀性增宽是提示错构瘤的特征性征象之一,其可以作为错构瘤与鼻息肉鉴别诊断的参考依据。尤其是双侧对称增宽更有诊断价值,双侧嗅裂宽度大于10 mm应高度怀疑有错构瘤的可能性。     

鼻内窥镜术后鼻腔粘连对疗效的影响

目的 :探讨鼻腔粘连对鼻窦内窥镜手术疗效的影响。方法 :应用Storz硬性鼻内窥镜 ,根据不同的病变部位 ,参照Messerklinger鼻内窥镜手术方法 ,行鼻内窥镜手术 84 5例 (15 5 8侧 ) ,术后定期随访 1年以上。结果 :治愈 12 80侧 ,总治愈率为 82 .2 %。其中Ⅰ型病例治愈率达 91%以上 ;Ⅱ型 1期和 2期分别为 98.9%和82 .8% ,3期为 75 .0 % ;Ⅲ型治愈率为 6 1.2 %。在 2 78侧无效病例中鼻腔粘连 15 1侧 ,占 5 4 .3%。结论 :鼻窦内窥镜术后鼻腔粘连以中鼻甲与其周围结构为主 ,导致鼻窦引流不畅 ,以致影响疗效 ,因此 ,减少术后局部粘连是提高手术疗效的关键。术中对中鼻甲的适当处理有助于减少术后粘连 ,提高手术效果     

慢性鼻窦炎I型患者鼻内镜术后鼻音及鼻腔通气程度的变化

目的通过对慢性鼻窦炎I型患者行内窥镜鼻窦手术(endoscopic sinus surgery,ESS)前后鼻音及鼻腔阻力检测,探讨ESS后鼻腔鼻窦共鸣特性的改变及鼻腔阻力的变化特点。方法对资料记录完整的75例成人慢性鼻窦炎I型患者(1期38例,2期15例,3期22例),ESS前后使用鼻声图仪和鼻压计分别对鼻音和鼻阻力进行检测。结果I型1期患者术后1月鼻音和总鼻阻力与术前无明显变化;进一步研究发现,单侧上颌窦炎对鼻音有一定影响,手术后1月及3月基本恢复正常;单侧额窦炎或蝶窦炎对鼻音无明显影响。I型2期和3期患者术后1月总鼻阻力无明显改变,而鼻音较术前改善(P<0.05),但仍低于正常范围,术后3月术腔上皮化后,鼻音基本恢复正常。结论对于慢性鼻窦炎I型患者,ESS术后虽然总鼻阻力正常,鼻音仍在一段时间里表现异常。若术中过多破坏鼻腔、鼻窦正常结构,使鼻腔、鼻窦的共鸣特性发生了改变,可能对从事语音工作者(如播音员、外语及语言老师)的语音产生影响。     

Comparison of decongestive capacity of xylometazoline and pseudoephedrine with rhinomanometry and MRI

Topical and systemic sympathicomimetics have been used for many years as a treatment of nasal congestion in diseases such as coryza and sinusitis. The aim of this study was to perform an objective measurement of the decongestive capacity of topical xylometazoline and oral pseudoephedrine in normal subjects and patients with chronic sinusitis. Ten healthy subjects and 10 patients with chronic sinusitis were included in this study. Xylometazoline (0.1%) and pseudoephedrine (120 mg) were each administered to 5 healthy subjects and to 5 patients with chronic sinusitis. Decongestion was measured with active anterior rhinomanometry before, 15 minutes, 30 minutes and 1, 2, 4, 6 and 8 hours after administration. Before and about 90 minutes after drug administration a MRI was performed to visualize the decongestive effect on the turbinates and the mucosa of the sinuses. Xylometazoline reduces the nasal airway resistance for an average 37.3% in all patients and healthy subjects during 8 hours. Pseudoephedrine does not show a clear and long lasting decongestive effect on the turbinates. Important interindividual differences are also noted. MRI clearly shows a clear cut superiority of xylometazoline over pseudoephedrine concerning decongestion of the nasal mucosa. However, there was no decongestive effect whatsoever on the mucosa of the sinuses with either sympathicomimetic.