Detection of particles within the nasal airways before and after nasal decongestion

Cleansing of the air is one of the most important functions of the nose. The aim of this investigation was to determine the influence of decongestion of the nasal mucosa with xylometazoline on the intranasal particle deposition at different sites of the nasal cavity. During respiration of an aerosol of starch particles, the non-deposited particles in the air were laseroptically detected in 10 healthy volunteers by a transnasally placed suction probe at different locations within the nasal cavity. The anterior nasal segment was the main area of intranasal particle deposition before and after decongestion of the nasal mucosa. Particle deposition after nasal decongestion was not significantly different from the values before application of xylometazoline. Decongestion of the nasal mucosa and increase in nasal cavity diameter seems not to influence particle deposition of inhaled and exhaled air within a short period after onset of the maximal decongestive effect of xylometazoline.     

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.     

Deposition pattern of nasal sprays in man

The intranasal distribution from an aqueous pump spray has been assessed in 13 normal subjects, using insoluble Teflon particles labelled with 99Tcm which were intended to simulate a suspension of drug particles. Three different combinations of metered volume and spray cone angle were compared. The main deposition of particles was in the anterior, non-ciliated, part of the nose, but some particles also penetrated more posteriorly into the main nasal passages and were cleared subsequently to the nasopharynx. No particles were detected in the lungs. With a single puff of 100 microliters volume, 46.5 +/- 4.4 (mean +/- SEM)% of the spray was retained in the anterior part of the nose after 30 minutes, but this was increased to 57.1 +/- 4.5% (P less than 0.05) with two puffs of 50 microliters. The latter were deposited over a significantly (P less than 0.05) smaller area in the nasal cavity. There was a trend towards lower particle retention and a greater area of deposition when the spray cone angle was decreased from 60 degrees to 35 degrees. These results indicate that the drug particles released from nasal pump sprays are distributed both to ciliated and non-ciliated zones, and that the choice of metered volume and possibly spray cone angle may play a role in determining the amount which penetrates to the main nasal passages.     

Lipopolysaccharide-induced nasal cytokine response: a dose–response evaluation

Information on the dose–response relationship is a prerequisite to defining the non-response threshold of exposure. We investigated whether nasal lipopolysaccharide (LPS) challenges induce an inflammatory response in a dose-dependent way. In three settings nasal lavage was performed before, and 20 min, 1, 6, 23, and 29 h after instillation of 0 μg, 10 μg, and 40 μg LPS for 10 s, in seven healthy subjects. Lavage fluids were analysed for concentrations of interleukin-6 (IL-6), IL-8, tumour necrosis factor-α (TNF-α), histamine, and albumin. Symptoms were recorded by questionnaire and spirometric lung function was assessed after each lavage. The instillation of 40 μg LPS caused a small increase in nasal symptoms. TNF-α was below the detection limit (0.5 pg/ml) in most subjects and, like IL-8 and albumin, showed no relation to the LPS challenge. IL-6 increased over twofold with 10 μg LPS and over 13-fold with 40 μg LPS, with a peak at 6 h after LPS provocation, and the repeated design ANOVA was significant for dose and for time. Six hours after the 40 μg LPS challenge the histamine level significantly increased compared to the saline treatment. We conclude that short-lasting instillation of LPS causes a dose-dependent IL-6 release in the upper airways and minor nasal symptoms. Received: 28 December 2000 / Accepted: 7 September 2000     

Deposition pattern from a nasal pump spray

The initial distribution and subsequent clearance of aerosol from a hand-operated nasal pump spray has been assessed from gamma camera scans in ten normal subjects, following labelling of placebo sprays with 99Tcm labelled Teflon particles (mean diameter 2 micron). Aerosol was concentrated chiefly in the anterior part of the nose, but the area of deposition varied between subjects. No particles reached the lungs. A mean 56% of the dose was retained at the initial site of deposition 30 minutes after administration, while the remaining 44% of the dose had cleared to the nasopharynx. The initial partitioning of nasal pump sprays between ciliated and non-ciliated zones is relevant both for effective topical therapy of the nasal cavity, and for possible systemic drug delivery by the intranasal route.     

Impact of resection of the turbinates and the lateral nasal wall on particle deposition

OBJECTIVES/HYPOTHESIS: The aim of the investigation was to determine the influence of complete resection of the turbinates and the lateral nasal wall on nasal deposition of particulate matter with an aerodynamic diameter of 10 microm or less (pm10) and its relation to nasal patency and geometry. STUDY DESIGN: Retrospective study. METHODS: Eight patients were enrolled in the study after unilateral sinus surgery for a unilateral inverted papilloma of the sinuses. Particle deposition from the inhaled and exhaled air was measured by means of a laser particle counter in the nasal valve area and the nasopharynx during nose-only breathing and nose-in, mouth-out breathing. The data on deposited fraction for the operated side were compared with the data for the untreated, healthy side. Rhinomanometry and acoustic rhinometry were performed. RESULTS: Particle deposition did not differ significantly between the operated and untreated sides of the nose at both detection sites. No correlation between the deposited fraction and rhinomanometric and rhinometric values was found. CONCLUSION: Radical resection of the turbinates does not seem to disturb particle deposition (pm10) measured in the nose to a significant degree. Factors other than impaction and sedimentation onto the mucosal surface of the turbinates seem to be sufficient for effective particle deposition after radical removal of the turbinates.     

Masses of nasal cavity, paranasal sinuses and nasopharynx: A clinicopathological study

An analysis of clinicopathological features of 240 cases presenting as mass in nasal cavity, paranasal sinuses and nasopharynx observed, both retrospectively and prospectively, over a period of 5 years in Jawaharlal Nehru Medical College. Aligarh. The incidence of masses in nasal cavity, paranasal sinuses and nasopharynx was 34.3 cases per year. Amongst the 240 cases studied, there were 144 cases (60%) of non-neoplastic lesions, 56 cases (23.33%) of benign lesions and 40 cases (16.67%) of malignant lesions. All age groups were involved and the mean age of presentation with the increasing age were: — non-neoplastic (22.5 years), benign tumors (26.8 years) and malignant tumors (35.3 years). The male to female ratio was 1.7:1 for non-neoplastic lesions; 3:1 for benign tumors: and 2.3:1 for malignant lesions. In this study maximum number of cases were present in nasal cavity (65%) followed by paranasal sinuses (20%) and least number of cases involved the nasopharynx (15%). The relative number of non-neoplastic and neoplastic lesions varies from region to region. A provisional diagnosis was made after clinical assessment and radiological investigation but final diagnosis was made after histopathological examination.     

Virtual endoscopy of the nasal cavity in comparison with fiberoptic endoscopy

Purpose: To apply virtual-endoscopic mode to display the nasal cavity and to evaluate clinical application of virtual endoscopy in comparison with nasal fiberoptic endoscopy. Materials and methods: Eleven patients were examined by virtual endoscopy after axial spiral computed tomography (CT) scanning was performed. In addition, 9 out of these 11 patients underwent fiberoptic endoscopy. Spiral CT scanning was performed with 1-mm collimation, 0.5- to 1-mm increment, 25–250 mA s, and pitch 1–2. Virtual endoscopy was performed by Explorer software package. Results: Virtual endoscopy could clearly demonstrate anatomic structures in the nasal cavity, septal deviation, stenosis and obstruction of the middle meatus, turbinate hyperplasia, and pathological masses larger than 3 mm in diameter. However, “false adhesions” may appear in virtual endoscopy. The main limitation of virtual endoscopy was the inability to evaluate mucosa and its surface. Conclusion: Virtual endoscopy of the nasal cavity is a new and noninvasive method. It can demonstrate normal and pathological structures in the nasal cavity. Its ability to visualize is comparable with fiberoptic endoscopy except for evaluating mucosal surface and secretions. In the future, this method will probably be a basic instrument of computer-assisted surgery in the midfacial region. Received: 9 December 1999 / Accepted: 7 September 2000     

Particle deposition efficiency of therapeutic aerosols in the human maxillary sinus

The deposition efficiency of therapeutic aerosol particles in the human maxillary sinus is evaluated both in the human body and in a model cast of the upper airway. In the experiments, three sample materials, such as mono-dispersed polystyrene latex particles, aqueous glucose solution and pure water, in the range of particle diameter of from 0.5 to 15.8 microns, are employed in the model cast. The radioactive labelled aerosol particle is also used in the human body. From the results of the experiment, it is confirmed that even though the maxillary sinus is a closed hollow organ, aerosol flow is able to be induced only when the pressure gradient is applied between the nasal cavity and the maxillary sinus. In this case, the particle deposition is is explained in relationship to the inertia impaction of the aerosol particles on the inside wall of the maxillary sinus. The total deposition efficiencies and the deposited particle sizes in the sinus area for both experiments, with the model and in the human body, are almost the same at 3%, and 3-10 microns in diameter, respectively. A physical model for this particle deposition suggests that these experimental values change not only with the size distributions of therapeutic particles and the pressure gradient, but also with the diameter of the sinus ostium. Moreover, since the therapeutic particle might not enter the maxillary sinus when the diameter of the sinus ostium canal is less than 1 mm, some pretreatment to open the sinus ostium canal would be necessary before applying such aerosol therapy in practice.     

Immunohistopathology of allergic rhinitis and conditions allied

Knowledge of nasal physiology and function is necessary for a proper comprehension of nasal symptoms; a short introduction on this topic follows. It is an important task for the nose to filter, humidify and warm the inhaled air. The shape of the nasal cavity and the structure of the nasal lining seem particularly well suited for this purpose. The narrow inlet to the airway (the internal ostium), the bend of the airflow in the nasopharynx and the slit-like cavity provide for effective sedimentation of practically all particles, larger than 10μm, and also of some smaller particles (2–3 μm).¹ Foreign particles deposited in the nasal filter, contact the local immune system. The airway mucosa is equipped with a secretory IgA immune system, which may help to render deposited micro-organisms harmless,² but also IgE producing cells are found in the mucous membrane and in the regional lymph nodes.³ Therefore, the constant sedimentation in the nose of potent allergenic substances (pollen, animal dander, house dust mite) and the consequent risk of allergic rhinitis is a price which has to be paid for nasal filtration and protection of the lower airways against unconditioned ambient air. The nose is also designed for heating and humidification of the inhaled air. Again the slitlike shape of the cavity is of decisive importance, as the intimate contact between the mucosal surface and the inhaled air is necessary for rapid supply of water and heat to the air the nasal cavity. Normally the air passes the nose at a speed of 2 m/sec.⁴ The numerous seromucous glands,⁵ some anterior serous glands⁶ and subepithelial capillaries of the fenestrated type⁷ form the basis for the supply of 500 ml water a day to the inspired air.⁸ The venous sinusoids seem especially designed for maintenance of a slit-like nasal cavity, so important for normal function. More than half of the nasal blood flow is shunted through an abundance of arterio-venous anastomoses.⁹ A comparison with hot water running in a radiator illustrates the importance of this arrangement for heating of the inspired air.     

The influence of nasal flow aerodynamics on the nasal physiology

The ability of the human nose to warm and humidify the respiratory air is important to maintaining the internal environment of the lungs, since ambient air is conditioned to nearly alveolar conditions (body temperature and fully saturated with water vapour) upon reaching the nasopharynx. Because of very short time of the inspiratory phase duration, as well as expiratory phase, only the rich vascularization of the nasal mucosa and specific organization of the submucosal vessels are not able to assure such effective physiological activity. Therefore the type of airflow during the respiration is essential to understanding the functional possibilities of the nasal mucosa. Most studies have investigated the airflow only in steady-flow conditions, where the laminar flow was observed. Anatomically accurate physical models of real nasal cavities and particle image velocimetry allow evaluation of the entire flow field in the nasal cavity. In these investigations a partially turbulent flow was observed even at low air velocities in most part of the nasal cavity. From a physiological perspective, a turbulent flow would seem sensible, since it enhances contact between air and the mucosal layer. By doing so, the nasal physiological functions - humidification, cleaning and warming are optimized.     

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.     

鼻腔内物理场及气固两相流数值仿真研究进展

掌握鼻腔内物理场及气固两相流运动沉积规律,对于探索鼻腔结构与功能之间的关系和认识鼻腔疾病及防病的机制具有重要意义。随着数值仿真研究手段的日趋成熟,计算流体力学仿真技术已成为研究鼻腔内流体流动及颗粒沉积的一种重要手段。目前,相关的数值仿真研究主要集中在鼻腔内速度场、压力场、温度场和湿度场等物理场的研究以及鼻腔结构变化对鼻腔内气流场所带来的影响,同时对于微纳米级颗粒的沉积特性,国内外学者也进行了大量的研究。本文从鼻腔内部物理场、鼻腔结构改变对物理场的影响以及颗粒在鼻腔内的沉积规律等方面,对近年来人体鼻腔内物理场及气固两相流数值仿真的研究进展进行综述。     

鼻腔和鼻咽恶性淋巴瘤诊治体会

目的进一步认识鼻腔和鼻咽恶性淋巴瘤,探讨其临床表现、诊断及治疗方法。方法18例鼻腔和鼻咽恶性淋巴瘤患者,14例行放疗加化疗,4例行单纯化疗。结果12例病情缓解,6例病情有所控制。结论恶性淋巴瘤表现复杂,组织学检查易出现假阴性,常被误诊误治,确诊须依靠病理检查及免疫组化,尽早进行治疗可以提高生存率。     

Effects of endoscopic sinus surgery on nasal spray deposition using dye-based methods for humans and a human silicone sinonasal cavity model

ObjectiveWe have evaluated that the deposition patterns of corticosteroid nasal spray in the sinonasal cavity of both post-operated human cases, which were further compared with a computed tomography-based sinonasal airway model.MethodsFifty-one patients with chronic rhinosinusitis following an endoscopic sinus surgery were enrolled in this study. Nasal spray mometasone furoate hydrate (Nasonex®) containing 0.1% indigocarmine was applied to the patients' nasal cavities and the sinonasal cavity was observed by endoscopy and video documentation. A single plaster sinonasal model was used to quantify the sinonasal deposition of nasal sprays containing 10% red ink solution using 12 round paper strips.ResultsThe predominant areas of the spray deposition of the operated sinonasal cavities were recognized in the ethmoid sinus and the olfactory cleft in the human study. The droplets were mainly deposited in the inferior turbinate followed by the posterior part of the ethmoid sinus, the olfactory cleft, and anterior part of the ethmoid sinus in a sinonasal model.ConclusionThe corticosteroid nasal spray efficiently reached the olfactory cleft and the ethmoid sinus in post-operative conditions, which was demonstrated by post-operated human cases and a computed tomography-based sinonasal airway model.     

Humidity and temperature profile in the nasal cavity

OBJECTIVES/HYPOTHESIS: Adequate air conditioning in the nasal airways is mandatory for respiration and gas exchange in the lower respiratory tract. The aim of the present study was to measure relative humidity and temperature in the airstream at different sites within the nasal cavity for mapping of relative humidity and temperature in the upper airways. STUDY DESIGN: Intranasal relative humidity and temperature of 23 volunteers was measured during respiration at different locations in the nasal cavity. METHODS: The end-inspiratory temperature and humidity data, obtained with a miniaturized thermocouple and a capacitive humidity sensor, were determined. RESULTS: A high increase of humidity and temperature at the end of inspiration, in relation to the environmental conditions, was found in the anterior nasal segment. The further increase of both parameters between turbinate area and nasopharynx was less pronounced in spite of the longer distance. CONCLUSIONS: The anterior part of the nasal cavity contributes within a short nasal passage to air conditioning of inspired air.     

Virtual Endoscopy of the Paranasal Sinuses Using Perspective Volume Rendered Helical Sinus Computed Tomography

Our goal was to use three-dimensional information obtained from helical computed tomographic (CT) data to explore and evaluate the nasal cavity, nasopharynx, and paranasal sinuses by simulated virtual endoscopy (VE). This was done by utilizing a new image reconstruction method known as perspective volume rendering (PVR). Thin-section helical CT of the nasal cavity, nasopharynx, and paranasal sinuses was performed on a conventional CT scanner. The data were transferred to a workstation to create views similar to those seen with endoscopy. Additional views not normally accessible by conventional endoscopy were generated. Key perspectives were selected, and a video “flight” model was choreographed and synthesized through the nasal cavity and sinuses based on the CT data. VE allows evaluation of the nasal cavity, nasopharynx, and paranasal sinuses with appreciation of the relationships of these spatially complex structures. In addition, this technique allows structural visualization with unconventional angles, perspectives, and locations not conventionally accessible. Although biopsies, cultures, and lavages routinely done with endoscopy cannot be performed with VE, this technique holds promise for improving the diagnostic evaluation of the nasal cavity, the nasopharynx, and the paranasal sinuses. The unconventional visual perspectives and very low morbidity may complement many applications of simple diagnostic endoscopy.     

Prevalence and clinical features of human papillomavirus in head and neck squamous cell carcinoma in Okinawa,southern Japan

Previous studies from Okinawa, a subtropical island in southern Japan, demonstrated a higher prevalence of human papillomavirus (HPV) in oral carcinoma and a higher incidence of oral and pharyngeal carcinoma than those for mainland Japan. The present study aims to investigate epidemiologic and clinical features of HPV in head and neck squamous cell carcinoma (HNSCC) in Okinawa. A total of 150 DNA samples from 150 Okinawan patients with head and neck squamous cell carcinoma (HNSCC) were screened for HPV sequences by PCR using three consensus primer sets, and HPV types were determined by direct sequencing. The samples were consisted of 46 cases from the hypopharynx, 44 from the oropharynx, 16 from the larynx, 25 from the oral cavity, 10 from the maxillary sinus, and 9 from the nasopharynx. HPV DNA was detected in 45 (30.0%) HNSCCs, and HPV-16 was identified in 86.7% of positive specimens. The highest prevalence of the HPV sequence was found in oropharyngeal carcinomas (50.0%), especially in tonsillar cancer (63.6%). Multivariate analysis showed that oropharyngeal carcinoma (P = 0.002; OR = 5.34; 95% CI = 1.83–15.58), oral cavity carcinoma (P = 0.012; OR = 4.94; 95% CI = 1.43–17.10), and histological poor differentiation (P = 0.011; OR = 4.25; 95% CI = 1.39–13.04) each independently increased the prevalence of HPV infection. The present study reveals that patients with HNSCC, e.g., oropharyngeal and oral cavity carcinomas, in Okinawa have relatively high HPV-16 positive rates and low HPV-18 positive rates comparing with mainland Japan.     

A comparative distribution study of two procedures for administration of nose drops

The intranasal distribution of nose drops has been studied in 12 healthy subjects, comparing an administration followed by two rapid inhalations through the nose, with an administration followed by turning the head to five positions. Insoluble particles of human serum albumin labelled with 99Tcm were suspended in the liquid before administration. A significantly larger area (p less than 0.05) in the nasal cavity was covered by the labelled nose drops when the subjects used the turning-the-head procedure. It appears that this procedure gave a larger passive distribution of the particles. The differences were about 10 to 15% between 3 and 45 min after administration. Some particles were rapidly transported into the pharynx. The retention of the particles at the initial site of deposition did not differ significantly between the two procedures and about 50% of the particles seemed to have penetrated to the ciliated region in the main nasal passages and were cleared. The results indicate that the procedure for administration of the nose drops influences the distribution in the nasal cavity, but the clinical relevance should be studied with respect to the efficacy of the active drug in patients.     

Prophylaxis of acute respiratory infections in children's collectives: results of treatment with nasal and nasopharyngeal irrigation

The aim of this paper is to report the results of a multicenter open randomized clinical study of the efficacy of nasal and nasopharyngeal irrigation for the prevention of seasonal morbidity due to acute respiratory infections (ARIs) in the groups of preschool and school children. A total of 2386 children attending secondary schools and 519 ones attending kindergartens were examined. The study has demonstrated that irrigation of the nasal cavity and nasopharynx efficaciously reduces (by 2.4-3.2 times) the morbidity due to ARIs in organized children's collectives throughout the entire length of the epidemiological period; moreover, it improves the clinical course of ENT organ diseases and bronchial asthma.